The Role of Medical Professionals in

SocietyG672

DiscussO Do you trust your doctor? Why/why

not?

O Do you think doctors have a high status in the contemporary UK?

In Pairs/Small GroupsO Create a mind-map demonstrating

all the different parts/branches of the medical profession.

The Role of Medical Professionals

Two Central Arguments:

1. THEY ARE A POSITIVE FORCE IN SOCIETY

Functionalism

2. THEY CAN BE A NEGATIVE FORCE IN SOCIETY

Weberianism, Marxism, Feminism

1. The Functionalist View

Medical Professionals are a Positive Force

Parsons (1951): The Sick Role

O Sickness is a potential threat to social order.

O Too much sickness in society is deviant. (Discuss: WHY?)

O To be considered legitimately ‘sick’, a person has to conform to the sick role.

Why is sickness deviant?

O Society is work-centred. In order for society to function, everyone needs to be fulfilling their roles as workers.

O Too much sickness means that too many people are not fulfilling this role and society will suffer.

Society therefore needs medical professionals.

Activity: Pairs

Make a list of:

O All the duties you relieve yourself of when you are ill

O The things you do to assist you recovery

The Sick Role

To acquire the sick role, you must:1. Define sickness as undesirable

and want to get better2. Not expect to take care of

yourself3. Be willing to seek and engage

with the help of medical professionals

4. Not go to work/school

The Sick RoleO If ‘sick’ people do not acquire the sick role,

they risk getting more sick and making people around them sick. This could be very disruptive to society.

O Parsons believes that the role of the medical profession is to promote the sick role and to ensure that sickness never becomes deviant.

O Doctors and other medical professionals basically protect society from sickness.

DiscussO What makes a good doctor?

O What rights and obligations do you think a good doctor should have, in order to do his/her job properly?

The role of Medical Professionals

To fulfil their own role, functionalists believe doctors should:O Have the right to examine patients (both

physically, and in terms of lifestyle)O Have authority over the patient and

autonomy in practice.O Put the needs of the patient before their

own.O Focus on restoring health by providing

specialist help/expertise.

The role of Medical Professionals

O Medical professionals should have high status and rewards because their job is so important to society.

O They have a strong social commitment e.g. the doctor’s Hippocratic Oath.

O It is important that people trust them…and functionalists believe we do trust them, because…

We Trust Them Because…

O They have studied and trained for many years to be able to make assessments of our health. Medicine is a competitive field; only

the best make it through.

O They follow a strict code of ethics, which ensures their decisions are made in the best

interests of their patients.

O The GMC regulate them very carefully.

Evaluation Points

Favours a biomedical approach:O What would McKeown say about the

sick role?O What would Illich say about the view

that people should always trust and obey medical professionals?

Evaluation PointsO People do not always follow medical

advice.O Publicised accounts of doctors failing

in their duties has eroded trust in medical professionals.

O Only a minority of symptoms ever get reported (Young; 2005)

O The sick role cannot be applied to conditions from which people never recover (e.g. chronic or terminal illnesses).

Further Evaluation

Watch the Clickview documentary: A Very Dangerous Doctor

2. The Weberian View

The medical profession does little more than serve its own interests…

Weber

The Weberian approach suggests that medical professionals enjoy having high status, powerful positions in society and want to ensure it stays that way…

Occupational groups use strategies to increase their amount of status and power (Max Weber)

It’s before 1958 and anyone can be a medical professional. We’re all surgeons. Hooray!!!

Now it’s 1958. The General Medical Council has been set up. Now, we decide who gets to be a medical professional. You have to pass our tests and standards. You can’t all be surgeons any more, so get lost. Now it’s after 1958. We passed the

tests, so we’re the medical professionals and are respected by our society (and get lots of money and power)…

…But I didn’t take the tests. I’m still allowed to try and help people, but I’m not allowed to call myself a medical professional, or doctor. I don’t get the same status or power.

Friedson (1970)O Claims that medical professionals

gain social closure through power and dominance.

O They have created a sector than only few can enter. Competing health providers are forced into subordinate positions, with less status/power.

Millerson (1964): Techniques of Closure

Social closure is gained through:O Theoretical knowledgeO Specialised educationO Formal examinationsO Independent regulatory bodiesO Professional codes of conductO The aim of ‘serving the public good’.

Turner (1987)O Doctors maintain their privilege

through having a monopoly on truth.

O They keep patients ‘mystified’ to maintain social distance (what did Foucault say about this?)

O Doctors remain at the ‘top’ of the profession through occupational dominance…

Activity

Individually: Read the article provided.

In Pairs: Answer the accompanying questions.

(15 mins)

Turner (1987): Occupational Dominance

Occupational dominance is achieved through:O Making other healthcare providers

(e.g. nurses, midwives) subordinate to doctors

O Forcing other ‘professionals’ to limit their activities to one part of the body (e.g. dentists)

O Excluding other healthcare practitioners (e.g. ‘alternative’ practitioners) from operating fully.

