As a PhD student in medical anthropology, and having come from a very "medical family," pursuing an MD has been a kind of shadow-dream of mine. For a year or two in high school, I was convinced that neonatology was the path for me; now I'm a doula and research the culture of childbirth.
Some people do live the double dream, and I recently interviewed two of them: Jenny Miao Hua at the University of Chicago and Rosalind Franklin University's Chicago Medical School, and Stanford's Amrapali Maitra, both of whom are medical anthropologists pursuing PhD/MD degrees. (Amrapali has brought an anthropological perspective to Scope through our SMS Unplugged series.)
The two came to their joint degree from different sides: Hua was an anthropology student interested in Chinese medicine and the body, while Maitra was enrolled in medical school and became serious about understanding the social context of illness. Each intends to pursue internal medicine, and each, incidentally, has family connections in the site she chose to research. We talked shop for quite a while, and what I found most interesting was their thoughts on what anthropology brings to clinical practice:
Maitra: On the broadest level, anthropology gives you an immense empathy for your patients and allows you to see them as people. It sounds cliché, but with the focus on efficiency and evidence-based medicine that has taken over American biomedical practice, even the most kind and caring individual can lose [his or her] empathy. And the kind of empathy you get from anthropology is not just sympathizing with the person, but really understanding where they're coming from, historically and because of their life position: why they live in a certain neighborhood or have a certain diet. It allows you to think creatively about what they're able to do or not do in pursuing their own health.
Hua: With anthropological training, students understand the various ways pathologies are dependent on larger socioeconomic forces. As a practicing physician, the person who comes through the door is never a textbook patient, so within a very short amount of time you have to pick up on this deep history, and when you're not careful you end up stereotyping and profiling. Anthropology brings a more nuanced way of thinking about patients: they're not just uniform biological entities, but hybrids of biology, society, and culture.
Maitra: I've seen so many clinic visits where I can tell, as the anthropologist in the room, that the attending physician and patient just have completely different agendas. There are simple questions like those Arthur Kleinman has laid out, asking what about the pain bothers her, why she thinks she's having it, what she hopes to get out of the encounter. I see some doctors use these, and their visits go so much better. They're able to build an alliance with their patient that's very therapeutic.
That's anthropology on the individual level, but on another level it allows you to recognize that certain things are trends. It allows you to think systematically about different kinds of structural violence. For example, why is it that so many people whose occupation is picking strawberries come in with knee and back pain issues? Treating pain is not going to solve the problem. It's about getting to the root of the occupational hazards of being a farm worker.
According to Hua, anthropology challenges the homogenous way physicians are traditionally trained to view biology around the world:
When you read classic medical texts, Hippocrates and other origin texts, they are enormously attentive to geographic variation and different habits. There's this idea that biology is not a singular thing, not one schematic you can apply across the board, but rather, there is biological pluralism as well as cultural. Pathologies are shaped by individual body histories, and ripple through local contexts. Some take root and become multigenerational.
We get into the habit of saying "Oh, it's just another COPD;" well, every COPD is different, even if it's the bread and butter of your practice. Clinicians learn to be attuned to what's the same, but that's the simple part. Differences are what matters when you're talking about a mediocre diagnosis versus a very astute diagnosis.
Anthropology understands problems on a human scale of time and place, whereas historians look at a bigger chunk of time, and nowadays medical science, which is very much influenced by epidemiology, looks at a bigger chunk of geography. In medicine, the particulars of space are overcome by numbers: the type of knowledge we are taught to respect as the most valid is based on large populational studies asking really broad questions, like whether Aspirin works for joint pain. It makes space homogenous.
Maitra would like to see anthropology incorporated into medical school curricula, but it's a challenge to convert 5-6 years of intense grad school training into a much tighter, skills-based curriculum. She's interested in working on that challenge while she writes her dissertation. "A start would be having more med students who study anthropology, because conversations are big ways we process challenges in med school," she told me.
Previously: Graphic medicine takes flight, An anthropologist on the wards, Physician writers share a "global perspective on healing", Rituals of the body: Honoring the loss of bodily wholeness in medicine and "How cancer becomes us": A conversation with author and anthropologist Lochlainn Jain
Photo by qthomasbower
