"Disease necessarily reflects and lays bare every aspect of the culture in which it occurs"
— Charles Rosenberg
There are complicated, constantly shifting relationships between society and its medical institutions. 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 a 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. Understanding social contexts of medical work is essential to the effective practice of medicine in any society.
The course will help you appraise and reflect critically on 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 persons and families understand illness? What are the relationships 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 dying in America? To answer these questions, you need perspectives from different social science and humanities disciplines.
This course enables you to deepen and build on your undergraduate foundations in humanities and social sciences, to examine how American medicine came to be the way it is, what our health care system is like now, and what could be done to alter or improve it. If physicians are to be significant actors in developing and shaping health care, it is important that they practice critical reflection about how their roles in society are shaped by social forces. Understandings of disease (from alcoholism to breast cancer to AIDS), and definitions of what is normal, are imbued with social and cultural values; interpretation of medical facts and employment of medical judgment draw on a rich heritage of professional and personal ethics; and the physician-patient relationship is built on knowledge about a person’s experience, perspective, needs, interests, and rights, as well as on habits of inquiry and empathy and skills of communication and listening. All these observations 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 exemplifies three themes: 1) social and cultural factors that influence health and health care; 2) ethics and the physician’s role; and 3) organization and financing of health care. These themes are interwoven throughout the course. This interweaving itself emphasizes the tangled relations of medicine and society: ethics in the physician’s role, for example, are intricately related to cultural concerns, and to structures of organization and financing. These relationships will emerge in seminar discussions and lectures, and you can expect to apply insights from this course to your other learning experiences.
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—but if you rely mostly on what you already know, you will dilute your own and your fellow students’ learning. Course faculty members 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 course issues. The purpose is not to instill a particular point of view. The course 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 introduce you to 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 throughout your professional 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:
- To increase knowledge of ways in which social and cultural contexts affect disease, experiences of illness, and the roles of physicians;
- To develop critical understanding of historical, educational, and ethical forces that shape physicians and doctor-patient relationships;
- To increase knowledge of social, political, and economic forces that influence the organization and delivery of medical services, and opportunities for health care reform.