AQA Unit 2: Sociology of Health (14)

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.

The role of medicine, the health professions and the

globalised health industry

Introduction

The medical profession – doctors covering over 60 specialities - have managed

to become one of the most prestigious and well-paid groups in society whilst
other health professionals such as nurses, midwives, paramedics, nurse
practitioners, health visitors etc have not managed as occupational groups to
achieve such giddy heights in terms of status and power.

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.

The term ‘doctor’ usually applies to General Practitioners (GP), which is

somebody trained in a broad range of medicine. Doctors work in a variety of
settings such as GP surgeries, where they treat people living in the local
community, and in hospitals, where they work alongside consultants, nurses
and other healthcare workers. They are responsible for diagnosis, treatment,
care and the well-being of patients. It is a doctor’s responsibility to make the
initial diagnosis of a patient and in many cases doctors can treat the condition
themselves. Doctors are permitted to write prescriptions, enabling patients to
buy controlled medicines, and can carry out minor procedures, and even minor
surgery.

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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.

(1) The functionalist approach: doctors are a benefit to

society

Functionalist sociologists see medical professionals as selfless individuals

working for the good of the community, often making great personal
sacrifices in the process of getting qualified. Functionalists argue that people
who want to be doctors need to be of the highest intelligence and skill,
have to undergo years of training and in their early careers earn very
little. They therefore argue that the high financial rewards that qualified
doctors earn are necessary to attract, retain and motivate the best
people into the medical profession.

The sick role – Talcott Parsons

Most functionalist sociologists argue that the medical profession is

beneficial to society. The first functionalist to argue this was Talcott
Parsons who saw doctors as central to the functioning of what he called ‘the
sick role’.

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:

 They must define sickness as undesirable and want to get better.

 They must allow doctors and nurses to take care of them.
 They must always follow the advice of their doctors.
 They must be exempted from their normal activities such as work or
school.

Parsons argued that the medical profession’s main function is to promote

the sick role to ensure that sickness does not become deviant or
threatening to social order. Doctors therefore have certain rights and
responsibilities such as:

 The right to carry out an examination of the patient’s physical

condition
 The right to ask personal questions about lifestyle.
 The right to exert authority over the patient (i.e. the patient must
follow doctor’s orders regardless of their status, e.g. even the
Queen obeys her doctor).
 The right to have the freedom to treat patients as they see fit –
other doctors and medical professionals must not interfere (although
GPs will defer to those with higher authority such as hospital
consultants).

However, Parsons notes that doctors also have obligations or

responsibilities towards patients including:

 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.

The professionalization of medicine - Barber

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’:

(a) Science underpins their knowledge – doctors have a full

understanding of medical theories about the body. This allows
them to make informed rational decisions about the cause of illness and
the best possible cure.

(b) They are fully trained to the highest possible standards –only the
most intelligent and skilled can enter the profession and succeed.

(c)Competence is tested by examination – there is no favouritism and

doctors are in their position as a result of their ability alone.

(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.

(e) They are regulated and controlled through a professional

organization (the General Medical Council) which decides who can
enter the profession. The GMC also has the power to punish and
exclude doctors from the profession for any misconduct (i.e. to strike
them off the medical register so that they can no longer practice
anywhere in the UK).

Criticisms of the functionalist approach

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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.

 Feminists are particularly critical of the male-dominated medical

profession and suggest that many iatrogenic diseases affect women
only, for example, those stemming from using contraceptive pills and
devices, and from hysterectomies. They also note disapprovingly that
doctors have medicalized pregnancy and childbirth and taken
control away from midwives and women.

 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.

(2) The Weberian approach: people go into the medical

profession because of the high financial rewards &
status

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.

Parry and Parry (1976) suggest that professionalization is an

occupational strategy for controlling the labour market for the
advantage of doctors. They note that in pursuit of greater financial
rewards doctors have deliberately acquired the following professional
characteristics:

(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.

(2) All doctors have to belong to the British Medical Association.

This means that doctors can claim they are maintaining the highest
public standards because they also claim the right to investigate and
punish their own members. This makes it difficult for other groups
such as the police or politicians to examine their activities.

(3) Doctors have managed to convince the government that only

their members are qualified to carry out medical diagnosis and
treatment. This monopoly is backed by law – it is a criminal offence to
impersonate a doctor and to carry out medical diagnosis.

