Mechanistic Model

Along with learning to master uncertainty, medical stu- dents also learn to consider the body analogous to a machine or factory and to consider illness analogous similar to a mechanical breakdown. For example, medical textbooks routinely describe the biochemistry of cells as a “production line” for converting energy into different products, and the female reproductive system as a hierarchically organized factory that “breaks down” at menopause. The mechanistic model of the body and illness leads naturally to a distrust of natural bodily processes. Doctors learn to always look for signs that the body is breaking down and to view changes in the body as causes or consequences of such breakdowns. As a result, doctors typically view pregnancy as a disease, fight against the effects of aging, use drugs to control minor fevers (the body’s natural process for fighting infection), and so on. For example, although the World Health Organization recommends that cesarean sections—a major abdominal surgery— should be performed only when necessary and in no more than 15% of births, many U.S. obstetricians now argue that cesareans are safer than vaginal childbirth and encourage women to choose cesarean section even when not medically necessary. In some hospitals, up to 70% of women now deliver via cesareans.

Intervention As this example suggests, learning to distrust natural processes is in- timately interwoven with learning to value medical intervention. During the first two years of medical school, most students receive only minimal instruction in using tools such as nutrition, exercise, or biofeedback to prevent or treat illness; during the rest of their training, such tools are rarely—if ever—mentioned. Conversely, professors routinely devote much class time to extolling the virtues of technological interventions and encourage students to aggressively seek experience in surgery and the like. Those who do so receive the most approval from their professors.