title: The 'worthy' patient: rethinking the 'hidden curriculum' in medical education.
abstract: This paper examines how physicians determine the quality and quantity of time to devote to each patient, and how these decisions are taught to physicians-in-training as part of the 'hidden curriculum' in medical education. The notion of moral economy is used to analyze how judgments of patient worth come to guide and influence interactions among physicians and physicians-in-training and patients, and how these interactions impact medical care. However, this paper also questions the notion of the hidden curriculum as a static or reified concept. Instead, the paper uses participant narratives to show how physicians-in-training are not simply passive recipients of the hidden curriculum but also actively resist judging patients based on perceptions of worth, even as they learn to operate within a moral economy of care.
authors.affiliation: University of California, San Francisco, Anthropology, History, and Social Medicine, 3333 California St., Suite 485, San Francisco, CA 94143, USA. robin.higashi@gmail.com
authors.forename: Robin T
authors.initials: RT
authors.lastname: Higashi
authors.forename: Allison
authors.initials: A
authors.lastname: Tillack
authors.forename: Michael A
authors.initials: MA
authors.lastname: Steinman
authors.forename: C Bree
authors.initials: CB
authors.lastname: Johnston
authors.forename: G Michael
authors.initials: GM
authors.lastname: Harper
mesh_terms: D060432:Anthropology, Medical; D003479:Curriculum; D003695:Delivery of Health Care / Q000941:ethics*; D004501:Education, Medical / Q000941:ethics*; D006801:Humans; D005791:Patient Care / Q000941:ethics*; D010820:Physicians / Q000941:ethics*; D012945:Social Values; D017748:Time Management; D035862:Vulnerable Populations