Evaluation PointsO Relies on the biomedical model again…if the

focus of society shifted to more social, preventative measures, doctors would lose some of their power…

O Paramedical occupations (e.g. nurses, midwives, pharmacists) are becoming increasingly professionalised. This too means doctors lose power…

O Alternative medicine is growing in popularity!!!

3. The Marxist ViewDiscuss: Based on your knowledge of

Marxism, what do you think the Marxist view of medical professionals would be?

The Marxist ViewThe medical profession benefits capitalism and the bourgeoisie. 1. It ensures a healthy workforce (therefore

increased profits)2. It gives power and wealth to drugs companies3. Expensive private medicine means wealthy

people get better healthcare4. Doctors focus on individual problems, hiding

the social causes of illness (e.g. poor working conditions).

(Navarro; 1979)

I’m a pharmaceutical company. I make people need pills and then make pills that people need. I’m rich.

I’m a private doctor. I charge a fortune for services that the NHS would give you for free. I’m rich.

Us doctors are also the only ones who can officially define you as sick. This means you have to come to us when your ill. It makes us richer, and other health providers poorer…

I’m a business owner. The medical profession means that my workforce are fit and healthy. This makes my companies more productive and therefore makes me and my wealthy friends richer!!!(PS: You’re fired. Just kidding.)

MarxismO The medical profession has an ideological

control over health (how we think about health is controlled by professionals)

O The biomedical model is promoted as the ‘best’ way of understanding health/illness, because this model gives power to professionals…

“The notion that illness is an individual biological problem is one that diverts attention away from the social system.

Medicine is a form of social control.” (Navarro)

Evaluation PointsO Marxists ignore the beneficial work that doctors

do…O …In the UK, the NHS provides ‘free’ healthcare

to people regardless of social class. The NHS is often referred to (especially by its US critics) as “socialized medicine”.

O Marxists also assume that we always do what doctors tell us…increasingly, this is not the case…

O …And there is increased awareness in the contemporary UK of social factors that influence health.

4. The Feminist ViewDiscuss: Based on what you know of Feminism, what do you predict the

feminist argument would be?

The Feminist ViewO The development of the medical profession

saw power and knowledge being taken from women by men (Doyal; 1985)

O Before the Medical Registration Act (1858), women were the main healthcare providers. Now they are ‘helpers’ in a male-dominated profession.

Are any types of medical professionals more often female?

The Feminist ViewThe Medical Profession serves

Patriarchal Interests

O Most contraception is designed for men. Not because men use them – but because they have health risks for women that men would not tolerate.

O Childbirth has been medicalised (Oakley; 1984) – women giving birth are treated like there’s something wrong with them…

The Feminist ViewO Women in healthcare tend to have

subordinate roles.O Cosmetic surgery is criticised as

being a medicalisation of beauty.O Labelling women with depression

and hysteria is a way of controlling them.

The Feminist Perspective

O Biomedicine neglects post-natal depression, menstruation and the menopause. Few male doctors take such conditions seriously and there has been little real medical research done in these areas.

The Feminist Perspective

O According to radical feminists, the medical profession works to control women e.g. the increasing diagnosis of ‘hysteria’ coinciding with the rise of the women’s movement…

O …This suggests that women wanting independence and acting assertively could be medically diagnosed as ‘abnormal’ (Showalter; 1991)

DiscussO How would feminists explain the

relationship between eating disorders such as anorexia and the medical profession?

CriticismsO Medicine does harm to men as well

as women e.g. until very recently, there was a significant lack of awareness campaigns for prostrate or testicular cancer (compared to those for breast cancer)…

5. Other Views

Other Views: Illich (1975)

O Health is the ability to cope with the reality of death and illness.

O Biomedicine is taking away that ability…O …Therefore, biomedicine (and medical

professionals) are making us ill through:1. Clinical iatrogenesis (the harm caused

through treatment)2. Social iatrogenesis (the medicalisation of

our normal processes)3. Cultural iatrogenesis (the destruction of

traditional ways of coping)

Other Views: McKeown (1976)

O Medical intervention has had little impact on health improvements over the last 200 years.

O Health improvements have been mainly due to social factors.

Other Views: Foucault (1973)

O Medical discourse is dominated by doctors and other ‘professionals’. They use it to medicalise human behaviour.

O Overweight becomes rebranded as obesity. Sadness is rebranded as depression and worry as anxiety.

O This use of language gives power to these professionals.

O Doctors use their special language and knowledge to gain power today in the same way that priests did in Medieval times.

Other Views: Postmodernism

O When we are ill, we ‘shop around’ to see what suits us best (Senior; 1993).

O Professionals may lose power as we take a more individualised approach to our own health and illness…

O …The Media may also be gaining power in this respect…

O …This may be because we are moving away from relying on only one model of health.

Evaluation PointsMany of these view assume:O The biomedical model is dominantO We always go to our doctor when we are

ill and always do what they sayO Healthcare is distributed unequally (e.g.

women or poor people are treated worse)

As societies move towards more social models, offer more variety of healthcare providers and offer free, universal healthcare, many of these

views may no longer apply.

Homework

Patients are not the priority of doctors

In 1000-1500 words, evaluate this statement in a blog/written

submission.

Due: Next Week