AIDS and Its Impact on Medical Work The Cultur

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 hospita

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he medical teaching environment is that students are changing their patterns of residency selection. They are shifting away from internal medicine, family practice, and pediatrics towards specialties such as orthopedics, ophthalmology, otolaryngology, and radiology. These latter specialties bring higher compensation and a technical distance from the patients. They also encompass activities that carry minimal risk to AIDS infection. AIDS as a total social phenomenon can be examined in terms of moral judgments about how the patients got the disease. Apparently there is a hierarchy of groups of AIDS patients. Those who develop AIDS from blood products are seen as innocent. Gay patients hold an intermediate position in the hierarchy. The underclass AIDS population are those who are the drug-using patients. Nothing about the Bosk and Trader article suggests that the presence of AIDS will turn the medical educational system into a more humane environment. Instead it is becoming more difficult to find compassionate mentors among the "burned-out martyrs, steely-eyed technicians, and teachers filled with fear" (Bosk & Frader, 1990, p. 274). They do voice the hope that as fewer numbers become medical students, more of those who e

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