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  • 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
  • Sue E. Estroff

    Eric J. Cassell

    Martha Balshem

    Holly F. Matthews

    Annie Dillard

    Arthur Frank

    Amy Bloom

    Irving Kenneth Zola

    Gordon Weaver

    Gail E. Henderson

    Nancy E. Adler

    Laurie K. Abraham

    Lawrence Wright

    Claire F. Horton

    Bobbie Ann Mason

    Doris Betts

    John M. Cornman

    Daniel Callahan

    Sharon R. Kaufman

    Ethan Canin

    Ronald P. Strauss

    Melvin Konner

    William Branch

    Perri Klass

    William Winkenwerder

    Abenaa Brewster

    David A. Asch

    Donald W. Seldin

    Gerald T. Perkoff

    Arnold S. Relman

    Carola Eisenberg

    Sir Arthur Conan Doyle

    Thomas S. Szasz

    David Hilfiker

    Maureen A. Flannery

    William Carlos Williams

    Nancy M. P. King

    Larry R. Churchill

    Marc D. Basson

    Antonella Surbone

    Edmund D. Pellegrino

    Benjamin Freedman

    Raymond Carver

    George J. Annas

    Judith Andre

    Leonard Fleck

    Nancy K. Rhoden

    Frank A. Chervenak

    Don Marquis

    Miles J. Edwards

    Timothy E. Quill

    Steven H. Miles

    Donald L. Madison

    Uwe E. Reinhardt

    Victor R. Fuchs

    Jafna L. Cox

    Sharon Redmayne

    Gail Povar

    Ezekiel J. Emanuel

    Donald R. Lannin

    James P. Mitchell

    Eric R. Kingson

    Richard J. Pels

    Robert S. Lawrence

    Ronald Arky

    Ruth M. Parker

    Marc H. Hollender

    Gerald Dworkin

    Marcia Angell

    Laurence B. McCullough

    Susan W. Tolle

    Rudolf Klein

    Jonathan Moreno

    Nancy Neveloff Dubler

  • “[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 and 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, r 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, Disabilities Studies Quarterly

    Reviews

  • “[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 and 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, r 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, Disabilities 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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  • Description

    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.

    About The Author(s)

    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.

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