Medicine and Society

“Disease necessarily reflects and lays bare every aspect of the culture in which it occurs"
— Charles Rosenberg

Course Description

There are fundamental relationships between society, on the one hand, and its medical institutions, ethical principles, and cultural perceptions about health and illness on the other.  This observation is not new.  In the early 20th century, Dr. Henry Sigerist, the Swiss medical historian, wrote: “Medicine is a mirror of society,” explaining that it reflects the values that society holds.  For Sigerist, disease reflected injustice and poverty, and studying medicine necessarily involved the study of society.

Such views complement the biological, technical view of medicine that underlies much of what you will learn in your other courses over the next two years.  Medicine and Society’s contribution to your medical education is the examination of relationships between medicine and the larger society of which medicine is a part.  Understanding these relationships is essential to the effective practice of medicine in any society.

The course is intended to help you appraise and critically reflect upon the world of your future profession.  What causes health?  Is it the outcome of medical intervention, or the natural consequence of “good” genes, or the result of good political arrangements and favorable economic conditions?  What causes illness?  How do patients and families understand illness?  What is the relationship between culture and medicine?  What ethical dilemmas confront physicians?  What are the options for reforming the U.S. health care system?  How is our sense of social justice embodied in the arrangements we make to finance and deliver health care?  How do we manage death in America?  To answer these questions, you need perspectives from different social science and humanities disciplines.

This course enables you to make use of the medical humanities and social sciences in order to examine how American medicine came to be the way it is, what our health care system is like now, and what, if anything, should be done by physicians and others to alter or improve it.  If physicians are to be significant actors in the development and shaping of health care delivery, it is important that they practice critical reflection about how their role in society is affected by the same forces that have shaped that society and the individuals within it.  The understanding of disease (from alcoholism to breast cancer to AIDS), and the definition of what is normal, are imbued with social and cultural values; the interpretation of medical facts and the employment of medical judgment draw on a rich heritage of professional and personal ethics; and the physician-patient relationship is built on knowledge about the patient’s experience, perspective, needs, interests, and rights, as well as on habits of inquiry and empathy and skills of communication and listening.  All these are drawn from a body of social medicine disciplinary knowledge to which you will be introduced in this course.

The progression of topics explored in the seminars and assignments of Medicine and Society reflect three themes: 1) social and cultural factors that influence health and health care; 2) ethics and the physician’s role; and 3) the organization and financing of health care.  These themes are interwoven throughout the course.  This interweaving itself makes an important point about medicine and society–that issues of ethics and the physician’s role, for example, are intricately related to social and cultural concerns, and to structures of organization and financing.  These relationships will emerge in seminar discussions and lectures, and you can expect to gain skill in applying insights from this course to your other learning experiences.

Course Objectives

During this year-long course, we will raise issues through readings, discussions and three large group sessions.  The core of this course is the directed discussion that takes place in your seminar groups.  We ask you to read carefully and critically all assignments made by your seminar faculty, and to come to class prepared to discuss the issues fully and freely.  We invite you to bring your own examples, experiences, and knowledge to bear in addressing the issues and assigned materials.  The faculty come from clinical, social science, and humanities backgrounds and bring to the seminar sessions significant experience in interdisciplinary research and teaching.

 The purpose of seminar discussion is to develop and strengthen your habits of critical thinking, interpretation, and reflection about these issues.  The purpose is not to instill a particular point of view.  It is not a forum for “politically correct” thinking; nor is it a forum for merely sharing opinions and emotions.  We are concerned with reflection, thought, and open discussion of issues that will follow you throughout your careers, and that will need continual, reasoned revisiting.  The course is intended to provide you with an introduction to the fields of knowledge that address Social Medicine questions and the tools and methods of inquiry employed by those fields, as well as to foster breadth of viewpoint and the development of interpretive skills and moral imagination that you can use to address these questions throughout your professional education and career.  We do not give exams, and you will not find Social Medicine questions per se on your Boards.  This is partly because the “answers” in Medicine and Society are many and changing, not suited to multiple choice questions, and not easily memorized.  Evaluation will focus on your writing, analysis, discussion, class participation, and comprehension of major concepts underlying the relationships between medicine and society.

 In summary, the course objectives are:

1. To increase knowledge of the ways in which social and cultural contexts affect disease, experiences of illness, and the roles of physicians;
2. To develop a critical understanding of the historical, educational, and ethical forces that shape physicians and doctor-patient relationships;
3. To increase knowledge of the social, political, and economic forces that influence the organization and delivery of medical services, and the opportunities for health care reform.