Where There is no Patient: An Anthropological Treatment of a Biomedical Category

Original Paper

Abstract

This work anthropologically applies the concept of ‘personhood’ to the Western biomedical patient role, and through cross-cultural comparisons with wellness-seeker roles (e.g. among the Maya of Guatemala and others) it seeks to discern the implications for global healthcare of assuming the universality of the “patient” role. Here, particular ethnographic attention is given to the presumption of the “patient” role in places and situations where, because of cultural and linguistic variation in local wellness-seeker roles and practices, there may be no “patient.” It is hoped that establishing the biomedical patient role (with the clinical expectations, communicative and comportment practices that prefigure it) as acquired rather than intuitive, will help redirect cultural competence to the acquisition of patienthood, broadening it from an endless accrual of cultural inventories by physicians. Also it aims to shift existing biomedical associations of cultural variations in wellness-seeking away from a priori assessments of clinical defiance towards deeper understandings of the kinds of cultural differences that may make the difference treatment outcomes.

Keywords

Global health Cultural competence Biomedicine Patient Maya Guatemala 

References

  1. Abramson, J. H., F. J. H. Mayet, and C. C. Majola 1961 What Is Wrong with Me? A Study of the Views of African and Indian Patients in a Durban Hospital. Journal of South African Medicine 35: 690.Google Scholar
  2. Adair, J., and K. Deuschle 1970 The People’s Health: Medicine and Anthropology in a Navajo Community. New York: Appleton-Century-Crofts.Google Scholar
  3. Adams, Walter Randolph, and John Palmer Hawkins 2007 Health Care in Maya Guatemala: Confronting Medical Pluralism in a Developing Country. Oklahoma: University of Oklahoma Press. Google Scholar
  4. Ainsworth-Vaughn, N. 1992 Topic Transitions in Physician-Patient Interviews: Power, Gender, and Discourse. Language and Society 21: 409–426.Google Scholar
  5. Ainsworth-Vaughn, N. 1998 Claiming Power in Doctor-Patient Talk (Oxford Studies in Sociolinguistics). Oxford: Oxford University Press.Google Scholar
  6. American Medical Association 1848 Code of Medical Ethics: Adopted by American Medical Association at Philadelphia, May, 1847, and by the New York Academy of Medicine in October 1847. pp. 14–14. New York: H. Ludwig.Google Scholar
  7. Blackwell, Barbara 1963 The Literature of Delay in Seeking Medical Care for Chronic Illness. Health Education Monographs 16: 3–32.Google Scholar
  8. Bloom, S. W. 1965 The Doctor and His Patient. New York: Free Press.Google Scholar
  9. Bourdieu, Pierre 1977 Outline of a Theory of Practice, trans. Richard Nice. Cambridge University Press. Google Scholar
  10. Briggs, C. L. 1986 Learning How to Ask: A Sociolinguistic Appraisal of the Role of the Interview in Social Science Research. New York: Cambridge University Press.Google Scholar
  11. Burn, J. L. 1951 Why do Some Parents Object to Diphtheria Immunization? Journal of Health Education 9: 70.CrossRefGoogle Scholar
  12. Chatterjee, J. S. 2006 From Compliance to Concordance in Diabetes. Clinical Ethics 32: 507–510.Google Scholar
  13. Cicourel, Aaron V. 1975 Discourse and Text: Cognitive and Linguistic Processes in Studies of Social Structure. Versu: Quaderni de Studi Semotici 12: 33–84.Google Scholar
  14. Clark, M. 1970 Health in Mexican American Culture. Los Angeles and Berkeley: University of California Press.Google Scholar
  15. Csordas, T. J. 1994 In Embodiment and Experience: The Existential Ground of Culture and Self. Thomas J. Csordas, ed., pp. 1–24. New York: Cambridge University Press.Google Scholar
  16. Davidson, Brad 2001 Questions in Cross-Linguistic Medical Encounters: The Role of the Hospital Interpreter. Anthropological Quarterly 74(4):170-178. Google Scholar
