Friday, January 23, 2009

Dealing with messed-up-ness of medical system as a healthcare provider?

Lately I have been thinking about, or feeling like I need to think more about, becoming a healthcare provider in such a messed up system. Messed up in a lot of ways, including the lack of access and profit-driven system in the U.S. (call your congresspeople about single-payer universal healthcare, expanded/improved medicare for all, now!!), but that's a whole other post. I'm thinking about more the ways in which medicine has such a history AND present of being rooted in systems of domination and oppression such as ableism, classism, homophobia, racism, sexism, and transphobia.

How do I bring into conversation the idea that medicine is inherently a project of domination (an idea I take from discussions I've had with friends - theoretical and personal, and people I've read and heard in activist and academic contexts) with:
-the left-wing but not queer or radical in the same way doctor-activists and nurse-activists that see "good medicine" as a force for change (with whom I sometimes vehemently disagree, but sometimes think have done really good, important work)
-the objectified and rude-ranging-to-abusive way I frequently see patients get treated by providers at the free clinic where I volunteer
-the idea that even if this field is inherently fucked up and untrustworthy, there are still many things people need to get from it (sometimes because it is expertise or a skill specific to medicine, sometimes because medicine and/or government has control and acts as a gatekeeper)
-my own privileged experiences of being a patient (on the object side of the patient/doctor equation, but in a very privileged class, and racial context and a not-visibly-marked body in terms of gender variance and disability)?

What do I need to do when I am a nurse practitioner to make sure I serve the needs of the patients and/or disrupt the messed up patterns and practices of healthcare? What do I need to do now when I am interpreting or facilitating classes at the clinic? To not EVER lose sight of treating people respectfully, like people, instead of like objects to be touched (with or without consent). Or like interesting ideas to be bounced around later with colleagues (a greater danger for me, as I have noticed myself doing this)?

I have decided to go to school to be a nurse practitioner instead of a doctor. I think not entering into the old-white-boys-club (which now some women and people of color can be a part of if they play their cards right and/or have enough class privilege) of medicine, will position me a little bit differently. And when it is problematic, I will not have to have 110% of my time and energy devoted to it, so I will have time to seek out other worlds/people and take care of myself enough to not become a total pompous stressed out asshole that thinks I'm more important than everyone else, especially patients. But it still is part of a messed up, disciplining field, and it would be ridiculous to think being a nurse would escape that. Also, I am going to the top of a very hierarchical nursing field (hierarchies with strong racial and class components), and in programs that skip a lot of the grunt work and go straight to the masters or doctoral level position. Programs that are in some ways designed to position us just like primary care doctors (and that is part of what appeals to me about them).

Some of this is the mind vomit that will be irritating to look back on (and maybe for others to read). But I needed a place to work on processing, and also to be held accountable or discuss ideas if anyone has any.

Further reading (an extremely incomplete list):
Mississippi appendectomy - forced sterilizations on women of color
Ashley X petition
FRIDA on Katie Thorpe's womb to be removed
Interview with Harriet Washington, author of Medical Apartheid
Medical Apartheid book
Bad Blood book (on Tuskegee Syphilis experiments)

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