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Feeling MedicineHow the Pelvic Exam Shapes Medical Training$

Kelly Underman

Print publication date: 2020

Print ISBN-13: 9781479897780

Published to NYU Press Scholarship Online: January 2021

DOI: 10.18574/nyu/9781479897780.001.0001

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(p.281) Index

(p.281) Index

Source:
Feeling Medicine
Publisher:
NYU Press
abortion, 33, 39, 50
affect: and capitalism, 202–9;
circulation of, 16, 164;
definition, 3–4, 6, 15–16, 79, 205, 239n17;
and emotion, 16, 142, 177, 205;
and language, 55, 80–81, 144, 160–62;
management of, 53, 67;
regimes of, 18–19, 65, 113, 138–39, 169, 175, 184, 195, 198;
affective capacities, 4, 7, 10–11, 19, 28, 60–61, 79, 96, 146, 175, 181, 193, 196, 204–5, 208–9, 240n23
affective disposition, 116, 118, 120, 132, 138, 142, 193, 204
affective economies, 11, 17, 32, 52–53, 60–62, 102–6, 109, 111, 201, 206–7, 209, 213
affective governance, 17–20, 21–22, 57, 78, 84, 97, 140, 170, 175, 196, 198, 202–3, 210–11, 240n23
affective labor. See labor
affective resonance, 130, 135–38
affective ties, 97, 170, 204
affective turn in clinical medicine, 15–18, 240n23
agency, 33, 153–54, 206, 252n6
Ahmed, Sara, 17, 102, 240n23
anatomy lab, 1–2, 19, 118, 120
anatomy, normal, 43–44
anesthesia, patients under, 5, 29, 31, 199, 204, 242n10, 247n3, 255n4. See also pelvic exam
anonymous vagina. See vagina
anxiety, 2, 4, 14–15, 41, 46–47, 50, 52, 54, 71, 73–74, 85, 93, 97, 108, 115, 127, 131, 159–60, 184, 187. See also emotion/ emotions
assemblage, 27, 38, 42, 145, 164–65, 205, 219, 227, 241n2, 241n3, 254n14. See also body/ bodies
assessment, 60, 58, 64–65, 67, 69, 73–77, 83, 175, 179, 251n8;
Likert scale, 74–75. See also clinical skills
Association of American Medical Colleges (AAMC), 7–8, 40, 69, 76, 221, 245n7, 245n8
attention, 22, 27, 70, 76, 85, 90, 97, 102, 109, 142–43, 149–52, 156–60, 165, 193
attentiveness, 21, 26, 68, 83–85, 94, 96, 99, 101
authenticity and artificiality, 130–36. See also simulation
authority, intimate, 78, 90–94, 97, 107–8, 111
authority, of physicians, 7, 43–44, 55, 62, 57, 65, 92, 203, 238n7, 240n1. See also professional dominance
Barad, Karen, 145, 252n6, 252n7, 253n9
Beckmann, Charles R. B., 41–45, 47, 52, 62, 66
bimanual exam. See pelvic exam
biomedicalization, 12, 20, 54, 190, 203, 208
biomedicine, 12, 15, 18, 20, 26, 34–35, 38, 41–44, 47, 54, 57, 65, 116, 130, 150, 170–79, 190, 192–95, 197, 223, 228 (p.282)
biopower, 112, 195, 207–8. See also affect
biovalue, 112–13, 176, 195, 207–10
bodily knowledge, 47, 56, 86, 90, 100, 248n10
body/bodies:
as assemblage, 164, 254n14;
materiality of, 27, 105, 145, 151, 153–54;
production of, 163–65;
sensation of, 3, 141–46, 148–50, 153, 155, 157, 159, 163, 182, 252n2;
stickiness of, 102–3, 106;
Boris, Eileen, 84–86, 93
boundaries, 17, 80, 103, 145, 150–51, 157, 248n11, 253n9;
subject/object binary, 143–44, 150, 181
Bourdieu, Pierre, 116–17, 255n3
breast exam, 75, 86, 100, 124, 191, 223, 249n21, 251n8
burnout, 2, 18–19, 118, 198, 205, 209, 212
cadaver, 1–2, 19, 31, 118, 120, 130–31, 200, 202, 243n18, 250n4
cancer, 6, 31, 34, 41, 87–88, 141, 172, 191–92
capitalism, 13, 16, 18, 20, 57, 94–95, 112, 170, 203, 205, 208, 211
care:
vs competence, 117–18;
fostering, 212–14;
politics of, 21–23, 25–28, 36, 51–56, 58, 68, 94–95, 175
checklist, 49, 56, 60, 75–77, 80, 183, 203, 205–6, 229–36, 244n4. See also assessment
cisgender, 237n5, 248n12
Clarke, Adele, 12, 38, 219–20
clinical skills, 6, 11, 21, 36, 64–65, 67, 70, 74,j 76–77, 86, 123–24, 126, 134, 137, 168, 193, 196, 222, 234, 239n13;
assembling clinical bodies, 163–67;
