The complexity of the social world requires that this analysis integrate structural issues (e.g., the health care system) and agency issues (e.g., the performance and interaction of patients and physicians). While there are several theoretical ways to do this, I drew from Anthony Giddens's theory of structuration, upon which Figure 1.1 in Chapter 1 is modeled. 1 Giddens views social structure and everyday activity as an ongoing, interwoven process of conflict and power that operates through a subjective interpretation of the world. Within this framework, people's collective action (agency) shapes the structure of their social institutions in the long term, which in turn shapes their own actions and opportunities in the short term.
To be more specific, people negotiate and socially create their own reality as they interact with each other over time. This view is the foundation of the sociology of W. I. Thomas, George Herbert Meade, and, more recently, Peter Berger and Thomas Luckmann, who assert that social reality is constructed. 2 Lest the reader feel that my analysis is drifting into a postmodernist account, let me emphasize that this social constructionist position accepts the notion of an absolute reality. The problem is that we cannot know it with complete objectivity.
This assertion can be made clearer by an example related to medical