Postmodern Medicine

We are all “medical citizens,” embedded as potential or actual patients, with physicians, in a system of social, moral, and organizational understandings. So writes Monrad professor of the social sciences Charles E. Rosenberg in Our Present Complaint: American Medicine, Then and Now (Johns Hopkins, $50; $19.95 paper), touching on sources of unease.

Disease has become a bureaucratic—and, thus, social and administrative—as well as biological and conceptual—entity.

What do I mean when I describe disease as a “social entity”? I refer to a web of practice guidelines, disease protocols, laboratory and imaging results, meta-analyses, and consensus conferences. These practices and procedures have over time come to constitute a seemingly objective and inescapable framework of disease categories, a framework that increasingly specifies diagnostic criteria and dictates appropriate therapeutic choices. In America’s peculiar hybrid health-care system, layers of hospital and managed care administrators enforce these disease-based guidelines. The past generation’s revolution in information technology has only exacerbated and intensified these trends—in parallel with the research and marketing strategies of major pharmaceutical companies…. This web of complex relationships has created a new reality for practitioners and patients alike. Physicians have had their choices increasingly constrained—if, in some ways, enhanced. For the sick, such ways of conceptualizing and treating disease have come to constitute a tangible aspect of their illness experience.

Of course, every society has entertained ideas about disease and its treatment; patients have never been blank slates.…Think of the generations of sufferers who were bled, sweated, puked, or purged to balance their humors. But never has the infrastructure of ideas, practices, thresholds, and protocols that comes between agreed-upon knowledge and the individual patient been so tightly woven and bureaucratically crafted.…

Yet, as I have emphasized, we are left with that inconveniently subjective object, the patient—in whose body these abstract entities manifest themselves. This is the characteristic split screen that faces today’s clinician: the tension between illness in the individual patient and disease as crystallized and made socially real in the laboratory’s and the epidemiologist’s outputs and inscriptions, practice guidelines, and algorithms.…Bedside, clinic, and physician’s office are the points at which the mandates of best—and increasingly most economically rational—practice bump up against the unique reality of the individual patient and challenge the physician’s traditional autonomy.…

It engenders a feeling of paradox, the juxtaposition of a powerful faith in scientific medicine with a widespread discontent at the circumstances in which it is made available. It is a set of attitudes and expectations postmodern as well as quintessentially modern.

Click here for the March-April 2008 issue table of contents

You might also like

The 2025 Pulitzer Prizes Announced

Winners across five categories, from commentary on Gaza to criticism on public architecture

The Chinese in America

Michael Luo ’98 on the first great wave of immigration—and of nativist anti-immigrant reaction

Jessie Cox

An experimental percussionist-composer pushing the limits of music

Most popular

Rebecca Henderson: Does Capitalism Need to be Reimagined?

How to reform capitalism to confront climate change and extreme inequality, with economist and McArthur University Professor Rebecca Henderson

The New Gender Gaps

What to do as men and boys fall behind

An Original Magna Carta, Hidden in Plain Sight

A rare original surfaces at Harvard at an “almost providential” moment. 

Explore More From Current Issue

Publications by Harvard Authors Spring 2025: New Releases

Operatic counterculture, a Passover graphic novel, James Joyce’s biographer, and more

Addressing Gaps in Care for Patients with Disabilities

Lisa Iezzoni explores the unmet needs of patients with disabilities.

Making Green Energy Projects Financially Viable

A proposed “green” swap enables decarbonization of emerging market development projects.