Abstract
In this article we examine the figure of the doctor in animated debates around public sector medicine in contemporary South Africa. The loss of health professionals from the South African public system is a key contributor to the present healthcare crisis. South African medical schools have revised curricula to engage trainee doctors with a broader set of social concerns, but the disjunctures between training, health systems failures, and a high disease burden call into question whether junior doctors are adequately prepared or whether conditions of care extend beyond medical training. A concern with 'resilience' suggests a correct ethical relation to a putative obligation to provide care in a struggling system. By examining the ways in which trainee doctors are expected to 'cope' with the demands of medical practice, to adopt the correct moral posture in relation to the urgency of care, and to enact a desirable ethical relation to the broader social and political context of medical practice, we examine the picture of humanist concern that animates the subjectivities and techniques of the self called for by this training, and advocate for endurance as an alternative framework for understanding the political and ethical relations between doctors, patients and health systems.
Highlights
Introduction'The first time I saw him I thought, he won't last. I was sitting in the office in the late afternoon and he appeared suddenly in the doorway, carrying a suitcase in one hand and wearing plain clothes - jeans and a brown shirt with his white coat on top
In this article we examine the figure of the doctor in animated debates around public sector medicine in contemporary South Africa
This essay argues that if we are to understand the current crisis of health care in South Africa, we must attend to the apparent disjunctures between how the state, training institutions, medical students, and graduates themselves understand what it means to be a 'good doctor.' We argue that key to understanding the poor retention of doctors in the public sector is an understanding of what Michel Foucault referred to as 'techniques of the self' (1988) that are elicited in the making and unmaking of doctors in contemporary South Africa
Summary
'The first time I saw him I thought, he won't last. I was sitting in the office in the late afternoon and he appeared suddenly in the doorway, carrying a suitcase in one hand and wearing plain clothes - jeans and a brown shirt with his white coat on top. The image of the pioneer remains the valued horizon of possibility for specialization and career advancement for South African doctors It is the one animated in South African university prospectuses advertising medicine to prospective students: 'excellence,' 'science,' and 'specializing' are implicitly linked, while little mention is made of the proposed plan for National Health Insurance or the state expectation that the majority of graduates should continue work in the public sector or in primary care roles after graduation. By framing the question in terms of the figure of the doctor, we suggest that notions of vocation, political commitment, pastoral care, or even an entrepreneurial self are narratively constructed within particular genres of thought and writing, in addition to particular social, political, and professional histories of medicine, and that these manifest as competing values for trainee doctors
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