European Journal for Person Centered Healthcare 2015 Vol 3 Issue 2 pp 222-227

ARTICLE

Medical Identity: A Socio-Cultural Analysis

Peter Musaeus PhD
Associate Professor, Center for Medical Education, Aarhus University, Denmark

Abstract
Purpose: To examine philosophical stances underpinning medical identity and assess the conceptual relationship between
physician, medical practice and culture.
Argument: Medical identity is about the ideals and moral positions that physicians take when justifying themselves.
Medical identity is the study of the sociocultural paragons that conceptually underlie the phenomenology of physicians’
coming to take themselves as autonomous social agents. The paper relies on Hegel’s Phenomenology of Spirit and
investigates dilemmas pertaining to first objectivist versus subjectivist views and second hedonistic versus sentimentalist
approaches to medical identity. The sociocultural philosophical analysis of medical identity can shed light on what it means
conceptually for a physician to harbor beliefs associated with him/her being taken to be an autonomous professional. It is
important because it touches on the meaning of being a compassionate, good and skilled physician, making its relevance to
person-centered medicine self-evident.
Conclusion: Medical identity should be analyzed with reference to literature, philosophy and medical practice in order for
the physician to exercise a reflective position in the care of the individual patient which is both scientifically rational and
subjectively meaningful.

Keywords
Ethics, Hegel, medical identity, medical philosophy, person-centered medicine, reason, sociocultural theory

Correspondence address
Dr. Peter Musaeus, Center for Health Sciences Education, Arhus University, INCUBA Science Park – Skejby, Palle Juul
Boulevard 82, DK-8200 Aarhus N, Denmark. E-mail: peter@medu.au.dk

Accepted for publication: 20 November 2014

Introduction and Hegel’s philosophy is an attempt to show how being

and knowing are deeply connected. Medical education
researchers might focus empirically on the verbal
Medical identity can be explored in terms of physicians’
interactions, physical sites and discourses that produce
professional ideals and the philosophical positions that aim
medical selves [6]. The sociocultural philosophical view
to clarify the notion of identity. Clinicians and medical
has greatly influenced educational research and has
sociologists care about medical identity because it touches
situated learning theory according to which identity is
on the meaning of being a compassionate, good and skilled
interwoven with the person’s place and participation in the
physician [1]. Medical identity is difficult to capture,
social world [7]. Here, the learning physician is neither a
presumably because physicians in different contexts differ
passive nor active recipient of information, as perceived in
in what they consider their proper identity and different
the cognitivist tradition, but foremost a participant imbued
disciplines provide different approaches to identity.
with a professional identity.
Philosophy, cognitive science and education provide
This paper will explore an account of medical identity
widely different definitions of identity and of the methods
inspired by a selected reading of Hegel’s work [4].
to study it. While cognitive neuroscientists study identity
Specifically, I will use Pinkard’s [8] non-metaphysical
by means of functional brain scans [2], philosophers have
reading of reason in Hegel’s Phenomenology of Spirit
for centuries offered influential conceptual accounts of
according to which identity should be understood as
identity. According to a virtue philosophical approach
personal as well as collective. In this view, identity is
(Aristotle), medical identity could be understood as
about how a collective rational social agent through reason
physicians’ evaluation and execution of excellence of
comes to affirm that the world is as it is. According to
character [3]. This is further explicated in Hegel’s
Pinkard [8], reason makes it possible to match and test our
sociocultural philosophy [4] where, although personal
ideas about the world with our ideals. Hegel’s notion of
identity is not given a short or simple definition, it can be
reason is used in this paper to refer to what is rational for a
understood in terms of social struggles to become
community of physicians to think and utter about medicine
recognized as a social agent within a shared culture.
and how physicians might view themselves as rational
Medical ethicists are increasingly taking the view that
social participants in Society. While Hegel’s philosophy
medical identity and knowledge are intricately related [5]

