Social Sciences and Medicine

Medicine, as both science and art, relies on a spectrum of knowledge to inform patient care and, by extension, to deliver that care and set health care policy. The research essential to create that knowledge comes from a wide range of sciences and fields of study, answering the different kinds of questions that medicine poses. Many of these sciences operate in the laboratory, contributing to the familiar picture of the physician as someone who conducts life-saving experiments. Other research moves out of the laboratory and is conducted directly with patients—to test the effectiveness of new treatments, for example—and therefore is like lab science in some of its methods but very unlike it because of the circumstances of dealing with people. And then there are the social and behavioral sciences, having to do with how people behave and why. At first glance, it might seem that medicine would not need them. But a look at the questions that can be answered by the social and behavioral sciences and that cannot be answered by the laboratory and clinical sciences shows how much medicine, and academic medicine in particular, relies on them. To state only a few: Why do some patients comply with the physician's instructions while others do not? What are the most effective ways to make patients more compliant? How does the physician make the patient comfortable in discussing embarrassing or taboo topics? Which applicants should be admitted to the medical school in order for it to achieve the graduates it wants? Are attending physicians spending less teaching time with medical students? Does the country have too many physicians? How do we know that the patient understands the informed consent form and therefore has given valid consent? How can more physicians be persuaded to practice in rural areas? How many patients die from medical errors each year? This list alone is formidable, and it is a tiny sample of the questions that lie in the realm of the social and behavioral sciences. These sciences are not considered part of the medical sciences, however, although their products are part of medical education and medical protocols and practice. They also have a poor reputation among many physicians, partly perhaps because the physicians have not been trained in them but have been trained in the biosciences, and perhaps because physicians consider the social sciences “soft” or “not tough.” This erroneous perception is not helped by the fact that many people without proper backgrounds have done very poor social science research related to medicine. Using the high standards of their fields, the practitioners of the social and behavioral sciences, and the physicians who join them, do rigorous research that continues to contribute importantly to medicine and health care.