Professional Documents
Culture Documents
We generally believe that doctors are good for us and society. This is
what functionalist sociologists like Parsons and Barber believe too.
However, this perspective has recently been questioned by a range of
critics. Illich suggests doctors often do more harm than good and
whilst this argument is a little exaggerated, the good old days when
doctors expected and got maximum respect seem to have gone.
Weberians like Parry & Parry suggest that doctors are generally
motivated by money whilst both Marxists and feminists suggest that
they are agents of capitalism and patriarchy respectively.
Postmodernists also point out that doctors are now under pressure
from alternative and complementary forms of medicine.
Introduction
Hinksman (2015) observes that in the UK, fully qualified medical practitioners
are placed into two categories, doctors and consultants. It is important to
understand the difference between these two medical roles.
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When a doctor diagnoses a particular condition and is unable, or equipped to
treat it, or the doctor can’t identify the condition, or the condition requires
extensive treatment, the doctor may refer the patient to a consultant.
Consultants have the same basic medical training as doctors but they also
have additional training in their specialist field of medicine so becoming a
consultant often takes longer than becoming say, a GP.
Consultants are therefore more senior to doctors. Most NHS hospitals divide
their wards into different speciality areas and a senior consultant will usually
be in charge of this ward, overseeing the other consultants and doctors that
work there. Most surgery in hospitals is carried out by consultants. An
important status difference between consultants and doctors is how they are
addressed. While doctors use the initials “Dr” before their name, many
consultants are referred to Mr/Mrs/Miss.
A number of sociological theories focus on how this particular group has come
to dominate the health profession in general.
Parsons argued that too much sickness could be bad for society because it
was a threat to social order. It could lead to the breakdown of the
economy, especially the specialised division of labour, i.e. the way work is
organised. For example, if this college’s caretaking staff were to go long-term
sick leave and not be replaced, think about how this might impact on other
jobs and roles within the college.
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Parsons argues that in order to manage sickness, modern industrial societies
have created the ‘sick role’. This means that society has agreed that
people need to conform to certain social characteristics in order to be
officially and legitimately defined as ‘sick’, i.e. to be excused work by
employers or teachers, to obtain a sick note, or to be officially
recognised as disabled or chronically ill enough to receive welfare
benefits.
The sick role involves certain rights and duties/obligations that ‘sick’
people need to adopt:
The patient’s needs must be put before the doctor’s self interest.
Confidentiality, i.e. the Hippocratic oath is central to the relationship
between doctor and patient.
The doctor must not take advantage of the patient in any way,
e.g. sexual exploitation can result in a doctor being struck off the
medical register and not being allowed to practice medicine.
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The doctor must use all their possible medical expertise to restore
health to the patient.
Other functionalist sociologists such as Barber (1963) argue that the medical
profession is very important for society because doctors deal with people
when they are in particularly vulnerable positions. It is, therefore, in the
interests of society to have the very best people, who maintain the highest
standards, to provide medical care. These people must not only be competent
but they must also be totally trustworthy.
According to Barber, doctors make up a true profession because they have the
following characteristics or ‘traits’:
(b) They are fully trained to the highest possible standards –only the
most intelligent and skilled can enter the profession and succeed.
(d) The profession has a strict code of ethics – doctors deal with
people at their most vulnerable and the code of ethics ensures that no
patient is exploited.
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Waitzkin (1979) argues that for many years these professional
characteristics and standards were mainly used as a barrier to prevent
groups, other than upper-middle-class white males, from entering the
profession. It is only in the last 20 years that there has been
significant recruitment of women and ethnic minorities into the
medical profession.
Functionalists claim that people become doctors because they are public
spirited –they are putting the community rather than self-interest first.
However, the existence of private medicine and the high financial
rewards paid to plastic surgeons to enhance feminine features
suggests that some people are attracted to the medical profession for the
money.
Illich suggests some doctors do more harm than good and that clinical
iatrogenesis (i.e. mistakes made by doctors in surgery and diagnosis as
well as the tendency to prescribe addictive drugs) is responsible for a
high number of patient deaths, harms etc.
