Individualized Medical Sociology

Introduction

Why is medical sociology taught at medical schools? Why is it useful? What can I do with it as a medical practitioner? Though medical sociology has been taught at medical schools for a few decades now, these are some of the questions medical students still ask when they are introduced to medical sociology. This paper discusses how medical sociology can be taught in a way that is more practical and thus more useful to medical students and medical practitioners.

Medical sociology has been taught at medical schools systematically since the end of the Second War World. It is taught largely through lectures and is applied to medicine and with the use of examples (Hunt and Sobal 1990). Medical sociology textbooks are numerous and they range from introductory resources to more specialized books, while the most up-to-date research in the field is found in well-established academic journals. Though research in medical sociology is quite developed and very influential in public policy making, teaching has been confined to the “cook book” approach (McKinlay 1971:456). One should expect such a cookbook approach not to be used in the twenty-first century; however, teaching medical sociology is still rather didactic and merely educational, not applied (Finkelstein 2010; Russell et al. 2004). This cookbook approach found in medical sociology teaching and textbooks is perhaps what is causing the uncertainty to medical students and medical practitioners about medical sociology’s usefulness beyond its informative and educational function. A common question, interestingly, is “what can I do with medical sociology?” In this paper, I propose to answer this question by presenting a specific example that could work as an exemplar for all of the main teaching areas in medical sociology and could make medical sociology applied and usable.

Teaching Sociology to Medical Students

In her publication titled The Development of Medical Sociology in Britain on the British Sociological Association’s Web site, Margaret Reid provided us with a well-structured overview of the development of the field of medical sociology and described how the introduction of medical sociology contributed to a welcome increase in the number of relevant textbooks. However, Reid also pointed out that “courses in the sociology of medicine should concentrate upon the organisations and social relations within health and illness. Few textbooks help with this approach at present.” Reid made this statement in the late 1970s. Since then, the number of introductory textbooks or more specialized books in the sociology of health and illness has escalated, but these textbooks tend to have a common strand. That is, they present theories, principles, research findings, and examples here and there. Most of them may be good textbooks and useful educational resources. However, they still do not do what Reid encouraged medical sociologists to do—place sociology in medical practice.

Other sociologists had similar approaches to Reid’s. Though a study by Najman et al. (1978) could be considered outdated and old, it still is very insightful. More specifically, Najman et al. highlighted that social sciences and medical practice had not been successfully merged into medical curricula for two main reasons. First, sociologists did not make sociology applicable to medical settings. Second, medical practitioners did not consider sociology useful possibly due to their lack of knowledge about its educational objectives. On these grounds, Najman et al. wanted to find out what medical students expected from medical sociology and then how they evaluated a sociology course. Therefore, they designed a course that was both theoretical and practical and asked students to evaluate it. They found that students appeared to be uncertain about sociology’s relevance to medical practice but students were rather positive toward the application of sociological principles to medicine. In general, students wanted more applications and more sociological problems to work with. However, students were negative toward learning the theory because they could not see how it was relevant or useful for medical practitioners.

Finkelstein (2010) presents three main reasons why we should teach applied sociology. First, applying sociology helps students understand the sociological principles better. Second, learning is not only about understanding but also about doing and bringing changes. Third, applied sociology is what students want to be able to improve their skills. Along similar lines, Steele and Marshall (1996) asserted that sociologists could elucidate the nature of various social problems and phenomena and could apply this knowledge for finding solutions, while DeMartini (1983) and Calderon and Farrel (1996) emphasized the importance of experiential learning in sociology. Interestingly, Lehman (1997:72) wrote “I was struck by our [colleagues’] agreement that we wanted students to do sociology, to be able to use it, to employ a sociological perspective.” He continued, “I was also struck by the confusion we shared about how to accomplish this.”

Lehman (1997) employed problem-based learning (PBL) to teach gender stratification. This approach helped students understand more, remember more, and develop critical thinking. Along similar lines, Ross and Hurlbert (2004) used a PBL exercise for teaching the history of American family and found that 70 percent of their students were very positive toward employing PBL to learn sociology. The use of PBL to teach sociology was also tested by Hodgkinson (2003) and Ojanlatva et al. (1995). Though some students did not generally embrace the idea of teamwork for learning purposes, Hodgkinson found that students understood the sociological principles better. Ojanlatva et al. redesigned a course in medical sociology and had students evaluate it. Their findings indicated that students appreciated problem-solving and applied theory but disapproved of didactic lectures.

Russell et al. (2004) tried to gauge the teaching situation of social and behavioral sciences in the United Kingdom in the early 2000s and found that teachers favored offering knowledge to their students that was relevant to medical practice. Russell et al. (2004:416) closed their article by stating that “social and behavioural scientists need to be better represented in the curriculum design teams in the development of innovative problem-based, community-based and information technology-based teaching and learning initiatives in medical education.” Regardless of the limitations of using PBL to teach sociology as identified by Hodgkinson, PBL could work as an applied context of placing sociology in medical practice, which could help students appreciate sociology’s usefulness and relevance to daily phenomena. Interestingly, the use of PBL as a teaching method in sociology has been largely experimental and has not been incorporated into sociology textbooks.

Scambler (2012) tried to shed some light on why medical sociology has not taken hold in clinical practice. He wrote,

But medical students have always asked, reasonably enough: “how does all this affect what I say or do when a patient comes to the surgery or clinic?” Well a few “evidence-based” tips might be forthcoming: listen to why your patient has come, join a dialogue of equals, explain any advice clearly, and so on. But much of sociology seems far removed from these individualistic encounters. This distinguishes it from most psychology, and epidemiology too deals in aggregates of individuals rather than social structures, relations and processes.

It seems to me crucial to recognise that sociology feeds less directly into clinical practice than perhaps any other discipline that students will sample in medical school. Its thrust is educational.

In other words, Scambler asserted that sociology cannot be applied at an individual level. I think that this where the problem lies. The sociologists’ argument that sociology is exclusively about the study and understanding of groups, collectivities, and societies—not individuals—is a false argument and a reductionist Durkheimian approach. It is false in the sense that groups, collectivities, and societies consist of individuals who carry the values and characteristics of their groups and societies. Thereafter, individuals could serve as representative members of their societies and be used as contexts of applying sociological material. Mills (1959) used the term sociological imagination to explain that social scientists can understand phenomena only if they see them as alien or in broader terms. Mills (1959:12) argued further that what is pivotal is to understand the link between biography and history. More specifically, Mills maintained that “the individual can understand her own experience and gauge her own fate only by locating herself within her period.” In other words, individuals cannot be understood in isolation but only in relation to the wider society in a specific historical time.

Along similar lines, Bruhn and Rebach (2007:71–72) present “the individual as a social unit” in the sense that there are three main systems that influence how the individual thinks and acts. First, the “biological influences” that include genetic factors, health, fitness, injury, disease, stress, diet, and so on. Second, the “psychological influences” that relate to beliefs, perception, meaning, values, attitudes, cognition, and so forth. Third, the “social influences” that refer to family, social class, community, culture, occupation, gender, and so on. These three systems, Bruhn and Rebach explain, intertwine and create a context or template for the individual to act. For example, disease may influence the individual’s perception and attitudes that may trigger the community’s reaction. Alternatively, socialization may relate to ill health that can then change the individual’s way of thinking about life. Thereafter, the individual and society are inseparable, in the sense that one can see the society in the individual. Bruhn and Rebach (2007:72) go on to explain how individual behavior is not merely a personal matter. That is, “behavior is voluntary,” but individuals act on the basis of what is available to them. Availability, however, may be determined by external forces (i.e., scarcity of resources due to poverty). Furthermore, “behaviors are learned” in a specific social surrounding. Individuals choose to behave in a specific way based on how they understand themselves and what they encounter. Finally, individuals do not only act in context, but their actions and understanding of the environment are influenced by their participation in social groups. In other words, social groups create collective minds but they guide individual understanding and action. Individual problems are what Johnson (2001:97) termed socioemotional disorders. Johnson called individual problems socioemotional disorders not only because they derive from the individual understanding of an encounter but also from the individual’s interaction within society of social groups.

