RESEARCH ON MEDICINE

Research on Medicine

Research on Medicine

Introduction

Hardly a daily newspaper appears without an article about doctors or about the medical profession. On popular television programs physicians are portrayed either as humanistic healers meeting the complex demands of individual patients, or, more recently, as frantic super-heroes ministering to somewhat anonymous bodies in high-tech emergency rooms. At the same time, there are accounts of strife between governments, insurance companies, or hospitals and medical organizations over fees or costs. Newspapers report on the huge incomes of some doctors, the horrors visited upon patients by malpractice or malfeasance, and complaints by unorthodox healers of being persecuted by the medical profession. An apparently endless procession of new medical discoveries, as well as the much-publicized potential of the 'new' genetics promises much, but the day-to-day reality is less Utopian. Whereas medicine at first glance might appear as the self-sacrificing, altruistic, scientific occupation par excellence, the reality is that it contains profound dualities and contradictions.

Professions and Power

Theory

To paraphrase Johnson (2000, pp. 187) in his comments about work: 'professions are a relation of power.' That is, within the sociology of health, medicine has most often been viewed as being the central node in a network of relationships in which the profession both generates power over other groups or institutions and reflects or is shaped by 'external' factors and forces. In discussing sociological views of medicine we are thus mainly talking about the changing extent, nature, sources, and consequences of, or explanations for, medical power. Put somewhat differently, the focus has been on the social and cultural authority of medicine and its professional autonomy (Elston 2001, pp. 166; Starr 2002, pp. 291). That is, medicine possesses power as expressed in social organization, in the way people think about and act regarding health care, as well as its control over medical work itself. In fact, sociologists are preoccupied with professional power to the neglect, perhaps, of other dimensions of the profession such as the changing nature of actual medical work, or the meaning or implications of illness, caring, and cure for both doctors and patients.

Social and Health-Care Trends

Just as sociological perspectives on medicine have changed over time, the profession has also inhabited a changing health and healthcare context. There has been a major transformation from a situation in which physicians were petty bourgeois entrepreneurs to physicians as part of huge and growing health-care markets. A situation in which health care was given primarily in the domestic sphere has been transformed into one in which most health care is provided 'impersonally' by paid experts within a mass market for care. In the duration of less than a century, medical work has changed from individual healers within a 'cottage industry' to a highly complex health-care division of labor surrounded by huge industries. Health care now dwarfs in size such industrial giants as steel and automobile manufacturing and, in most Western countries, spending on health care is in the range of 8-9 per cent of national ...