When spending on health care represents nearly 11% of the gross national product, why are more Americans finding it more difficult to get the medical treatment they need at a price they can afford? It is tempting to blame the doctors, but that glosses over the problem. In "The Doctor's Dilemma," George B. Shaw argues that "it is not the fault of our doctors that the medical service of the community, as at present provided for, is a murderous absurdity." Doctors, says Shaw, are as much a product of society as the rest of us and are just as susceptible to current trends, values and economic pressures.
If Shaw were alive today, he would heartily endorse Dr. Arthur Kleinman's "The Illness Narratives," a critique of the American health-care system that, with its pursuit of profit and its addiction to technology and quick fixes, reduces medicine to a commodity. Thus, according to Kleinman, "what counts today is not how effective the physician is in helping the chronically ill to deal with suffering, but how much time and money are spent and how much profit is left."
Kleinman looks at medical practice through the dual vision of a physician--he is a psychiatrist in the Department of Social Medicine at Harvard Medical School--and an anthropologist--he is also a professor of anthropology at Harvard University, and he has made a special study of Chinese medicine. From this perspective, he sees the patient's dilemma arising out of a gap between what the patient experiences and what the doctor treats . The private inner world of personal experience and the culture in which that world has taken shape are ignored in the process of treating disease rather than illness--the distinction is crucial to Kleinman's thesis, as is the difference between "doctor" and "healer." Kleinman infuses the theme with fresh insights and "empathic witnessing," through the use of narrative, the stories of pain and suffering that give form and meaning to the experience of illness. "The story of a sickness may even function as a political commentary," Kleinman observes, "pointing a finger of condemnation at perceived injustice and the personal experience of oppression. . . . Acting like a sponge, illness soaks up personal and social significance from the world of the sick person."