Individuals, therefore, are social units, and they should be studied as such. On this note, individual cases can be placed in the context of medical practice to teach students how sociology can help them understand their patients. Hunt and Sobal (1990:321) wrote “physicians and medical students live in a pragmatic world. For an idea to be useful to them, it must make a difference in their ability to treat patients.” However, instead of expecting medical students to understand the sociological principles or theories and apply them on their own in a setting that does not seem relevant, we should make medical sociology individualized and place it in the health settings where medical students and practitioners find themselves. By doing so, medical students will stop wondering why and how sociology is useful for medical practitioners because they will be able to understand it in context. The critical question here is this: how can we create individualized medical sociology and place it in medical practice?

Individualized Medical Sociology in Medical Practice

Before presenting ideas about how to place sociology in medical practice, let me first explain what I mean by the term individualized medical sociology. Individualized medical sociology refers to the application of the principles of medical sociology to individuals, not groups or societies. The reason this is important is that medical practitioners treat individuals, not collectivities. My suggestion is not about reducing sociology to individual cases but about applying sociology to individuals who work as examples of wider social trends and who might consult a medical practitioner at some point in their life. To do this, medical sociologists need to think of specific real-life scenarios to present to students or medical practitioners and then demonstrate how sociological theory can help them make sense of these scenarios. By doing so, medical sociologists achieve two goals at the same time. First, they make sociological principles more tangible. Second, scenarios, cases, or problems that medical practitioners may be encountered with can make sense and be workable.

To achieve an effective merge between medical sociology and real-life scenarios, medical sociologists first need to know the literature very well. They have to feel confident with simplifying the material in a way that people with no prior background can understand. Second, they need to identify the main areas in medical sociology (i.e., health inequalities, illness experience, gender and health, and so on) and record the main principles, theories, and research findings in each area. Third, they need to activate their imagination and think of realistic scenarios or individual cases that illustrate the relevant literature. Four, they write a text that nicely and effectively merges the literature with the scenario. So, medical sociologists do not use independent examples to explain the main sociological concepts but they come up with a multilayered story about an individual and then apply sociological theory to make sense of this story. The big advantage of an individual story or scenario over independent examples is that it can capture the complexity of social reality, whereas the independent examples work only as snapshots.

To summarize, medical sociologists should construct the scene of medical practice, start with a scenario or an individual story in a health setting, have questions for the readers to consider, have the sociological material unraveled and applied to the scenario, have more questions for the readers to think about, apply more sociology, and close the story (Barrows 1996). To put this very simply, I propose using PBL as an approach to teach medical students but not necessarily in the sense that students are presented not only with a problem to solve but also with a detailed case to understand and conclude. This problem-based sociology should be at an individual level so that students can link the sociological concepts they have learned to the patients they will encounter in clinical practice. Below, I present a scenario of stigma as an exemplar of individualized medical sociology that could be used for in-class teaching in learning resources and textbooks. The structure of the scenario is reminiscent of the course of assessment in sociological practice as proposed by Bruhn and Rebach (2007). That is, a medical practitioner should gather as much information as possible from the patient to assess the case. The medical practitioner should then plan and implement an intervention program or a course of action for helping the patient. The final step, Bruhn and Rebach assert, is to evaluate the program to understand its effectiveness and identify any areas for improvement. Because the medical practitioner is treating patients in the end and is using sociology only as a supportive mechanism, the last step of evaluation is not relevant for our purpose here.

The Example of the Sociology of Stigma

Conclusion

The sociology of stigma, as outlined above, is a simple example of making sociology individualized in a problem-based context in medical practice. This could be applied to all main areas of the sociology of health and illness. For example, a medical sociologist could come up with a story of a patient who is in conflict with his or her GP because he or she attributes the causes of his or her condition to the evil eye. Through such a case, the medical sociologist could cover lay health beliefs and the comparison between the biomedical model and social knowledge of diseases. Furthermore, a medical sociologist could present health inequalities and the association between social class and mortality/morbidity through the story of a working-class person who suffers a heart attack and his or her GP tries to help him or her to change his or her lifestyle. I introduce more applied scenarios in my recently published book Applied Sociology of Health and Illness: A Problem-based Learning Approach (Constantinou, 2014). I hope that this paper will open a fruitful discussion about how to apply medical sociology to health settings and thus make it more relevant to medical practice. I also hope that it will spark further interest in researching the effectiveness of teaching individualized medical sociology through PBL.