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SCHI – The Social Context of Health and Illness.

I am going to write about our SCHI course today, a course about the “social context of health and illness”… and about interacting with patients. I’ve been planning to write about this for a while, but today I am also creating this entry for opportunistic reasons: I need to motivate myself to study SCHI later tonight… the exam is in two weeks!

SCHI is part of the 1st year medical course in Cambridge. It’s where students learn about sociology, anthropology and some ethics of medicine. It’s where we are reminded that we will deal with patients, which is easily forgotten during the seemingly endless science lectures and practicals. The SCHI course is really well organised and consists of tutorials (ok, supervisions!) and lectures in which we are given factual introductions to the topics, but also meet patients and learn about their experiences in coping with an illness.

Amongst our many science lectures, SCHI offered a welcome break in our schedule where we could remind ourselves of the altruistic reasons for studying medicine in the first place, and realise that science cannot (ok, in some cases, not yet, but certainly not always) explain everything or represent the sole basis for dealing with patients. Obviously, doctors don’t deal with the patients’ bodies in isolation, but with the entire human being who is real, whose life is embedded into social surroundings, a particular culture, and a society.

I was therefore quite surprised to find out that many medical scholars do not think highly of the course and question its necessity, that the course was apparently imposed onto Cambridge by the GMC (the General Medical Council), and therefore introduced rather reluctantly. What an interesting piece of gossip. But how can this be?

These opinions of SCHI reminded me of an impression I’ve had during the first term of medschool, actually starting in the very first week. During that week, the graduates spent time in the hospital and I personally spent an afternoon in the emergency department, where I saw my first open wound and lots of blood. A colleague and I were shadowing a nurse, who seemed to be very good at her job, very experienced, but also somehow roughened up after many years of hard work. We watched her stitch up a young woman with a laceration on her hand. I was surprised by her lack of empathy and harshness towards the poor lady who would not be able to work in her job for a while and would be left with an ugly scar on her hand. Obviously, this was no case of malpractice, but it left a certain impression that kept being reinforced from this point onwards: that the idealism with which one starts medical school must wear off quite quickly.

Back in Cambridge, I then noticed that the loss of idealism is not only discouraged, but sometimes even encouraged (you’ve just got to imagine that the first patient a standard course medical student meets is a dead one in the dissection room…). Perhaps it is also a result of the huge amount of science taught in the first two years of med school, which somehow makes you lose sight of the more human aspects of medicine.

I guess the subject of sociology does not fit in with this initial desensitisation of the students. Maybe the course brings up topics that doctors don’t like to be reminded of, after all it must be very hard to make it through a lifetime of medical practice without gaining some degree of cynicism. Perhaps it also has to do with the fact that a huge part of the first years of medical school is taught and organised by scientists, who can easily relate to the science behind medicine, but maybe not as easily to other “softer” aspects involving care, leaving them dismissive of the subject.

I have decided not to become roughened up yet (hopefully not ever), to keep enjoying the topic and not give up my altruistic intentions too soon.

But it’s sad to see that so many undergraduates are drawn in by this atmosphere so dismissive of anything not strictly biomedical. You can truly watch them being molded into shape, so that they will carry on the hubris of the medical profession into the next generation.

Wow, that’s getting dramatic now… Now I really have to start studying!!!!



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