The largest disparity between position in the social hierarchy of Western medicine is between the patient and the physician. The patient/physician interaction is critically shaped by the rigidity of the social hierarchy. In describing the nature of the patient/physician relationship, Parsons lays out four distinct features that establish and maintain a particular form of the subordinate/superior relationship, most commonly 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. For instance, in at least one form, the legitimization of authority allows one to exercise more power. Authority therefore enhances elements like one’s reputation or one’s social standing. Authority, also, could be viewed as an entirely different form of power. Whereas power may stipulate the explicit use of force/coercion (i.e. violence), authority may stipulate a softer version of that with similar end results but without the use of force/coercion. Instead, psychological mechanisms and tools may be utilized. I don’t want to go too far down the rabbit hole on this, but suffice it to say they are conceptually and logically distinct and should be kept that way for current purposes.
In this case, the physician is bestowed with authority through his/her extensive knowledge of 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 is verified by the physician and then communicated out 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. Such exemptions may be less time working each week or more bed rest each night or modified forms of movement. As Illich observes, 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 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 solved by any medication but require a shift in societal attitudes and organized efforts to catalyze desired 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 more disposable income and a gap in access to health 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.
The 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).