ebook img

Feeling Medicine: How the Pelvic Exam Shapes Medical Training PDF

296 Pages·2020·2.087 MB·English
Save to my drive
Quick download
Download
Most books are stored in the elastic cloud where traffic is expensive. For this reason, we have a limit on daily download.

Preview Feeling Medicine: How the Pelvic Exam Shapes Medical Training

Feeling Medicine Biopolitics: Medicine, Technoscience, and Health in the Twenty- First Century Series General Editors: Monica J. Casper and Lisa Jean Moore Missing Bodies: The Politics of Visibility Men at Risk: Masculinity, Monica J. Casper and Lisa Jean Moore Heterosexuality, and HIV Prevention Shari L. Dworkin Against Health: How Health Became the New Morality To Fix or to Heal: Patient Care, Public Edited by Jonathan M. Metzl and Health, and the Limits of Biomedicine Anna Kirkland Edited by Joseph E. Davis and Ana Marta González Is Breast Best? Taking on the Breastfeeding Experts and the New Mattering: Feminism, Science, and High Stakes of Motherhood Materialism Joan B. Wolf Edited by Victoria Pitts- Taylor Biopolitics: An Advanced Introduction Are Racists Crazy? How Prejudice, Thomas Lemke Racism, and Antisemitism Became Markers of Insanity The Material Gene: Gender, Race, and Sander L. Gilman and James M. Heredity after the Human Genome Thomas Project Kelly E. Happe Contraceptive Risk: The FDA, Depo- Provera, and the Politics of Cloning Wild Life: Zoos, Captivity, and Experimental Medicine the Future of Endangered Animals William Green Carrie Friese Personalized Medicine: Empowered Eating Drugs: Psychopharmaceutical Patients in the 21st Century Pluralism in India Barbara Prainsack Stefan Ecks Biocitizenship: On Bodies, Belonging, Phantom Limb: Amputation, and the Politics of Life Embodiment, and Prosthetic Edited by Kelly E. Happe, Jenell Technology Johnson, and Marina Levina Cassandra S. Crawford Toxic Shock: A Social History Heart- Sick: The Politics of Risk, Sharra L. Vostral Inequality, and Heart Disease Janet K. Shim Managing Diabetes: The Cultural Politics of Disease Plucked: A History of Hair Removal Jeffrey A. Bennett Rebecca M. Herzig Feeling Medicine: How the Pelvic Contesting Intersex: The Dubious Exam Shapes Medical Training Diagnosis Kelly Underman Georgiann Davis Feeling Medicine How the Pelvic Exam Shapes Medical Training Kelly Underman NEW YORK UNIVERSITY PRESS New York NEW YORK UNIVERSITY PRESS New York www.nyupress.org © 2020 by New York University All rights reserved References to Internet websites (URLs) were accurate at the time of writing. Neither the author nor New York University Press is responsible for URLs that may have expired or changed since the manuscript was prepared. Library of Congress Cataloging-in-Publication Data Names: Underman, Kelly, author. Title: Feeling medicine : how the pelvic exam shapes medical training / Kelly Underman. Description: New York : New York University Press, [2020] | Series: Biopolitics : medicine, technoscience, and health in the twenty-first century series | Includes bibliographical references and index. Identifiers: LCCN 2019041471 | ISBN 9781479897780 (cloth) | ISBN 9781479893041 (paperback) | ISBN 9781479836338 (ebook) | ISBN 9781479878666 (ebook) Subjects: LCSH: Gynecology—Study and teaching—United States. | Physicians—Training of—United States. | Pelvis—Examination—Social aspects—United States. | Human anatomy—Models—United States. | Gynecologist and patient—United States. Classification: LCC RG143.A1 U84 2020 | DDC 618.071/173—dc23 LC record available at https://lccn.loc.gov/2019041471 New York University Press books are printed on acid- free paper, and their binding materials are chosen for strength and durability. We strive to use environmentally responsible suppli- ers and materials to the greatest extent possible in publishing our books. Manufactured in the United States of America 10 9 8 7 6 5 4 3 2 1 Also available as an ebook For Dad, who taught me to be curious. Contents Introduction: The Quandary of the Sacred Vagina: Medical Education in a New Era 1 1. The Pelvic Exam and the Politics of Care 25 2. From Assessing Knowledge to Assessing Performance: GTA Programs, Medical Education Research, and Technologies of Affect 58 3. “This Power with My Body”: Intimate Authority in GTA Sessions 82 4. Practicing Professionalism, Performing Authenticity 114 5. “What Does It Mean to Relax Your Hand?” Learning to Feel with the Body in the Pelvic Exam 141 6. Not Just Bones, Organs, and Science: The New Clinical Subjects of Patient Empowerment 168 Conclusion: Is the Vagina Different from the Mouth? Affect and the Making of Physicians 199 Acknowledgments 215 Appendix A: Methodology 