  17. Deasy, L. I. 1956 Socio-economic Status and Participation in the Poliomyelitis Vaccine Trail. American Society Review 21: 185.CrossRefGoogle Scholar
  18. Deveugele, M., A. Derese, A. van den Brink-Muinen, J. Bensing, and J. de Maeseneer 2002 Consultation Length in General Practice: Cross-sectional Study in Six European Countries. British Medical Journal 325: 472–478.CrossRefGoogle Scholar
  19. Díaz-Duque, O. F. 1998 Communication Barriers in Medical Settings: Hispanics in the United States. In Linguistics at Work: A Reader of Application. Dallin D. Oaks, ed., pp. 86–98. Newark, NJ: Harcourt Brace College.Google Scholar
  20. Donovan, J. L., and D. R. Blake 1992 Patient Non-compliance: Deviance or Reasoned Decision Making? Social Science and Medicine 34: 507–513.CrossRefGoogle Scholar
  21. Dow, James 1986 Universal Aspects of Symbolic Healing: A Theoretical Synthesis American Anthropologist, New Series, 88(1): 56–69. Google Scholar
  22. Durkheim, E. 1995 The Elementary Forms of Religious Life. Karen E. Fields, trans. New York: Free Press (original 1912).Google Scholar
  23. Edelsky, Carole 1981 Who’s got the floor? Language in Society (10): 383–421.Google Scholar
  24. Eder, Karin, and Maria Manuela Garica Pu 2002 Model of Indigenous Maya Medicine in Guatemala. Guatemala: ACESCA.Google Scholar
  25. Enelow, Allen J., and Scott N. Swisher 1979 Interviewing and Patient Care. 2nd ed. New York: Oxford University Press.Google Scholar
  26. Epstein, Julia 1995 Altered Conditions. New York: Routledge.Google Scholar
  27. Evans-Pritchard, E. 1937 Witchcraft, Oracles and Magic among the Azande. London: Oxford University Press.Google Scholar
  28. Finkler, K. 1994 Sacred Healing and Biomedicine Compared. Medical Anthropology Quarterly 8(2): 178–197.CrossRefGoogle Scholar
  29. Fisher, S. 1998 Doctor Talk/Patient Talk: How Treatment Decisions Are Negotiated in Doctor- Patient Communication. In Linguistics at Work: A Reader of Applications. Dallin D. Oaks, ed. New York: Harcourt Brace College.Google Scholar
  30. Fisher, S., and S. B. Groce 1990 Accounting Practices in Medical Interviews. Language in Society 19: 225–250.Google Scholar
  31. Fortier, J.P., and D. Bishop 2003 Setting the Agenda for Research on Cultural Competence in Health Care: Final Report. In C. Brach, ed. Rockville, MD: U.S. Department of Health and Human Services Office of Minority Health and Agency for Healthcare Research and Quality.Google Scholar
  32. Foucault, M. 1973 The Birth of the Clinic. Alan Sheridan, trans. London: Tavistock (originally published 1963).Google Scholar
  33. Foucault, M. 1979 Discipline and Punish: The Birth of the Prison. Alan Sheridan, trans. London: Allen Lane.Google Scholar
  34. Frake, C. O. 1961 The Diagnosis of Disease among the Subanun of Mindanao. American Anthropologist 63(1): 113–132.CrossRefGoogle Scholar
  35. Frankel, Richard 1990 Talking in interviews: a dispreference for patient-initiated questions in physician-patient encounters'. In Interactional Competence, George Psathas, ed. Washington: University Press of America. pp. 231–262. Google Scholar
  36. Frazer, Sir James 1922 The Golden Bough: A Study of Magic and Religion. New York: Macmillan.Google Scholar
  37. Freund, Peter 1990 The Expressive Body: A Common Ground for the Sociology of Emotions and Health and Illness. Sociology of Health & Illness 12(4): 452–477.CrossRefGoogle Scholar
  38. Gaines, Atwood D., and Robert A. Hahn 1985 Among the Physicians: Encounter, Exchange and Transformation. In Physicians of Western Medicine: Anthropological Approaches to Theory and Practice. Robert A. Hahn and Atwood D. Gaines, eds. Dordrecht, the Netherlands: D. Reidel.Google Scholar
  39. Goffman, E. 1967 Interaction Ritual: Essays on Face-to-Face Behavior. Garden City, NY: Doubleday.Google Scholar
  40. Gordis L. 1976 Methodological issues in the measurement of patient compliance. In Compliance in Health Care. D.L. Sackett, R.B. Haynes, eds., Baltimore: Johns Hopkins University Press.Google Scholar
