In Western medicine, just as in law, religion, and the military, there is a single group located above all others at the top of this social institution. This group is an authoritative minority endowed with certain privileges/rights/duties/obligations and, subsequently, they are required to fulfill certain roles. This group is, of course, composed of physicians.
As a group, physicians are individuals who have spent an extensive amount of time and other resources in order to study the human body in great detail, normally honing in their expertise on a specific organ or organ system. As a result of their formal training at medical school and practical experience in clinics and hospitals, they are, so long as they meet the proper professional standards, in a nearly inimitable place within Western medicine. Their knowledge of the human body and experience preventing and healing illnesses make them technically competent.
Just below physicians on the totem pole of Western medicine, there are a plethora of other groups such as nurses, medical assistants, emergency responders, interns, and administrative personnel. These secondary and tertiary groups assist the physicians in successful diagnosis and treatment of patients (to varying degrees, depending on the context), but their roles do not inherently merit or require the same amount of respect, authority, or technical competence that the roles of physicians do in Western medicine.
All the way down at the bottom of that totem pole, and with the largest disparity in position and capacity (relative to the leading role of the physician in the social hierarchy of Western medicine), is the patient. The patient/physician interaction is critically shaped by the rigidity of the social hierarchy to be found within Western medicine. In describing the nature of the patient/physician relationship, Parsons lays out four distinct features of the patient/physician relationship that establish and maintain a particular subordinate/superior form of relationship expressed in terms of power/authority.
Before going further, an extremely important distinction must be drawn. Power and authority are, categorically, not the same things. The legitimization of authority, in at least one form, allows one to exercise more power. In this case, the physician is bestowed with authority through his extensive knowledge of and training with the human body, coupled with the recognition of the former by the social structure known as medical school. The authority of the physician allows him/her to suggest, recommend, and, in some cases, command the patient to complete or permit certain actions.
The first feature of this relationship is an “exemption [of the patient] from normal social role responsibilities” (Parsons 294). When a physician declares or verifies that an individual is “ill,” he/she is publicizing to the rest of society that this particular patient is not capable of fulfilling his/her normal social roles. This declaration or verification is not only descriptive in that it seeks to explain the physiological malfunctioning of the patient’s body (AIDS, leukemia, mononucleosis, etc.), but also normative in that it carries with it a modified set of obligations, responsibilities, and connotations for the individual.
This participatory exemption (i.e. justification for not fulfilling one’s social role(s)) is verified by the physician and then communicated to those affected by it, usually in some sort of written form, whether it be a physician’s note or a prescription for some kind of pharmaceutical drug. Yet, as Illich observes, more than that, the physician can “define either temporary or permanent roles for the patient” (89). A diagnosis of the flu or ringworm can be cured and the status of the patient reverts back once treatment is complete. But in other cases, especially with cancer, a stigma continues to hound the patient and the patient’s family even if treatment is successful, which isn’t always the case (Sontag 7-9).
The next distinct aspect of the medical relationship is that the patient who is sick or ill cannot properly be praised for getting well on his/her own nor condemned for not doing so; “he[/she] is in a condition that must “‘be taken care of’” (Parsons 294). The level to which the patient must “be taken care of” by the physician depends on several factors, not all of which are anatomical/physiological in nature. Such factors span the realms of economics, politics, and the like and cannot be resolved by any medication, but require a shift in societal attitudes and organized efforts to catalyze the desired change.
As Michael Moore notes in his documentary Sicko, there are numerous instances each year in the United States in which a patient’s ability to recover and regain his/her former condition of health is hampered by the inability to afford certain types of treatment/medication.
Compare their situation to those who have private health insurance and have more disposable income and a gap in access to health itself becomes strikingly obvious. Those poorer patients end up relying on the physicians and their accompanying resources more intensively and for a longer period of time.
A third component of being declared sick or ill is that such a condition is held to be undesirable by the patient. There is an expectation of the patient to want to recover, to want to be healthy once more. Failure to do so communicates to the physician a different kind of “deviance” other than what may be ailing the patient’s body.
The final element of this social role of the patient is tied into the previous one in that the patient is obliged “to seek technically competent help…and to cooperate with [the physician] in the process of trying to get well” (Parsons 294). However, this feature could face immense pressures of erosion in contemporary times.
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