Vol.2, No 6, 1999 pp. 157 - 160
NEW BOOKS REVIEW
BUCHBESPRECHUNGEN
MEDICAL SOCIOLOGY OF TODAY
At the beginning of the year, the book Medical Sociology
(Conceptual and Historical Survey) by Ph. D. Milan Antić, a professor of
the Medical Faculty in Niš, appeared in edition of "Grafosrem" , and although
it is not voluminous, it is of great scientific significance. It is conceived
as the first one in a series of publications dedicated to conceptual and
historical questions and developing trends of medical sociology as a sociologycal
subdiscipline. The book is comprised of several characteristic works by
domestic and foreign authors, which are important for the discipline both
in pur country and abroad. The period 1975-1985 was taken as a time period
for the choice of texts, but it was slightly widen ed, so that besides
the texts by Prokić and Claus from this period, there could be found texts
preceding these (Sokolovska, Freidson) as well as texts published after
this period and which complete this period in a sense (Letica-Letica, Cockerham).
In the text The Factors of the Origin and the Field of
the Sociology of Medicine, Magdalena Sokolovska researches significant
factors, which provided for the convergency of medicine and sociology,
and medical care as a separate social subsystem and an attractive field
for research of the sociology of medicine. The inability of a more successful
and rational solution to practical social problems based on biomedical
knowledge urged a rapid development of the youngest branch of empiric sociology
which, in only a lew decades, entered the curritulum at medical schools,
with a obvious rise in the number of experts taking an interest in it.
Sokolovska states that a modern physician without philosophical and social
knowledge is helpless when facing basic human problems, like the feelings
of uncertainty, hopelessness and solitude. The need to bring closer sociology
and medicine, indicated by demographic and social changes in industrialized
countries, was brought about by these foltowing social phenomena: an increase
in the population and ageing, automation, sparetime, changes in the family,
the problem of juvenile delinquency, alcoholism, rehabilitation of the
handicapped and invalids, and many others.
Realizing that many theoretical and practical problems
(interpersonal relationships, professional status and roles, efficiency
of the relationslhips between patients and physicians, quality of services
and equal rights on health, application of technology and the dehumanization
of medical work) are a field of interest to those who deal with the sociology
of medicine, Sokolovska suggests some interesting theses: which criteria
are used by different groups and categories of people when choosing a physician,
how people experience the role of a patient, and how they behave in hospitals,
what influence does the social system have on medical institutions in the
sense of therapy, cure and rehabilitation, etc.
In the text A Conceptual Outline of the Sociology of
Medicine, Eliot Freidson tries to enlighten the characteristic conceptual
subject matter of the sociology of medicine, stating his opinion about
traditional sociological concepts of diseases and the distribution of a
disease, the role of a patient, the medical profession, hospitals and medical
care and medical institutions in a community. Of primary interest to the
sociologists are the social consequences of the stating of a disease, that
is, treatment of a disease as a type of social deviation, which is of great
significance to the scientific treatment of some human actions. In developed
western societies, the status coherency of those who are recruited to the
medical profession is still present so it is possible to talk about the
fact that professional socialization includes mainly representatives of
higher social groups. It seems that the stability of the profession is
conditioned by the competition in the medical profession, that is, the
role of a physician is closer to what is professionally desired if it is
carried out in front of other physicians. According to some opinions, the
stability of a professional role varies, depending on the organized scope
in which it is performed. Today the centres of medical work are hospitals
where teams of professionals are surrounded by managers and other expert
groups that causes two separate currents of authority in the hospital -
medical and administrative. The administrative department which is free
to make and carry out administrative decisions, while single professionals
are left to make and carry out professional decisions, provides the existence
of the two currents. Examining the significance of the community in medical
treatment and the rehabilitation of the sick, Freidson concludes that its
attention is not definite in the therapeutic tretment, but it includes
a net of other organizations dealing with the medical care as well as preventive
actions in changes of behavior and circumstances which are believed to
cause the disease.
In the text On the Origin of the Sociology of Medicine,
Boško Prokić studies the causes and stimulus of sociological researches
of single phenomena and processes in public health. He thinks that the
basic determinants of the origin and the development of the sociology of
medicine could be put into two groups. The first one stems from the need
for the development of a general sociology that is no longer capable of
following the numerous phenomena and dynamic processes in all spheres of
society. The other one stems from the need for a more successful and rational
solution of practical social needs that cannot be solved on the basis of
existing knowledge of the natural sciences. Social and economic factors
became the object of interest of medical work that caused a modification
of the cocial function and profile of a physician. The classification of
medicine into many branches, specialities and subspecialities initiated
the need for team work in providing medical services, and realizing the
significance of social factors for health made it oblikatory to study the
relationships between the hospital and the community, medical personnel
and managers, medical and administrative personnel, a nursing staff and
those who do not work in hospitals as well as the relationships between
physicians and patients. The unity of a cure and prevention of a disease
had a satisfactory influence on the excessiveness of the idea that a disease
is a natural phenomenon. The system of education of medical personnel,
having been deprived of traditionalistic study, especially of the natural
and scientific knowledge and skills, turned out to be an appropriate field
for the affirmation of the social components of medical work. As a stimulating
factor of the origin of the sociology of medicine, the strengthening of
the social hygiene could be taken as a scientific, teaching and practical
discipline in the previous and this century.
