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Medical sociology is the sociological analysis of medical organizations and institutions; the production of knowledge and selection of methods, the actions and interactions of healthcare professionals, and the social or cultural (rather than clinical or bodily) effects of medical practice. The field commonly interacts with the sociology of knowledge, science and technology studies, and social epistemology. Medical sociologists are also interested in the qualitative experiences of patients, often working at the boundaries of public health, social work, demography and gerontology to explore phenomena at the intersection of the social and clinical sciences. Health disparities commonly relate to typical categories such as class and race. Objective sociological research findings quickly become a normative and political issue.
Early work in medical sociology was conducted by Lawrence J Henderson whose theoretical interests in the work of Vilfredo Pareto inspired Talcott Parsons interests in sociological systems theory. Parsons is one of the founding fathers of medical sociology, and applied social role theory to interactional relations between sick people and others. Key contributors to medical sociology since the 1950s include Howard S. Becker, Mike Bury, Peter Conrad, Jack Douglas, David Silverman, Phil Strong, Bernice Pescosolido, Carl May, Anne Rogers, Anselm Strauss, Renee Fox, and Joseph W. Schneider.
The field of medical sociology is usually taught as part of a wider sociology, clinical psychology or health studies degree course, or on dedicated master's degree courses where it is sometimes combined with the study of medical ethics and bioethics. In Britain, sociology was introduced into the medical curriculum following the Goodenough report in 1944: "In medicine, 'social explanations' of the aetiology of disease meant for some doctors a redirection of medical thought from the purely clinical and psychological criteria of illness. The introduction of 'social' factors into medical explanation was most strongly evidenced in branches of medicine closely related to the community — Social Medicine and, later, General Practice" (Reid 1976).
Samuel W. Bloom argues that the study of medical sociology has a long history but tended to be done as a one of advocacy in response to social events rather than a field of study. He cites the 1842 publication of the sanitary conditions of the labouring population of Great Britain as a good example of such research. This medical sociology included an element of social science, studying social structures as a cause or mediating factor in disease, such as for public health or social medicine.:11
Bloom argues the development of medical sociology is linked ot the development of sociology within American universities. He argues that the 1865 creation of the American Social Science Association (ASSA) was a key event in this development.:25 ASSA's initial aim was policy reform on the basis of science.:25 Bloom argues that over the next few decades the role of ASSA moved from advocacy to academic discipline, noting that a number of academic professional bodies broke away from the ASSA during this period, starting with the American Historical Association in 1884. The American Sociological Society formed in 1905.:26
The Russell Sage Foundation formed in 1907, was a large philanthropic organization which worked closely with the American Sociological Society, which had medical sociology as a primary focus of its suggested policy reform.:36 Blooms argues that Donald R Young's, a professor of sociology, presidency of this foundation starting in 1947 was significiant in the development of medical sociology.:182 Bloom argues that Young, motivated by a desire to legitimize sociology, encouraged Esther Lucile Brown, an anthropologist who studied the professions, to focus her work on the medical professions.:183
Harry Stock Sullivan
Harry Stack Sullivan was a psychiatrist who investigated the treatment of schizophrenia using approaches of interpersonal psychotherapy working with sociologists and social scientists including Lawrence K. Frank, W. I. Thomas, Ruth Benedict, Harold Lasswell and Edward Sapir.:76 Bloom argues that Sullivans work, and its focus on putative interpersonal causes and treatment of schizophrenia influenced ethnographic study of the hospital setting.:76
Social medicine is a similar field to medical sociology in that it tries to conceptualize social interactions:241 in investigating how the study of social interactions can be used in medicine.:9 However, the two fields have different training, career paths, titles, funding and publication.:241In the 2010s, Rose and Callard argued that this distinction may be arbitrary.:242
In the 1950s, Strauss argued that it was important to maintain the independence of medical sociology from medicine so that there was a different persepctive on sociology separate from the aims of medicine.:242 Strauss feared that if medical sociology started to adopt the goals expected by medicine the risked losing their focus on analysing society, fears that have been echoed since by Reid, Gold and Timmermans.:248 Rosenfeld argues that the study of sociology focused solely on making recommendations for medicine have limited use for theory building and its findings cease to apply in different social situations.:249
Richard Boulton argues that medical sociology and social medicin are "co-produced" in the sense that social medicine responds to the conceptualization of medical practices by medical sociology and alters medical practice and medical understanding in response, the effects of these changes are then analyzed by medical sociology.:245 He argues that the tendency to view certain theories such as the scientific method (positivism) as the basis for all knowledge, and conversely the tendency to view all knowledge as associated with some activity both risk undermining the field of medical sociology.:250
The Sick Role
Parsons argued that the sick role is a social role approved and enforced by social norm and institutional behaviours where an individual is viewed as showing certain behaviour because they are in need of support.:212
Parsons argues that defining properties are that the sick person is exempt from normal social roles, that they are not "responsible" for their condition, that they should try to get well, and that they should seek technically competent people to help them.:213
The concept of the sick role was critiqued by sociologists from a neo-marxist, phenomonological and social interactionist perspective, as well as by those with an anti-establishment viewpoint.:76 Burnham argues that part of this criticism was a rejection of functionalism due to its associations with conservatism. The sick role fell out of favour in the 1990s.
