40 different theories about illness become more

Info icon This preview shows pages 6–8. Sign up to view the full content.

40 Different theories about illness become more familiar as their merits are investigated. This fact explains why many medical anthropologists are clinically trained and why many clinicians take up medical anthropology. When illness is at stake, the appreciation of these factors by caregivers and their ability to communicate with those they care for becomes important. These are not the only reasons why clinical competence should include cultural competence. By the 1970s, the value of clinical communication and, particularly, caregivers’ understanding of patients’ individual back- grounds, were not only understood, but also quantified. In 1975, the importance of communication for clinical competence was shown by the results of a study 41 that compared effectiveness of face-to-face interviews with both physical examinations and laboratory tests for achievement of clinical accuracy. In 66 of 80 patients (83%) “the medical history provided enough information to make an initial diagnosis of a specific disease entity which agreed with the one finally accepted”. If 83% of all correct diagnoses can be made by taking of a complete medical history from the patient, why are clinicians so often held to brief and often routine clinical encounters? 42 And why has this fact not been taken into account during assessment of the costs and health benefits of what happens in the clinic? Some say testing has increased for entirely non-clinical, but quite cultural, reasons. Scientific American com- mentator John Horgan puts it bluntly: “Over-testing undoubtedly stems in part from greed. Most American physicians are paid for the quantity of their care, a model called ‘fee for service.’ Doctors have an economic incentive to prescribe tests and treatments even when they may not be needed. Physicians also over- prescribe tests and treatments to protect themselves from malpractice suits.” 43 According to Ezekiel Emanuel, the yearly cost of health-care provision in the USA was almost US$8000 per person. 44 Emanuel invites us to compare this
Image of page 6

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

The Lancet Commissions Vol 384 November 1, 2014 1613 expense with the entire GDP of China, the world’s second-largest economy: “China’s G.D.P. is $5·9 trillion (compared to America’s $14·6 trillion). So the United States, with a population a quarter of the size of China’s, spends just on health care slightly less than half of what China spends on everything…If we continue at this rate of growth, health care will be roughly one-third of the entire economy by 2035—one of every three dollars will go to health care—and nearly half by 2080.” 43,44 But if laboratory investigations are not cost eff ective, why are they used instead of reallocating resources so that clinicians can spend more time with patients? Is it because health care has become an increasingly predatory business endeavour? Is it because biomedical cultures have become overly devoted to testing practices? In what way, for example, might health-care cultures in the USA be called caring
Image of page 7
Image of page 8
This is the end of the preview. Sign up to access the rest of the document.
  • Summer '18
  • Jeanne Hughes
  • Lancet

{[ snackBarMessage ]}

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern