| In this dissertation I examine the relationship between medical education, community health, and urban poverty in the United States. Through ethnographic research of a medical student voluntary outreach program to the poor, I explore the ways in which medical students encounter, understand, and give meaning to their experiences with the poor. My field site of Rochester, NY presents a unique community in which to do this research for several reasons: it has been held up as a national model of health care for its comprehensive, low-cost health care system and yet has persistently poor community health outcomes. Moreover, Rochester has a school of medicine renown for a model of medical practice which seeks to incorporate patients' social context into the process of diagnosis and treatment.; I argue that the American cultural context of radical individualism shapes a medical ideology that reifies physicians, and that consequently, medical education aims to produce more culturally sensitive physicians, without, however, changing health outcomes in poor communities. My research also explores the other side of student outreach to the poor, i.e. women in one particular shelter. I argue that the poor women here represent, in contrast to the medical students, knowledgeable subjects who through mutual support and collective action, seek to transform the social conditions of poverty.; My research also shows that medical students, in their capacity as adult learners, recognize the transformative power of learning through social interactions, and create communities of practice in which to learn. However I argue that medical students do not use this transformation to question or challenge the forms of social organization that promote and perpetuate poor health outcomes in impoverished communities; students mostly assume the definitions of reality given to them in their medical education. This study reveals that even in the best of programs, a medical ideology of individual responsibility for physicians and patients, does little to bring about better health outcomes. Increased morbidity and mortality rates among the poor, and most notably among African-Americans, need to be addressed in new ways that combine caring physicians with more comprehensive programs that focus on the social good. |
