The Social Medicine Reader

The Social Medicine Reader

Book Pages: 528 Illustrations: 19 tables, 6 graphs Published: June 1997

Medicine and Health > Medical Humanities, Sociology

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.


“[A] wonderful extensive collection that provides an understanding of how contemporary medicine and medical practice are profoundly influenced by social, cultural, political, and economic forces. What distinguishes this volume is its genuine orientation to values and qualitative analysis. The sociality of medical practice is not only illuminated from many different perspectives but above all is critically analysed in a social, human, and moral way that shows the possibilities for change in medical education and in medical practice not only in the American context. . . . [A] valuable anthology. . . .” — Miroslav Mastilica, Social Science & Medicine

“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.” — Joseph Haberer, Bulletin of Science, Technology & Society

"[R]efreshing. . . .[I]mpressive. . . . The publication of The Social Medicine Reader is welcome. It is an outstanding anthology for those in academic medicine who are involved in the teaching of such courses and for all those in the profession and in the public who feel that medicine may be losing some of its holistic and humane attributes." — Walter Roufail, North Carolina Medical Board Forum

"[The authors] have integrated a rich assortment of materials. . . . [T]his reviewer strongly recommends The Social Medicine Reader to the attention of medical educators." — Samuel W. Bloom, JAMA

"[W]e found [this collection] to be a helpful tool for teachers of medical humanities and an excellent source book for anyone interested in the subject. . . . Overall, the book is quite useful and well organized, and we should all be glad that it is available." — David J. Hufford David Barnard Michael Green and Anne Hunsaker Hawkins, Medical Humanities Review

"This excellent book is a compilation of 70 essays and poems, many of them classics, that analyze the complexity of health and illness experiences. . . . The editors have gathered a splendid collection of work that is thoughtful, well-written, and timely. . . . [A] must-buy." — D.B. Hamilton, Choice

"This is a compilation of enthralling, gentle, and humanistic stories that illuminate sensitive and complex sociocultural issues that pervade the delivery of health care. . . . This book, although written for medical students, will be of interest to all health care professionals. . . . [A] fresh approach in the enduring quest to balance biological knowledge with social knowledge in the practice of medicine and healthcare delivery." — Michael Issel, Doody's Review Service

"This very important Reader would provide a sound framework for any professional, clinical or non-clinical, interested in health care work. By combining discussions of pathology with narrative accounts, short stories, and poetry, the editors make the issues of health care real and poignant." — Stephen French Gilson, Disability Studies Quarterly

“A wonderful collection that in its impressive breadth and depth gives a full account of a nation’s contemporary medicine as it has been shaped by the events of the late 20th century.” — Robert Coles


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Author/Editor Bios Back to Top

Gail E. Henderson, Associate Professor of Social Medicine and Adjunct Professor of Sociology at the University of North Carolina at Chapel Hill, is the author of The Chinese Hospital: A Socialist Work Unit.

Nancy M. P. King, Associate Professor of Social Medicine at the University of North Carolina at Chapel Hill, is the author of Making Sense of Advance Directives.

Ronald P. Strauss is Professor of Dental Ecology and Social Medicine at the University of North Carolina at Chapel Hill and is author of numerous articles on social and ethical issues in the care of chronic illness.

Sue E. Estroff is Professor of Social Medicine and Adjunct Professor of Anthropology and Psychiatry at the University of North Carolina at Chapel Hill. She is the author of Making It Crazy: An Ethnography of Psychiatric Clients in an American Community.

Larry R. Churchill is Professor of and Chair of the Department of Social Medicine at the University of North Carolina at Chapel Hill. He is the author of Self-Interest and Universal Health Care: Why Well-Insured Americans Should Support Coverage for Everyone and Rationing Health Care in America: Perceptions and Principles of Justice.

Table of Contents Back to Top
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
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Additional InformationBack to Top
Paper ISBN: 978-0-8223-1965-8 / Cloth ISBN: 978-0-8223-1957-3
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