BEHAVIORAL SCIENCES - Universitatea de Medicină şi Farmacie

transitional. Szasz and Hollender's (1956) work refined Parsons by
elaborating different doctor-patient models arising around different types
of illness:
(1) Patient passivity and physician assertiveness are the most
common reactions to acute illness;
(2) Less acute illness is characterized by physician guidance and
patient cooperation;
(3) Chronic illness is characterized by physicians participating in a
treatment plan where patients had the bulk of the
responsibility to help themselves.
Critics have also shown that there is a great deal of inter-cultural
and inter-personal variation in sick roles and norms. The "American" sick
role is not as useful a concept as the more specific "white, Midwestern,
Scandinavian, male" sick role. There is also cross-class variation. Some of
the poor adapt to their lack of access to medical care by becoming
fatalistic, rejecting the necessity of medical treatment, and coming to see
illness and death as inevitable. On the other hand, the educated classes
have become more assertive in the relationship, rejecting the norm of
passivity in favor of self-diagnosis or negotiated diagnosis. There is also
inter-cultural variation in physician roles, and variation among physicians
in the success of their role socialization. While Parsons' model of doctors'
affective neutrality, collective-orientation, and egalitarianism towards
patients did express the professional ideal, some physicians are more
affectively neutral than others. Following Parsons' lead, some sociologists
began to focus on the socialization (professionalization) of physicians and
the factors in medical school and residency that facilitated or discouraged
optimal role socialization to doctor-patient relationships.
Thus, Conrad (1989) considers that the Parsons’ work generally
took the division of labor in medicine for granted, and painted a more or
less heroic picture of medical self-sacrifice. Beginning to focus on aspects
of the physician role and medical education which themselves militated
against humanistic patient care he suggested that medical schools and
residencies socialized physicians into "dehumanization," and to place
professional identity and camaraderie before patient advocacy and social
idealism.
James "J." Hughes considers that the most important weakness of
Parsons' functionalist account of the doctor-patient relationship arose from
his poor understanding of the ecological concepts of dysfunction and niche
62