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 European Journal for Person Centered Healthcare 2015 Volume 3
does not in the slightest focus on physicians’ use of
cultural identity ideals, I will use its elaboration of
philosophical stances on identity and knowledge to explore
a novel contribution to understanding medical identity.
The Phenomenology of Spirit
Hegel (1770-1831) published the Phenomenology of Spirit
[4] in 1807 on the brink of Napoleon’s military and
ideological invasion of Prussia that brought French
revolutionary ideals about freedom and identity to German
philosophy. The meaning of the work is illusive, starting
with the word phenomenology, which here means the
investigation of concepts coming to the fore to a social
agent. Hegel’s intersubjective account of identity goes
beyond a person to person agreement or struggle about
who the other is because it builds on communal aspects of
what it means to be a person and to be able to reason as a
social autonomous agent. While the Phenomenology of
Spirit has played a contentious role in philosophy, there is
no questioning its influence. Although Hegel intimates that
the work is merely an introduction or a ladder to his more
systematic philosophy published later, influential
commentators [8,9] have appraised the Phenomenology of
Spirit as perhaps Hegel’s most inspiring work. The noted
philosopher Marx Wartofsky [9], for example, thus urged
medical scientists, clinicians and educators to study
Hegel’s rich philosophical account in the Phenomenology
of Spirit [4]. In the following, I will not give a complete
exposition of this work, but I will derive two dilemmas that
sum up key movements of medical reason.
Dilemma 1: The objectivist versus
subjectivist view
The objectivist stance, according to which identity is
measurable, is the first position Hegel asks us to consider.
Hegel, when investigating reason, warns that the
objectivist stance eventually leads into conflicts with the
subjectivist stance. But before jumping ahead, let me
formulate the objectivist stance on medical identity:
• Because medical science is objective, medical identity
is objective.
In other words, the objectivist argument is: since
medicine is based on measurable evidence, medical
identity is as solid and objective as the ground that the
physician stands on. The objectivist view of identity has
been used to explain health as grounded in empirical
biological facts [10]. It has repeatedly been asserted that
since the late 19th Century and in intention much before,
medicine aspired for rationality through the objectivity of
the natural sciences [11,12]. So the question is not whether
medicine rests on natural science, but what this objectivist
stance means for medical identity.
I will examine two objectivist stances: The
neurocognitive and the mechanistic. Historically the
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objectivist view was exemplified in the behavioristic plea
for studying identity in terms of overt behavior and this
philosophy is arguably evident in contemporary cognitive
brain-scanning-studies or eye-tracking methodologies,
which attempt to study identity objectively. For instance,
Zaytseva et al. [3] reports a single experimental case study
using fMRI brain scans to study an expert opera singer’s
identity analyzed in terms of neural correlates with the
singers’ perception of self-related (listening to own voice)
and self-referential (listening to other voice) stimuli.
The neurocognitive stance
The neurocognitive view on identity runs into trouble for
two reasons. First, although this stance pretends to be
objective, experimental data do not yield certainty that
what we measure (the physician’s brain activity or his
measurable action) and correlate with the experience of
identity, derive from that phenomenon which we label
identity. The objectivist view assumes that which we need
to prove conceptually: that physicians can derive a sense of
identity out of the fact that their brain waves and eye-gaze,
etc., can be measured. The objectivist view cannot be taken
to be a meaningful script about who physicians are because
objective brain-states and measureable actions, etc., are not
what physicians are or what they are aspiring to be. A
related problem is that the logical consequence of this
objectivist view is that the physician becomes a mere
spectator of his or her identity. For the physician to be seen
as a mere spectator of his or her identity is not a satisfying
view. We would expect a physician to actually identify
with his or her role as also argued by influential medical
authors such as Osler and Flexner who made the case that
medicine was an all-engulfing vocation [13,14], not
something assumed or created by the putting on of a white
coat.
The mechanistic stance
The other objectivist stance is the mechanistic stance.
Commentators have bemoaned the risk that physicians and
medical students acquire a mechanistic view of the patient
as mere body parts and not integral human persons with
psychology, emotionality and spirituality, relating to others
in the work and social setting of life [9,13,15]. While this
view of the person as a collection of body parts might aid
the physician in reducing complexity, diagnosing and
treating the biological body, it has been criticized for
depriving the patient of personhood and morality [16].
Furthermore, the mechanistic view might lead to a
situation where the physician becomes an object where
medical identity becomes something to study detached
from the physician’s self. As the self becomes its own
object it becomes in Hegel’s vocabulary alien or other for
itself [4]. For instance, realizing that while your medical
identity exists in being an object to yourself and others, the
objective evidence (the mechanics of the workings of the
brain or the time it took to perform an action, etc.) does not
square with what you mean by being a physician. Thus, the
objectivist view leads to a situation where identity is
Musaeus Medical identity

