Reflections on the centrality of power in medical sociology: an empirical test and theoretical elaboration.

ABSTRACT

This paper explores the contemporary relevance of sociological theorisations centred on medical power, including the medical dominance and deprofessionalisation theses. To achieve this it examines two issues that have been tentatively linked to the relative decline of the power and autonomy of biomedicine--complementary and alternative medicine (CAM) and the Internet-informed patient. Drawing on these two different but interconnected social phenomena, this paper reflects on the potential limitations of power-based theorisations of the medical profession and its relationship to patients and other non-biomedically situated professional groups. It is argued that power-based conceptual schemas may not adequately reflect the non-linear and complex strategic adaptations that are occurring among professional groups.

KEY WORDS

Cancer, internet, complementary and alternative medicine, sociology, medical dominance, informed patient

Introduction

The concept of medical power, or indeed medical dominance, has been employed by medical sociologists as a means of conceptualising the relationships between the biomedical community and various other stakeholders within western healthcare systems. Perhaps the most common utilisation of this notion, in the context of health workers, has been in relation to the biomedical community's engagement with complementary and alternative medicine (CAM), the nursing profession, midwifery and the allied health professions (e.g., Coburn 1993; Ovretveit 1985; Willis 1989). Moreover, notions of medical power and dominance have been deployed as part of broader critiques of doctors' control (or influence) over their workplace practices, patients, healthcare rationing, medical training and professional regulation (e.g., Broom and Woodward 1996; Coburn et al. 1997).

Medical sociologists have illustrated the relevance of the medical dominance thesis to the trajectory of the various facets of the biomedical community. Studies of CAM (particularly chiropractic) and midwifery have illustrated the strong political power of biomedicine in shaping the nature and delivery of primary healthcare (e.g., Dew 2000). Part of this work aimed to illustrate that healthcare delivery was not, and is not, purely based on what is 'effective' or 'efficacious'. Rather, what constitutes these very notions is a mix of the physiological, contextual, ideological and political. Paradigmatic basis, it has been argued, has been fundamental in assessing the legitimacy of a therapeutic intervention and such arguments regularly underlie sociological critiques of medical power and dominance (Willis 1989).