Freidson Then and Now: An “Internalist” Critique of Freidson's Past and Present Views of the Medical Profession

1992 ◽  
Vol 22 (3) ◽  
pp. 497-512 ◽  
Author(s):  
David Coburn
Keyword(s):  
Health Care ◽  
Medical Profession ◽  
The United States ◽  
Professional Autonomy ◽  
Policy Recommendations ◽  
Structural Determinants ◽  
The Core ◽  
Social Structural ◽  
Core Elements ◽  
Medical Dominance

Freidson is a foremost analyst of the medical profession. Most recently Freidson attacks those who claim that medicine is declining in power. He insists that medicine has not lost the core elements that make it a powerful, indeed, the dominant, health profession. The author compares Freidson's early writings on medicine with his most recent ones, and shows that there are critical confusions in Freidson's central concepts of professional autonomy and dominance. This difficulty is illuminated by viewing dominance, autonomy, and subordination as on a continuum of control. Using this continuum, the author argues that Freidson implicitly admits what he set out to deny (that medicine has not declined in power) by shifting his focus from medical dominance to that of autonomy. Freidson also now rejects valid parts of his earlier work (that which emphasizes social structural determinants of behavior over socialization). In equating medicine in the United States with teaching in that country, Freidson's contention of “little change in medical power” meets its own refutation. Finally, despite his derogation of others, Freidson's lack of an adequate framework to explain the dynamics and not simply the structure of health care produces purely normative, Utopian (and unhelpful) policy recommendations.

Moving Beyond Capitalism for Our Health

2020 ◽  
Vol 50 (4) ◽  
pp. 458-462
Author(s):  
Howard Waitzkin
Keyword(s):  
Health Care ◽  
National Health ◽  
Medical Profession ◽  
Universal Access ◽  
Private Insurance ◽  
The United States ◽  
Health Programs ◽  
National Health Programs ◽  
Public And Private ◽  
Private Profit

Deepening crises now affect not only the capitalist health system in the United States, but also the national health programs of countries that have achieved universal access to services. In our recent collaborative book, Health Care Under the Knife: Moving Beyond Capitalism for Our Health, we analyze these changing structural conditions and argue that the struggle toward viable national health programs now must become part of a struggle to move beyond capitalism. Privatization, cutbacks in public-sector services and institutions, and public subsidization of private profit-making through transfer of tax revenues into private insurance corporations have worsened under neoliberal policies. Financialization of capitalist economies includes the increasingly oligopolistic and financialized character of health insurance, both public and private. Those struggling for just and accessible health systems now need to confront the shifting social class position of health professionals. Due to loss of control over the work process and a reduced ability to generate high incomes compared to other professional workers, the medical profession has become proletarianized. To achieve national health programs that will remain viable over a long term, a much more fundamental transformation needs to reshape not just health care, but also the capitalist state and capitalist society.

scholarly journals Women, Midwives, and a Medical Model of Maternity Care in Switzerland

2017 ◽  
Vol 7 (3) ◽  
pp. 117-125 ◽  
Author(s):  
Sue Brailey ◽  
Ans Luyben ◽  
Edwin van Teijlingen ◽  
Lucy Frith
Keyword(s):  
Health Care ◽  
Maternity Care ◽  
Medical Profession ◽  
Medical Model ◽  
Professional Autonomy ◽  
Power Structures ◽  
Disciplinary Power ◽  
Study Approach ◽  
Care System

This article presents a case study on the organization of maternity health care in Switzerland. Switzerland has a costly health care system with high intervention rates within an obstetric-led maternity care model. Evidence has shown that midwifery care is associated with lower cost, higher satisfaction rates among women, and less intervention. However, in this model, midwives are both marginalized and underused.The article focuses on the distribution of power and knowledge between midwives, women, and the medical profession. The varying power structures that shape the maternity care system in Switzerland are examined, using a case study approach that draws on Foucault’s concepts of the gaze, surveillance, disciplinary power, and the docile body. This article critically analyzes the model of maternity care received by women in Switzerland and how it negatively impacts on both women’s personal and midwives’ professional autonomy while simultaneously driving up costs.A better understanding of the underlying power structures operating within the maternity care system may facilitate the implementation of more midwifery-led care currently being endorsed by the Swiss Midwifery Association and some government agencies. This could result in reduced cost and lower intervention rates with reduced associated morbidity.

