Academic journal article Health Sociology Review

Reflections on the Centrality of Power in Medical Sociology: An Empirical Test and Theoretical Elaboration

Academic journal article Health Sociology Review

Reflections on the Centrality of Power in Medical Sociology: An Empirical Test and Theoretical Elaboration

Article excerpt

Introduction

The concept of medical power, or indeed medical dominance, has been employed by medical sociologists as a means of conceptualising the relationships between the biomedical community and various other stakeholders within western healthcare systems. Perhaps the most common utilisation of this notion, in the context of health workers, has been in relation to the biomedical community's engagement with complementary and alternative medicine (CAM), the nursing profession, midwifery and the allied health professions (e.g., Coburn 1993; Ovretveit 1985; Willis 1989). Moreover, notions of medical power and dominance have been deployed as part of broader critiques of doctors' control (or influence) over their workplace practices, patients, Healthcare rationing, medical training and professional regulation (e.g., Broom and Woodward 1996; Coburn et al. 1997).

Medical sociologists have illustrated the relevance of the medical dominance thesis to the trajectory of the various facets of the biomedical community. Studies of CAM (particularly chiropractic) and midwifery have illustrated the strong political power of biomedicine in shaping the nature and delivery of primary healthcare (e.g., Dew 2000). Part of this work aimed to illustrate that healthcare delivery was not, and is not, purely based on what is 'effective' or 'efficacious'. Rather, what constitutes these very notions is a mix of the physiological, contextual, ideological and political. Paradigmatic basis, it has been argued, has been fundamental in assessing the legitimacy of a therapeutic intervention and such arguments regularly underlie sociological critiques of medical power and dominance (Willis 1989).

This biomedical trajectory of 'relative clinical autonomy' has necessarily involved the deployment of a variety of discursive and regulatory means of maintaining control of primary Healthcare delivery, particularly in relation to CAM and midwifery. We have witnessed the constraints imposed on the encroachment of non-biomedical therapeutics into primary care. Empirical studies have illustrated the complex subordination of various actors increasingly operating in hospital systems (e.g., midwives) as well as those operating within the community (i.e., CAM practitioners) (e.g., Kelner et al. 2004).

The central question posed here then is: in the current context, is the role and position of biomedicine most adequately conceptualised as a matter of power, delimitation, subordination or control? An overview of medical sociology in recent years suggests a diminution in interest in structuralist critiques of professional power, and a refocusing on issues associated with the mechanics of knowledge production (e.g., EBM) (Timmermans and Kolker 2004); the sociocultural impact of specific conditions such as HIV/ AIDS (e.g., Ciambrone 2001); and, the impact of new technologies such as genetics, cloning and nanotechnology (e.g., Hall 2005; see also Willis and Broom 2004). This movement may reflect an emerging trend in medical sociology toward a focus on the complexity of medical work (including technological innovation) and the waning relevance of binary views of dominance/ subordination to such complex systems. Certainly, some health sociologists are pointing toward the inadequacies of previous structuralist notions of medical dominance or power to contemporary healthcare contexts (e.g., Ballard and Elston 2005; Williams and Calnan 1996).

This paper, then, argues that the contemporary application of power-based models in medical sociology1, particularly as applied to CAM and the Internet, has tended to produce overly linear, simplified representations of interprofessional and lay/expert dynamics. This has resulted in reification of the non-differentiated character and professional autonomy of biomedicine, avoiding inter- and intra-professional complexities which underlie the shape and form of individual patient care.

Background

Medical sociology, in the context of the 1970s and 80s, was largely focused on the hegemonic influence of biomedicine on healthcare delivery, and for good reason. …

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