Patient Requests in Primary Care Clinics

Abstract

Much of medical education is devoted to introducing students to the vast theoretical and data base of contemporary medical science. Students become physicians rather than basic scientists, however, when they develop a particular way of looking at the world — “the clinical perspective” — and learn to apply their knowledge to the treatment of individual patients.² Medical students and residents develop “clinical judgment” as they learn to gather clinical data, make medical decisions and take responsibility for a patient’s care, working in the context of uncertainty and severe time constraints. Learning to see the world as a physician requires students to narrow their vision from the natural gaze to the “clinical gaze” (Foucault 1973). They must reorganize their perception and learn new “structures of relevance” (Schutz 1970): they must learn what to consider data, what differences make a difference, how to screen out the irrelevant and focus on data that may reveal pathology. Carlton describes the socialization of clinical perception in this way:

... the use of the clinical perspective ... entails learning a particular mode of seeing — removing some blinders and acquiring others. The student physician learns to read meaning from a patient’s shuffling gait, even when the patient is not aware of how he looks when walking. Yet the student physician can also learn to become unaware of the visible signs of social discrimination which surround him or her within the hospital organization.... one learns to “see” a limited realm of things as problems, as well as a limited range of solutions to those problems. (Carlton 1978: 82–83)

The Physician in training is thus taught both what to regard and what to treat as context or background.

This research was funded by a California Policy Seminar Award from the Department of Governmental Studies, University of California, Berkeley. Our thanks to members of the clinics in which we carried out the research, and to Diane Stumbo, Sandra Gifford and James Cooper for their participation in data collection and analysis.