From House, M.D. to someone like me
An anthropology student-researcher’s changing perception of medical students and how they relate to the social sciences
Tyler Harvey is currently reading Anthropology (BSc) at the University of Kent. His studies involve Social and Biological Anthropology, and he intends to apply knowledge from both disciplines to Medical Anthropology at masters-degree level and beyond.
This blog reflects on my experiences working as an intern for a Kent and Medway Medical School (KMMS) research project on the Behavioural and Social Sciences (BSS) in the undergraduate medical curriculum. While BSS is a core component of the General Medical Council’s Outcomes for Graduates (GMC 2018), it remains a challenge to meet the ideal of biomedical and BSS topics being treated as equally valuable by medical students. My reflections below may be useful to BeSST members, as I consider my own process of being inducted into the discussions involved in promoting social sciences teaching in medical education.
I came to be involved in the project through my undergraduate studies in Anthropology at the University of Kent. The research project, supervised by Dr Brianne Wenning, was advertised as an opportunity to apply the principles of the social sciences we have learned so far to a real-world research context. For this internship I worked with a specific dataset (medical student interview transcripts) from an auto-ethnographic study conducted by Professor Lisa Dikomitis which centred around her experiences of teaching social sciences in several medical schools in the UK (see Dikomitis and Kelly 2018; Dikomitis 2021; Dikomitis et al 2022). Using the knowledge Dr Wenning and I gained from collaborative coding and the helpful suggestions and edits by Professor Dikomitis, we ultimately produced an article, currently under review, that contained suggestions for embedding anthropology into medical curricula to encourage medical students to see the practicality and value the social sciences can have for their professional lives.
Coming from an outsider’s perspective, it is quite clear why many medical students begin their training with the idea that medicine is (or should be mainly) the ‘biomedical’. Surely the role of the doctor is to save lives, and knowledge of anatomy and physiology is paramount to this. This impression was reinforced through my analysis of the interview data. This certainly is the kind of messaging that comes from public representations of clinicians. Take TV programmes such as House, M.D., for example. The audience marvels at the genius of the Sherlock Holmes-esque titular character as he uncovers the medical mystery, at the same time chuckling at his general aloofness toward the actual human beings suffering from these ‘mysteries’, since it is ultimately not his job to fix their lives but their medical issue. Whilst it is certainly true that the dramatic representation of clinicians is not intended to be taken as a reflection of the realities of being a doctor (it would be interesting to see how long a real Gregory House would last in medical school!), I would argue that cultural products like these could certainly implicitly colour medical students’ early expectations of doctorhood as they did mine.
I saw this attitude reflected in the data set. Professor Dikomitis found that it was common for students to rush what they described as ‘fluffy stuff’, the BSS content such as topics in anthropology and sociology that relate to health outcomes (Dikomitis 2021; Dikomitis et al 2022). Some societal expectations of medical students were discussed by her interlocutors, in particular the idea that they all had to be very clever to belong to that particular social group. I make the assumption here that ‘clever’ is acting as a synonym for ‘gifted in the natural sciences’, because that is certainly what I experienced at A-level. I think that the general trends in UK university culture in which the humanities sit a rung below the natural sciences in terms of prestige (and therefore often funding too) reflect the high value ascribed to this type of science in society, and I now see better how this can affect the experience of being a medical student. Reading about some of the medical students’ experiences on placements, in which their doctor-mentors would align themselves with the medical detective role, reminded me of the workplace stories my mother, an NHS nurse, would share. These stories often featured the idea that it was the nurse’s job to care for the patient and the doctor to diagnose them. I would always be left wondering how these practices emerged and were maintained in a medical setting and participating in this research project allowed me to investigate this.
Despite my background in anthropology, which largely revolves around the various processes of socialisation, I still implicitly accepted the idea that all doctors needed to do was be ‘clever’ to succeed. So, I held the belief in common with many medical students that the ‘social’ was ultimately separate and largely irrelevant to the ‘biomedical’, and technical competency was all that was needed to be a good doctor. I was therefore quite lucky to have the opportunity to rectify my views through this research project. I now realise why this is in fact not the case, and that the idea of the ‘good doctor’ I had was indeed inspired more by fiction (such as in those aforementioned TV drama) than by fact. Further, reviewing the literature, particularly focusing on the processes of clinician socialisation, allowed me to see how these attitudes – including the hierarchical separation of ‘biomedical’ and ‘social’ content – are learned and reproduced within the hidden curriculum.
It was encouraging to see that the medical students themselves also began to make these kinds of realisations, as they wrote about them in their reflexive statements for Professor Dikomitis’ Student Selected Component: ‘An Introduction to Medical Anthropology’. In covering themes familiar to students of anthropology, such as ethnocentrism, it seemed that many of the medical students began to better appreciate the relevance of the BSS content to medicine and how it may actually be integral to their practice as doctors - exactly what I came to realise throughout my own reading of the literature. It was ultimately an important realisation to come to as it became one of the main motivators concerning the article that Professor Dikomitis, Dr Wenning, and myself eventually developed for the project. This article sought to double down on the promotion of the perceived clinical relevance of BSS content by suggesting medical students conduct an autoethnography of their experiences in clinical placements. Ideally, we think it would be productive to relate these experiences to the wider processes of physician socialisation and the ways in which they impact the development of a professional/clinician identity and ultimately clinical practice. We hope that students utilising methods typically thought of as more ‘subjective’ in the clinic (like ethnography) will contribute to the continued validity of the use of multiple perspectives and epistemologies - not only a biomedical framework - when approaching the everyday work of a doctor.
A new perception of doctors is what I personally got from this internship, though. Rather than a cadre of medical detectives singularly focused on solving medical mysteries through biomedical mastery, I now see people existing within the push and pull of social forces and expectations as we all do. I think this is an important step for those new to this research setting since it facilitates the legitimate study of these forces to judge which might help or hinder the development of good doctors, and a better understanding of how we might get to this goal.