The Nature of Medicine: Part I.
Haha okay, hell week is over! :)Finally has time to blog about things that I want to talk about for some time already.
> Mum wasn't very happy about my aunt's doctors (not only the one that screwed up the operation, but the rest as well).
Quotes:
'Why are they treating all their patients like a set of numbers - that can be deleted anytime?'
'Why are they just treating the symptoms, and don't attempt to solve the cause...'
According to medical anthropologist Susan Greenhalgh, the biomedical discourse consists of 4 different main components, namely objectification, quantification, pathologisation, and amelioration. Her categorisation of the biomedical discourse is very critical; probably you should be able to guess what she meant from the 4 terms she used.
I told mum not to be too upset about the doctors - because they can hardly be blamed. That is how they are trained - the biomedical discourse, which is viewed critically by some anthropologists and sociologists, is necessary for medicine to function as a science. Also, from their standpoint, a patient is merely one of the many cases that they have everyday - the patient surely doesn't mean as much to the doctor as she means to us. Anyway, I do not completely agree with the amelioration point: the ultimate aim of biomedicine is still to find out the cause of disease and eradicate it; amelioration is merely a transitional means to make the patient more comfortable. Also, it is unfair to blame medicine for doing that - we still know so little about our bodily processes, making treating the cause of disease sometimes simply impossible. That is why I can still find a job.
Medicine is a very complex profession - way more complex than the biomedical sciences as far as I currently understand. Medicine exists at the point where the social meets the technical - the social and the individual has a set of expectations towards the medical profession which, when placed against personal professional aspirations or even epistemological interests for general good, produces serious clashes that can hardly be resolved.
The mess is mind-bloggling. I have a certain interest towards the modern history of medicine which is filled with various forms of patient activism, the advancement of therapeutics, the creation of the asymptomatic patient, ethical issues behind the three-phase clinical trials and the double-blind, placebo-controlled phase II trials, the balance between the financial interests of pharmaceutical companies and patient accessibility to new treatment, etc etc...
Most of these things that I have been studying occurred in America, where the population is vividly conscious of their rights as individuals. Singapore didn't have to go through all these because we are in a different culture - but, as our population becomes more and more affluent, it would be expected that medicine and the biomedical sciences will have to struggle to remain at a position of authority.
Medicine is complicated because it involves people. Unlike many science and engineering disciplines, which do not directly relate to people, doctors directly deal with patients, and any decision that is made within the profession (e.g. should this drug or treatment procedure be licensed, etc.) directly affects the lives (literally - lives) of people. Thus, I have to agree that medicine is both a science and an art: not art in the sense that was widely perceived in a skillful surgeon but art in a sense that doctors need to make decisions and have an attitude that displays thorough understanding of all situations that their patients are being put through. When I say 'thorough understanding', I don't just mean the medical conditions that are observable and quantifiable - but also the social forces at work on the patient that created his illness experience. That's why medicine is an art.
If this is not handled properly, it is not only the doctor's credibility that is at stake, especially when it comes to decision making at the policy level - the whole profession's credibility can be at stake, because these issues are all life and death issues, and this carries with it huge social implications.
This is a huge burden that comes with the profession, because this is the nature of it. Mum understood it (hopefully) after I explained to her why doctors are mostly like that and why she couldn't help perceiving them as such - firstly, even if they are aware of these issues, it is still way easier to use a purely scientific approach to tackle every case presented to them. Secondly, it is also possible that they are not even aware of these issues, or they might just simply not be bothered. This is especially the case when they are practising in Hong Kong, which medical system is also highly strained and overstretched, there is no more important issue in the hospitals than to get rid of patients as fast as possible.
There are some readings that dealt with the relationships between doctors, basic scientists, physician scientists, the biomedical establishment, the pharmaceutical companies, the patients, and society in general, which I haven't got time to closely analyse and we don't have time to analyse them closely in class so, when I have the time I will write a part II to this :)
(DAD! LOOK AGAIN! When I decided to major in History of Science it is not irrelevant to my work! See how important these things are! :D Of course I won't allow this to compromise the quality of science coursework that I pursue so you can relax...)
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