Profession of Medicine: A Study of the Sociology of Applied knowledge is a book by the
medical sociologist
Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care practices ...
Eliot Freidson
Eliot Freidson (1923 – December 14, 2005) was a sociologist and medical sociologist who worked on the theory of professions. Charles Bosk says that Freidson was a founding figure in medical sociology who played a major role in the growth and le ...
published in 1970. The book received the Sorokin Award from the
American Sociological Association
The American Sociological Association (ASA) is a non-profit organization dedicated to advancing the discipline and profession of sociology. Founded in December 1905 as the American Sociological Society at Johns Hopkins University by a group of fif ...
for most outstanding contribution to scholarship, and has been translated into four languages.
Synopsis
The book comprises four parts: the first part explores the organization of the medical profession, the second explores the performance of day-to-day work, the third, how the concept of illness functions socially, and the last explores what the role of technical expertise should be in a free society.
Freidson argues that the definition of profession is ill-defined and that people do not agree on which activities should be considered professions. He seeks to explore the sociological properties of the medical profession in order to under what "profession" is.
Part I: Formal Organization of Medicine
In this first section Fredison, explores the history of medicine from a sociology perspective contrasting modern medicine with that the Greeks, Renaissance Medicine, and witch doctors in Africa. He distinguishes professions that help people solve problems, including lawyers and doctors in this class, from those that find out what is true, such as academic scholars.
Freidson contrasts medicine to the
Zande medicine of East Africa documented by
E. E. Evans-Pritchard
Sir Edward Evan Evans-Pritchard, Kt FBA FRAI (21 September 1902 – 11 September 1973) was an English anthropologist who was instrumental in the development of social anthropology. He was Professor of Social Anthropology at the University ...
.
Here the role of the doctor was to be a third party who established the causes of illness, as well as leechcraft that consisted of administering drugs and supposedly removing magical pellets emebedded in the body. The Zande people believed that witchcraft was an innate property of individuals that was passed hereditarily but could be inactive.
If an individual was found to be practicing witchcraft they could apologize, claim lack of intent and beg for their witchcraft to "cool". Zande witch doctors were not very respected, Freidson hypothesizes this is because their divinations of the causes of ailments were not very effective. Freidson arges that in the past western medicine had a similar role to such witch-doctoring.
Freidson argues that the study of the history of medicine does not give an accurate portrayal of the profession, since the study tends to only identify times at which medicine discovered things that are now considered true, rather than considering the ineffective treatments that were considered best practice at the time. Historians also fail to distinguish between the history of medical discover, and medical practice, noting that discoveries did not necessarily form part of medical practice.
He argues that medical practice in the past consisted of a number of conflicting theories for the cause of disease, where untrue theories such as the
humoral medicine would sit beside more scientific viewpoints.
Freidson notes the 1860 discovery that anthrax was caused by a bacteria as a significant turning point in the practice of medicine, followed by a period where a theoretical model established a cause of a number of diseases. This allowed empirical treatments to be replaced by treatments based on the actual cause of the disease, or the prevention of the disease by the likes of Koch and
Pasteur
Louis Pasteur (, ; 27 December 1822 – 28 September 1895) was a French chemist and microbiologist renowned for his discoveries of the principles of vaccination, microbial fermentation and pasteurization, the latter of which was named after ...
.
Part II: The organization of professional performance
Freidson explores medical workplaces in this section.
Part III: Social construction of disease
Freidson follows
Luckmann and Berger's
The Social Construction of Reality
''The Social Construction of Reality: A Treatise in the Sociology of Knowledge'' (1966), by Peter L. Berger and Thomas Luckmann, proposes that social groups and individual persons who interact with each other, within in a system of social classes, ...
to consider how illness can function as a
social rather than biological state.
Illness is explored as a form of social deviance.
Freidson looks at the construction of illness from a professional, lay, and societal perspective.
Freidson notes that the
role of medicine had increased in American society taking over roles that had previously been filled by religious concepts.
Citing
Thomas Szasz
Thomas Stephen Szasz ( ; hu, Szász Tamás István ; 15 April 1920 – 8 September 2012) was a Hungarian-American academic and psychiatrist. He served for most of his career as professor of psychiatry at the State University of New York Upstate M ...
, e argues that defining problems as medical problems rather than moral one's risks removing individuals rights to judge moral matters oneself drawing comparison to the individuals right to interpret scripture for themselves.
Part IV: Consulting Professions in a Free Society
Freidson argues that professions should have autonomy to make decisions that are technical, but they should not make decisions in areas where they do not have expertise, and that on moral or evaluative questions lay people should have as same involvement in decision making as experts.
Freidson distinguishes between codified expert knowledge and theories, which is stored in textbooks and publication; and the practice being an expert, which he refers to as ''research'' and ''practice''.
Freidson argues that since the practice of expertise happens in a social environment, the practice of knowledge if a social and socially biased activity.
Regarding the practice of knowledge, Freidson distinguishes four aspects of medicine:
germ theory, the classification of disease, the analysis of
prevention
Prevention may refer to:
Health and medicine
* Preventive healthcare, measures to prevent diseases or injuries rather than curing them or treating their symptoms
General safety
* Crime prevention, the attempt to reduce deter crime and crimi ...
or reversing disease states, and the management of when the techniques of disease prevention are applied.
Freidson notes that the use of medical technology, in the sense of diagnosis and treatment, has social meaning and so is a social activity.
Freidson thinks germ theory is an expert activity in which the layman is not involved.
However, Freidson argues that the identification of disease is in part a moral activity. Drawing analogy to law, a doctor may be an expert in what is or is not a disease, but not whether the diagnosis and treatment is moral, since it is a moral question to decide whether a particular state is undesirable or not.
Influence
Peter Conrad argues that the book was the first book to apply sociological analysis to the profession and institution of medicine itself. The book contains many concepts that have affected our understanding of medicine including professional dominance, functional autonomy, clinical mentality, self-regulation, the social construction of illness, the connection between illness and deviance, illness as a social state. Bosks draws comparison of with the ideas in the book to
Max Weber's analysis on the role of technical rationality and profession expertise on decision-making in a democratic society.
Michael Calnon argues that the books sociological perspective is similar to that of
structural pluralism where the medical profession is seen as a mediator between the state and the public, with the benefit of increased trust and reduced governmental costs.
References
{{Reflist
1970 non-fiction books
Medical sociology