Medical Power

Question 1

French and Raven (1959)’s 5 bases of power within organisations

Answer 1

• Legitimate (formal authority within org.)
• Referent (ability to persuade/influence)
• Expert (possessing needed skills/experience)
• Reward (ability to give benefits)
• Coercive (punish/withhold reward)

Question 2

Definitions of medical power

Answer 2

• Ability to impose one’s will on others even if they resist in some way
• Real or perceived ability or potential to bring about significant change in people’s lives through one’s actions
• Power to define illness and accordingly manage those who are ill

Question 3

How power operates

Answer 3

• Through professions and their organisations
• Institutions of knowledge
• Institutions of practice
• Personal interaction with patients
• In wider society

Question 4

Characteristics of professions

Answer 4

• Body of knowledge (theory + skills)
• Regulated training overseen by profession
• Monopoly of practice through registration
• Autonomy (self-regulating, make own rules)
• Interaction with government
• Interprofessional care/teamwork

Question 5

Social role of profession within the profession

Answer 5

• Self-interest (staying autonomous, dominance over other professions)
• Upholding ethical values
• Sense of belonging

Question 6

Social role of profession outside the profession

Answer 6

• Embodying wider role of service
• Social status

Question 7

Freidson (1988) medical dominance definition

Answer 7

Authority that the medical profession can exercise over:
- Patients
- Other occupations within healthcare
- Society

Question 8

Advantages of a diagnosis/label

Answer 8

• Expectation of treatment
• Offers socially acceptable explanation (eg. for behaviour)
• Sympathy
• Aids coping with illness
• Sick pay
• Access to prescriptions
• Insurance payments

Question 9

Disadvantages of a diagnosis/label

Answer 9

• Major change in status from ‘person’ to ‘patient’
• Must accept asymmetry of relationship with doctor
• May not be able to get (cheaper) insurance, mortgage, employment

Question 10

Parsons (1951)’s obligations of the ‘sick role’ for the patient

Answer 10

• Must want to get well as quickly as possible
• Should seek professional advice/co-operate with doctor
• Are allowed/expected to shed normal activities + responsibilities
• Should be regarded as being in need of care and unable to get better by own decisions/will

Question 11

Parsons (1951)’s expectations from the doctor

Answer 11

They should:
- Apply high degree of knowledge/skill
- Act for welfare of patient + community rather than own self-interest
- Be objective (not judge patient, not become emotionally attached, etc.)
- Be guided by rules of professional practice

Question 12

What is socialisation?

Answer 12

Mechanisms by which people learnt the rules, regulations and acceptable ways of behaving in society or group they belong to

Question 13

Types of socialisation

Answer 13

• Primary
• Secondary
• Anticipatory

Question 14

Where does each type of socialisation take place?

Answer 14

• P = in the family (eg. gender role - blue for boys)
• S = throughout life (school, peer group, etc.)
• A - when rehearsing for future position (applying to med school, etc.)

Question 15

What is patient socialisation?

Answer 15

Learning ‘correct’ behaviour as a patient and how to interact with healthcare systems

Question 16

Examples of where patient socialisation can occur from

Answer 16

• Own experience in the system
• Family/friends
• Other patients
• Material published by organisations/charities
• Hospital leaflets of ‘what to expect’

Question 17

Inverse care law (Tudor Hart 1971)

Answer 17

Those who most need medical care are least likely to receive it

Question 18

Characteristics of total institutions (Goffman, Asylums)

Answer 18

• All aspects of life are conducted in the same place under a single authority
• Daily life is carried out in groups (“batch living”) with scheduled activities
• Sharp distinctions between managers and managed, between whom there is little communication
• There is an institutional perspective, therefore assumption of an overall rational plan

Question 19

Mechanisms used in institutions to facilitate management of inmates

Answer 19

• Physical/psychological reminders of a person’s identity being stripped (removing personal possessions, restricting privacy)
• Information about individual and institution is controlled
• Mobility restricted

Question 20

What is institutionalisation?

Answer 20

Patient becomes unable to undertake simple tasks on their own or make decisions

Question 21

Goffman’s 5 modes of adaptation an inmate can employ at different stages in their career in the institution

Answer 21

• ‘Situational withdrawal’ (no contact with others)
• ‘Intransigent line’ (patient refuses co-operation)
• ‘Colonisation’ (hospital preferable to alternative)
• ‘Conversion’ (becoming model patient)
• ‘Playing it cool’ (variety of strategies including the above depending on situation)

Question 22

Evidence of permeability in an institution

Answer 22

• Ward membership is temporary or ‘revolving’
• Contact with outside world is maintained
• Institutional identities are blurred

Question 23

Consequences of permeability in an institution

Answer 23

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

Question 24

Management of permeability in an institution

Answer 24

• Limiting unwanted movement
• Using discretion
• Patient input (negotiation + subversion)

Question 25

Threats to medical power

Answer 25

• Shifting intra-professional division of labour; team based approaches
• CAM
• Technological developments
• Availability/accessibility of information
• Patient empowerment
• Erosion of autonomy