constituted independent of the individual physicians’
activity - regardless of what he might feel, think and
believe, etc. Physicians rely on a view of themselves as
rational and of medicine as being entirely objective in its
nature, yet they resist the view that their identity is a mere
object which leads to the opposite position:
autonomous agent is not being produced cannot be
disregarded. The physician’s identity depends on the
interpretation of others about what meaning to attribute to
self-identity. This is untenable to the physician because
medical identity aims to be self-regulating as explored in
the next section.

• Because medical identity is appropriated by the Dilemma 2: Hedonism versus

individual physician, it is subjective. sentimentalism
The subjectivist account strives to give a scientific
Hedonism is a philosophical school of thought that
account of how physicians actively author a self that feels
perceives the satisfaction of desire as the aim of one’s life.
and senses what it means to be a physician. The
Sentimentalism is the school of thought which argues that
subjectivist view is the humanistic view on the physician
we know what is morally right by following our emotions.
as learner. It focuses on the physicians’ feelings and self-
The second dilemma and philosophical position that
realization and has been formulated in discussions of
physicians could come to take is this: that if Hegel’s
medical professionalism and education [3,17]. According
analysis is followed, medicine should be the vehicle for
to Hegel, the objectivist view falls short because it depends
their personal enjoyment:
on conceptual categories for what it means to be an
observer of identity. For example, the physician might
• If medicine does not give objective truths to the
realize that statistical correlations of brain scans with
physician about identity, at least it must give the
socially constructed psychological questionnaires and
physician pleasure.
social scientific concepts are all human constructs. Also,
the physician realizes that clinical medicine is not the
Medical studies are generally considered to be
objective science advanced in medical school.
relatively time-consuming and it is not unreasonable to
Montgomery writes about clinical learners in
assume that physicians and medical students learn to study
apprenticeship: ‘They want to be doctors: they want to be
hard for examinations and that they sacrifice some of their
able to diagnose and treat patients. If the biology textbooks
own personal comfort (leisure, sleep, etc.) as part of their
they devoured in the first two years now seem distant
studies. Indeed, there is evidence that physicians are taught
abstractions, it matters not a whit; evidence-based gurus
to put their own needs after the patients by being socialized
advise physicians to burn their textbooks. Instead, they are
to working long and late hours [13]. In other words,
acquiring clinical maxims, rules of thumb and tricks of the
physicians learn to delay the gratification of their desires.
trade, along with instructions, habits and skills from their
In order to examine this theme, I will venture with Hegel
clinical elders. Yet the working assumption all the while is
to examine the legend of Faust.
that the clinical teachers’ thinking is scientific: objective,
Faust is the story, by Goethe, of a medical doctor,
testable and potentially replicable in a series of similar
lawyer, theologian, magician, scientist and lover who
patients’ [13].
never ceases to pursue new pleasures. Hegel analyzes
The death of patients and hierarchical power struggles
Faust as a tragedy, where Faust is a person who attempts to
with other physicians or clinicians can be part of medical
relate to himself neither by obeying customs nor by
practice. Famously, Hegel [4] argues that social agents, in
acquiring a theoretical understanding of nature, but
order to achieve autonomy, must overcome their fear of
through sheer enjoyment. This hedonism becomes
dying and avoid succumbing to the other in power
expressed when Faust abandons his mistress Gretchen after
struggles. Themes about frailty and uncertainty are
having asked her to kill not only her brother, but also
prevalent in modern medicine as Montgomery writes:
Faust’s illegitimate child with her. Faust subjects and
‘[U]ncertainty and death pervade clinical education. They
perverts the established social order (symbolized by
give the culture of medicine its texture, and they inform the
Gretchen), yet in doing so he turns out not to be the agent
student’s accommodation to its practice. The claim that
that he thought he was because he is not directing his own
medicine is a science with an ideal of quantifiable certainty
fate, but depends upon circumstances tied to that social
and unfailing replicability, a defense wielded against
order.
uncertainty and death, is a part of that culture’ [13].
In the following, I will argue that the Faust legend
In summary, a medical culture that offers its
offers five considerations about hedonistic aspects of
practitioners a version of medical identity based on laws
medical identity. First, there is something familiar in the
that rely on quantifiable certainty and observations will not
role of the physician as visiting scholar or travelling
satisfy the subjective demand to be self-authoring of these
journeyman. Faust the wandering scholar, coincidentally,
laws. And medical students who grow emotionally
was a medical doctor whose character builds on the life of
detached from medicine, as a classical account from 1963
the early renaissance doctor Paracelsus [12,18] who
[16] suggests, cannot identify with the demands of clinical
influenced pre-modern medicine. Today physicians are
medicine to be a person with passions for healing and
expected to go on the journey from hospital to hospital
caring. Even if the physician identifies with the products of
from state to state preferably in different countries. Or, to
his or her clinical work and the objectivity of his or her
be more precise, ambitious physicians are supposed to
science, the fact that a view of his or herself as

