Challenging medicine's humiliations: the need to re-educate the practitioners

Thesis (Ph. D.)--University of Washington, 2000Current efforts to make medical practice more humane by introducing humanistic techniques such as caring, empathy, and mutuality are based on a superficial diagnosis of the problem and hence are misdirected and inadequate. These efforts are misdirected because they implicitly encourage practitioners to take for granted certain problematic structures and customs in daily medical practice. Based on this misguided diagnosis, the treatment plan for addressing difficulties in medical practice has focused on compensating for such problems by encouraging the application of humanistic techniques. While these techniques are perhaps partially useful, they are inadequate to address the enormity and complexity of the task at hand and therefore merely serve as temporary bandages. This approach treats the problem symptomatically and does not attempt to discover the underlying source or cause. Therefore, there is a need for a new diagnosis of the nature and cause of difficulties in modern medical practice. In providing such a diagnosis, I focus on medical practice as the site of various forms of domination. These forms of domination give rise to varieties of humiliation that may, in practice, injure the self-respect of patients. Using case studies, I show that forms of domination and humiliation exist on at least three general levels in our medical culture: institutional, technological, and psychosocial. I argue that these conceptual areas Must be given proper attention in, the course of seeking a better diagnosis of problems in medical practice. Once a more accurate diagnosis is made, a correspondingly more realistic and useful treatment plan can be developed and integrated into medical practice. Because these powerful influences on the medical relationship are ubiquitous, yet rarely discussed in the medical humanities literature, there is a need to re-educate practitioners to question commonly suggested approaches to making medicine more humane. By recognizing and critically examining these pervasive forms of medical domination as well as thoughtfully considering their ramifications in daily practice, concerned practitioners can perhaps strive individually to reformulate a missed diagnosis. Consequently, they may be inspired to recognize and challenge medicine's humiliations