Labelling theory derived from work by Howard S. Becker who studied the sociology of marijuana use. He argued that norms and deviant behaviour are partly the result of the definitions applied by others. Eliot Freidson applied these concepts to illness.:226
Labelling theory separates the aspects of an individuals behaviour that is caused by an illness, and that which is caused by the application of a label. Freidson distinguished labels based on legitimacy and the degree to which to this legitimacy affected an individuals responsibilities.:227
Labelling theory has been criticized on the ground that it does not explain which behaviours are labelled as deviant and why people engage in behaviours which are labelled as deviant: labelling theory is not a complete theory of deviant behaviour.:228
The Doctor-Patient relationship
The doctor–patient relationship, the social interactions between healthcare providers and those who interact with them, is studied by medical sociology. There are different models for the interaction between a patient and doctor, which may have been more or less prevalent at different times. One such model is medical consumerism that has partly given way to patient consumerism.
Medical paternalism is the perspective that doctors want what is best for the patient and must take decisions on behalf of the patient because the patient is not competent to make their own decisions. Parsons argued that though there was an asymmetry of knowledge and power in the doctor patient relationship the medical system provided sufficient safeguards to protect the patient justifying a paternalistic role by the doctor and medical system.:496
A system of medical paternalism was prominent following the second world war through to the mid 1960s. Freidson writing in the 1970s referred to medicine as having "professional dominance" determining its work and defining a conceptualization of the problems that are brought to it and the best solutions.:497
Yeyoung Oh Nelson argues that this system of paternalism was in part undermined by organizational change in the following decades in the US whereby insurance companies, managers and the pharmaceutical industry started competing for role of conceptualizing and delivering medical services, part of the motive being cost saving.:498
Bioethics studies ethical concern in medical treatment and research. Many scholars believe that bioethics arose due to a perceived lack of accountability of the medical profession, the field has been broadly adopted with most US hospitals offering some form of ethical consultation. The social effects of the field of bioethics have been studied by medical sociologists.:2 Informed consent, having its roots in biothetics, is the process by which a doctor and a patient agree to a particular intervention and has. Medical sociology study the social processes that influences and at times limit consent.
Reid, Margaret (1976), "The Development of Medical Sociology in Britain", Discussion Papers in Social Research No 13, University of Glasgow, archived from the original on 2011-09-30, retrieved 2011-03-11
- Bloom, Samuel William; Bloom, Samuel W. (2002). The Word as Scalpel: A History of Medical Sociology. Oxford University Press. ISBN 978-0-19-507232-7.
- Boulton, Richard (August 2017). "Social medicine and sociology: the productiveness of antagonisms arising from maintaining disciplinary boundaries". Social Theory & Health. 15 (3): 241–260. doi:10.1057/s41285-016-0014-1. ISSN 1477-8211.
- Čeledová, Libuše; Holčík, Jan (2019-05-01). Social Medicine: An Introduction to New Public Health. Charles University in Prague, Karolinum Press. ISBN 978-80-246-4276-5.
- Cockerham, William C. (2017-04-21). Medical Sociology. Taylor & Francis. ISBN 978-1-317-21171-6.
- Burnham, John C. (2014-02-01). "Why sociologists abandoned the sick role concept". History of the Human Sciences. 27 (1): 70–87. doi:10.1177/0952695113507572. ISSN 0952-6951.
- Cockerham, William C. (2021-03-22). The Wiley Blackwell Companion to Medical Sociology. John Wiley & Sons. ISBN 978-1-119-63375-4.
- Hauschildt, Katrina; Vries, Raymond De (2020). "Reinforcing medical authority: clinical ethics consultation and the resolution of conflicts in treatment decisions". Sociology of Health & Illness. 42 (2): 307–326. doi:10.1111/1467-9566.13003. ISSN 1467-9566. PMC 7012693. PMID 31565808.
- Corrigan, Oonagh (November 2003). "Empty ethics: the problem with informed consent". Sociology of Health and Illness. 25 (7): 768–792. doi:10.1046/j.1467-9566.2003.00369.x. ISSN 0141-9889.
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