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Faith and Doubt at the Doctor's University of Pennsylvania ScholarlyCommons Publicly Accessible Penn Dissertations 2019 Faith And Doubt At The oD ctor’s: Class, Race, And The Role Of Community In Medical Decision Making Lindsay Wood Glassman University of Pennsylvania, [email protected] Follow this and additional works at: https://repository.upenn.edu/edissertations Part of the Sociology Commons Recommended Citation Glassman, Lindsay Wood, "Faith And Doubt At The octD or’s: Class, Race, And The Role Of Community In Medical Decision Making" (2019). Publicly Accessible Penn Dissertations. 3294. https://repository.upenn.edu/edissertations/3294 This paper is posted at ScholarlyCommons. https://repository.upenn.edu/edissertations/3294 For more information, please contact [email protected]. Faith And Doubt At The oD ctor’s: Class, Race, And The Role Of Community In Medical Decision Making Abstract How do parents make medical decisions for themselves and their children? Why do some parents agree to interventions – such as vaccines, obstetrical treatment, and antibiotics – that others do not? And how do class and race shape those decisions? Past research has shown that white, middle class parents are the most likely to refuse medical interventions on philosophical grounds, including vaccines (Reich 2016a). Yet the existing research does not help us understand why others in similar circumstances don’t make the same choice, nor how we should understand working class patients with their own medical refusals. The current study seeks to address these puzzles by taking a comparative view of medical decisions. Drawing on data from ninety interviews with middle- and working-class adults (overwhelmingly mothers) and over three years of ethnographic research, I show that community ties play a vital role in shaping participants’ medical decisions. These ties, mediated by social class and race, help participants interpret their interactions with the medical establishment, and orient patients towards either a skeptical or trusting relationship with providers. Ultimately, patients’ interpretations of those interactions, and if/how they draw on social support to make medical decisions going forward, determines their position in four distinct categories, which I label Entitled Skeptics, Constrained Skeptics, Believers, and Compliers. Degree Type Dissertation Degree Name Doctor of Philosophy (PhD) Graduate Group Sociology First Advisor Melissa J. Wilde Keywords Community, Medical Non-Adherence, Medical Sociology, Race, Social Class Subject Categories Sociology This dissertation is available at ScholarlyCommons: https://repository.upenn.edu/edissertations/3294 FAITH AND DOUBT AT THE DOCTOR’S: CLASS, RACE, AND THE ROLE OF COMMUNITY IN MEDICAL DECISION MAKING Lindsay Wood Glassman A DISSERTATION in Sociology Presented to the Faculties of the University of Pennsylvania in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy 2019 Supervisor of Dissertation _____________________ Melissa J. Wilde, Associate Professor of Sociology Graduate Group Chairperson _____________________ Jason Schnittker, Professor of Sociology Dissertation Committee: Annette Lareau, Edmund J. and Louise W. Kahn Professor in the Social Sciences, Professor of Sociology Jason Schnittker, Professor of Sociology Charles Bosk, Professor of Sociology ACKNOWLEDGMENTS I am deeply thankful for the support and guidance of my Chair, Melissa Wilde. Her mentorship has made me a better scholar and a better person, and I am eternally grateful. My sincerest thanks go also to Annette Lareau for her thoughtful feedback since the very beginning of this project. Her guidance on my methodology, and her willingness to work through the inevitable setbacks, improved the study immeasurably. I am grateful to Jason Schnittker for providing much needed support as I ventured into the field of medical sociology, and to Charles Bosk for his words of wisdom on conducting qualitative research on medical issues. Thank you to the Louisville Institute, the University of Pennsylvania Office of the Provost, the Society for the Scientific Study of Religion, and the Religious Research Association for their generous support. ii ABSTRACT FAITH AND DOUBT AT THE DOCTOR’S: CLASS, RACE, AND THE ROLE OF COMMUNITY IN MEDICAL DECISION MAKING Lindsay Wood Glassman Melissa J. Wilde How do parents make medical decisions for themselves and their children? Why do some parents agree to interventions – such as vaccines, obstetrical treatment, and antibiotics – that others do not? And how do class and race shape those decisions? Past research has shown that white, middle class parents are the most likely to refuse medical interventions on philosophical grounds, including vaccines (Reich 2016a). Yet the existing research does not help us understand why others in similar circumstances don’t make the same choice, nor how we should understand working class patients with their own medical refusals. The current study seeks to address these puzzles by taking a comparative view of medical decisions. Drawing on data from ninety interviews with middle- and working-class adults (overwhelmingly mothers) and over three years of ethnographic research, I show that community ties play a vital role in shaping participants’ medical decisions. These ties, mediated by social class and race, help participants interpret their interactions with the medical establishment, and orient patients towards either a skeptical or trusting relationship with providers. Ultimately, patients’ interpretations of those interactions, and if/how they draw on social support to make medical decisions going forward, determines their position in four distinct categories, which I label Entitled Skeptics, Constrained Skeptics, Believers, and Compliers. iii TABLE OF CONTENTS ACKNOWLEDGMENTS ............................................................................................................ II ABSTRACT ................................................................................................................................ III TABLE OF CONTENTS ........................................................................................................... IV INTRODUCTION ........................................................................................................................ 1 Bridget’s Story ........................................................................................................................................ 1 How Do We Make Medical Decisions? .................................................................................................... 7 Table 1. Participant Groups ....................................................................................................................... 8 Table 2a. Number of Interventions Refused (% of Sample) ..................................................................... 12 Table 2b. Interventions Accepted and Refused (% of Sample) ................................................................ 12 Community Ties: The Mechanism of Medical Decision-Making ............................................................. 13 The Role of Class, Race, and Religion .................................................................................................... 16 Table 3. Medical Orientation and Social Class (n) .................................................................................... 17 The Study ............................................................................................................................................. 20 Table 4. Medical Orientation and Race (n) .............................................................................................. 23 What This Study is Not ......................................................................................................................... 23 Chapter Overview ................................................................................................................................ 24 CHAPTER 1: BACKGROUND AND MOTIVATION .......................................................... 29 Introduction ......................................................................................................................................... 29 Individualized Care and the Fracturing of Medical Authority ................................................................ 30 Class and Race in Clinical Interactions ................................................................................................... 32 Medical Non-Adherence ....................................................................................................................... 35 Alternative Understandings of Health: Complementary and Alternative Medicine ............................... 37 Natural Healing in the United States ....................................................................................................... 39 iv Divine Healing in the United States ......................................................................................................... 42 Refusing Conventional Medicine: Cultural Schemas and Collective Resistance ...................................... 47 Conclusion ............................................................................................................................................ 52 CHAPTER 2: ENTITLED SKEPTICS ................................................................................... 53 Introduction ........................................................................................................................................
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