Embracing Messiness in Medicine, Research, and Ourselves

By: Eve Purdy

To begin to appreciate biomedicine as its own culture, we must appreciate alternate ways of knowing.

As individuals we become indoctrinated into either biomedicine or the social sciences and we are taught to view the world in a particular way. (1,2) Medical students devotedly learn about all the ways that the body can go awry and then physicians spend the majority of clinical time interacting with these aberrances. We desperately search for a problem, and feel most comfortable when we find one. We are especially grateful if it is an issue we can fix.

Many of us feel uncomfortable with uncertainty and will often continue the search for objective evidence of any disease until it is found. Physicians are described as practical, problem-oriented, and efficiency focused. (1) We become familiar with interpreting evidence that is generated most preferably through prospective, blinded, and quantitative means.

This, in contrast to anthropology, which is a more philosophical, theoretical, and reflexive field. (1) It is less problem focused, and not necessarily outcome oriented. The non-reductionist and non-positivist approach leaves open the possibility of multiple truths (don’t worry there are still facts) and ambiguity in understanding of the world.

This can make physicians feel quite uncomfortable; I certainly was. Epistemological differences between the biosciences and anthropology could result in conflict, but their combination might also result in an elevated level of understanding. (3,4)

Different types of research should be used to answer different questions. As van der Geest reminds us, “Disciplines are merely human designed (cultural) tools to study and interpret and explain reality. No discipline is all-embracing or has the final word.” (1)

Much of the literature from anthropology would not be recognized as “high quality” or necessarily even recognized as research by those primarily indoctrinated by biomedicine. The methods feel foreign to most. I have experienced this skepticism repeatedly while engaging with biomedical ethics review boards when attempting to get basic and low risk anthropology projects off the ground. There are few numbers, no p-values, and sometimes not even a-priori questions.

There is, however, authentic engagement with the complexity of our work in medicine. There is a driving central tenet that the patients we care for, and the people with whom we work, are human. The evidence is not that with which we are classically familiar, but certainly that with which we should seek to become more familiar. Anthropology, if we allow it to, provides an exciting new lens for us to explore the messiness of medicine, research, and ourselves.


References

  1. Van der Geest, Sjaak. “Overcoming ethnocentrism: how social science and medicine relate and should relate to one another.”The Concept of Race” in Natural and Social Science” (2014): 173.
  2. Whitehead, Cynthia. “Scientist or science‐stuffed? Discourses of science in North American medical education.”Medical education 47, no. 1 (2013): 26-32.
  3. Paltved, Charlotte, and Peter Musaeus. “Qualitative research on emergency medicine physicians: a literature review.” International Journal of Clinical Medicine3 (2012).
  4. Ecks, Stefan. “Three propositions for an evidence‐based medical anthropology.”Journal of the Royal Anthropological Institute 14, no. s1 (2008).

Feature photo provided by author