Critical Dialogues and Reflections

Abstract

Medicine and medical education have become technicized. Aspects of the subjective and normative worlds are shoved to the side or annulled. Doctors and medical students are reduced to “specialists without spirits.” Patients are objectified and dehumanized. “Critical dialogue and reflections” is an attempt to call out the inadequacies of our current framework of thinking about medicine and medical education, written by someone who is a patient, a doctor, an educator, and a researcher. This is a two-paper dissertation. The first paper is a conversation in critical theories. In the first part, I present dialogues and reflections on Foucault’s Power/Knowledge and Habermas’s Theory of Communicative Action. In the second part, I advance the conversation on Habermas’s distinction between communicative and strategic actions, leveraging Hegel’s early writings on morality. This paper develops a methodological framework that gives the theory of communicative rationality a central position. It is a methodological framework in three interrelated senses: methodological foundations for conducting research on the social aspects of medical education and medical practice; methodological framework to guide pedagogy in medical education; and methodological framework for doctor-patient relations. In the second paper, I use the communicative rationality framework to propose a developed method of learning for doctors in training. The theoretical features of this method are articulated through qualitative data analysis of video-taped doctor-patient interactions. It argues for general principles as they are implicitly embedded within the interactions that I analyze through the framework presented in the first paper. In this method, resident physicians review videos of their work through dialogues with their peers. Attending physicians also review the videos and dialogue with one another as they reflect on resident performance. In this work, I restore the normative evaluative and let the subjects speak. It is my belief that medical education and medicine are in desperate need of an alternative theoretical framework. My work here comes to provide just that.