Week 5 Flashcards
What is power French & Raven 1959 5 bases of power within organisations
Legitimate (formal authority within the organisation)
Referent (ability to persuade/influence)
Expert (possessing needed skills and experience)
Reward (ability to give valued benefits)
Coercive (punish/ withhold reward)
What is medical power
The ability to impose ones will on others even if they resist in some way (eg demand compliance)
The real or perceived ability or potential to bring about significant change in peoples lives through one’s actions- often seen as beneficial but there are risks
The power to define illness and accordingly manage those who are ill- especially relevant for mental illness but also legitimising illness absence from work
How does power operate
Through professions and their organisations
Institutions of knowledge
Institutions or practice
In personal interaction with patients
In wider society (status of doctors)
Key sociological fields of study
Professions as social organisation
Social effects of being diagnosed
Learning to behave as a patient
Power in the consultation
Institutions
Characteristics of professions
A body of knowledge: theory and skills
Regulated training overseen by the profession
Monopoly of practice through registration
Autonomy- self regulating, making own rules
However:
Interaction with government (resources, contracts)
“Interprofessional” care; team work
Social role of profession
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
Outside the profession:
-embodying wider role of service
-social status
Medical dominance (Freidson 1988)
Medical dominance: the authority that the medical profession can exercise
-over other occupations within healthcare system
-over patients
- over society, through being cultural authorities in matters relating to health
Advantages of diagnosis/label
Expectation of treatment
Offers a socially acceptable explanation eg for individuals behaviour
Sympathy, excused normal social roles
May aid coping with the illness
Sick pay
Access to prescriptions
Insurance payments
Disadvantages of diagnosis/label
Major change in status from person to patient
Must accept the asymmetry of relationship with doctor
May not be able to get cheaper insurance, mortgage, employment
The ‘sick role’ for the patient (Parsons 1951)
Must want to get well as quickly as possible
Should seek professional advice/ co-operate with the doctor
Are allowed (may be expected) to shed some normal activities and responsibilities (eg work, household, care for others)
Should be regarded as being in need of care and unable to get better by their own decisions and will
Expectations from the doctor (parsons 1951)
Apply a high degree of skill and knowledge
Act for welfare of patient and community rather than for own self interest, desire for money advancement etc
Be objective
Be guided by rules of professional or practice
What this means for power
Sickness a ‘problem’ for society which needs to be managed by medical profession
Power imbalance between doctor and patient who submits to medial authority
Recognises doctors are allowed interventions in patients lives not given to others
Potential for abuse of power- why standards/regulations are needed
Socialisation in general
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
Primary socialisation occurs in the family- gender roles
Secondary socialisation continues throughout life eg school
Anticipatory socialisation- rehearsing for future position eg applying to medical school
Patient socialisation
Learning ‘correct’ behaviour as a patient and how to interact with health systems; for example from:
-own experience of healthcare system
-family and friends
-other patients
-materials published by organisations/ charities
-hospital leaflets for patients
The patient career
Initial contact with medical services
Hospital admission
Hospital discharge
Displace present role with patient role
Secondary socialisation adapt old rules/ develop new rules
In chronic illness patient career
Closer links to practice/ staff, continuity
Ongoing prescriptions- sense of dependency
Self management; main responsibility goes to the person managing the condition
Change in identity
Patient organisations/ self help groups can be powerful and also provide socialisation
Imbalances of power
Difference in level of/ access to information
Social position of the patient relative to the doctor
Eg difference in social class can lead to some patients being ‘silenced’ ( Waitzkin 1991)
Easier to interact if life experiences are similar
Cultural health capital (shim 2010)
Knowing how to interact with the system
More difficult for migrants people ‘less likely to be listened to’
More affluent/educated better at this
This can contribute to inverse care law: those who most need medical care are least likely to receive it (Tudor Hart 1971)
Consider intersectionality
Developed to challenge discrimination initially in employment law (crenshaw 2011)
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
Social role of the ‘good patient’
Premium on being polite/ uncomplaining
This can lead to problems eg in medication adherence many people stop taking meds or change their dose without telling the doctor
Relationship breakdown can lead to sanctions
NHS as a social good- fear of taking too much
Mental illness and the concept of the ‘total institution’
Social patterns in large mental institutions provided rich material for medical sociologists
Characteristics of total institutions (Goffman, asylums)
All aspects of life are conducted in the same place and under a single authority
Daily life is carried out in a group with others (“batch living”) with scheduled activities
Sharp distinctions between the managers and the managed between whom there may be little communication
There is an institutional perspective; therefore the assumption of an overall rational plan
Mechanisms used in institutions to facilitate management of inmates
Physical and psychological reminders of a persons 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
Adapting to total institutions
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
- situational withdrawal: no contact with others
-intransigent line: patient refuses cooperation
-colonisation: hospital preferable to alternative
-conversion: becoming a model patient
-playing it cool: using a variety of strategies including the above depending on the situation
