Americans have assumed that within the framework of cultural expectations, behavior in these roles is voluntary. The American approach, however, has been to construct models that separate each role according to its structure-its reciprocal privileges and obligations-and its function for the society, defining the doctor as the legitimizer of illness and thereby the agent of social control, and the patient as an involuntary deviant who is allowed temporary exemptions from normal social expectations but is required to resume his or her place as soon as possible. Initially, this perspective placed the patient in a primarily passive role. The change signaled by the Todd Report suggests "the beginnings of the fabrication of patient subjectivity" or, more simply, the activation of the patient (Armstrong).Īmericans, on the other hand, have been preoccupied largely with the analysis of medicine as a profession, placing emphasis upon the role of the physician as a professional with resultant claims to autonomy and dominance (Freidson, 1970b). Beginning in the eighteenth century, such surveillance invoked a disciplinary power and required that the body (and hence the patient) be a discrete (passive) object. Essentially, Foucault viewed the clinical examination as a technique of surveillance. Not until the Todd Report was history taking described as "a great deal more … than simply asking a series of prescribed questions and checking the accuracy of the answers" ( Great Britain). David Armstrong, a British medical sociologist, has pointed out that in Britain, not until about 1970 was the importance of the "inherently problematic … … doctor–patient relationship" recognized (Armstrong Interdepartmental Committee on Medical Schools). This perspective makes the human body, and hence the patient, the passive recipient of pathology, and sees the professional as an agent of the state (Rosen). European sociologists consistently have emphasized the significance of power (Foucault). There are also distinctive regional-cultural interpretations of the therapeutic relationship. At the same time, the changing facts of technology, organization, and cost were charted as the necessary context for understanding the changes in professional–patient encounters. Many of the most distinguished sociologists have used this particular problem to illustrate theories of the field. From a classic view of the relation between doctor and patient "as a pure person-to-person relation" (Sigerist), the full range of psychosocial and sociocultural influences has been studied. No other aspect of medicine has attracted more sociological analysis than the medical professional–patient relationship. Both are essential for understanding the issues surrounding the therapeutic relationship today. The purposes of this article are to provide a sociological perspective of the doctor–patient relationship by sketching the models of it as they have been developed by sociology, and to summarize contemporary sociological analysis.
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