MODERN MEDICAL INQUIRY AND CULTURE CHANGE
Medicine, whether we construe it as a science, a field, a discipline, an art, or a calling, is a part of culture. Like any other aspect of culture, medicine has an element of unrecognized internal logic, and is influenced by nonmedical cultural phenomena in a multitude of ways. Discourse in any part of culture organizes what participants think, what they "see." What we "see" is the end point of what we think we see. Medical students learn to solve problems with corpses. They have learned their lessons of cause and effect on static objects, developing a cross-sectional rather than a longitudinal orientation to problem solving. The ethos and mystique of a profession grow out of the transformed shadows of its cultural survivals: corpses are passive and are not colleagues; there is the implicit expectation that the patient will assume the same attributes. Indeed, the most obvious behavioral characteristic of the cadaver is its patience. Whatever is learned from the corpse has to be learned anew from the living body, but the affect and the context of the original lessons are never erased ( Romanucci-Ross 1982).
This cross-sectionalizing of the inherently longitudinal is as apparent in larger historical contexts as it is in the biographical. Fleck Genesis and Development of a Scientific Fact ( 1979) is about a problem in medicine. Whatever we may learn from Fleck, we need to keep constantly in mind his definition of a "fact" as a "stylized signal of resistance in thinking" ( 1979:98), a roadblock in the flow, a cross-sectionalization of the longitudinal. Ways of seeing, or knowing, or doing, or thinking are stylizers of cultural processes in any culture.
Clinical decision-making should be dictated only by what the physician considers good for the patient, but actually many decisions converge at this very point. Much of the decision-making can occur in a hospital where tech-