The Doctor-Patient Relationship: A Review
Talcott Parsons' work for the subsequent development of medical relationship as a social system built upon Emile Durkheim's interest in the societal return, the physician is reciprocally obliged to act in the patient's best . structural functionalism is described at such a level of generality that it defies. Talcott Parsons was the first social scientist to theorize the doctor-patient relationship, Physicians exemplify for Parsons the shift to "affect-neutral" relationships in . biological processes from the patient, 2) use the passive voice in describing. Parsons' sick role concept has become problematic in the face of the increased fundamentally changing the doctor-patient relationship. But as the various transitions described under labels like 'post-Fordism' and 'the New Economy', both.
In order to get well, the sick person needs to seek and submit to appropriate medical care.
Professional–Patient Relationship: II. Sociological Perspectives | posavski-obzor.info
These postulates, and societal attitudes towards illness, were vividly captured in the bawdy films of the time such as Doctor in the House and Carry on Doctor. The patient, in gown or pyjamas thereby identifying and labelling them as illlistened anxiously to the dispassionate words of the august surgeon who graced their bedside, desperate for any clue as to when he or she might be released from hospital back into society. The route of such release was rather binary: From the sick role to…? Health,; Vol 9 2: Gone are the days of languishing in pyjamas for weeks in hospital.
Being sick is no longer a temporary phase, and not one which exempts us from our usual obligations; now the unwell usually continue completely as normal in their jobs and social lives. Patients will also be self-managing for most of their illness; the requirement that they must seek and submit to medical care is also looking unsound.
Instead of wanting to get better an impossibility in much chronic diseasepatients are now more concerned with avoiding the sick role altogether.
The medical profession has accordingly had to adapt to the demise of the traditional sick role. We no longer expect the subservient patient to submit to our bedside ministrations. Health behavior as coping Julius A. Roth General theory: The patient, as a result of pressures to join large healthcare organizations, cannot freely choose a doctor or join with the doctor in certain decisions because cost control by the organization intervenes.
Such interpretations were buttressed by the increase in large-scale organizations for the delivery of healthcare, but the interest of scholars in psychosocial factors in therapeutic encounters continued to be strong.
Compliance, the extent to which patients follow the recommendations of their therapists, for example, remained an important problem independent of the organizational framework for healthcare. Marshall Becker and Lois Maimon described a "health belief model" that made individual motivations and beliefs about the validity of treatment methods the central factors of health behavior.
Attempts to quantify the sociobehavioral determinants of compliance preoccupied many researchers during the next two decades. The physician, at the same time, has been scrutinized in comparable empirical and quantitative detail as a "decision-maker" Elstein et al. This quantitative trend is reflected in the training and assessment of medical students and residents.
With the increasing orientation toward the use of measurements of clinical reasoning and behavior, didactic teaching and memorization are being replaced by problem-based learning and experiential learning situations such as simulations of clinical cases, called standardized patient SP methods Woodward and Gerard.
The goal of these efforts to change how physicians are trained is to create a more patient-oriented approach and, at the same time, influence doctors to become active, lifelong learners in order to maintain effectiveness under conditions of rapidly advancing basic medical sciences Marston and Jones.
The Nonmedical Healing Professions The history of the healing professions has been dominated by medicine. Although nurses, public-health workers, dentists, and social workers have been major contributors to the health of individuals and communities, their professional status and power have always been less than those of physicians.
However, dramatic changes have expanded the need for the care of health and disease, challenging the monopoly of doctors. Constantly advancing technology applied to diagnosis and treatment, the increase in life expectancy and consequent growth of the elderly population, and changed patterns of illness and disability have forced physicians to depend on partnerships with members of other healing professions.
Nursing is the outstanding case in point. Nurses, although much more numerous than physicians four nurses for every doctorincreasingly professionalized overhave master's or doctorate degreesand performing tasks in health settings previously restricted to physicians, continue to struggle for release from the view, argued by Freidson, that, following precedents established by Florence Nightingale more than a century ago, "All nursing work flowed from the doctor's orders … [so that] nursing became a formal part of the doctor's work, a technical trade.
There is some evidence that success in this struggle is at last being achieved. Advanced-practice nurses, for example, are registered nurses with specialty training, usually at the master's degree level, in primary care i.
The practice of nurse practitioners has been evaluated since when the role was developed by Henry Silver, M.
When measures of diagnostic certainty, management competence, or comprehensiveness, quality, and cost are used, virtually every study indicates that the primary care provided by nurse practitioners is equivalent or superior to that provided by physicians. As a result, nurse practitioners can establish independent practices that parallel those of primary care physicians either solo or health maintenance organizationsor they can establish collaborative practices in which doctors and nurses care for patients together.
