Taylor Janelle S
Department of Anthropology, University of Washington, Seattle, Washington 98195, USA.
Acad Med. 2003 Jun;78(6):555-9. doi: 10.1097/00001888-200306000-00003.
The author presents reflections from medical anthropology on the institutional culture of medicine and medical education, which sees itself as a "culture of no culture" and which systematically tends to foster static and essentialist conceptions of "culture" as applied to patients. Even though requirements designed to address cultural competence are increasingly incorporated into medical school curricula, medical students as a group may be forgiven for failing to take these very seriously as long as they perceive that they are quite distinct from the real competence that they need to acquire. To change this situation will require challenging the tendency to assume that "real" and "cultural" must be mutually exclusive terms. Physicians' medical knowledge is no less cultural for being real, just as patients' lived experiences and perspectives are no less real for being cultural. Whether this lesson can be effectively conveyed within existing curricular frameworks remains an open question. Cultural competence curricula will, perhaps, achieve their greatest success if and when they put themselves out of business-if and when, that is, medical competence itself is transformed to such a degree that it is no longer possible to imagine it as not also being "cultural."
作者展示了医学人类学对医学机构文化和医学教育的思考，医学机构文化和医学教育将自身视为一种“无文化的文化”，并且系统性地倾向于培养应用于患者的静态和本质主义的“文化”观念。尽管旨在培养文化能力的要求越来越多地纳入医学院课程，但只要医学生群体认为这些要求与他们需要获得的真正能力截然不同，他们不把这些要求当回事或许情有可原。要改变这种状况，需要挑战那种认为“真实”和“文化”必定相互排斥的倾向。医生的医学知识尽管真实，但同样具有文化性，正如患者的生活经历和观点尽管具有文化性，但同样真实。这一教训能否在现有的课程框架内有效传达仍是一个悬而未决的问题。如果文化能力课程能够让自身不再必要——也就是说，如果医学能力本身转变到无法想象它不具有“文化性”的程度，那么这些课程或许会取得最大的成功。