Some sociologists are critical of the role of the General Medical Council
which is supposed to supervise the profession. It is argued that they
usually whitewash or ignore cases of incompetence, etc. Final
sanctions, like striking a doctor off the medical register, are used only
rarely and then more often for sexual misconduct rather than for
gross incompetence.
The Weberian approach is named after the early 20th century sociologist Max
Weber who argued that all workers compete with each other for status
and high rewards. He noticed that one way in which middle-class jobs like
doctors or solicitors did this was to organize themselves along professional
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lines, i.e. to form professional associations in order to bargain with
employers and protect their financial interests.
(1) They have gained control over the training and entry
requirements necessary for membership. This means that they are able
to control the numbers of people qualifying as doctors by
constructing a series of specialist educational courses and qualifications.
The number of new doctors is deliberately kept quite low in order to
ensure scarcity and consequently this means they can demand or
charge more for their services.
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para-medical practitioners who have patients referred to them by
doctors.
Parry and Parry argue that doctors are self-seeking individuals who adopt
market strategies in order to maximize their earning power. In
particular, controlling access to the profession and limiting the number of
doctors being trained has been very effective and has resulted in doctors
becoming very wealthy, privileged and secure. From a Weberian
perspective, then, the medical profession is looking after its own
interests as well as those of its patients.
Marxists argue that doctors are agents of the state who work on behalf
of the capitalist class in a number of ways:
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illness is a product of the unequal way capitalist society is
organized. Marxists claim that the main way to improve health is by
reducing economic and social inequalities.
Marxists point out that health and illness in a capitalist society are
carefully linked to being able or not being able to work. Doctors play a
key role in deciding who is fit to work and who is sick enough to
be eligible for state disability and sickness benefits. In this sense,
doctors socially control the workforce on behalf of the capitalist
class. They ensure that people do not skive off work.
However, critics point out that Marxism ignores the genuinely beneficial
work that doctors do, and that to characterize their work as mainly focused
on misleading and controlling the population is inaccurate. Doctors do mainly
work in the context of individual problems but they also recognize and
acknowledge stress in the workplace and the role of poverty.
Some Marxists, notably McKinley suggest that Navarro and Doyal and Pennell
exaggerate the power of doctors. He argues that their professional
freedom has been weakened by the state to the extent that doctors too are
exploited by the capitalist bourgeoisie. McKinley argues that their role
has been reduced to ‘drug pushers’ in that they prescribe drugs for all ills
and so generate greater profits for the bourgeoisie who own and
control the drug companies.
However, the biggest external challenge to the power of doctors has come
from complementary or alternative medicines, which include homeopathy,
herbal remedies, acupuncture and a range of other techniques.
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Giddens (1991) has argued that this challenge is the result of the
development of late-modern society. Three particularly relevant characteristics
of late modernity are:
Feminist sociologists, such as Oakley (1986) and Witz (1992), suggest that
the activities of doctors contribute to the social control of women. They
point out that medicine has traditionally been a male occupation. In the
past women were excluded from practicing medicine. Now they are accepted,
they are often marginalized into junior roles. These processes simply
reflect and reinforce the subordinate position of women in society.
Feminists point out that historically, women have always held a key role in
healing and traditional healthcare. For example, women dominated health
care in medieval Britain as herbal healers. However, feminists claim that
women’s power as healers threatened patriarchal power in this period and
women who practiced herbal medicine were consequently labelled ‘witches’
and punished accordingly.
Similarly, women in Victorian Britain were not legally prevented from entering
the medical profession but the patriarchal values of this period meant that
women were generally excluded from higher education which meant that they
were effectively barred from becoming doctors.
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In recent years, feminist sociologists such as Oakley have complained that
doctors have attempted to take control of areas of health such as
childbirth that were previously dominated by female health workers
such as midwives. Graham points out men still dominate the top jobs in
the NHS, i.e. consultants and surgeons. Women consultants are
disproportionately represented in stereotypically feminine areas such as
paediatrics.
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