Summing ut the common denominator of the origin and development
of the medical sociology in Europe since the Second World War is the object
of interest to Lisbeth Claus in the text The Development of the Medical
Sociology in Europe. The different tempo of the European development of
the discipline was dictated by numerous mutually connected, enabling and
disabling factors. The enabling factors are: the significance of the government
in financing sociological research, the growth of the university, the expansion
of sociological research, the students' protest, the recommendations and
regulatons of medical education and personal professionalization. Among
the disabling factors are the rigid structure of the university, perception
of medical sociology as a critical discipline, the power of opposing disciplines,
the lack of support of the main discipline and the lack of possibility
of professional training. As the three main and mutually connected characteristics
of European medical sociology, the following stand out: disciplines which
are widely stated and disease-defined boundaries of the discipline, the
applicable character, or in other words, the striving of sociological knowledge
to be subordinated to the application in medical care and orientation to
the creation of policy. According to the developmental degree of the discipline
in every single country, the model of the European medical sociologists
containing live different groups, is presented: ambassadors, professionals,
research workers, activists, and passers-by. The described situation of
the European medical sociology refers to the conclusion that its further
development is limited by the individual progress of single national medical
sociologies which means that real professional communication will be provided
only by exceeding social and cultural differences in European countries.
The goal of the text Modern Medical Sociology: where
it comes from and where it is going by Gordana Cerjan-Letica and Slaven
Letica is to give detailed information about the origin, subject matter,
problems and perspective of medical sociology to those who are not well
informed. A systematic phase characterizes its development. The first phase
includes the time period until the 1950s when this discipline is presented
only as an inspiration for the sociological research of medicine. The second
phase beins in the 1950s when the discipline has been grdually founding
itself in an autonomous way. According to the authors, the sociology of
medicine deals with medicine and public health as a subsystem of the global
social system, that is, it deals with the research of the fundamental principles
and laws of performing and behaving of the performers. That is why it is
recommended to make the distinction between the sociology of medicine and
the sociology in medicine, which applies existing knowledge in solving
concrete problems of organization, profession and health. In the survey
of the basic conceptual accomplish-ments in the sphere of modern sociology,
the absolute domination of the American medical sociology is noticable
in the main course of the scientific discoveries or inovations. Medical
sociology in Yugoslavia is said to be mainly academic, descriptive and
receptive and not analytic, researchoriented and publicistic-creative discipline
and that its scientific promotion would be more successful if it was included
in the teaching programmes of the studies of sociology as an optional subject.
Another insight into the origin, the field of research,
and perspective of medical sociology is given in the text written by William
Cockerham. He sees the stimulus to this new discipline in the pressure
of the medical and governmental sources to produce results that could be
applied in medical practice and in creating medical policy, out of which
greater professional orientation of medical sociologists toward applied
rather than theoretical researches has arisen. One of the products of such
a course is the division of sociologists info those who examine medicine
in applied situations and those who practice voluminous theoretical activity,
usually ia a non-medical academic environment, in other words, division
info the sociology in medicine and the sociology of medicine. The author
directs his discussion toward four spheres of medical sociology: differences
in health betwen men and women, the use of medical services, health and
social stratification, the growth in number of women-doctors and the reduction
of the autonomy of physicians. Let us see some observations related to
the last two spheres.
Women-doctors will be normal phenomenon in the future,
and the trend of sex-transformation of medicine will cause changes, first
of all, in the physician-patient relation. Signs alluding to the modification
in the professional domination of physicians in the future are noticed
as well. Three factors are responsible for that. The first one is the increased
interference of the government in giving medical care. The second one is
the increase in medical sonsumerism where influential and welleducated
people try to take control of their health. The third factor, an especially
effective movement, includes the taking over of an important part of the
medical market by great business conglomerates. A physician becomes attached
to the rules, regulations and practical procedures established by the corporation
and he will no more be of crucial significance in making decisions about
the policy, hospital budget, major investments, salaries, promotions and
personal nominations. As a perspective, according to Cockerham, new fields
of the engagement of medical sociology are: the way of socialization of
women-students at medical schools under the influence of medical education,
the role of the nursing profession and different paramedical workers in
giving technical support to the physicians, the way of taking the stress
in some medical disosrders, an ageing of the population, medical policy,
and giving medical care ind different countries, etc.
Since the medical sociology in our country is in the
phase of "the original accumulation" of the conceptual, theoretical and
methodological knowledge, the given subject matter should be considered
as a long-term professional investment. That is, this modest publicatton
is enriched and future efforts of the increasing activistically-directed
educated professionals devoted to the career of a medical sociologist are
accelerated. Finally, with this book, the author joins rare individuals
who are responsible for creating and promoting credibility, which is necessary
for the institutionalization of the field of research of one of the youngest
sociological disciplines in Yugoslavia.
Dragan Todorović
