Title of Dissertation:
MEDICAL OBJECTIVITY: THE NARRATIVES THAT STRUCTURE KNOWLEDGE AND IDENTITY IN MEDICINE
Summary of Dissertation:
Objectivity is an epistemological virtue that physicians aspire to embody in our practice. Historians and philosophers have pointed out that objectivity is culturally specific: it varies with time, place, and profession. In pre-clinical training, physicians learn to honor a scientific version of objectivity, in which the self is understood primarily as a potential source of error and “scientific selves” seeks to eradicate the pernicious influence of the self from scientific data. In practice, however, this research identifies that medical objectivity is distinct from scientific objectivity. This dissertation examines memoirs of medical training to understand how physician trainees learn, experience, and use objectivity. Medical objectivity is defined herein as attitude within medical epistemology that serves physicians’ attempt to structure clinical knowledge as scientific knowledge. It is situated (within the bodies and selves of physicians and medical trainees), dynamically subjective (insofar as it both changes people and changes according to the people who embody it), structured by narratives (such as narratives of race and narratives of self), and learned. The objective/objectifying gaze is an epistemological technique that serves a limited but crucial role in medical objectivity. The devaluation and attempted eradication of the self that inheres in an idealized “scientific objectivity” persists in medical providers’ narratives of self, within the objective/objectifying gaze, and in the experiences of clinical detachment and aequanimitas. Medicine’s appeal to social authority relies in part on the perception that we are “scientific.” However, medical objectivity is best understood as a subjectively situated and narratively structured attitude that serves (and, in some cases, disserves) medicine: a science-using, moral practice. Truly embracing medical objectivity as a subjective and narrative practice can both alleviate trainee discomfort and improve care. Not only can our narratives be fruitfully examined and challenged, but also we can harness subjectivity (including our discomfort, our joy, and our narratives of self) as a tool to improve the quality of care we provide.
- Jason Glenn, Ph.D., (CHAIR), Associate Professor, PMCH; Member, Institute for the Medical Humanities, UTMB
- Michele Carter, Ph.D., Professor, PMCH; Frances C. and Courtney M. Townsend, Sr., M.D. Professor in Medical Ethics, Interim Director and Member, Institute for the Medical Humanities, UTMB
- Rebecca Hester, Ph.D., Assistant Professor, Medical Humanities Graduate Program, UTMB
- Robert Beach, M.D., Professor Emeritus, Pediatric Nephrology, UTMB
- Kathryn Montgomery, Ph.D., Professor Emeritus of Medical Humanities & Bioethics and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
Rachel is in the MD-PhD Combined Program. She began her PhD work in medical humanities in the summer 2009 term. She then went back to medical school for a while, then came back to us to complete her PhD work in the fall of 2012. Rachel Pearson has a BA from the Plan 2 Honors program at the University of Texas at Austin, where she received the Robert C. Solomon Scholarship in the Arts and Philosophy. She has worked variously as a journalist, a patient advocate, and an actress in a traveling children's theatre troupe, and her creative work has appeared in the Mid-American Review, the Indiana Review, and on the air through Chicago Public Radio's Third Coast Audio Festival. Rachel has a keen interest in issues of the mind, the brain, and narrative medicine.
In July 2016, Rachel will begin her residency in pediatrics at the University of Washington in Seattle.