The Trilogy of Health Care: Caring and Healing of the Clinician

2021 ◽  
pp. 002436392110555
Author(s):  
Bro. Ignatius Perkins ◽  
Allen H. Roberts
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Daily Living ◽  
Human Person ◽  
Early Discharge ◽  
The United States ◽  
The Core ◽  
Effective Interventions ◽  
History Of ◽  
Caring And Healing

Today, more than we are aware of in the history of health services in the United States, is the critical need to reclaim and apply the core values and principles that inspired physicians and nurses to respond to their original call become consolers and healers of the sick and those in distress, and to refocus our attention on the person of the healer. In clinical practice today, we are endowed with enormously effective interventions that were unimaginable only a few decades earlier. In light of the fund of knowledge, clinical competencies, and technological advancements that we bring to bear in our experience in caring for our patients, the learning curve is never flat, never complete, and never static. Newer, safer, and more effective interventions in the cure of illnesses, management to relieve stress, moderate fear of surgery, and to promote healing that often lead to early discharge and return to normal activities of daily living are readily available in clinical practice. Yet, there are looming threats that compromise the person of clinician, for example, dehumanization, consumerism, commodification, and fungeability of the human person. This article will describe the Trilogy of Health Care: Caring and Healing of the Clinician and its application to the care and healing of physicians and nurses as they accompany one another in caring for a world in need of healing and hope.

Labor Law and Physicians' Privileged Position: An Example of Structural Interest Influence

1982 ◽  
Vol 12 (2) ◽  
pp. 249-261
Author(s):  
Paul M. Swiercz ◽  
James K. Skipper
Keyword(s):  
Health Care ◽  
Interest Groups ◽  
Political Institutions ◽  
Social Economic ◽  
Care Delivery ◽  
Medical Profession ◽  
Labor Law ◽  
The United States ◽  
Privileged Position ◽  
Group A

Health care delivery in the United States may be characterized as a dynamic system of conflicting interest groups. Since the reorganization of the medical profession in 1910, however, physicians have been able to maintain their position as a dominant structural interest group. A dominant structural interest in one which is served by the structure of social, economic, and political institutions. It does not have to reorganize continuously to protect its privileged position. Although several medical sociologists have noted the privileged position of physicians, few have attempted to explicate the process of status maintenance. This paper examines the development of labor law in health care as one example of structural interest influence. Labor law provides an excellent illustration of this influence in that its development and application are far removed from the physicians' sphere of direct influence. It is demonstrated that the ideology that physicians should hold a privileged position is so ingrained that their interests are protected even in their absence.

scholarly journals Core Elements of a State HAI/AR Program With Emphasis on Partnership Networks

2020 ◽  
Vol 41 (S1) ◽  
pp. s181-s182
Author(s):  
Cecilia Joshi ◽  
Elizabeth Mothershed ◽  
Wendy Vance ◽  
Anita McLees ◽  
Margaret Paek ◽  
...  
Keyword(s):  
Public Health ◽  
The United States ◽  
Academic Community ◽  
Healthcare Associated Infection ◽  
Core Element ◽  
Health Crisis ◽  
The Core ◽  
National Implementation ◽  
Core Elements ◽  
State And Local

Background: There is a critical need for comprehensive and effective healthcare- associated infection and antibiotic resistance (HAI/AR) programs in the United States. Since 2009, the CDC has funded and engaged public health, healthcare, academic, community, corporate, federal, and other stakeholders to develop effective HAI programs that rely upon such these stakeholders for success. State and local public health programs play a central role in these programs because they bridge healthcare and the community. They may regulate and assess facilities, collect and validate data on infections, and implement prevention programs. Myriad other state, federal, and privately supported stakeholders play essential roles. CDC is developing a framework for highly effective state HAI/AR programs that describes core program elements and can be used as a strategic tool, both in day to day processes and in a public health crisis, such the COVID-19 response. Program elements may include engaged leaders and champions, reliable data for action, effective policies, evaluation, program innovation, communications, and partner networks. This presentation describes a success framework for developing and leveraging HAI/AR partner networks to achieve and sustain their capacities and impact.Methods: CDC collected qualitative data in select states and combined with expert opinion to draft core elements for success among a network of partners working to achieve HAI/AR and COVID-19 response and prevention in states. The core elements serve as a foundation for the framework. Ongoing analyses will inform refinement of the core elements and framework. The CDC is gathering stakeholders’ input on the framework for applicability and usability in states, with the goal of national implementation. Results: Currently, data indicate the following core elements for partner networks: leadership, strategy and structure; policies; innovation and adaptability; implementation; expertise and resources; communications; and monitoring and evaluation. The framework includes a process for partner network development and sustenance, maturity levels, and supporting tools. States have reported support for core elements and agreed that a success framework is beneficial to achieving core elements. Multiple states have reported support for a process that includes building partner networks and clearly defining roles, as a critical step toward full implementation of Program core elements. Conclusions: A framework for building high-level strategy and competency in partner networks has never been developed for HAI/AR programs. Effective partner networks represent an essential core element of a comprehensive state HAI/AR program. This framework could be applied to a variety of programs and public health contexts, increasing the effectiveness of partner networks.Funding: NoneDisclosures: None