assessment of, 65–70. See also assessment
comprehensive medicine, 62, 171
consent, 11, 36, 54, 105, 172, 176–77, 199–202, 237n3
consumerism, patient, 8–9, 12, 64, 113, 174, 206
corporatization of healthcare, 12, 64, 169, 174, 198
cultural health capital, 177, 181, 193–94. See also patient: empowerment
Deleuze, Gilles, 15, 164, 205, 239n17, 241n3
detached concern, 10, 118, 139, 173
detachment, 2, 139, 249n19
discipline, 15, 19–20, 163
disgust, 81, 104, 249n16. See also emotion/ emotions
Ducey, Ariel, 112, 212
economies, affective. See affective economies
electronic health records, 12, 175, 255n2
embarrassment, 126, 132. See also emotion/ emotions
embodiment, 17, 82–83, 92, 109, 117, 123, 149, 165, 177
Emma Goldman Health Center, 39–40, 51–52, 243n16
emotion/ emotions, 10, 16–17, 43–44, 102, 115, 119, 132, 186, 201;
and affect, 16, 60, 205;
management, 60, 120–21, 128, 137–38, 140;
of medical students, 46, 52–54, 56, 120–21, 132, 134;
of patients, 3, 68–69, 81, 134
emotional labor. See labor: emotional
empathy, 2, 35, 56, 80, 129, 139–40, 186
empowerment. See patient
experience, 79, 143, 162
expertise. See medical expertise
exploitation, 18, 29, 34–38, 66, 203, 208 (p.283)
fatness, 106, 253n12
fear, 48, 71, 83, 85, 126–27, 191, 201. See also emotion/ emotions
feeling/feelings, 1–2, 6, 10, 16, 19, 121, 186;
embodied forms of, 15–16, 142, 163;
mode of clinical perception, 162–63
feeling with, 22, 143–46, 149, 151, 153–57, 160, 162–73, 165–66;
as translation, 157–63
feminist activism, 3, 26, 33–34, 40, 49, 55, 202, 206–7
feminist practices, cooptation of, 35–36, 54–55, 59, 169, 181, 184. See also Women’s Health Movement
feminist self-help clinics, 33, 39, 50, 55, 183, 193, 243n17
Foucault, Michel, 12–13, 15, 18–19, 44, 163, 176, 184, 241n2, 251n2, 255n3;
gaze, 163, 252n2;
neo-, 12, 195
gaze, medical, 25, 29, 146, 148, 163, 167, 185, 241n2, 251n2, 22n2
governance, affective. See affective governance
GTA:
impact on students, 73–74, 93–94, 101, 116, 129;
intimacy with coworkers, 99–101;
precarity of work 86, 88–89, 98, 112–14;
and sexuality/ sex work, 220, 248n11;
GTA programs, 7, 31, 37–38, 43, 49–52, 59–60, 64, 73, 202;
touch and language, 59–60, 108–9; 187, 194, 229
Guattari, Felix, 164, 239n17, 142n3
gynecological teaching associate. See GTA
gynecologists, 42, 55, 87
habitus, medical, 123–25, 128–29, 136, 165, 204. See also affect; profession/ professionalism
haptic knowledge, 84–92, 142, 247n2
haptic pelvic simulators, 155–56
Harvard Medical School, 35–36
Hoffman, Steve, 118, 135
humanism, 170, 180, 187, 203
ICE (inspect, check, examine), 121, 134, 139
identities, embodied, 116–17
inequality, 178, 198, 210–13
informed consent, 11–12, 36–37, 54, 199–201
insider knowledge, 220, 226
intimate knowledge, sharing bodies of, 98–102
intimate labor. See labor
knowing, process of, 144–46, 148
knowledge, 13, 47, 60, 66, 84–85, 93, 143, 145, 213, 226;
objects of, 143, 148, 150–51, 153, 155, 157
Kretzschmar, Robert, 37, 62
labor, 86–90;
affective, 16, 72, 84, 96, 101, 112, 135, 206, 247n4, 251n9;
emotional, 16, 56, 83–84, 118, 138, 140, 206–7;
gendered, 56, 88, 112;
intimate, 84–85, 90, 111–12, 102, 136, 221, 138
licensing, 2, 18–19, 75–78, 139, 193, 196
life itself, 113, 176, 206–8
listening, 2, 8–9, 19, 66, 75–78, 139, 193, 196
managed care, 8–9, 12, 64
manikins, 73, 114–15, 155–56, 204, 250n1. See also plastic models
marginalization, 7, 17, 194–97, 210, 213
Massumi, Brian, 16, 78, 144
materiality, 153–54, 163–64, 225, 241n4
measurement, 145, 166
medical expertise, 13–14, 60–64, 149, 154, 165, 210, 245n5 (p.284)
medical gaze. See gaze, medical
