American Culture Studies Ph.D. Dissertations

Title

Poverty and the Art of Medicine: Barriers to Empathy in Medical Education

Date of Award

2015

Document Type

Dissertation

Degree Name

Doctor of Philosophy (Ph.D.)

Department

American Culture Studies

First Advisor

Andrew Schocket (Committee Chair)

Second Advisor

Ellen Berry (Committee Member)

Third Advisor

Sarah Rainey (Committee Member)

Fourth Advisor

Michael Strand (Other)

Abstract

Medicine is caught in a contradiction between values of scientific distance and compassion. These seemingly opposite concerns are negotiated by physicians on a daily basis, but are not addressed explicitly in medical education curriculum. This study investigates poverty as one particular issue caught in the contradiction between science and compassion. Medical education culture implicitly creates a variety of understandings of what it means to be poor in the United States and how poverty contributes to overall health outcomes. A cultural studies approach was utilized to analyze the topic of medical education and poverty from a variety of vantage points. The shift of medical education to a science focus in the early twentieth century is explored historically by looking at the discourse within the Association of American Medical Colleges' annual meeting minutes as well as discussions within the Journal of American Medicine. Twenty-four physicians were interviewed directly about their experiences with poverty. Contemporary critical theory was used to analyze medical education culture and better understand how power is negotiated in medical settings across class. A debate emerges from discussions of poverty in early twentieth century medicine about the potential loss of the art of medicine for the science. The art of medicine is not carefully defined but is discussed as the doctor's personal experience, the relationship between the doctor and the patient and what is uncertain about medicine. Science cultures did come in the way of the art of medicine but so did class dynamics. For some physicians, middle-class sensibilities and science cultures of detachment create poverty as invisible. Compassion and feelings of responsibility for the poor were common feelings shared by the physicians interviewed. Empathy for what it must be like to live poor in America was less common. From this analysis, this dissertation argues that doctors learn about medical solutions, not only from their science training, but also from their personal experience. Knowledge that is gained by personal experience in medicine, or the art of medicine, is not interrogated in medical education. This study looked more closely at physicians that were able to empathize with the poor and physicians that engaged in activities to improve health care for the poor. Doctors who empathized with the poor discussed solutions like community-focused care and the need for cost consideration in medical education. Doctors are gaining knowledge about poverty from their personal experience with the poor, which could prove helpful in macro level solutions to disparities in health care.

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