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journey to Anglo-Saxon countries to gain excellence and
recognition, whereas one hundred years ago the ideal
placement for a physician was in Germany and before that
in France. But this wanderlust of the physician is hardly
hedonistic, unless of course he or she chooses to go to
places that are more pleasurable than educative and it
suggests a resemblance between medical identity and Dr.
Faust damned to wander the earth and all sciences.
Second, the Faust legend illuminates how medical
identity can be negative. While we can readily speak about
the satisfaction obtained as a physician from becoming
better, behaving according to norms and helping patients
etc., there might be negative identity ideals associated with
medical identity: the drug-abusing physician [19] or the
male physician coveting the female body and engaging in
sexual relationships with patients [20]. But these are not
medical identities proper and hardly help explain how
medical identity is justified and explicated. We might
conclude that while pleasure is part of the picture of being
a physician and that medicine should be a joy to practice,
negative identity ideals are actively discouraged and
sanctioned against.
Third, we might in Faust’s tragic relation with the
Devil examine the Prince of Darkness with whom the
aspiring resident makes a bargain. Although case studies of
diabolic pacts in medicine are the realm of fiction rather
than empirical study, one thought-up example would be the
senior doctor who offers the young resident or student a
golden career with a PhD, tenure etc., on the condition that
she compromises her principles in turn. Another such
example is the medical firm that will ensure funding - as
long as the physician does not publish negative results. A
third example is the scientist blind to the environmental
catastrophe that his science brings about [18]. For instance,
the physician blindly believing in penicillin, yet belittling
the dire consequences that bacterial resistance will have for
mankind. Finally, Faust can be read as a resort to the
magical thinking that some devilishly clever theory,
person, or object will come along and enchant the medical
identity and make it overly enjoyable and thus satisfy the
physicians’ most inner longings to be on top of the World.
Fourth, we might look for more everyday clinical
episodes where colleagues or patients act as mere sources
of enjoyment. An example could be the clinical teacher
who offers teaching to the extent that it provides him
gratification to see how excellent he is. But Goethe’s Faust
aside, the physician who in patients and colleagues merely
seeks his own enjoyment - who asks about a patients’ life
story to the extent that the patients have something novel
to relate, jokes with the colleagues to the extent that they
are funny to be around etc., - is not fulfilling the obligation
of the ethical physician who acts in the interest of medicine
and not himself.
Fifth, the Faustian quest, according to Hegel, is a
modern quest for self-realization. For the medical student
to find his or her true calling through medical studies not
only puts the student under the pressure that if they do not
find true happiness in medical identity they are wrong, but
the entire self-realization project can be read as a tragedy.
The point is that Faust is a tragedy about the physician
who, although he establishes a professional identity
225
through long studies, never ultimately finds himself.
Because of Faust’s dissatisfaction with his life and science
he strikes a bargain with the Devil. His ambition that
medicine reveals to him the secrets about the world and his
own place in this world comes to nothing.
In summary, there is no inherent self-gratification in
mastering objective medical science if the subjective realm
of feeling, behaving and thinking like a physician is
disconnected. Although Faustian hedonism is no more than
a paragon of negative physician identity, the wandering
scholar is a positive ideal wrought with dangers. But even
if we can point to empirical examples of physicians’
substance abuse, unethical behavior and dissatisfaction
with having to move around in residency etc., the power of
