Wily Patients, Welfare Queens, and the Reiteration of Race in the U.S

I. IntroductionThis paper is a product of eighteen months of anthropological fieldwork undertaken in the obstetrics clinic of Alpha Hospital - a large, public hospital in Manhattan. After finally receiving authorization to begin my fieldwork from all relevant Institutional Review Boards ("IRB"), well over a year after I began the approval process, I was eager to begin observation of the Alpha Hospital obstetrics clinic. Dr. Christina Smith - the Director of the Ambulatory Care Building that housed the obstetrics clinic, my initial contact with the hospital, the person who had been named as principal investigator of my study in the NYU IRB documents, and my direct supervisor in the hospital - suggested that I introduce my research and myself to the clinic staff at the clinic's monthly interdisciplinary meeting. Accordingly, my fieldwork began with me describing my project (within the five minutes allotted to me) to a motley assemblage of nurses, medical doctors,1 midwives, and administrative assistants that drifted in and out of the classroom over the course of the meeting.Subsequent to my brief talk, the executive director of Alpha Hospital gave a presentation, entitled "The Alpha Hospital Mission and Vision." In it, she described "the unanimous sentiment" felt by Alpha employees that working at Alpha was a challenging endeavor. The presentation continued with a relatively grim portrait of the hospital. She depicted a hostile state of affairs in which the categories of the players in the clinic were positioned in oppositional relationships to one another: hospital and clinic administrators against providers,2 providers against ancillary staff,3 and ancillary staff against patients. After the director concluded, Dr. Smith commented that, with regard to the acrimonious relationship between ancillary staff and patients, her personal observations supported those of the director. She offered that she received a consequential number of complaints from patients who were dissatisfied with and angered by the way that they were treated by staff persons. Indeed, over the course of the eighteen months during which I observed and worked in the Alpha obstetrics clinic, my field notes became filled with descriptions of outrageously hostile interactions between the frontline staff and patients. These displays of antagonism became a banality - an eventuality that I could observe on any given day that I was in the clinic. It was the ordinariness of these contentious interactions that compelled me to inquire into their significance, their causes, and their effects.Belligerent confrontations between staff and patients, I believe, are the consequence of a phenomenon whereby patients are largely viewed by Alpha Hospital ancillary staff as uneducated and unintelligent, yet somehow incredibly shrewd manipulators of the Alpha "system." The intersection of these contradictions in the fantasy of the patient seeking healthcare from Alpha produces a figure that I call the "wily patient." The wily patient, although obtuse, backwards, and altogether unintelligent, nevertheless possesses the ability to craftily and astutely exploit the hospital for the purpose of attaining access to undeserved appointments, ultrasounds, and other gratuitous healthcare.I explore this figure of the wily patient in Part II. The first section of this Part discusses demonstrations of that which is perceived by ancillary staff as patient stupidity, while the second section discusses demonstrations of that which is perceived as patient duplicity - the other term in the "wily patient" equation. The simultaneity of the contradictions present in the wily patient is not unlike that found in the fantasy of the "welfare queen" - that is, the obtuse, backwards, and unintelligent woman who nevertheless possesses the ability to craftily and astutely exploit the federal and state governments for the purpose of attaining access to undeserved cash assistance. Part III compares the figures of the wily patient and the welfare queen and notes a divergence between the two: while the welfare queen is implicitly Black, the wily patient appears to be of any race. …