Medical Objectivity: The Narratives that Structure Knowledge and Identity in Medicine

Date

Journal Title

Journal ISSN

Volume Title

Publisher

Abstract

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.

Description

Keywords

objectivity, medicine, medical education, narratives, narrative medicine, history of medicine, race, racial bias, memoirs, medical students, residents, residency

Citation