To meet the needs of the rapidly changing world of health care, future physicans and health care providers will need to be trained to become wiser scientists and humanists in order to understand the social and moral as well as technological aspects of health and illness. The Social Medicine Reader is designed to meet this need.
Based on more than a decade of teaching social medicine to first-year medical students at the pioneering Department of Social Medicine at the University of North Carolina, The Social Medicine Reader defines the meaning of the social medicine perspective and offers an approach for teaching it. Looking at medicine from a variety of perspectives, this anthology features fiction, medical reports, scholarly essays, poetry, case studies, and personal narratives by patients and doctors-all of which contribute to an understanding of how medicine and medical practice is profoundly influenced by social, cultural, political, and economic forces.
What happens when a person becomes a patient? How are illness and disability experienced? What causes disease? What can medicine do? What constitutes a doctor/patient relationship? What are the ethical obligations of a health care provider? These questions and many others are raised by The Social Medicine Reader, which is organized into sections that address how patients experience illness, cultural attitudes toward disease, social factors related to health problems, the socialization of physicians, the doctor/patient relationship, health care ethics and the provider's role, medical care financing, rationing, and managed care.
Preface ix
Introduction 1
Part I. A Cultural Perspective of Experiences of Illness, Disability, nd Deviance
Introduction / Sue Estroff 6
1. Culture, Health, and Illness 12
The Nature of Suffering and the Goals of Medicine / Eric J. Cassell 13
Cancer, Control, and Causality: Talking about Cancer in a Working-Class Community / Martha Belshem 23
Coming to Terms with Advanced Breast Cancer: Black Women's Narratives from Eastern North Carolina / Holly F. Matthews, Donald R. Lannin, and James P. Mitchell 43
2. Illness Experiences and Illness Narratives 61
The Deer at Providencia / Annie Dillard 63
The Cost of Appearances / Arthur Frank 66
Silver Water / Amy Bloom 69
3. Experiences of Deviance, Chronic Illness, and Disability 75
Self, Identity, and the Naming Question: Reflections on the Language of Disability / Irving Kenneth Zola 77
Finch the Spastic Speaks / Gordon Weaver 87
Tell Me, Tell Me / Irving Kenneth Zola 95
Part II. The Influence of Social Factors on Health and Illness
Introduction / Gail E. Henderson 100
1. The Relationship between Social Class, Race/Ethnicity, and Health 108
Socioeconomic Inequalities in Health: No Easy Solution / Nancy E. Adler 109
"Where Crowded Humanity Suffers and Sickens": The Banes Family and Their Neighborhood / Laurie K. Abraham 121
One Drop of Blood / Lawrence Wright 131
2. Gender and Health 142
Women Have Headaches, Men Have Backaches: Patterns of Illness in an Appalachian Community / Claire F. Horton 143
Spence + Lila (excerpts) / Bobbie Ann Mason 156
The Mother-in-Law / Doris Betts 163
3. Old Age 167
Trends, Issues, Perspectives, and Values for the Aging of the Baby Boom Cohorts (excerpts) / John M. Cornman and Eric R. Kingson 168
What Do Children Owe Elderly Parents? / Daniel Callahan 175
Decision Making, Responsibility, and Advocacy in Geriatric Medicine: Physician Dilemmas with Elderly in the Community / Sharon R. Kaufman 184
We Are Nighttime Travelers / Ethan Canin 196
Part III. The Culture of Medicine and Medical Practice
Introduction / Ronald P. Strauss 205
The Socialization of Physicians 209
Basic Clinical Skills: The First Encounters / Melvin Konner 210
Becoming a Doctor: Critical-Incident Reports from Third-Year Medical Students / William Branch, Richard J. Pels, Robert S. Lawrence, and Ronald Arky 223
