Boys in White: Student Culture in Medical School by Blanche Geer, Everett C Hughes, Anselm Strauss, Howard Saul Becker. Transaction, $29.95/£23.50, pp 456. ISBN 0878556222
This book describes the pioneering 1961 study by Howard Becker and his colleagues of how “boys in white”—medical students—become doctors. It remains a remarkable ethnographic study of how these young men at the University of Kansas lived: their schedules, their efforts to find out what professors wanted from them in tests and exercises, their “latent culture” (the division into alphas and betas, fraternity and non-fraternity men); their slow assimilation of medical values through peer pressure and example; their learning how to negotiate a hospital or clinic in all its complexity; and their perspectives on their futures.
Much of this is still pertinent today, but my overwhelming sense in rereading this book is the same one I get rereading classic anthropology: the tribe is gone and with it many of its initiation rituals; and the anthropologist who can isolate his tribe from the surrounding world is gone too. The world that Becker and his colleagues report is not quite as distant as 19th century Paris or Vienna, but it is fading fast. The relatively comfortable, professionally self sufficient world of late 1950s' medicine in the United States is more and more a memory.
In the first place, there is the matter of gender. This book is self consciously about “boys in white”—the authors say that there were not enough women to worry about. As the percentage of women entering medical school approaches 50%—it was 45% in 1999-2000—all this has changed. How big a difference the dramatic increase of women in the profession will make remains to be seen, but everywhere in medical training and practice as well as in how medicine presents itself to its consumers much is made of new approaches and perspectives. In any case, the old male dominated world is fading, if not gone.
Then there is the question of professional autonomy. This book is about initiation into a system that was almost entirely self governing. Standards were maintained from within. The scene that the authors describe in which some students comment disapprovingly on the error committed by another—he inadvertently did an abortion because he failed to ask about pregnancy—would be inconceivable today. “Risk managers” would be on the spot. There would be much wringing of hands and much discussion of error, a topic on which the authors are silent. These students assume that they are entering a self monitoring world in which poor patients should be humble and other patients duly grateful. This world is gone.
Finally, the book conveys a curious lack of interest in how the outside world affects the tribe of medical students. Today's medical students are not so innocent of the great moral issues of their day as their counterparts were in the 1950s and early 1960s. I suspect that they are more caught up than were their predecessors with outside concerns: treating patients from radically different backgrounds, races, and languages and dealing with end of life questions and the social causes of illness.
Today's tribe is not as isolated and self sufficient as that described by Becker and his colleagues, and today's social scientists are not as quietly self confident. In 40 more years Boys in White will have become a historical document.
Figure.
BLAIR SEITZ/SPL
How “boys in white” become doctors