(4) The medical profession has attempted to exclude any

competition to doctors’ expertise and knowledge. Alternative
medicines such as faith healing, homeopathy, aromatherapy etc have
been attacked and discredited by the medical profession who claim
that only scientific medicine and surgery are effective.

A good example of this exclusion in practice has been provided by Cant

and Sharma (2002), who studied the relationship between the medical
profession and the practitioners of chiropractics. (Chiropractics is the
manipulation of the spine, joints and muscles in order to realign them.)
For over 60 years, chiropractors campaigned to gain legal recognition,
which was finally granted in an act of parliament in 1994. But Cant and
Sharma point out that in order to get this recognition, chiropractors
effectively had to subordinate themselves to doctors. In other words,
they do not have the same status as doctors – they are effectively

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 para-medical practitioners who have patients referred to them by
doctors.

(5) Medical professionals are concerned with maintaining their

privileges and status. Doctors have fought all attempts to impose any
controls over them –they demand clinical freedom - the right to do
what they think is best – and they fight any attempts to hand over part
of their work to others, such as allowing nurses to prescribe medicines.

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.

(3) Marxist approaches – doctors work on behalf of

capitalism

Marxists, such as Navarro (1977), argue that in capitalist societies such as

Britain, a small ruling class exploits society for its own benefit. He argues that
doctors are agents of this capitalist class and their high status and
salaries are the rewards they receive from the capitalist ruling class for
playing their part in maintaining economic inequality and exploitation.

Marxists argue that doctors are agents of the state who work on behalf
of the capitalist class in a number of ways:

 Marxist writers on health, such as Doyal (1979) and O’Connor

(1973), argue that doctors and the health service have a ‘legitimation’
role, in that they persuade the bulk of the population that capitalism
‘cares’ for them. In this role, the medical profession acts to limit class
conflict and social unrest by creating a sense of false harmony.

 Doctors mislead the population as to the real cause of their

illnesses. The medical profession explains health and illness in terms of
individuals’ actions and genetics. Marxists claim that doctors very
rarely focus on the poor working conditions, poverty, poor
housing and inequalities in society, which Marxists claim are the
true, underlying causes of ill health. Doyal and Pennell argue that a
NHS based on cure rather than prevention helps hide the fact that

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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.

 Doctors ensure the health and fitness of the workforce so that

workers go to work on a regular basis and continued to be
exploited by the capitalist class.

 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.

(4) Postmodernist approaches – the decline in public

confidence in doctors

Postmodernists argue that the dominance of scientific and medical ‘meta-

narratives’ has been challenged in recent years. Doctors are no longer
seen as infallible and the concept of iatrogenesis has undermined the concept
of medical professionalism.

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:

 There has been a decline in conformity. There is now a greater

stress on individualism and choice. If people are ill today, going
to the doctor is only one possible choice of treatment among
many.

 People are becoming disillusioned with medical science and

consequently there has been a decline in the idea that ‘doctor knows
best’ because of problems like iatrogenesis.

 A much wider range of behaviour is tolerated today - this makes

the distinction between ‘normal’, ‘eccentric’, ‘creative’ and mental illness
far less clear.

Consequently, people in postmodern society no longer instantly defer to

the medical profession as in the past. They are more likely to question
the way doctors operate.

(5) Feminist approaches – doctors behave in patriarchal

ways

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.

The role of patriarchy

Feminists argue that women’s illnesses result from patriarchal factors

such as women’s subordinate position in society and in the family.
However these causes are turned into a medical problem by a male-
dominated medical profession. This shifts the issue away from the social
position of women in general, to the particular medical condition of a single
woman.

Furthermore, feminist sociologists claim that symptoms reported to doctors by

females are often dismissed as ‘women’s problems’ which are defined by
doctors as less serious than other medical problems. There is evidence too
that women are more likely than men to be victims of clinical
iatrogenesis because of the side effects of contraceptives, anti-depressants
and tranquillisers which are disproportionately prescribed to women.

However, in criticism of the feminist perspective:

 The traditional male-dominated medical profession’s monopoly of

healthcare has been strongly challenged over the last 20 years by an
influx of ethnic minorities and women.

 There is also evidence that doctors are failing to meet men’s

health needs too, e.g. prostate and testicular cancer prevention and
screening programmes have not been given the same priority by the
NHS as breast or cervical cancer.

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