Nevertheless, these other professions remain in the shadow of medicine. As a consequence, nurses, probably the highest-status members of the paramedicals, earn an average of less than a third of physicians' incomes; their training, except for the 5 percent who have earned higher degrees, is considerably shorter and less rigorous; and nursing is almost totally a women's profession, a fact that, regrettable though it is, remains a classic indicator of low occupational status.
However, as indicated by the testimony of Mary Mundinger above, the status of nursing as a profession has changed. Increasingly, nurses are both trained in and responsible for the complex knowledge and technical aspects of patient care.
In83 percent of new graduates were trained in hospitals, the rest in colleges and universities.
Bythose figures had reversed. We are witnessing, therefore, a historical development in nursing reminiscent of the changes that occurred in medicine in the s. Like medicine in the post-Flexner era and followingnursing is seeking to increase its professionalism by extending its training in close association with the university.
Included is new emphasis on biomedical science and research. The value implications of these changes are of particular concern.
Professionalism for nurses tends to emphasize intellectual and technical skills in an occupation whose major function has been as much the ministering of nurturant and humane care as technical prowess. For the patient, the options seem to narrow as knowledge and technical skill increase. Whereas once it seemed reasonable to expect physicians to combine technical expertise with emotional sensitivity and skill, and nurses to complement them in both, now the patient gains equality and independence but with increasing emotional distance from caregivers.
Under the current conditions of healthcare, social workers would seem to have a strategic role. They are, after all, uniquely trained in the skills of interpersonal relations, and professionally are intended to function as the patient's advocate for well-being, both within the period of illness and in preparation for the recovery period.
Yet, here, too, the pressures for professional status take an ironic toll.
A trend toward private practice with fee-for-service financial rewards attracts social workers toward professional status on the medical model and away from the team model in which their function is to balance the technical with the social.
The same value dilemma confronts all the healing professions. A polarization has developed between two orientations, one centered on the what of healthcare and the other on the how. The former has been called a reductionistic approach, emphasizing biomedical knowledge and technology; the latter is the "social ecology" or "humanistic" approach.
The values of these two approaches are significantly different. The more traditional, reductionistic approach is dominated by faith that all problems of health and illness have rational solutions, and by a dedication to competence in practice and to a community of science that transcends personal interest.
Patient, societal, and ethical issues are seen as matters of opinion not susceptible to rational discourse Pellegrino; Fox, The approach of social ecology, on the other hand, rests on a very different set of values.
The social and behavioral sciences and even the humanities are here as pertinent as the biological sciences; students are selected on the basis of social concern and interest in people and their problems; emphasis is on caring as much as on curing.
The community, not the university hospital, is the proper locus for the education of health professionals. Although one can say that neither of these approaches has sought or gained exclusive dominance, their differences are important enough to generate partisan claims from each about the failures of the past, the needs of the future, and the implications for patients and society. Both the value of modern science and the critical need for enlightened social and ethical orientations can be found in the way national commissions are addressing the problems of today's healing professions Marston and Jones.
Summary and Conclusions The definition of the professions is the foundation of sociological analysis of the professional—patient relationship. Uniquely among modern occupations, a profession has been seen as an activity that requires extensive training based upon a continuously developing knowledge base coupled with the application of such knowledge for the general welfare of society.
II. SOCIOLOGICAL PERSPECTIVES
Therefore, although the rewards of professional life have been substantial, it is assumed that the professional is not free to exploit such skills and knowledge for personal gain alone, as other entrepreneurs may—the socalled principle of caveat emptor let the buyer beware.
On the contrary, the professional is granted unusual privileges involving access especially to the personal and biological privacy of patients, but only on an implicit contractual premise that such professional rights will conform to general rules of the welfare of society.
Medicine has been the primary subject of such analysis because it is seen as the archetype of professions. Virtually every person needs the help of healing occupations; the other classic professions, the law and the clergy, are not so ubiquitous.
Therefore, a large sociological literature grew out of the study of medicine as a profession. However, the practice of medicine has changed radically in modern times and continues to change. Research in the biomedical sciences is usually considered the major driving force of this transformation, but changes in the social organization of the delivery of health services, the application side of the medical profession, have been no less dramatic.
In the wake of both the bioetchnological and application developments, new ethical issues have appeared and earlier ones have deepened. Bioethics as a separate discipline has grown significantly, very likely as a direct consequence of these changes. Sociology, meanwhile, has spawned its own forms of interest in medical ethics.
In part, sociologists have followed the tradition of individualism, which interprets behavior as a social psychological process determined by the values individuals learn and carry with them into social encounters. A different perspective emphasizes the material technologies and organizational constraints that dominate the therapeutic relationship. For example, the bureaucratization of medicine has advanced, creating a situation in which both doctor and patient meet less as individuals than as members of groups.