the Faust story is that it teaches us that the medical career
is not something that the physician should reach out and
pluck for his or her own enjoyment or out of blind
idealism. Hedonism is not a valid position and cannot
justify hedonistic medical identity because it leads to a
one-sided individualism based on only what the individual
physician might feel or sense in his conscience, which
according to Hegel leads logically to the sentimentalist
position that if pleasure is n ownot a moral guide,
physicians must follow their instincts.
The hedonistic dilemma leads, according to Hegel, to
Sentimentalism - the agent turns inward to follow the law
of the heart. The problem above was that the agent
exemplified by Faust can readily accept that natural
science might enable him to grasp medical identity, but
without providing reasons for certain actions rather than
others. At this stage emerges a sentimentalist take on
medical identity. Thus, sentimentalism overcomes the
problems by pointing the actors of medical identity to their
own heart. Indeed, the narrative of the heart has been
evoked in medical education where medical students are
sometimes seen as acutely intelligent, yet lacking in
sentiments. Coulehan [3] argues that full-time faculty
physicians must act as role-models to teach novice
residents and students to act virtuously and communicate
with their heart. The necessity of such actions in
cultivating a person-centered way of ‘thinking’ and ‘doing’
are clear [21].
Hegel warns, however, that this approach fails on the
ground of practical knowing and the question as to how an
ethical maxim (Kant) can have validity for all agents. Here,
the physician, by looking inwards to his or her own heart,
feels a unity with universal norms about medical identity.
This version of identity relies on sentiments about what is
right to feel, but not what is the right way to act. Pinkard
writes: ‘Faustian individualism fails […] because of its
empty conception of both what it means to be an individual
and what it means to have a self-chosen reason for doing
something. Sentimentalism offers a more concrete
conception of what it means to choose something for
oneself - namely to consult one’s “heart” and act in terms
of one’s cultivated sensibility - but it fails as an account of
practical knowledge’ [8].
Pinkard’s philosophical analysis suggests there is an
inherent problem with this sentimentalist approach to
identity. When applied to medicine the argument runs like
this: while the physician might succeed in subduing others
Musaeus
(holding power over younger physicians or other
healthcare professionals, etc.) and deciding what is best for
patients, there is nothing particular that this all-powerful
physician wants out of his medical vocation apart from
pleasure. If emotions were key to understanding medical
identity, this would lead to a resort into a sentimentalist
position. This would be a call for a medicine of the heart:
medical identity is what the physician feels. But this view
is untenable because there are many hearts that can define
what medical identity is and, equally, many hearts that can
reject what others feel is right. Even if the modern
physician might subject the established social order in
doing so, he turns out not to be the social agent that he
thought he was, that is, he is not directing his own fate, but
depends upon circumstances tied to that social order.
In conclusion, it is untenable to conceive of medical
identity in hedonistic and sentimentalist terms. Medicine
viewed as a practical art or science does not rely on mere
sentiments, for instance that a physician should not rely
merely on gut-feelings when diagnosing patients. A
physician who prescribes drugs to him or herself might
lead a pleasurable life, but a hardy virtuous one. Medical
identity carries a meaning of goodness to it that asks of us
to consider what the virtuous physician does that does not
square with a lusting for personal gratification.
Discussion
Does Hegel’s philosophy offer more than an abstract
philosophical account that is neither empirically validated,
historically correct, nor relevant to contemporary medical
practice? This criticism of not mirroring actual practice