  41. Grønseth, Anne Sigfrid 2006 Experience of Illness and Self: Tamil Refugees in Norway Seeking Medical Advice. In Multiple Medical Realities: Patients and Healers in Biomedical, Alternative and Traditional Medicine. Helle Johannessen and Imre Lázár, eds., pp. 148–161. New York: Berghahn Books.Google Scholar
  42. Groves, James E. 1978 Taking Care of the Hateful Patient. New England Journal of Medicine Apr 20: 298(16): 883–887.Google Scholar
  43. Gumperz, J. 1968 The Speech Community. International Encyclopedia of the Social Sciences. pp. 381–386. London: Mcmillan.Google Scholar
  44. Hahn, Robert A., and Atwood D. Gaines, eds. 1985 Physicians of Western Medicine: Anthropological Approaches to Theory and Practice. Dordrecht, the Netherlands: D. Reidel.Google Scholar
  45. Harvey, T.S. 2003 K’iche’ Expression of Wellness and Illness in Disputed Fields of Care: A Comparative Analysis of Maya Intra-Cultural Therapeutic and Cross-Cultural Biomedical Care. Ph.D. Dissertation. University of Virginia.Google Scholar
  46. Harvey, T.S. 2006a Humbling, Frightening, and Exalting: An Experiential Acquaintance with Maya Healing. Anthropology and Humanism 31(1): 1–10.Google Scholar
  47. Harvey, T.S. 2006b Ipseity, Alterity, and Community: The Tri-unity of K’iche’ Maya Healing. Zygon: Journal of Religion and Science 41(4): 903–914.Google Scholar
  48. Harvey, T.S. 2008 Cultural Issues in Health Communication. Encyclopedia of Public Health.Google Scholar
  49. Heath, Christian 2006 Body work: The Collaborative Production of the Clinical Object. In Communication in Medical Care: Interaction between Primary care physicians and patients, eds. John Heritage and Douglas Maynard. pp. 185–213. Cambridge: Cambridge University Press.Google Scholar
  50. Hein, N., and R. Wodak 1987 Medical Interviews in Internal Medicine: Some Results of an Empirical Investigation. Texts 7(1): 37–65.Google Scholar
  51. Heritage, John, and Douglas Maynard 2006 Communication in Medical Care: Interaction between Primary Care Physicians and Patients. Studies in Interactional Sociolinguistic 10. Cambridge: Cambridge University Press.Google Scholar
  52. Huber, Brad, and Alan Sandstrom, eds. 2001 Mesoamerican Healers. Austin: University of Texas Press.Google Scholar
  53. Hymes, D. 1972 Models of Interaction of Language and Social Life. In Directions in Sociolingusitics: The Ethnography of Communication. John Gumperz and Dell Hymes, eds., pp. 35–71. New York: Holt.Google Scholar
  54. Janzen, J. 1978 The Clan as Patient”. In Quest for Therapy in Lower Zaire: Comparative Studies of Health Systems and Medical Care. Berkeley: University of California Press. pp.114–125.Google Scholar
  55. Jutel, Annemarie 2006 The Emergence of Overweight as a Disease Entity: Measuring Up to Normality. Social Science and Medicine 63: 2268–2276.CrossRefGoogle Scholar
  56. Kleinman, A. 1980 Patients Healers in the Context of Culture. Berkeley: University of California Press.Google Scholar
  57. Kleinman, A. 1988 The Illness Narratives: Suffering, Healing, and the Human Condition. New York: Basic Books.Google Scholar
  58. Kleinman, A. 1995 What Is Specific to Biomedicine. In Writing at the Margins. pp. 21–40. Berkeley, CA: University of California Press.Google Scholar
  59. Knipper, Michael 2006 Self, Soul and Intravenous Infusion: Medical Pluralism and the Concept of Samay among the Naporuna in Ecuador. In Multiple Medical Realities: Patients and Healers in Biomedical, Alternative and Traditional Medicine. Helle Johannessen and Imre Lázár, eds., pp. 137–147. New York: Berghahn Books.Google Scholar
  60. Kockelman, Paul 2007 Inalienable possession and personhood in a Q’eqchi’-Mayan community Language in Society. 36: 343–369. Printed in the United States of America.Google Scholar
  61. Koos, E. L. 1954 The Health of Regionville. New York: Columbia University Press.Google Scholar
