Medical Power

Question 1

What is power (French and raven)

Answer 1

5 bases of power within organisations:

Legitimate (formal authority within the organisation) - consultants
Referent (ability to persuade/ influence)
Expert (possessing needed skills and experience)
Reward (ability to give valued benefits)
Coercive (punish/ withhold reward)

Question 2

What is medical power definition

Answer 2

•The ability to impose one’s will on others even if they resist in some way (e.g. demand compliance)
•The real or perceived ability or potential to bring about significant change in people’s lives through one’s actions – often seen as beneficial (i.e. power to cure) but there are risks
•The power to define illness and accordingly manage those who are ill – especially relevant for mental illness e.g. ‘sectioning’ but also legitimizing illness, absence from work

Question 3

How does power operate

Answer 3

Through professions and their organisations
●Institutions of knowledge (Royal Colleges, medical schools)
●Institutions of practice (hospitals, NHS trusts)
●In personal interaction with patients
●In wider society (status of doctors / consensus on what counts as illness)

Question 4

What are key sociological fields of study about medical power

Answer 4

1.Professions as social organisation
2.Social effects of being diagnosed
3.Learning to behave as a patient
4.Power in the consultation
5.Institutions

Question 5

What are the characteristics of medical profession

Answer 5

●A body of knowledge: theory and skills
●Regulated training overseen by the profession
●Monopoly of practice through registration - not everyone can be a doctor
●Autonomy – self regulating, making own rules
However:
●Interaction with government (resources, contracts)
●“Interprofessional” care; team work - not just doctors

Question 6

What is the social role of the medical professional for a person

Answer 6

Within the profession:
- Self-interest (staying autonomous, dominance over other professions / groups)
- Upholding ethical values (fitness to practice, prohibiting abuses of power)
- Sense of belonging, collegiality

Question 7

What is the social role of medical professional for wider society

Answer 7

• Outside the profession
- Embodying wider role of service (~nurses!)
- Social status (trust and respect from others)

Question 8

What is medical dominance (freidson)

Answer 8

Medical dominance: the authority that the
medical profession can exercise. Consensus of medics has large impact on society.
- over other occupations within the healthcare system
- over patients
- over society, through being cultural authorities in matters relating to health

Question 9

What is the advantages of diagnosis/ label for a patient

Answer 9

~ Expectation of treatment - better than untreatable disease. Less stress.
• Offers a socially acceptable explanation e.g. for individual’s behaviour
• Sympathy, excused normal social roles
• May aid coping with the illness
• Sick pay
• Access to prescriptions (free for some)
• Insurance payments (potentially)

Question 10

What is the disadvantages of diagnosis/ label for a patient

Answer 10

• Major change in status from ‘person’ to
‘patient’ (e.g. epileptic, schizophrenic) - undermines individuals identity
© Must accept the asymmetry of relationship with doctor
© May not be able to get (cheaper) insurance, mortgage, employment - retinopathy cant drive

However: is the patient of today an informed
and critical consumer?

Question 11

What is the criteria for a sick role for a patient (parsons)

Answer 11

1. Must want to get well as quickly as possible
2. Should seek professional advice/ cooperate with the doctor
3. Are allowed (and may be expected) to shed some normal activities and responsibilities (e.g. work, household, care for others)
4. Should be regarded as being in need of care and unable to get better by their own decisions and will

Question 12

What are the expectations of a doctor that a patient has (parsons)

Answer 12

They should:
1. Apply a high degree of skill & knowledge
2. Act for welfare of patient & community rather than for own self-interest, desire for money, advancement etc.
3. Be objective (i.e. should not judge patients’ behaviour or become emotionally involved with them)
4. Be guided by rules of professional practice

Question 13

What does the sick role mean for medical power

Answer 13

• Sickness a ‘problem’ for society which needs to be managed by medical profession
• Power imbalance between doctor and patient who submits to medical authority
• Recognises doctors are allowed interventions in patients’ lives not given to others (e.g. invasive examination/ asking intimate questions)
• Potential for abuse of power - why standards/ regs are needed

Question 14

What is socialisation

Answer 14

• Mechanisms by which people learn the rules, regulations and acceptable ways of behaving in the society or group they belong to
  • Often taken for granted/ invisible

Question 15

What are different types of socialisation

Answer 15

• Primary socialization occurs in the family - e.g. gender roles - blue for boys, girls in pink
• Secondary socialization continues throughout life e.g. school, peer group, occupation
• Anticipatory socialization - rehearsing for future position e.g. applying to Medical schl

Question 16

What is patient socialisation

Answer 16

Learning ‘correct’ behaviour as a patient and how to interact with health systems; for example from:

• Own experience of the healthcare system (esp. in chronic illness - over time)
• Family & friends (parents; those w. similar illness)
• Other patients (self-help groups; ‘expert’ patients)
• Materials published by organisations/ charities (e.g. National Eczema Society)
• Hospital leaflets for patients ‘what to expect’

