American Medicine as Culture

Description

Medicine in America, argues Professor Howard Stein, is not merely the product of a biomedical model, but rather an intricate human culture. In this ethnographic study of the American medical system, Dr. Stein uses anthropological, small-group, and psychoanalytic paradigms to interpret diverse and often hidden aspects of medical culture in the United States.Based on two decades of teaching and counseling physicians, Dr. Stein's case studies allow us to hear doctors speak candidly about themselves, their feelings, their fears of failure, their interactions with nurses and other hospital staff, and the ways in which they sometimes internalize the problems of their patients. We also learn how doctors come to label their clients as "good" or "bad" patients, and we see how these labels can affect a patient's care. In addition, Dr. Stein explores the rich symbolism of money in a profession that has great difficulty discussing financial concerns with its clients.Taking the reader on an odyssey through the socialization process of becoming a physician in America, Dr. Stein links the culture of medicine with both the psychodynamics of individual practitioners and the currents of American society at large. He uncovers a rich vein of moralism lying beneath medicine's official position of scientific neutrality and finds that American values such as activism and mastery, and metaphors from competitive sports, warfare, and technology pervade clinical decisionmaking, treatment, and education.This is a fascinating study of a complex culture within our society, a book that will interest scholars, students, and the general reader. Cover Half Title Title Copyright Dedication Contents List of Tables and Figures Preface Acknowledgments Introduction: An Anthropological Interpretation of American Biomedical Culture The Nature of Ethnographic Fieldwork Authors Experience as Data Base Medicine and Culture Multiple Models in Biomedicine The American Medical System and the Larger Culture Notes 1 Medicine, Value Orientations, and Their Meanings Values: Basic Premises and Clinical Implications The Sick Role and Its Associated Values The Biomedical Value System Therapeutic Activism Control as a Value in Medicine Gender Issues as Values in Medicine Professional Role Identity: A Matter of Focus 2 Medical Metaphors and Their Role in Clinical Decisionmaking and Practice Cultural Metaphors in Medicine Medical Metaphor as a Discourse of Control Images in American Medicine: The Altar of High Tech Disease as Metaphor The Medicalization of Life Notes 3 Medicine, Moralism, and Social Control Good Versus Bad Patients: The Moralistic Model Mistaken Identity: Moralism in Patient Care The Cultural Context of Medical Moralism Body Narcissism: The Wellness Movement and Core American Values The Paradox of Biomedicine as Cultural Therapy 4 The Influence of Group Dynamics on Clinical Thinking and Practice The Team Concept in Biomedicine Medical Specialties: Us Versus Them Clinical Decisionmaking: The Emotional Limitations of Groups Leadership and Group Dynamics The Mirror Image of Families in Groups Groups as Human Bodies: A Focus of Anxiety Cascades in Medicine: Group Action as Acting Out 5 Money and Medicine: An Identity Problem Front Versus Back: Identity Splitting in Medicine Conflicting Priorities Within Medicine The Sacred Shrine of the Bottom Line Aggression: The Phantom in Medical Finance Finance in Medicine: The Elusive "Big Picture" 6 Socialization and the Process of Becoming a Physician Paradoxes in Medical Training Time: A Metacurriculum Within Medicine Forgetting and Splitting as Tools of Professional Socialization Excremental Symbolism in Biomedical Training Pimping 7 The Self of the Physician: Links Between Culture and Personality Physician, Family, and Culture: Overlapping Contexts in Patient Care The Unwelcome Incursion of the Past into the Present Forbidden Tools of the Self Self and Clinical Role Conclusion: Implications of an Anthropological Approach for the Study, Teaching, and Practice of Biomedicine References Index