Montgomery and “Practicing” Medicine   2 comments

The reading this week has confirmed my intuitive mistrust of medicine as science; I have long believed that if it were so, doctors would “do” medicine instead of “practicing” it. I cannot help but wonder how much popular media has to do with our cultural expectations of medicine’s positivistic potential. TV medical shows invariably pose a critical malady as a puzzle to be solved by a dedicated, brilliant physician or team of doctors with the latest technology. Sometimes (but rarely) the physicians fail, but always with the unspoken message that they will get it “right” the next time.

Scientific exploration, and the technology it generates, sets the standard for contemporary diagnostic expectations. Consider medicine without science: leeches and hacksaws, and visions of medieval practices. In reality science—used as a toolkit—has enabled medicine to save lives that in earlier ages would have perished. However, as Montgomery notes, placing medicine in a purely scientific context “promises the unambiguous regularities of Newtonian physics” (Montgomery 31), a promise that leads to the belief that human mortality, given enough study, is a curable malady. As Montgomery points out, science alone cannot meet all the needs of the individual patient, nor decipher all the manifestations of human frailty. Living organisms, including humans, are differentiated and individuated, and refuse simple codification. Technical abilities to view life at a sub-cellular level give both the public and medical practitioners false confidence that we can ultimately control the complex variables of life.

The contemporary health care system—so-called managed care—reinforces the idea of medical standardization and patient conformity as an ideal. The managed-care business model requires this kind of simplification to generate profits, and formulaic diagnostic tools are just as attractive an idea to insurance companies as to physicians searching for a positivistic shortcut. As in so many facets of science and medicine, it is all about power and authority.

Many feminist critics recognize that science confers authority to its practitioners through notions of scientific neutrality. Ingunn Moser notes that “Science and technology are social and cultural projects, formed in power structures and coloured by dominating values in the societies and the cultures in which they occur. As such they are constituted on as well as constitutive of cultural and social conditions. Science and technology are reality-producing and -reproducing practices” (6). Inasmuch as medicine craves the label of science, as Montgomery asserts, then medicine can also be viewed as producing reality and reproducing practices.

Thus, the image of medicine and its practitioners in the modern era is as much a construct as the science it lays claim to, but it is a construct the public endorses. Medicine is about control: controlling disease, and controlling human mortality. Acknowledging that medical practice engages in areas where “always situational, always interpretive” ways of knowing (Montgomery 134) prove more beneficial than reams of diagnostic tests disturbs the invisibility of the construct. Likening doctors to “naturalists or archeologists” (16) challenges the valorized ideal of empirical purity sustained both by the medical profession and lay public.

As patients, we do not want see our doctors as fallible human beings reliant on instinct and intuition; we are believers in science, and prefer the mythic, bionic image of infallible technology. Mongomery’s text works in a positive direction to instill a breath of humility into medical practitioners and to coach them in “medicine’s epistemological predicament, its phronesiology, and the use of competing maxims as interpretive strategies for coping with uncertain knowledge” (136).  The question remains: if enough physicians are exposed to these ideas early in their education, will it change the perception of clinical reasoning as a poor follow-up to scientific theory?

Montgomery, Kathryn. _How Doctors Think_. Oxford: Oxford UP, 2006.

Moser, Ingunn. “Introduction: Mobilizing Critical Communities and Discourses on Modern Biotechnology.” _Biopolitics: A Feminist and Ecological Reader on Biotechnology_. Eds. Vandana Shiva and Ingunn Moser. London: Zen Books Ltd., 1995. 1-24. Print.

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Posted August 30, 2010 by MGalbreath in Uncategorized

2 responses to “Montgomery and “Practicing” Medicine

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  1. Great question, though it assumes that doctors already devalue clinical reasoning and judgment.

  2. Thank you for bringing up the role of popular culture in creating and reinforcing the view of medicine as positivistic (and even infallible). When Montgomery notes that through individual cases, doctors sometimes “work out something entirely new about the disease or its therapy, an exception to the known rules…” (78), I couldn’t help but think of Grey’s Anatomy episodes where residents desperately want to try something experimental (the last ditch effort) and stay up all night flipping through books trying to find that single case study to convince the chief or the neurosurgeon (Dr. Dreamy;) or whoever needs convincing that this could work! Of course it usually does but unfortunately fiction is only a version of reality and the stakes are much higher when the patient is not an actor. Groopman provides the physician/intern/resident perspective(s) in his discussion of the anxiety that accompanies these profound implications. However, medicine demands such risks and the only way to really know if something works is via a human guinea pig. Chemo patients are perhaps the ultimate guinea pigs. While chemo cures cancer in many cases, the long-term effects are not completely understood. Those which are understood include cancer. A side effect of chemo is cancer; such is medicine’s paradox. Romanticizing medicine creates unrealistic expectations for its practitioners.

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