medical habitus. See habitus, medical
menstrual cycle, 50–51, 100–101, 136, 153–54, 249n13
Merleau-Ponty, Maurice, 144, 252n3
midwives, 29, 36
National Board of Medical Examiners (NBME), 8, 76
new materialism, 143–45, 163–64
objectivity, 68–70, 79–80, 219, 225
ovaries, 142, 151, 154, 156, 158, 160, 226
Pap smear, 6, 30, 177, 191
paternalistic medicine, 32, 168, 181, 191
patient:
activating, 181–83, 193;
bodily autonomy of, 5, 12, 45, 49, 183, 187, 202;
centered, 2, 54–55;
consumerism, 12, 64, 206;
at ease, 186–90;
empowerment, 169–75, 179–81, 192, 211, 213;
good, 176–77, 193;
interiority of, 183–84;
passivity of, 91, 156, 181;
subjectivity, 170, 181, 185–86, 192–93, 197. See also anesthesia, patients under
patient instructors, 72, 90–91
patient satisfaction, 76–77, 112, 140, 174, 195, 209
patient-as-partner, 181, 186, 188–90
pelvic exam, 3–6, 9–11;
bimanual, 6, 46–47, 74, 87, 98, 103, 141, 154, 159, 165, 225–26, 235–36;
concepts of care in, 26–27, 54–48;
history of, 25–27, 29–31, 44–48;
learning to feel with the body in, 146–49;
lithotomy, 160–61;
programmed, 71, 74;
rectovaginal, 46, 88, 233. See also anesthesia, patients under; speculum
Pelvic Teaching Program (PTP), 35, 56, 59, 195
perception, 143–44, 149–50, 157, 159, 165–66, 205
phenomenology, 143–45, 163, 252
physicians. See authority of physicians
Planned Parenthood, 40, 52
plastic models, 31, 37, 87, 114, 130–33, 153, 155–56. See also manikins
potentiality, 79–80, 144, 208
practices of care, 26–27, 56
Prentice, Rachel, 118, 155
professional dominance, 20, 22, 35, 60, 65, 70, 140, 170, 174–75, 178, 203, 211–12. See also authority, of physicians
professional socialization, 60, 116, 136, 143
profession/professionalism, 1, 10–11, 12–121, 123–25, 139, 169, 226;
para-professionalism, 86–90;
in simulation, 119–25. See also simulation
psy-sciences, 61–63, 171, 173
race, 29, 141, 94, 194, 210–11, 241
racism, 22, 29, 195, 208, 210, 213
rectovaginal exam. See pelvic exam
reflexivity, 11, 103, 126, 165
rehearsal, 12–13, 25, 128–29, 131, 134, 211
relationality, 6, 56, 96–97, 99, 205, 209, 214
Rose, Nikolas, 13, 176, 184
sacred vagina. See vagina
science and affect, 10–11, 55, 79–80, 92. See also affect
self-responsibility, 14, 182, 182, 194, 211
sex workers, 29, 31, 33, 52, 220, 241n5, 248n11, 251n9
sexuality, 5, 29, 30, 37, 44, 86, 103–6, 109, 124–25, 136, 163, 210, 224;
potential, 136, 224, 248n11
shame, 15, 47, 104–6, 147, 199, 251n8
Shim, Janet, 177–78, 194
socialist feminism, 51–52
Society for Directors of Research in Medical Education, 69–70, 78
speculum, 2, 6, 29, 31, 33, 45–47, 74, 87, 91, 98, 104, 107, 126, 132, 150, 152–56, 158, 161, 183, 253n11. See also pelvic exam
Sprinkle, Annie, 5, 237n6
sterilization, 30, 33, 56, 119
sticky bodies. See body/ bodies
subjectivity, 25, 126, 129, 161, 170, 183, 185–86, 193, 197
subject-making, 179, 180–81, 184, 193
subordination, 91, 106–7, 109, 111, 163, 206
surveillance, 30, 33, 176, 190
talk before touch, 87, 132, 134, 139, 182, 194
touch and language, 107–9, 125, 144, 158–59, 163
translation, 55, 79–80, 100, 135, 142, 148, 157–58, 160–61, 163, 166, 225
trust, 9, 18, 20, 42–43, 55, 65, 67, 85, 101, 108, 122, 137, 172, 184, 188–91, 193–95, 200, 206, 209
University of Illinois (UIC), 39–43, 48, 53–55, 139, 198, 212
University of Minnesota, 114–15, 132
USMLE, 2, 5, 9, 76, 77, 140, 196
uterus, 141–42, 154, 158, 182, 192
vagina:
anonymous, 25–26, 57;
sacred, 4, 6, 99, 206
vulnerability, 5, 33, 84–85, 91, 98, 106, 136, 162, 213
Wacquant, Loïc, 117, 119, 125
Women’s Community Health Center, 34, 35, 46, 58
Women’s Health Movement, 5, 9, 26, 32–33, 38, 40, 42–44, 46, 53, 181, 192 (p.286)