219 Appendix B: Pelvic Exam Checklists 229 Notes 237 Bibliography 257 Index 281 About the Author 287 vii Introduction The Quandary of the Sacred Vagina: Medical Education in a New Era The anatomy lab has long held a fascinating and central position on the path to becoming a physician. And why not? Scholars of medical education and physicians have both written about how working with the cadaver prepares the medical student for this singular profession, in which personhood— for patient and trainee— is reworked or vacated entirely, death is a daily fact, and the body is cut into and opened up in ways that violate many deeply held cultural values. Commentators have noted that the anatomy lab also sets the model for the physician-p atient relationship: a stoic expert applies knowledge to the inert and voiceless patient. Of course, none of these lessons is explicit. Trainees learn from their instructors and their peers about the so- called “soft skills” of being a physician from interactions with one another and everything that goes unsaid. And yet, the anatomy lab is rapidly losing ground as the key mecha- nism for teaching trainees about the physician- patient relationship and the profession of medicine (Vinson 2019). Since the 1990s, the implicit and informal ways in which medical students were socialized have lost prominence in favor of explicit and formal systems of knowledge and practice that teach medical students how to become physicians. The rise of required courses on professionalism is just one such example, and one of the most visible. Attend any conference on health professions education today, and you will hear experts debate the most cutting-e dge and scientifically vetted methods for producing the next generation of physicians. With this shift toward the explicit, formal, and intensive has come a dramatic change in the profession’s attitude toward feelings. In the old 1 2 | Introduction model of the anatomy lab, learning to suppress your horror, disgust, fear, or sadness was as central a lesson as learning the shapes and locations of organs. However, newer models of educating trainees take feelings head- on: medical students have memorial services to honor the humanity of their cadavers and grapple with their emotions around death and dying, attend art classes to develop their empathy, and, perhaps most tellingly, are judged on a portion of the United States Medical Licensing Exam (USMLE) on their ability to evoke and manage patient’s feelings about their illnesses. This shift is fascinating for a profession that has spent almost the entirety of the twentieth century cultivating detachment and dispas- sionate concern among its initiates. Nowhere is this shift more appar- ent than in teaching and learning the pelvic examination. In previous generations, medical students learned this exam on clinic patients who were given no opportunity to refuse. Medical students were taught to ignore their own and their patients’ feelings about the exam, much in line with the model of expert- object established in the anatomy lab. In fact, patients who did have feelings about the exam— perhaps that the speculum hurt or that the exam reminded them of past trauma— were pathologized. Today’s medical students now almost all learn the exam on the body of a trained and well- paid layperson who is simul- taneously also their instructor. These laypeople emphasize not just the manual skills of inserting a speculum and checking the internal organs for disease, but also the interactional aspects of how to make patients feel safe, comfortable, and respected. In addition, they acknowledge the medical students’ own feelings of anxiety or squeamishness and provide a supportive environment for trainees to make mistakes. Learning about the body from a body that sits up and talks back is a markedly different kind of socialization than learning from the cadaver or the inert clinic patient. This new kind of pedagogy is embedded in a broader transformation in the profession to value feelings between and within phy- sicians and patients. Conversations about empathy and burnout abound, even as metrics assessing the encounter, such as patient satisfaction scores, proliferate. No longer is the patient a passive object receiving the physician’s expert knowledge. The patient is centered in the relationship, the patient is empowered, the patient is to be engaged in decision- making. There is clearly a new landscape about feelings in clinical medicine.1

See more

The list of books you might like

Most books are stored in the elastic cloud where traffic is expensive. For this reason, we have a limit on daily download.