  62. Korsch, Barbara M., Ethel K. Gozzi, and Vida Francis 1968 Gaps in Doctor-Patient Communication: I. Doctor–Patient Interaction and Patient Satisfaction. Pediatrics 42: 855–871.Google Scholar
  63. La Fontaine, J. S. 1996 Person and Individual. Some Anthropological Reflections. In The Category of the Person. Michael Carrithers, Steven Collins, and Steven Lukes, eds., pp. 123–140. New York: Cambridge University Press.Google Scholar
  64. Lakoff, G., and M. Johnson 1981 Metaphors We Live By. Chicago: University of Chicago Press.Google Scholar
  65. Lupton, D. 1997 Foucault and Medicalization Critique. In Foucault, Health and Medicine. Alan Patterson and Robin Bunton, eds. New York: Routledge.Google Scholar
  66. Maine, Sir Henry Sumner 1930 Ancient Law: Its Connection with the Early History of Society and its Relation to Modern Ideas. London: John Murray, Albemarle Street, W.Google Scholar
  67. Martin, Emily 1992 The Woman in the Body: A Cultural Analysis of Reproduction. Boston: Beacon Press.Google Scholar
  68. Mattingly, C. 2002 The Mimetic Question. In Healing Dramas and Clinical Plots: The Narrative Structure of Experience. pp. 25–47. Cambridge: Cambridge University Press.Google Scholar
  69. Mattingly, C., and L. Garro, eds. 2000 Narrative and the Cultural Construction of Illness and Healing. Berkeley: University of California Press.Google Scholar
  70. Mauss, Marcel 1972 A General Theory of Magic. Robert Brain, trans. New York: Norton.Google Scholar
  71. Mauss, Marcel 1996 A Category of the Human Mind: the Notion of the Person; the Notion of Self. In The Category of the Person. Michael Carrithers, Steven Collins, and Steven Lukes, eds., pp. 123–140. New York: Cambridge University Press (originally published 1902–1903).Google Scholar
  72. Maynard, C. L., D. Fisher, E. R. Passamani, and T. Pullman 1986 Blacks in the Coronary Artery Surgery Study (CASS): Race and Clinical Decision Making. American Journal of Public Health 76: 1446–1448.CrossRefGoogle Scholar
  73. Mentore, George 2005 Of Passionate Curves and Desirable Cadences. Lincoln Nebraska: University of Nebraska Press. Google Scholar
  74. Merleau-Ponty, Maurice 1989 The Phenomenology of Perception. Colin Smith, trans. London: Routledge and Kegan Paul.Google Scholar
  75. Mishler, E. G. 1997 Interactional Constructions of Narratives in Medical and Life-History Interview. In The Construction of Professional Discourse. B. L. Gunnarson, P. Linell, and B. Norberg, eds., pp. 223–244. New York: Longman.Google Scholar
  76. Mitchell, Carlton T. 1989 Values in Teaching and Professional Ethics. Macon, GA: Mercer University Press.Google Scholar
  77. Ohnuki-Tierney, Emiko 1984 Illness and Culture in Contemporary Japan: An Anthropological View. Cambridge: Cambridge University Press.Google Scholar
  78. Parsons, T. 1951 The Social System. Glencoe, IL: Free Press.Google Scholar
  79. Parsons, T. 1975 The Sick Role and the Role of the Physician Reconsidered. MMFQ/Health and Society 53: 257–278.Google Scholar
  80. Perloff, Richard, Bette Bonder, George Ray, Eileen Ray, and Laura Siminoff 2006 Doctor-Patient Communication, Cultural Competence, and Minority Health. American Behavioral Scientist 49: 835–852.CrossRefGoogle Scholar
  81. Pritchard, Evans E. 1933 Witchcraft, Oracles and Magic among the Azande. Oxford: Clarendon Press.Google Scholar
  82. Reich, Warren T. 1978 Declaration of Geneva. In Encyclopedia of Bioethics, 4 vols., Warren T. Reich, ed., p. 1749. New York: The Free Press.Google Scholar
  83. Riffenburgh, R.S. 1966 The Doctor-Patient Relationship in Glaucoma Therapy. Archives of Ophthalmology 75: 204.Google Scholar
  84. Roter, D.L., and Hall, J.A. 1993 Doctors Talking with Patients/Patients Talking with Doctors: Improving Communication in Medical Visits. Westport, CT: Auburn House.Google Scholar
  85. Sansom, B. 1983 The Sick Do Not Speak. In Semantic Anthropology. David Parkin, ed., pp. 183–195. New York: Academic Press.Google Scholar
  86. Sartre, Jean-Paul. 1966 Being and Nothingness. New York: Washington Square PressGoogle Scholar
