A descriptive, as contrasted with a prescriptive, model of biomedical decision making is presented. The ethnographic method, widely used in anthropology, is advocated as a means of eliciting this level of data. Several vignettes are presented to illustrate the complex texture of medical thought and action. The utility of ethnographic approaches in health practitioner education and clinical work is proposed.
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References
1.
Appell, G. H. (1989). British vs American-trained ethnographers. Anthropology Newsletter[American Anthropological Association], 30(6), 39-39, 48-48.
2.
Balint, M. (1972). The doctor, his patient and the illness. New York: International Universities Press.
3.
Burnside, J. W. (1983). Medicine and war-A metaphor. JAMA, 249-249, 2091-2091.
4.
Caster, J. H. , & Gatens-Robinson, E. (1983). Metaphor in medicine. JAMA, 250-250, 1841-1841.
5.
Davidson, R. H. (1986). Transference and countertransference phenomena: The problem of observer in the behavioral sciences. Journal of Psychoanalytic Anthropology, 9, 269-283.
6.
Devereux, G. (1967). From anxiety to method in the behavioral sciences. The Hague: Mouton.
7.
Dubos, R. (1959). Mirage ofhealth: Utopias, progress and biological change. Garden City, NY: Anchor/Doubleday.
8.
Hahn, R. A. (1985). A world of internal medicine: Portrait of an internist. In R. A. Hahn & A. D. Gaines (Eds.), Physicians of Western medicine: Anthropological approaches to theory and practice (pp. 51-111). Boston: D. Reidel.
9.
Katz, J. (1984). The silent world of doctor and patient. New York: Free Press/ Macmillan.
10.
La Barre, W. (1978). The clinic and the field. In G. D. Spindler (Ed.), The making of psychological anthropology (pp. 258-299). Berkeley and Los Angeles: University of California Press.
11.
Mathews, H. (1987). Predicting decision outcomes: Have we put the cart before the horse in anthropological studies of decision making?Human Organization, 46, 54-61.
12.
Mold, J. W. , & Stein, H. F. (1986). The cascade effect in the clinical care of patients. New England Journal of Medicine, 314, 512-514.
13.
Pliskin, K. L. (1987). Silent boundaries: Cultural constraints on sickness and diagnosis of Iranians in Israel. New Haven, CT: Yale University Press.
14.
Slovic, P. , Lichtenstein, S., & Fischoff, B. (1988). Decision making. In R. C. Atkinson, R. J. Herrnstein, G. Lindzey, & R. D. Luce (Eds.), Steven's handbook of experimental psychology (2nd ed., pp. 673-738). New York: Wiley.
15.
Smith, R. C. , & Stein, H. F. (1987). A topographical model of clinical decision making and interviewing. Family Medicine, 19, 361-363.
16.
Spiro, M. E. (1982). Preface. In M. E. Spiro, Buddhism and society:A great tradition and its Burmese vicissitudes (2nd ed., pp. xi-xix). Berkeley: University of California Press.
17.
Stanley, J. M. (1989). The Appleton consensus: Suggested international guidelines for decisions to forego medical treatment. Journal of Medical Ethics, 15, 129-134.
18.
Stein, H. F. (1982). Physician-patient transaction through the analysis of countertransference: A study in role relationship and unconscious meaning. Medical Anthropology, 6, 165-182.
19.
Stein, H. F. (1983). The influence of counter-transference upon the dinical relationship and decision-making. Continuing Educationfor the Family Physician, 18,625-630.
20.
Stein, H. F. (1985). The psychodynamics of medical practice: Unconsciousfactors in patient care. Berkeley and Los Angeles: University of California Press.
21.
Stein, H. F. (1988). Uncomfortable knowledge: An ethnographic clinical training model. Family Systems Medicine, 6(1), 117-128.
22.
Stein, H. F. (1990). American medicine as culture. Boulder, CO.: Westview.
23.
Stein, H. F. , & Apprey, M. (1985). Context and dynamics in clinical knowledge (Ethnicity, Medicine, and Psychoanalysis Series, Vol. 1). Charlottesville: University Press of Virginia.
24.
Stein, H. F. , & Apprey, M. (1987). From metaphor to meaning: Papers in psychoanalytic anthropology (Ethnicity, Medicine, and Psychoanalysis Series, Vol. 2). Charlottesville: University Press of Virginia.
25.
Stein, H. F. , & Apprey, M. (1990). Clinical stories and their translations (Ethnicity, Medicine, and Psychoanalysis Series, Vol. 3). Charlottesville: University Press of Virginia.
26.
Stein, H. F. , & Hill, R. F. (1986). We buy what we are: The commercial use of American cultural metaphors in medicine and business. High Plains Applied Anthropologist, 6(1),18-20.
27.
Stein, H. F. , & Mold, J. W. (1988). Stress, anxiety, and cascades in clinical decision-making. Stress Medicine, 441-48.
28.
Wilmer, H. A. , (1962). Transference to a medical center: A cultural dimension in healing. California Medicine, 96, 173-180.