could easily be leveled at any philosophical analysis and I
think it is misguided because the aim of philosophical
analysis is not to make a catalogue of all possible ways that
something can appear or how identity looks or feels.
Granted, it would be problematic to construct medical
identity merely in terms of ancient (Greek) or early modern
(Faust) ideas on the person of the enlightenment, rather
than who the physician is today. But the gist of the
Phenomenology of Spirit [4] is not to write a history of
events, but to trace what logically is the case given that we
want to trace our identity as self-governing social agents.
In this paper, I have used Hegel’s philosophy to argue that
medical identity is neither a natural scientific object, nor a
personal biographical project, but part of a social activity
to explain how the physician as an autonomous social
agent is the product of sociocultural influences including
the enlightenment and Western European history of
science and philosophy. Other studies (in medical
sociology for instance) must examine the characteristics of
medicine as profession and how non-Western cultures (not
only ancient Indian or medieval Arabic medicine) in multi-
cultural societies inform how medical identity should be
conceived today.
Turning to the strengths, the argument pursued is that
Hegel’s sociocultural philosophy gives insights into the
development, logically speaking, of what concepts and
which cultural paragons and philosophical traditions are at
226
Medical identity
play when physicians struggle to be fully recognized. To
be a physician means to be recognized as a physician by a
larger community. Medical identity is situated in scientific
rationalism developing into a reflective medical identity,
which is both objectively and subjectively meaningful. To
be an observer of one’s identity, according to Hegel,
becomes untenable when the observer realizes that the
categories about what constitutes good doctoring and
medical professionalism need to be appropriated by the
individual and enacted in situations where the
observer/physician is consequently not a mere observer of
his or her identity, but someone actively pursuing a
medical identity. There is no objectivist scientific account
that can help us posit laws about what it means to be a
physician or how medical students’ develop a medical
identity. We must rely on a social scientific and relativistic
accord of how concepts and ideas evolve culturally. Even
if medical science could tell the physician which scientific
laws his identity obeys, this would be too abstract and
devoid of subjective meaning to be of use in formulating
who physicians are. Medical identity presupposes that
physicians through a self-reflective process can integrate
the norms and values of medicine with those values of
themselves.
Conclusion
Hegel’s account of identity and collective reason
developed here elaborates the social underpinnings of both
the good physician’s moral character as well as the positive
and negative identity ideals that the physician can
subscribe to. It helps clinicians more fully to appreciate the
one-sidedness of both objectivist (neurocognitive) and
subjectivist (humanistic) learning paradigms. Clinicians
with an interest in the identity aspect of learning might
benefit from digging into the Hegelian sociocultural
philosophical background of contemporary learning
theories (e.g., situated learning theory). Clinicians with an
interest in medical philosophy might find Hegel’s
philosophy one of the most ambitious attempts to explain
how being a physician and knowing medicine are logically
contingent notions. In conclusion, the ideal of medical
identity is that the physician is a virtuous person, inclined
to serve the common good of the community and, in
mastering the objective laws of science and the laws of the
heart, meets his or her individual interests in restoring
health to patients and recognition to the role of the
physician. As the conceptual basis of person-centered
healthcare evolves [22], it would valuably take into
account Hegel’s thinking.
Conflicts of Interest
The author declares no conflicts of interest.
 European Journal for Person Centered Healthcare 2015 Volume 3

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