Association between statewide adoption of the CDC’s Core Elements of Hospital Antimicrobial Stewardship Programs and rates of methicillin-resistant Staphylococcus aureus bacteremia and Clostridioides difficile infection in the United States

2019 ◽  
Vol 41 (4) ◽  
pp. 430-437
Author(s):  
Alessandra B. Garcia Reeves ◽  
James W. Lewis ◽  
Justin G. Trogdon ◽  
Sally C. Stearns ◽  
David J. Weber ◽  
...  
Keyword(s):  
United States ◽  
Staphylococcus Aureus ◽  
Antimicrobial Stewardship ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
The United States ◽  
The Core ◽  
Staphylococcus Aureus Bacteremia ◽  
Clostridioides Difficile ◽  
Core Elements ◽  
Clostridioides Difficile Infection

AbstractObjective:To measure the association between statewide adoption of the Centers for Disease Control and Prevention’s (CDC’s) Core Elements for Hospital Antimicrobial Stewardship Programs (Core Elements) and hospital-associated methicillin-resistant Staphylococcus aureus bacteremia (MRSA) and Clostridioides difficile infection (CDI) rates in the United States. We hypothesized that states with a higher percentage of reported compliance with the Core Elements have significantly lower MRSA and CDI rates.Participants:All US states.Design:Observational longitudinal study.Methods:We used 2014–2016 data from Hospital Compare, Provider of Service files, Medicare cost reports, and the CDC’s Patient Safety Atlas website. Outcomes were MRSA standardized infection ratio (SIR) and CDI SIR. The key explanatory variable was the percentage of hospitals that meet the Core Elements in each state. We estimated state and time fixed-effects models with time-variant controls, and we weighted our analyses for the number of hospitals in the state.Results:The percentage of hospitals reporting compliance with the Core Elements between 2014 and 2016 increased in all states. A 1% increase in reported ASP compliance was associated with a 0.3% decrease (P < .01) in CDIs in 2016 relative to 2014. We did not find an association for MRSA infections.Conclusions:Increasing documentation of the Core Elements may be associated with decreases in the CDI SIR. We did not find evidence of such an association for the MRSA SIR, probably due to the short length of the study and variety of stewardship strategies that ASPs may encompass.

Icon and taboo: single-payer politics in Canada and the US

2019 ◽  
Vol 35 (1) ◽  
pp. 5-24 ◽  
Author(s):  
Carolyn Hughes Tuohy
Keyword(s):  
United States ◽  
Health Care ◽  
Medical Profession ◽  
Private Insurance ◽  
The United States ◽  
Hospital Services ◽  
Popular Support ◽  
Single Payer ◽  
The Us ◽  
Political Economies

AbstractIn 1965 and 1966, the United States and Canada adopted single-payer models of government insurance for physician and hospital services – universal in Canada, but restricted to certain population groups in the US. At the time, the American and Canadian political economies of health care and landscapes of public opinion were remarkably similar, and the different policy designs must be understood as products of the distinctive macro-level politics of the day. Subsequently, however, the different scopes of single-payer coverage would drive the two systems in different directions. In Canada, the single-payer system became entrenched in popular support and in the nexus of interest it created between the medical profession and the state. In the US, Medicare became similarly entrenched in popular support, but did so as part of the larger multi-payer private insurance system. In the process universal single-payer coverage became politically iconic in Canada and taboo in the US.

Professional Autonomy Reconsidered: The Case of Czech Medicine under State Socialism

1997 ◽  
Vol 39 (2) ◽  
pp. 346-372 ◽  
Author(s):  
Lily M. Hoffman
Keyword(s):  
United States ◽  
Decision Making ◽  
Soviet Union ◽  
Medical Profession ◽  
Extreme Case ◽  
The United States ◽  
Professional Autonomy ◽  
The State ◽  
Clinical Autonomy ◽  
Corporate Autonomy

