Physician Teachers As the Link Between the Medical Profession and Its Members

Understanding the relationship between the institution/profession and the individual professional’s behavior is a challenging issue. This is because the actions of professionals do not always align with the broad goals of the institutions they are embedded in. However, because professionals generally participate in a professional education or training program, it is reasonable to investigate the role of training in communicating institutional goals and standards to novice professionals. In the U.S. context, the medical profession provides a good case for examining this phenomenon because of the length and intensity of medical training and because of the continuing social transformation of American medicine. Drawing on four years of ethnographic research at a United States medical school, I show how practicing physicians integrate broad institutional goals with their personalized approaches to patient care as they teach first- and second-year medical students. I find that during class sessions practicing physicians articulate differences between the contemporary context of medical practice and the context in which they themselves were trained. Their teaching takes into account not only changes within the medical profession, but also changes in other stakeholders, such as patients. Insight into the perspectives of both practicing professionals and novice professionals will help us understand how professionals today balance the values of professional autonomy with the rise in corporate/managerial constraints on medical practice, as well as the implications these macro-level forces have for the conduct of patient care.