Professional Dominance: The Social Structure of Medical Care

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In the United States today we are confronted by a number of serious social problems, not the least of which concern the character of our basic human services. In each of the broad public domains of welfare, education, law, and health there are crises of public confidence. Each in its own way is failing to accomplish its essential mission of alleviating material deprivation, instructing the young, controlling and righting criminal and civil wrongs, and healing the sick. The poor, the student, the offender and the victim, the sick-all have in some way protested the failure of the institutions responsible for them. And these protests occur at a time when the human services are absorbing an increasingly massive amount of money and manpower. Awareness of that crisis intensified in the second half of the twentieth century. Increasing energy has been invested in research designed to determine what can be done. Each of the human services has long had its own research tradition, but during the sixties each has also made a concerted effort to mobilize and use the skills of such comparatively new disciplines as sociology. Owing to these new demands, sociology itself has grown. The hitherto obscure specialties of the sociology of law and medicine and the established specialties of criminology and educational sociology have taken on new vigor. In applying themselves the task of studying the human services, however, these segments of sociology have had to choose between two different strategies. Rather than dealing with the details of the human services for their own sake-and this lack of detail in a characteristic limitation of the second approach-this book shall instead attempt to stand outside the system in order to delineate one of its critical assumptions and a strategic feature of its basic structure. This book deals with the concept of profession, for the concept rests on assumptions about how services to laymen should be controlled and is realized by a special kind of social structure that organizes the presentation of those services. Eliot Freidson was Professor Emeritus of Sociology in the Graduate School of Arts and Science of New York University. He received his undergraduate, M.A., and Ph.D. degrees from the University of Chicago. Professor Freidson is past Chairman of the Research Committee for Medical Sociology of the International Sociological Association; he has also served on scientific advisory boards for the Social Security Administration, the National Institutes of Health, and the National Center for Health Services Research and Development.