BEHAVIORAL SCIENCES - Universitatea de Medicină şi Farmacie

width. Social structures cannot be assumed to be functional for the social
system simply because they exist, any more than an organic structure, such
as an appendix, can be assumed to be functional for its organism. All that
can be said about a structure, or in this case a role relationship, is that it
has not yet pushed the organism outside its niche, causing its extinction. In
other words, the study of doctor-patient relationships in one society does
not indicate how many the particular structures and norms of the providerpatient
relationship are simply the result of historical chance, rather than
necessitated by the nature of illness and healing in industrial society. And
second, such a study does not indicate whether the particular practices and
norms are leading in a dysfunctional direction. A critical sociology of the
doctor-patient relationship thus arose to challenge the internal
contradictions of the Parsonsian biological metaphor: were American
doctors the perfect immune system for society, or had they developed into
a parasitic growth threatening the health of society?
To the more critical 60's generation of social scientists, inspired by
growing resistance to unjust claims to power, physicians' defense of
professional power and autonomy appeared to be merely self-interested
authoritarianism. Physicians' battle-cry of the sacred nature of the doctorpatient
relationship sounded hollow in their struggles against universal
health insurance. Physicians' high incomes and defense of autonomy
appeared to result in both bad medicine and bad health policy, and
physician's unaccountable power appeared all the more nefarious because
of medicine's intimate invasion of the body.
In this context, Eliot Freidson's work (1961, 1970, 1975, 1986)
crystallized the notion that professional power was more self-interested
than "collectivity-oriented." Freidson saw the doctor-patient relationship
as a bargained interface between a professional system and a lay system,
each with its own interests and hence with the high potentiality of conflict.
Freidson's approach to the sick role went beyond Parsons to assert that
doctors create the legitimate categories of illness. Professionalization
grants physicians a monopoly on the definition of health and illness, and
they use this power over diagnosis to extend their control. This control
extends beyond the claim to technical proficiency in medicine, to claims of
authority over the organization and financing of health care, areas which
have little to do with their training.
63