The opening of the formerly closed, state socialist societies of East Central Europe has provided the opportunity to bring new empirical evidence to bear upon models of profession-state relations developed in pluralist western societies. The classic view of Tocqueville and Durkheim has been that professions are an intermediary group linking individuals and the state. Although not always explicitly stated, this model served as the basis for scholarly work on the professions in the post-World War II period, where it (more or less) fit the image of a differentiated pluralist society. Most work on the professions was based on the Anglo-American case.But even in the United States, state support was more central to maintaining professional authority than was originally thought. Without explicitly discarding the model, Freidson (1970) introduced a distinction between corporate and technical (clinical) autonomy that provided a way out of the paradox he identified, that both aspects of professional autonomy are protected by the state. Corporate autonomy refers to the political power of the organized profession to define the social and economic context of professional work, and clinical autonomy, to the control of decision making in the workplace. Testing his hypothesis on the United States, the United Kingdom, and the Soviet Union, Freidson argued that despite differing degrees of corporate autonomy, the medical profession retained clinical control of decision making, the core of professional autonomy, even in the extreme case of the former Soviet Union.

Labor Migrations of Poles in the Atlantic World Economy, 1880–1914

1989 ◽  
Vol 31 (2) ◽  
pp. 237-272 ◽  
Author(s):  
Ewa Morawska
Keyword(s):  
Economic System ◽  
World Economy ◽  
World System ◽  
The United States ◽  
Structural Determinants ◽  
Population Movements ◽  
Large Wave ◽  
The Core ◽  
Labor Migrations ◽  
Economic Imbalances

The recent influx to the United States of a new large wave of immigrants from Hispanic America and Asia has reinvigorated immigration and ethnic studies, including those devoted to the analysis of the origins and process of international migrations. The accumulation of research in this field in the last fifteen years has brought about a shift in the theoretical paradigm designed to interpret these movements. The classical approach explains the mass flow into North America of immigrants (from Southern and Eastern Europe, in the period 1880 to 1914), as an international migration interpreted in terms of push and pull forces. Demographic and economic conditions prompted individuals to move from places with a surplus of population, little capital, and underemployment, to areas where labor was scarce and wages were higher (Jerome, 1926; Thomas, 1973; Piore, 1979; Gould, 1979). This interpretation views individual decisions and actions as the outcome of a rational economic calculation of the costs and benefits of migration. Recent studies of international population movements have reconceptualized this problem, recasting the unit(s) of analysis from separate nation-states, linked by one-way transfer of migrants between two unequally developed economies, to a comprehensive economic system composed of a dominant core and a dependent periphery— a world system that forms a complex network of supranational exchanges of technology, capital, and labor (Castells, 1975; Cardoso and Faletto, 1979; Kritz, 1983; Sassen-Koob, 1980; Portes, 1978; Portes and Walton, 1981; Wood, 1982). In this conceptualization, the development of the core and the underdevelopment of the peripheral societies are seen not as two distinct phenomena, but as two aspects of the same process—the expanding capitalist world system, explained in terms of each other. Generated by the economic imbalances and social dislocations resulting from the incorporation of the peripheries into the orbit of the core, international labor migrations between the developing and industrialized regions are viewed as part of a global circulation of resources within a single system of world economy. This interpretation shifts the central emphasis from the individual (and his/her decisions) to the broad structural determinants of human migrations within a global economic system.

The Aging Prison Population

Criminology ◽  
2018 ◽  
Author(s):  
Samuel Scaggs
Keyword(s):  
Health Care ◽  
Prison Population ◽  
The United States ◽  
Policy Recommendations ◽  
Correctional Institutions ◽  
Government Officials ◽  
Inmate Population ◽  
Older Prisoners ◽  
Nursing Services ◽  
Policy Concern

Since the 1980s, the proportion of state and federal prisoners who are older has experienced unprecedented changes to the extent that they currently represent the fastest-growing inmate population in the United States. This increase has become an important policy concern for government officials and correctional administrators due to older prisoners’ health-care and confinement expenses. Consequently, politicians are increasingly under pressure to implement innovative policies to respond to the growth in this low-risk, albeit costly, prisoner population. At the same time, correctional administrators in several states are planning for the increased use of nursing services. The study of older prisoners involves scholarly works from an amalgam of disciplines including criminology, demography, economics, gerontology, public health, social work, and sociology. To study aging in prison, researchers must first understand the conceptual definitions ascribed to being older in prison and the typology of older prisoners. They must also gain a sense of social and demographic contributors to the aging inmate population over time. These explanations lend themselves to a description of health-care issues associated with an increasingly aging prisoner population. Since older prisoners are similar to their younger counterparts in that many will return to the community, the reader must also understand reentry issues among older ex-prisoners. Finally, the growth in the proportion of older prisoners has been followed by an array of policy recommendations to address the growth in older prisoners, meet the needs of prisoners aging inside correctional institutions, and assist older ex-prisoners with their transition back to the community.

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