  87. Sapir, E. 2001 The Unconscious Patterning of Behavior in Society. In Readings for a History of Anthropological Theory. Paul A. Erickson and Liam D. Murphy, eds., pp. 181–195. Buffalo, NY: Broadview Press (originally published 1927).Google Scholar
  88. Scheper-Hughes, Nancy, and Margaret Lock 1986 The Mindful Body: A Prolegomenon to Future Work. Medical Anthropology Quarterly 17(5): 137–140.Google Scholar
  89. Sharf, B.F., and Kahler, J. 1996 Victims of the franchise: A culturally sensitive model of teaching patient doctor communication in the inner city. In Communication and disenfranchisement: Social health issues and implications. E.B. Ray, ed., pp. 95–115. Mahwah, NJ: Lawrence Erlbaum. Google Scholar
  90. Sherwin, Susan 1992 No Longer Patient: Feminist Ethics and Health Care. Philadelphia: Temple University Press.Google Scholar
  91. Shuy, R. 1974 Problems of Communication in the Cross-Cultural Medical Interview. Working Papers in Sociolinguistics 19: 1–36.Google Scholar
  92. Spradley, J.P. 1979 The Ethnographic Interview. New York: Holt, Rinehart and Winston.Google Scholar
  93. Tannen, Deborah, and Cynthia Wallat 1982 Doctor/Mother/Child Communication: Linguistic Analysis of Pediatric Interaction. In The Social Organization of Doctor–Patient Communication. Sue Fisher and Alexandra Dundas Todd, eds. Washington DC: Center for Applied Linguistics.Google Scholar
  94. Taussig, M.T. 1980 Reification and the Consciousness of the Patient. Social Science and Medicine 14B: 3–13.Google Scholar
  95. Taylor, Kenneth 1976 Body and Spirit Among the Sanumá (Yanoama) of North Brazil. In Medical Anthropology. pp. 26–48. Chicago: Aldine Publishing Company. Google Scholar
  96. Trouillot, M.-R. 1991 Anthropology and the Savage Slot: The Poetics and Politics of Otherness. In Recapturing Anthropology: Working in the Present. Richard Fox, ed., pp. 17– 44. Santa Fe: School of American Research Press.Google Scholar
  97. Turner, E. 2005 Among the Healers: Stories of Spiritual and Ritual Healing around the World. New York: Praeger.Google Scholar
  98. Turner, V. 1967 Forest of Symbols: Aspects of Ndembu Ritual. Ithaca, NY: Cornell University Press.Google Scholar
  99. van Ryn, M., and Burke, J. 2000 The effect of patient race and socio-economic status on physicians’ perceptions of patients. Social Science & Medicine 50: 813–828. Google Scholar
  100. Veatch, Robert M. 1991 The Patient–Physician Relationship. Bloomington: Indiana University Press.Google Scholar
  101. Wagner, R. 1989 Symbols That Stand for Themselves. Chicago: University of Chicago Press.Google Scholar
  102. Weber, M. 1958 The Three Types of Legitimate Rule. Hans Gerth, trans. Berkeley Publications in Society and Institutions 4(1): 1–11.Google Scholar
  103. Werner, D., C. Thuman, and J. Maxwell 1992 Where There Is No Doctor: A Village Health Care Handbook. Berkeley, CA: Hesperian Foundation.Google Scholar
  104. West, Candice 1984 When the Doctor Is a “Lady”: Power, Status and Gender in Physician–Patient Encounters. Symbolic Interaction 7: 87–106.CrossRefGoogle Scholar
  105. Whorf, B. 1939 The Relation of Habitual Thought and Behavior to Language. Language, Thought, and Reality 134–159.Google Scholar
  106. Worsley, P. 1982 Non-Western Medical Systems. Annual Review of Anthropology 11: 315–348. CrossRefGoogle Scholar
  107. Young, Allen 1982 The Anthropologies of Illness and Sickness. Annual Review of Anthropology 11: 257–285.CrossRefGoogle Scholar
  108. Zhang, Jinjin, and Marja J. Verhoef 2002 Illness Management Strategies among Chinese Immigrants Living with Arthritis. Social Science & Medicine 55: 1795–1802.CrossRefGoogle Scholar
  109. Zola, Irving Kenneth 1973 Pathways to the Doctor—From Person to Patient. Social Science and Medicine 7: 677–689.CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Department of AnthropologyUniversity of California, RiversideRiversideUSA

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