Invasions / Perri Klass 227
Ethical Dilemmas fro House Staff Physicians: The Care of Critically Ill and Dying Patients / William Winkenwerder Jr. 230
A Student's View of a Medical Teaching Exercise / Abenaa Brewster 236
The Libby Zion Case: One Step Forward or Two Steps Backward? / David A. Asch and Ruth M. Parker 238
2. Medical Practice in Social Context 244
Presidential Address: The Boundaries of Medicine / Donald W. Seldin 244
The Boundaries of Medicine / Gerald T. Perkoff 254
The Changing Demography of the Medical Profession / Arnold S. Relman 263
Medicine is No Longer a Man's Profession: Or, When the Men's Club Goes Coed It's Time to Change the Regs / Carola Eisenberg 266
The Doctors of Hoyland / Sir Arthur Conan Doyle 270
3. Relationships between Doctors and Patients 277
The Basic Models of the Doctor-Patient Relationship / Thomas S. Szasz and Marc H. Hollender 278
Facing Our Mistakes / David Hilfiker 287
Simple Living and Hard Choices / Maureen A. Flannery 293
The Paid Nurse / William Carlos Williams 300
Part IV. Health Care Ethics and the Provider's Role
Introduction / Nancy M. P. King 304
1. The Provider-Patient Relationship 309
Bioethics in Social Context / Larry R. Churchill 310
The Use of Force / William Carlos Williams 320
Case Study: The "Student Doctor" and a Wary Patient / Marc D. Basson, Gerald Dworkin, and Eric J. Cassell 323
Truth Telling to the Patient / Antonella Surbone 326
Is Truth Telling to the Patient a Cultural Artifact? / Edmund D. Pellegrino 330
Offering Truth: One Ethical Approach to the Uninformed Cancer Patient / Benjamin Freedman 333
What the Doctor Said / Raymond Carver 341
Informed Consent, Cancer, and Truth in Prognosis / George J. Annas 341
Swapping Stories: A Matter of Ethics / Judith Andre 346
Case Study: Please Don't Tell / Leonard Fleck and Marcia Angell 349
2. Interests in Conflict 353
Cesareans and Samaritans / Nancy K. Rhoden 354
Justified Limits on Refusing Intervention / Frank A. Chervenak and Laurence B. McCullough 365
Faith (Healing), Hope, and Charity at the FDA: The Politics of AIDS Drug Trials / George J. Annas 375
Case Study: The Doctor's Unproven Beliefs and the Subjects Informed Choice / Don Marquis 386
3. Choices about Treatment 391
Disconnecting a Ventilator at the Request of a Patient Who Knows He Will Then Die: The Doctor's Anguish / Miles J. Edwards and Susan W. Tolle 393
The Last Words of My English Grandmother / William Carlos Williams 398
Death and Dignity: A Case of Individualized Decision Making / Timothy E. Quill 399
Informed Demand for "Non-Beneficial" Medical Treatment / Steven H. Miles 403
The Case of Helga Wanglie: A New Kind of "Right to Die" Case / Marcia Angell 407
Part V. Medical Care Financing, Rationing, and Managed Care
Introduction / Larry R. Churchill 410
1. Medical Care Financing 415
Paying for Medical Care in America / Donald L. Madison 415
Reforming the Health Care System: The Universal Dilemma / Uwe E. Reinhardt 446
2. Rationing: The Dilemmas of Fair Distribution 460
The "Rationing" of Medical Care / Victor R. Fuchs 461
The Prostitute, the Playboy, and the Poet: Rationing Schemes for Organ Transplantation / George J. Annas 464
Ethics of Queuing for Coronary Artery Bypass Grafting in Canada / Jafna L. Cox 469
Rationing in Practice: The Case of In Vitro Fertilisation / Sharon Redmayne and Rudolf Klein 475
3. Managed Care and the Physician's Changing Role 481
Hippocrates and the Health Maintenance Organization: A Discussion of Ethical Issues / Gail Povar and Jonathan Moreno 482
Physicians and Business Managers: A Clash of Cultures / Arnold S. Relman 491
Preserving the Physician-Patient Relationship in the Era of Managed Care / Ezekiel J. Emanuel and Nancy Neveloff Dubler 495
Bibliography 510
Acknowledgment of Copyrights 514
Index to Authors 517
