Special Treatment by Anna Ruddock;

Author:Anna Ruddock;
Language: eng
Format: epub
Publisher: Stanford University Press
Published: 2021-06-15T00:00:00+00:00

CHAPTER 6

GRADUATION

The Consequences of Excellence

FOR MANY OF THE STUDENTS I met at AIIMS, the end of the MBBS was already approaching. In Turner’s sense, the students were on the brink of emerging from the liminal stage of their initiation into medicine and being reincorporated into society as doctors—in theory, at least. In reality, none of the students I met intended to practice medicine with an MBBS degree. In their work on medical education in South Africa, Pentecost and Cousins describe how “notions of vocation, political commitment, pastoral care, or even an entrepreneurial self” combine with “particular social, political, and professional histories of medicine” to produce competing values that trainee doctors have to negotiate as they consider their career paths.1 This chapter is concerned with AIIMS students’ perceptions of possible futures, which are shot through with discursive threads about achievement and reputation, family, the state, money, and technology. These threads combine to produce a hierarchy of biomedical practice that privileges a conventional wisdom about the devaluation of the MBBS degree and primary care and the logical pursuit of a career in urban, superspecialized medicine. Highly specialized medicine has implications: for the students compelled to pursue it, for the patients for whom it contains its own aspirational logic encouraged by the market dynamics of private healthcare, and for the role of medical education in training doctors to respond to the most pressing healthcare needs of a deeply inequitable society.

Not all medical students pursue medical professions, as we will see. However, whether a student aspires to a career as a superspecialist, a public health practitioner, a civil servant, or an entrepreneur, I argue that the choice is inextricable from the status bestowed upon AIIMS students at the moment of admission.2 In her writing about young people in South India, Jocelyn Chua reflects: “Aspirational horizons are more than abstraction. They are the practical coordinates by which people locate themselves in the world, orient themselves to specific futures, and thus engage—and sometimes lose the capacity to engage—the present.”3 As I show in the following pages, the social life of winning a place at AIIMS, combined with the influence of norms around class, caste, gender, and kinship, produces expectations of the future and an individual’s place within it, offering different but related impressions of what it means to be a graduate of India’s most prestigious medical college.4

THE NEW CONVENTIONAL WISDOM

Because familiarity is such an important test of acceptability,

the acceptable ideas have great stability. They are highly

predictable. It will be convenient to have a name for the ideas

which are esteemed at any time for their acceptability, and it

should be a term that emphasizes this predictability. I shall

refer to those ideas henceforth as the conventional wisdom.

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