Question 17

What is a patient career model for acute illness

Answer 17

Symptoms - anticipatory socialisation. Displace present role with social role.
During diagnosis and treatment - secondary socialisation
Outcome - may need to develop new roles/ adapt old roles

Question 18

What happens to a patient during a patient career model with chronic illness

Answer 18

• Closer links to practice/ staff, continuity
• Ongoing prescriptions-sense of dependency?
• Self-management; main responsibility goes to the person managing the condition (but are they equipped for this?)
• Change in identity, e.g. now a ‘diabetic’ (see labelling effects earlier)
Patient organisations/ self help groups can be powerful and also provide socialisation

Question 19

What are imbalances of medical power

Answer 19

• Difference in level of/ access to information - patient hasn’t got same knowledge
• Social position of the patient relative to the doctor
- E.g. difference in social class (e.g. middle-class Dr vs. working class patient) can lead to some patients being ‘silenced’ (see Waitzkin
1991)
• Easier to interact if life experiences are similar - small talk

Question 20

What is cultural health capital (shim)

Answer 20

• Knowing how to interact with the system
• More difficult for migrants, people less likely to be listened to’
~ More affluent/ educated better at this
- e.g. by being articulate; knowing what they want while not appearing overtly demanding

o This can contribute to Inverse Care Law:
those who most need medical care are least likely to receive it (Tudor Hart 1971)

Question 21

What is intersectionality

Answer 21

Developed to challenge discrimination, initially in employment law (Crenshaw 2011)
- How can we challenge a firm that hires black men and white women, but few black women?

© At the structural level, different power differentials overlap and compound
© At the individual level, the experience of discrimination is shaped by where people ‘sit’ on the spectrum of race/ ethnicity, class, gender, sexuality, education, migrant status…

Question 22

What is the social role of the good patient

Answer 22

• Premium on being polite/ uncomplaining
© This can lead to problems e.g. in medication adherence, many people stop taking meds or change their dose without telling the doctor!
© Relationship breakdown can lead to sanctions e.g. removal from GP list (see
Stokes 2003)
• try to protect NHS -fear of taking too much?
Covid patients wouldn’t want to bother the drs but still should have.

Question 23

What are characteristics of total institutions (Goffman)

Answer 23

o All aspects of life are conducted in the same place and under a single authority (main manager)
o Daily life is carried out in a group with others (“Batch living” – not much individuality) with
scheduled activities
o There is a sharp distinction between the managers and the managed between whom there may be
little communication
o Positive: There is an institutional perspective therefore the assumption of an overall rational plan
o Examples: mental asylums, boarding schools, prisons, military recruit schools

Question 24

What are mechanisms used in total institutions to facilitate management of inmates

Answer 24

• Physical and psychological reminders of a person’s identity are stripped by removing personal possessions and restricting privacy and individual responsibility
• Information about the individual and the institution is controlled
• Mobility is restricted
• Can lead to institutionalisation - patients become unable to undertake simple tasks on their own or make decisions.

Question 25

How an inmate adapts to total institution

Answer 25

Goffman identifies five modes of adaptation which an inmate may employ at different stages in their career in the institution, or alternate between during one point in that career:

1. ‘situational withdrawal’: no contact with others
2. ‘intransigent line’: patient refuses co-operation
3. ‘colonisation: hospital preferable to alternative. May be homeless so anything better than that.
4. ‘conversion’: becoming a model patient
5. playing it cool: using a variety of strategies, including the above, depending on the situation

Question 26

What is permeable institution

Answer 26

Different model to total health institution
More modern - what used in mental institutions now

• Ward membership is temporary or revolving
• Contact with the outside world is maintained
• Institutional identities are blurred (people keep own clothes and called by first names)

Question 27

What are the consequences of permeability in institutions

Answer 27

• Reduced risk of institutionalisation
• Potentially increased risk to staff and patients

If you have less restrictions and rules e.g., no separation of genders à can make women at
risk of sexual abuse or violence.

Question 28

What is management of permeability in institutions

Answer 28

• Limiting unwanted movement
• Using discretion
• Patient input: negotiation and subversion

Question 29

What are Los

Answer 29

Explain, using examples of clinical settings and clinical problems, the following concepts. medical power, types of power, medicalization, the sick role, medical autonomy, medical dominance.
* Begin to think about these concepts in a way that includes intersectionality
Define the terms. socialization, primary, secondary and anticipatory socialization.
Give examples of agents of socialization for patients.
Describe the experience of a patient with a chronic condition using so
the model of the ‘patient career.
Define a total institution’ according to Goffman (1961) and contrast it to a ‘permeable institution’ (Quirk, 2006)

Question 30

Examples of threats to medical power

Answer 30

© Shifting intra-professional division of labour (Annandale, 1998); team based approaches
• Complementary & alternative healthcare
• Technological developments
• Availability/accessibility of information
• Patient empowerment
• Erosion of autonomy