Parsons and Freidsons Models - Essay Example

Parsons’ and Freidson’s Models Introduction Societal changes, such as the impact of professional and common assumptions about health and illness, have influenced sociological research into medical practice, particularly doctor-patient relationship. When the subject matter was initially studied in the mid-twentieth century, patients and health care practitioners approved a hierarchical system that positioned physicians at the uppermost level (Gabe, Bury, & Elston, 2004). In general, social interaction and relations in the 1950s and 1960s was more courteous than it is today. Nowadays, patients usually challenge professionals with knowledge acquired from various sources, like the Internet (Gabe et al., 2004). Conceptual models of the doctor-patient relationship used in sociological research reveal the influence of various methodological and theoretical models within medical sociology. This essay critically examines the doctor-patient relationship theories of Parsons and Freidson, and determines whether their assumptions are still relevant today. Until the mid-twentieth century social scientists had paid little attention to the subject of therapeutic relationship. It was Talcott Parsons, an American sociologist, who originally placed emphasis on medicine in his structural-functional perspective (Pescosolido, 2011). However, social scientists questioned the assumptions of structural-functional perspective. Freidson (1970 as cited in Gabe et al., 2004, p. 97) argued that it was hidden conflict, and not compromise, that distinguished doctor-patient relationship. He examined the different perspectives which patients and doctors held. He explained the lay knowledge of disease and differentiated this with the clinical perspective of illness. Focus on the incompatible perspectives of professional and lay individuals also revealed the distinct cultural and social domains occupied by lay individuals. Parson’s Model of Doctor-Patient Relationship Parsons views the therapeutic relationship as mutual where the patient and the physician have specific rights and responsibilities which are tied to their functions. In essence, the doctor-patient relationship is rooted in the role of each party (Bradby, 2008). The patient is expected to consult a doctor and to have faith in the doctor and believe that the doctor is a capable health care provider. On the other hand, the doctor is obliged to respond according to the health requirements of his/her patient; to keep his/her professionalism; to provide quality service; and to conform to principles of professional conduct. The rights tied to the role of the professional are that they have professional authority and independence, and are given access to private and physical difficulties (Bradby, 2008). In addition, according to Mishler (1981), the physician has power over the sick role, and hence authorises the rights related to the recognition of the sick role. The doctor-patient relationship is portrayed by Parsons as a phenomenon typified by consensus, although it is an unequal relation. The power of the physician is recognised by the patient because the physician’s greater knowledge and the patient completely obeys the physician, as the physician acts in accordance to the patient’s wellbeing and needs (Holton & Turner, 1986). It is hence a consensus paradigm demonstrating the broader premise of a collective value system which is addressed in Parsons’ functionalist theory. However, Parsons’ theory of doctor-patient relationship has been criticised as founded on ideas that the physician is the professional to whom the patient submits to, and works with. These ideas are founded on the ‘rationality’ premise of the biomedical framework (Moon & Gillespie, 1995, p. 116). Freidson (1970) has been opposed to this romanticised picture of the therapeutic relationship, and particularly the medical profession which he portrayed as “blinded by the glitter of its own status” (as cited in Moon & Gillespie, 1995, p. 116). He believes that the doctor-patient relationship is characterised by conflict rather than harmony. Medical sociology has followed a different path after the introduction of radical models like feminism and neo-Marxism. This major development has made Parsonian model of doctor-patient relationship fairly obsolete. It is not only that Parsons’ theory of the professions is currently considered to be conceptually weak; contemporary sociology is wholly anti-professional (Bury & Gabe, 2004). Moreover, this critical discourse generally implies that physicians have failed to comply with the professional standards, particularly of universalism. Specifically, to condemn physicians for a class prejudice in the handling of patients necessitates reference to those principles which Parsons specified as the distinguishing features of professionalism (Pescosolido, 2011). As stated by Alder (2009), critical sociology embraces the principles of universalistic, technical capability as the standard by which to denounce physicians for being unable to behave or respond as professionals. Obviously, this criticism is not the only one that critical sociology has to present. One of its objectives is to explain the evolving attributes of the professions and professionalism within the framework of late capitalism, where state involvement is required in establishing norms of professional service and training, and in strengthening medical superiority (Holton & Turner, 1986, p. 117). Hence, Parsonian model of therapeutic relationship is clearly obsolete, because it was formulated within the framework of a laissez-faire economy, where a personal agreement between patient and physician was the standard. For that reason, Parsons’ theory is not completely applicable to societies where in there has been a major nationalisation of medical services and where in the state serves a major function in controlling medical costs (Holton & Turner, 1986, p. 118). In such instances, the established independence of the medical profession has been weakened by state involvement. Together with these changes is the undermining of physicians’ status. The disintegration of the profession, the weakening of established independence, and the growth of the division of labour in medical profession, have encouraged a number of social scientists to believe that there is a ‘proletarianisation’ and ‘de-skilling’ process happening within health care occupations (Holton & Turner, 1986, p. 118). Numerous of these developments have made Parsons’ doctor-patient relationship model out of date. Freidson’s Model of Doctor-Patient Relationship Another seminal theory of doctor-patient relationship is developed by Eliot Freidson. The perspective of Freidson, even though recognising a core distinction in patients’ and doctors’ roles and privileges, is more conflictive (Bradby, 2008). He argues (Calnan & Manning, 1985, p. 125): Conflicts in perspective and interest are built into the interaction and are likely to be present to some degree in every situation. They are at the core of the interaction, and they reflect the general structural characteristics of illness and its professional treatment as a function of the relations between two distinct worlds, ordered by professional norms. He views the possession of medical expertise as a determinant of the doctor-patient relationship. Physicians, who are reluctant to share their knowledge with their patients, try to preserve their prestigious status and professional position in society. Freidson believes that patients and physicians are competing over access to knowledge (Calnan & Manning, 1985). Both Freidson and Parsons characterised doctor-patient relationship with regard to social structure. Yet, during the time of Freidson, the perception on the various roles of doctors and patients was evaluated against an idea of how professional functions are vulnerable to change, particularly in the medical sector. Freidson’s model of illness was largely informed by labelling theory to prove that physicians develop the rightful classifications of disease. He was one of those who disapproved of the beliefs that doctors were simply motivated by self-sacrifice and philanthropy (Alder, 2009). He emphasises the disagreement between the opposite interests of patient and doctor, the different factors against and for the uninterrupted completion of doctors’ directives. A major suggestion of this idea is that, given the present-day structure of health care, there are numerous bases to assume that the reciprocal relationship, although favourable, may not be achievable. Freidson argues that doctors expect their patients to follow their orders submissively, whilst “patients seek services on their own terms” (Mishler, 1981, p. 135). Such instances of conflicting intentions result in clashes rather than consensus. In his study of patients from three distinct clinical contexts, Freidson identifies ‘lay referral systems’ (Mishler, 1981, p. 135) of patients. Discussion with other lay people was discovered to be a major contributing factor to patients’ initial beliefs and later interactions with doctors and other health care providers. The impact of this interpersonal network outside the medical context is undervalued, or overlooked completely, when patient and doctor are viewed as fulfilling socialised functions. From such discoveries, Freidson claims that strong influences on the relationship between patient and doctor originate from the “interpersonal networks that are part of everyday life” (Mishler, 1981, p. 135). Freidson also argues that the guidance-cooperation framework is the model largely associated with the doctor-patient relationship. The patient is aware of the circumstances, has decided to consult a physician, and obliges by obeying the doctor’s instructions. In this framework, the doctor decides and the patient responds as told (Gabe et al., 2004). Even though this has been the most widespread perspective of doctor-patient relationship, it is currently being refuted by patients who demand more involvement in decision making. Freidson further argued that the relationship indicated by the model of mutual participation necessitates patients’ attributes that enable communication. It is not a suitable framework for patients who are mentally weak, insufficiently informed or educated, or inexperienced (Gabe et al., 2004). The most essential social factor in doctor-patient relationship seems to be social class, with those belonging to the lower class as having the most serious communication difficulties with doctors (Moon & Gillespie, 1995). Nevertheless, Freidson believes that when the mutual participation framework is effective, it does so because an equal status is existent. Both patient and doctor should view each other as equals in the pursuit of an answer to the patient’s difficulties. The effect of the physician on the patient depends mostly on the capacity of the doctor to encourage the patient to follow a prescribed course of action. Conclusions As shown in the essay, Parsons and Freidson have very different views of doctor-patient relationship. Parsons believes that the relationship between the physician and the patient is driven by the former’s selfless motives and the latter’s need to seek solutions for his/her health problems. For Parson, the relationship is one of consensus. On the other hand, Freidson believes that the doctor-patient relationship is characterised more by conflict rather than consensus. This conflict stems from competition over access to knowledge. Parsons’ model is considered obsolete nowadays, because of increasing state involvement in the health care sector. On the contrary, Freidson’s model may still be applicable today because of the conflict-ridden nature of contemporary medical profession. References Alder, B. (2009) Psychology and Sociology Applied to Medicine: An Illustrated Colour Text. UK: Elsevier Health Sciences. Bradby, H. (2008) Medical Sociology: An Introduction. London: Sage. Bury, M. & Gabe, J. (2004) The sociology of health and illness: a reader. London: Routledge. Calnan, M. & Manning, N. (1985) Sociological approaches to health and medicine. London: Routledge. Gabe, J., Bury, M., & Elston, M. (2004) Key Concepts in Medical Sociology. London: Sage. Holton, R. & Turner, B. (1986) Talcott Parsons on Economic and Society. New York: Taylor & Francis. Mishler, E. (1981) Social Contexts of Health, Illness, and Patient Care. New York: CUP Archive. Moon, G. & Gillespie, R. (1995) Society and Health: An Introduction to Social Science for Health Professionals. London: Routledge. Pescosolido, B. (2011) Handbook of the Sociology of Health, Illness, and Healing: A Blueprint for the 21st Century. New York: Springer. Read More