ABSTRACT
Biomedicine is appropriate only for those existential threats in the present. It is the inability of most doctors to recognize that a healing ritual intended for the present is inappropriate for an existential threat in the past or future that has drawn such criticism from medical anthropologists. The medical students and residents occasionally get frustrated and judgmental when a patient refuses to follow the expected biomedical "ritual." To elicit illness narratives when someone is facing a life and death situation in the present is inappropriate. It is equally inappropriate to continue to push the biomedical healing ritual when the diagnosis is incorrect. Surgeons need to know when to do the procedure and when it is contraindicated. This decision is often determined by an anatomical diagnosis. For other difficult patients, the author diagnoses "social death." These patients have circumstances where there are no social connections that make life worth living. It carries a horrible prognosis. These patients need a "Mattingly procedure".
