The Good, the Bad and the Difficult: Clinical training and the entrenching of inequality

The study entailed 70 qualitative in-depth interviews with 27 medical students undertaking clinical rotations in five medical schools in the United States. To highlight the subtle, yet powerful, ways in which inequality is reproduced and entrenched, this paper analyses ideas of the ‘good’ and the ‘bad’ patient among medical students undertaking clinical rotations. ‘Bad’ patients question not only biomedical knowledge but also medical students’ commitment to helping people. ‘Good’ patients engage with medical students in a manner that upholds biomedical knowledge as well as enables students to assume the role of the healer and the expert. At the same time, ‘good’ patients possess cultural skills that align with those of medical practitioners. This alignment is, furthermore, central to definitions of the ‘good’ patient. Distinctions drawn between ‘good’ and ‘bad’ patients thus both embody as well as enforce social inequality. The subtle reproduction of inequality is, however, difficult to discern because judgments about patients are entwined with emotional responses that patient encounters engender.