AIDS and Its Impact on Medical Work:
The Culture and Politics of the Shop Floor:
The full impact of AIDS on the present system of medical care will not be clearly known for years. It has already impacted the culture of American medicine in the teaching hospitals, which are already beset with anger, pain, and sadness. The article, "AIDS and Its Impact on Medical Work: The Culture and Politics of the Shop Floor," concerns shifts in attitudes among house officers and medical students in a teaching environment, particularly in terms of the sociological ideas of Hughes and Becker. The purpose of this paper is to summarize the contents of that article and support the main ideas with information from The Role of Medicine by Thomas McKeown and National Health Interview Surveys of 1987 and 1991.
Bosk and Frader view AIDS as a social phenomenon rather than a mere disease (1990, p. 257). They choose the idea of the urban academic hospital as a shop floor as a rhetorical device to remind us that house officers and students are workers in a real and active sense. This perspective invites us to move away from conventional idealized views of medical occupations. The work of Everett C. Hughes and Becker in the late sixties and early seventies emphasizes the equivalencies between lowly and proud occupations, the handling of mistakes, and the management of what is termed "scut work" (Bosk & Frader, 1990, p. 258).
The concentration of cases in urban teaching hospitals is such that house officers and students have a high likelihood of encountering patients with AIDS. The descriptors of the changes that AIDS has brought into this work environment are gleaned from medical literature, Bosk and Frader's teaching experiences, and thirty interviews with medical personnel who care for AIDS patients.
The shop floor culture of medical house officers and students is apparently a peer culture. Senior faculty members are mostly absent. When...