Introduction Empathy in doctor-patient relationships is a familiar topic for medical scholars, and a crucial goal for medical educators. Nonetheless, there are persistent disagreements in the research literature concerning how best to evaluate empathy among physicians, and whether empathy declines or increases across medical education. Some researchers have argued that the instruments used to study “empathy” may not be measuring anything meaningful to clinical practice or to patient satisfaction. Methods We performed a systematic review to learn how empathy is conceptualized in medical education research. How do researchers define the central construct of empathy, and what do they choose to measure? How well do definitions and operationalizations match? Results Among the 109 studies that met our search criteria, 20% failed to define the central construct of empathy at all, and only 13% had an operationalization that was well-matched to the definition provided. The majority of studies were characterized by internal inconsistencies and vagueness in both the conceptualization and operationalization of empathy, constraining the validity and usefulness of the research. The methods most commonly used to measure empathy relied heavily on self-report and cognition divorced from action, and may therefore have limited power to predict the presence or absence of empathy in clinical settings. Finally, the large majority of studies treated empathy itself as a black box, using global construct measurements that are unable to shed light on the underlying processes that produce empathic response. Discussion We suggest that future research should follow the lead of basic scientific research that conceptualizes empathy as relational—an engagement between a subject and an object—rather than a personal quality that may be modified wholesale through appropriate training.

The philosophy of "evidence-based medicine"--basing medical decisions on evidence from randomized controlled trials and other forms of aggregate data rather than on clinical experience or expert opinion--has swept U.S. medical practice in recent years. Obstetricians justify recent increases in the use of cesarean section, and dramatic decreases in vaginal birth following previous cesarean, as evidence-based obstetrical practice. Analysis of pivotal "evidence" supporting cesarean demonstrates that the data are a product of its social milieu: The mother's body disappears from analytical view; images of fetal safety are marketing tools; technology magically wards off the unpredictability and danger of birth. These changes in practice have profound implications for maternal and child health. A feminist project within obstetrics is both feasible and urgently needed as one locus of resistance.

At an understaffed and underresourced urban African training hospital, Malawian medical students learn to be doctors while foreign medical students, visiting Malawi as clinical tourists on short-term electives, learn about "global health." Scientific ideas circulate fast there; clinical tourists circulate readily from outside to Malawi but not the reverse; medical technologies circulate slowly, erratically, and sometimes not at all. Medicine's uneven globalization is on full display. I extend scholarship on moral imaginations and medical imaginaries to propose that students map these wards variously as places in which-or from which-they seek a better medicine. Clinical tourists, enacting their own moral maps, also become representatives of medicine "out there": points on the maps of others. Ethnographic data show that for Malawians, clinical tourists are colleagues, foils against whom they construct ideas about a superior and distinctly Malawian medicine and visions of possible alternative futures for themselves. [biomedicine, tourism, Africa, imaginaries] ZUSAMMENFASSUNG In einem unterbesetzten, unterfinanzierten afrikanischen Lehrkrankenhaus werden malawische Medizinstudenten zuÄrzten ausgebildet. Auch ausländische Medizinstudenten studieren dort; sie besuchen Malawi als "klinische Touristen" für kurzfristige Aufenthalte, bei denen sie Wahlfächer belegen und etwasüber "globale Gesundheit" lernen. Wissenschaftliche Ideen zirkulieren dort schnell. Medizinische Technologien verbreiten sich langsam, unregelmäßig, und manchmalüberhaupt nicht: die ungleiche Globalisierung der Medizin ist unübersehbar. Ich erweitere die Literaturüber moralische und medizinische Imaginationen und argumentiere, dass die Studenten sich diese Krankenhausabteilungen auf "moralischen Karten" vorstellen, entweder als Orte wo-oder von wo aus-sie eine "bessere Medizin" anstreben. Klinische Touristen (die ihren eigenen moralischen Karten folgen) repräsentieren außerdem die Medizin "da draußen": Sie werden zu Punkten auf den "moralischen Karten" Anderer. Für malawische Medizinstudenten sind diese ausländischen klinischen Touristen Kollegen, ein Hintergrund, vor dem sie Ideen einerüberlegenen und spezifisch malawischen Medizin und alternative Zukunftsvisionen für sich selbst konstruieren. RÉSUMÉ Dans un hôpital d'enseignement africain, en sous-effectif et manquant de ressources, lesétudiants malawiens apprennentàêtre médecins alors que lesétudiantsétrangers, « touristes cliniques » en visite au Malawi, s'informent sur la « santé publique mondiale ». Les idées scientifiques circulent rapidement; les touristes circulent facilement de l'étranger au Malawi mais pas vice-versa; quand les technologies médicales circulent, c'est lentement. La mondialisation inégale de la médecine est exposée. J'accrois la recherche sur les imaginations morales et imaginaires médicaux, argumentant que lesétudiants dépeignent cette expérience commeétant un lieu où, et par l'intermédiaire duquel, ils recherchent une médecine meilleure. Les touristes affichent leur schème m...

The gender inequalities that characterise intimate partner relationships in Malawi, a country with one of the highest HIV prevalence rates in the world, arguably place marriage as an important risk factor for HIV infection among women, yet few studies detail the complex interactions of marriage and risk. In order to develop HIV-prevention interventions that have lasting impacts in such communities, we need a deeper understanding of the intricacies of women's lives, how and why they are involved in marital relationships, and the implications of these relationships for HIV transmission or prevention. This article describes how women understand marriage's effects on their lives and their HIV risks. Drawing from focus group discussions with 72 women attending antiretroviral clinics in Malawi, we explore why women enter marriage, what women's experiences are within marriage and how they leave spouses for other relationships. Based on their narratives, we describe women's lives after separation, abandonment or widowhood, and report their reflections on marriage after being married two or three times. We then review women's narratives in light of published work on HIV, and provide recommendations that would minimise the risks of HIV attendant on marriage.

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