I am an incoming medical student at OHSU, so I have given a lot of thought to how I intend to interact with our current healthcare system, and what changes are available to current providers within a much larger context of social norms and systems. I think a part of my background that surprises people is that besides completing my medical pre-requisites during my undergrad, I also pursued a degree in philosophy.
During my degree, I became passionate about the metaphysics of medical topics, and specifically, the way we characterize human traits. This includes the differentiating of natural and human kinds. Natural kinds are those that exist outside of the human influence. Human kinds are developed and influenced by the social factors. In medicine, we prefer to deal with natural kinds, as they are easier to study objectively. However, especially in medicine, there are notable ‘gray areas’ between the kinds: such as race and gender. While it would be less complicated to view these as natural kinds, they are not. Our perception of race and gender is a product of culture. This can be seen, historically, as our view of constructs like ‘black,’ or ‘feminine’ have evolved.
Human kinds can be changed through the way we view them: thus the social evolution of these concepts. The ability to reshape human kinds, and the subsequent influence of the evolved concept on then shaping a new norm is known as Hacking’s looping effect. This has historically been seen in in medicine, through examples like the historical medicalization of queerness, followed by its modern de-medicalization.
The reason I wanted to discuss human kinds and the looping effect, is that the area of healthcare I would change is the current health equity divide that exists in our country. However, effectively closing this divide is not a simple endeavor. There are tangible steps that need to be taken to address health inequality: like improving access and decreasing costs. But a broader solution is more extensive and less simple. Our medical system has structural norms that can make it a difficult space for vulnerable populations. For example, even when adjusted for income and insurance, black populations are still less likely to have access to kidney transplants, pain treatments, etc. In my research, I have learned that this is (at least partially) due to the social influence of human kinds. This can make change feel inaccessible to those of us operating within a system defined by norms that have developed at a level far greater than ourselves. But, at an individual level, we do have some control over the way we are influenced by cultural perceptions of human kinds. Cultural understanding of concepts like blackness are not homogenous. As such, how we learn about these human kinds can be powerful in shaping our perception of them. I feel that how physicians, and other medical professionals, learn about approaching these topics in medical contexts can shape their long-term practice. Therefore, the change I would make is to emphasize to physicians that although we can't change the entire system through one individual action, our actions still matter and they have ripple effects.
The looping effect dictates that our perceptions of human kinds are a product of the way they are defined culturally, but it also means that individual perception ultimately shapes and reshapes our larger cultural perception, which allows for growth and change. This means that through intentional learning, even individual providers can help to redefine our norms, and we can begin to shift our cultural paradigms to make medical spaces more comfortable for marginalized groups.