title: Medical education and practice on the periphery: consultation psychiatry and the psychosocial tradition in American medicine.
abstract: The culture of American medicine has both central biomedical and peripheral psychosocial traditions, a pluralism which demands further study. Anthropologists have traditionally learned a great deal about any culture by studying the socialization process, and the same is true of medicine. In consultation-liaison psychiatry, the peripheral position of the psychosocial tradition can be better understood as psychiatrists teach students and residents how to assist biomedical specialists in the care of their hospitalized patients. Through such student socialization, the use of the technology of biomedicine by psychiatrists for both the manifest function of patient care and the latent function of cementing interprofessional relationships is revealed. In consultation psychiatry, students are also taught that the object of their ministrations is not the patient, but all members of the ward milieu, a focus which is not characteristic of the biomedical tradition. Students in consultation psychiatry are inculcated with attitudes and values which are divergent from those of the biomedical tradition; the competitive presentation and selective assimilation of such elements of professional ideology by students further betrays the peripheral position of psychosocial concerns in medicine. This position is also highlighted by the teaching of 'survival strategies' to students and residents in psychiatry, designed to increase the likelihood of acceptance by biomedical specialists. These include mimicking biomedical approaches to diagnosis and treatment, viewing biomedical specialists as patients who are unwitting victims who can be cured with the right treatment, manipulating symbols and using metaphors of biomedicine to affirm the basic kinship of all physicians, and otherwise promoting psychiatry as central to modern medicine. Yet, the psychosocial tradition, itself, is not homogeneous.(ABSTRACT TRUNCATED AT 250 WORDS)
mesh_terms: D001291:Attitude of Health Personnel; D003253:Consultants; D004501:Education, Medical; D006801:Humans; D007400:Interprofessional Relations; D010348:Patient Care Team; D011570:Psychiatry / Q000193:education