Who is Medicine?
This article is part of Faith in Medicine week.
Okay, who are we actually trusting, or distrusting, when we put our faith in medicine? Medicine is a vast institution whose borders are no easy thing to delimit. Who is promoting and challenging this faith?
Here are a few professions and industries that I think might be part of medicine, and a few I think might not be a part of medicine. This exercise will illustrate the thorny nature of the questions above.
Medical Correspondents
Yes: they can serve as an ombudsman, unraveling medical quackery like Brian Deer did during the vaccine-autism panic, or they can disseminate misinformation, like the medical correspondents that John Oliver recently pranked. In general, journalism becomes symbiotic to and indistinguishable from the topics it covers, and we call this process double hermeneutics. As political journalism is politics (ask CNN commentators and former Senators Rick Santorum and Heidi Heitkamp) and art journalism moves the art world, so does medical journalism become indistinguishable from medicine.
Medical Communicators
By this I mean doctors on Instagram, medical influencers, Dr. Fauci, Joe Biden when he gives a speech about vaccines. To revise my previous entry: media in general, rather than journalism in particular, becomes indistinguishable from its subject. Donald Trump, then, was part of the medical community for a disastrous year, and his actions explain the distinct vaccine skepticism and COVID denialism in the American right-wing. Easily the shittiest colleague I've ever had.
Hospital Coders / Credentialing / Behind-the-Scenes Hospital Staff / Hospital IT Staff
Generally, due to lack of awareness, patients do not consider the administrative staff necessary to run a hospital as medicine. Individual actors therein may, or may not, be considered medical professionals were you to explain their job to a patient. They do have impact: Credentialing teams process administrative actions against doctors, and ensure providers are fit to practice. Hospital coders have less direct impact on patient care: these are the people who record the relevant details of a hospital encounter in order to submit claims to insurance companies. They are vital for a hospital's bottom line, but decisions made by a hospital coding team will have no direct impact on patient care.
Insurance Companies
Yes. They are the least liked part of American medicine.
Psychologists
Yes.
Counselors
Oh, also yes.
Social Workers
This one seems tougher. Social care is its own distinct, but overlapping, practice. For example, Epic, my former employer, produces software for both doctors and social care workers, and I have worked with clinics that offer both social care and traditional primary care. But social care has its own history, with its own criticisms.
Dentists
Oh, uh, I don't know. Yes? Epic likewise provides software for dentists, and dentistry has become more integrated with medicine. At the same time, I don't know if the same conspiratorial mindset has beset dentistry. I can think of no analogue to the anti-vaccine movement. I may not be knowledgeable enough to adjudicate here, primarily having worked with doctors, but faith in dentistry seems less controversial a topic than faith in medicine, at least from an outsider's perspective.
Alternative Medicine
It may depend on the branch, the practitioner, and what the patient is trying to get from the "alternative". Most alternative medicines see themselves as a direct competition to medicine. Herbal medicine and homeopathy replace medicine. Meditation can be an alternative to medicine, but it has been incorporated into psychotherapy, so it can serve as either supplement or replacement.
Pharmaceutical Company Execs
Scratch my evaluation of insurance companies: Big Pharma is definitely the public's least favorite part of healthcare.
Pharmaceutical Company Chemists
Are the scientists who make these wonderful drugs part of medicine? I think so.
Pharmaceutical Factory Workers
I think that, if we include the latter two entries, we should include the factory workers. Yet, like hospital coders, they have less direct an impact on care, and not being in the public view, they do not impact public perceptions of medicine at this time.
Lawyers
There are radiology clinics who exist solely to supply evidence in workman's comp cases, and malpractice law likewise serves as ombudsman in the healthcare industry, so yes.
Software Developers for Healthcare Software Companies
Yes. Epic, my former employer, was recently in the news for developing an appointment scheduling algorithm that consistently under-schedules Black patients. Such algorithmic bias erodes greatly faith in medicine.
Sanitation Services for Hospitals
Yes.
Doctors
Trivially yes.
Nurses
Trivially yes.
Barbers
No, which is why medical clinics that partner with barber shops can reach under-served populations, notably Black patients. A barbershop that provides such a partnership may briefly become a part of healthcare, but when giving haircuts, I'd warrant it distinct.
I have shown not only that medicine sprawls, but that it has expanded over time to include administrators, software developers, the law, media, and social care. Individuals and organizations can even become part of medicine temporarily. This makes analyzing and proposing solutions for distrust in medicine a difficult process.
With an institution this vast, "faith in medicine" ends up having at least two interconnected meanings. It means a general stance towards the healthcare industry, and the actors described above, but it also includes a bundle of different faiths: faith in vaccines, faith in dentistry, faith in Big Pharma, faith in insurance, all of these compose a greater faith in medicine. And when one of these sub-disciplines of medicine lose the faith of the public, it impacts the general faith in medicine. To give an example: Andrew Wakefield perpetrated the vaccines-autism hoax to assist a corrupt lawyer in winning a lawsuit, and so bad faith actors in medical law can tarnish the reputation of evidence-based medicine, like vaccines. Then, professions that have historically been distinct from (or even at odds with) one another now must work diligently together to maintain faith in medicine, from yoga instructors, to malpractice attorneys, to hospital systems, insurance companies, and social workers.
Uncomfortably, everyone on the list above, myself included, is in this together, as are many other industries and professions I did not note, out of lack of awareness or space. Wish us luck.