Arguments Surrounding Physician Authority In Medical Sociology

INTRODUCTION

Physician authority has been understood as an important point of question in medical sociology. Scholars have written on the importance of physician authority through a variety of lenses, such as physician authority in the doctor-patient relationship (Parsons 1951; Waitzkin 1985), physician power and knowledge as a source of authority (Foucault 2003 [1963]), and the importance of the professionalization of physicians in marking medical experience (Becker et al. 1961; Friedson 2007 [1970]). This article summarizes the dominant debates surrounding physician authority in sociological (and related relevant) literature. Understandings of how physician authority shapes patient care are contested within this literature. The divide exists

Beginning with discussions of the sick role, and expectations of what is socially expected of a sick person, we learn that in contrast to the sick role, within society, physicians are expected to be competent and responsible (Parsons 1951: 293). Physicians are also, of course, members of a profession, where they learn how to embody their roles as expected by their practice, their patients, and society (Becker et al. 1961). Becoming a physician involves a process of socialization where trainees are exposed to the opinions of their peers, as well as the expectations of their instructors. This socialization in the role of a “physician” prepares physicians for the social role of their title, and gives physicians authority over trainees, patients, and medical discourse within the larger society (Friedson 2007 [1970]: 41-41). Physicians are experts; they have knowledge about the body and illness, which gives them power and a position of expertise (Foucault 1980

Medical sociology acknowledges the shift that took place after the development of clinics as treatment centers for patients who are ill, and how this shifted the authority/accountability dynamic between physicians and patients (Foucault 2003 [1963]). With the development of clinics, patients were no longer viewed through the sick role, but rather as a collection of symptoms meant to be treated by physicians. Illness and its symptoms itself then came to exist within a rational space of disease, where doctors and patients are tolerated intruders (Foucault 2003 [1963]: 32). This focus on the purely medical serves to remove responsibility from the physicians, as well as the greater social context of a patient’s life when it comes to diagnosis and medical interactions. By looking only at medical symptoms, physicians may miss and ultimately ignore the effect that social problems have on health (Waitzkin 1993). In this position, physicians also help replicate greater social patterns of inequality through their roles as experts (Waitzkin