Newsletter: December 2001
Ann Miles and Fred Bloom Co-Contributing Editors
Hospital Work: An Anthropologist in Biomedicine
Elisa Sobo, (Children's Hospital, San Diego)
Two years back, I wrote about my experiences as an anthropologist in a medical school. I am now even further from the anthropological epicenter: although still university-affiliated, I work for a hospital.
The fact that a hospital post was open to an anthropologist has to do with the attention that terms such as ‘culture’ and ‘ethnography’ now receive in biomedicine. This is good news, but we should not be deceived: there still is no real understanding about what these terms mean, or what anthropologists like me, who specialize in qualitative research, actually do.
So what do I do? My research directly affects hospital operations and thus child health outcomes. Sometimes I am called to help departments improve performance. Other projects are driven by my own interests. But all my work must be justified to top management as adding to the bottom line.
Let me give you three examples. My research on how MDs decide if a parent is a ‘good’ parent is allowable because findings can be used to help MDs avoid expensive ‘social’ admissions (non-medical admissions made when parents or guardians are perceived of as incompetent). Likewise, an evaluation of enrollment efforts for a statewide health insurance plan for low-income children can be defended because insured children do not drain money from the health care system. Research on complementary and alternative medicine is justified in terms of the need for information on market forces and consumer demands.
While some may find this justification game frustrating, for me the benefits far outweigh the costs. My work has direct, measurable effects on biomedical practice and on children’s and families’ experiences of the heath system. And, although I continue to address anthropological audiences, in my ‘health services researcher’ role, I am helping to spread an anthropological perspective beyond university walls. Publishing in journals that biomedical professionals respect and conducting more directly applied research helps increase our chances to influence biomedical thinking, practice, and policy.
Let me close with an example of why it is imperative that we publish beyond the narrow confines of anthropology. As others have reported in this column, the troublesome and muddled concept of ‘cultural competence’ is popular in biomedical circles. In my experience, it frequently is deployed for political purposes, to lay claim to moral high ground or to show that federal equal access mandates are taken into account. Biomedical disregard for anthropological journals—and our hesitance to publish in biomedical forums—means that our contributions to culture theory and to the understanding of diversity are paid little if any heed by the biomedical world.
This explains how it could be that an article published in a key biomedical journal (Pediatrics) actually stated in the introduction that "little is known about the importance of culture in health care." Even more galling was the claim, "The actual clinical ramifications of culture… have rarely been examined" (Flores 2000: 14). The article was featured as an invited commentary by a professional deemed an expert on cultural issues by his biomedical peers.
I once believed that biomedicine ignored anthropology because our journals are not indexed in Medline. That is less and less the case. But as the above-cited article suggests, even when indexed in Medline our journals lack name-brand recognition and remain invisible to biomedical eyes. The truth is that biomedicine is not going to come to us; we must therefore go to biomedicine.
We can do this by publishing in journals that biomedical professionals read, and by sending reprints to the people that biomedicine sees as experts in cultural issues or the topics we specialize in. It may also be worthwhile for the SMA or medical anthropology journals to launch public relations efforts in the biomedical arena. The SMA might hold meetings with associations such as the Academy for Health Services Research and Health Policy (AHSRHP). Indeed, it was at the latter group’s annual meeting that the above article was distributed. That article may have begun quite differently had anthropologists been a more active presence in the author’s field of vision.
To submit to this column, contact Ann Miles at miles@wmich.edu.