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Weberian approach to health professionals

  • all occupational groups compete with each other for status and high rewards
  • they organise themselves along professional lines to form professional associations in order to bargain with employers and protect their financial interests
  • Parry and Parry argue that doctors' claim to be altruistic disctracts from the afct that they adopt makrjet strategies that maximise their earning power.
  • Controlling access to the profession and limiting the numbe rof doctors being trained have been as very effective strategy in ensuring that doctors enjoy high pay, job security and privellege
  • Parry and Parry suggest that professionalisation is an occupational startegy aimed at controlling the labour market so that it economically benefits doctors. The process of professionalisation has important dimesions: production of a body of esoteric knowledge, educational barriers, exclusion of comeptition, maintenance of privellege and maintenance of standards
  • medical profession benefit its own interest
  • Friedson argues that professions act in order to gain social closure through professional dominance
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  • Millerson's traits fo profession can be seen as techniques of closure and they include: theoritical knowledge, specialised education, formal examinations, an independetn regulatory body, professional code of behaviour and the aim of public good
  • Turner occupational domination has been achieved through subordination (nurses, midwives), occupational limitation (e.g. dentistry) and exclusion (e.g. homeopathy)
  • professional groups with the health system are staus groups priamarily organised to protect the interest of their members. This is achieved by doctors through:
  • Specialisation- as group can restrict entry and as a result raise their status and income through the increasing specialisation of the medical role.
  • They create barriers for entry by claiming exclusive knowledge, increaisng the need for long and expensive tarining, establishing monopoly practices
  • These barriers are complemented by a range of practices: strict regulation, self governance, specialised training
  • Alexander characterises this as a form of social exclusion by restricting and controllign their membership, a group creates artificial shortages of expertise which is then translated into a range of rewards such as high status and power exclsuively enjoyed by group members
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criticisms of weberianism

  • Professionalisation provides benefits for those who require medical services as it results in trained and competent medical staff, ethical behaviour governed by a code of conduct and high standards of behaviour and care
  • Barriers to entry can also serve the public by ensuring taht those who offer medical services are properly qualified and that the service has been tested, assesed as effective and not harmful
  • Goldacre, Fitzpatrick, Sheeran
  • Fuctionalist theory
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Marxist approaches

  • Navarro argues that in capitalist societies, a small ruling class exploits society for its own benefits. Doctors are agents of the capitalist class and their high status and salaries are the rewards they receive from the cpaitalist ruling class for playing their part in mainatining economic inequality and exploitation
  • Doyal argues that docotors and health service legitamise the organisation of capitalism by pursuading the workforce that capitalism cares for them e.g. through the NHS. This is to reduce the potential for class ocnflict and political unrest
  • Doctors mislead the workforce as to the real cause of any illness they might suffer by explaining illness in terms genetics and individual actions rather than focusing on poverty, poor living and working conditions, inequality in wealth, which are the true causes of illness
  • Doctors guarantee the good health of the workforce so that capitalist production, exploitation and profit making can continue undisturbed
  • Docotors socially control the workforce on behalf of the capitalist class e.g. by decidign who is able to work
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  • Medical profession serves to promote the interest of the capitalist class by the following structures:drugs/pharmaceutical companies, private medicine, gatekeeper role (defining, legitimising and access) defining new disorders which can be treated by new and profitable drugs, maintaining a fit and healthy workforce and ideological role fo medicine
  • Bambra et al. argue that in capitalist societies health is a commodity; something to be bought and sold and the role of health professionals is to service this market
  • Althusser argues that medicine is an ideological state apparatus: the means through which people are socialised to accepts a range of ideas beneficial to a ruling class and this included the idea that health is an individual, not collective problem and the belief that curative medicine is superior to all toher forms
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criticism of marxist

  • ignores the beneficial work that doctors do (Sheeran, Goldacre, Fitzpatrick)
  • Doctors also recognise and acknowledge stress in the workplace and poverty as causes of illness
  • Mckinley doctors professional freedom has been weakened by the state to the extent hat they are exploited by the capitalist class aswell
  • it simply replaces the functionalist diea that the role of health professionals benefit society as a whole with the idea that they provide various benefits to a ruling class
  • Marxists underpaly the significant differences between different cpaitalsit societies
  • Turner argue that we need to understand the diversity of medical systems in capitalist societies
  • Fuctionalist theory
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Postmodernist approaches

  • Believe that knowledge is power
  • Foucault argued that in every society groups are batteling to look after their own interests and the best way fo doing this is to get control of what is regarded as thruth or knowledge. Power can be aquired through language 'discourse', so being overweight becomes obesity. So definitons of health and illness depend on who has the power to define the state our body is in
  • Those in power can exercise social control in subtle ways
  • The biomedical model of health has gained dominance over all the other theories of health including alternative therapies, however postmodernists argue that in a rapidly changing and fragmented world no single approach to health and illness can be seen as the truth
  • Consumers now buy into or out of private healthcare, state healthcare and alternative medicine
  • Giddens argues that this is the result of late modernity as there has been a decline in conformity and a decline is confidence in doctors
  • Senior notes people may shop around for what they feel is the best explanation for their illness
  • No single theory can reduce all experiences to the biomedical model
  • Senior argues all theories ar simply ideas which compete to become recognised as the truth
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Feminist approaches

  • Feminists see medicine and medical knowledge as a means of mainatining patriarchal control over women
  • Oakley and Witz suggest that the activities of doctors contribute to the social control of women, both as patienst and as medical practitioners
  • Medicine has traditionally been a male dominated occupation with women excluded or marginalised into junior roles and therefore reinforcig the subordinate position fo women in society
  • Graham points out that men still dominate the top jobs in the NHS
  • Feminists argue that women's illnesses result from patriarchal factors such as women's position in society and the family. However these causes are turned into a medical problem by a male dominated medical profession
  • symptoms reported to doctors by women are often dismissed as 'women problems' and women are more likely than men to be victims of clinical iatrogenesis e.g. side effects of contraceptives
  • Abbott and Wallace medicine seeks to control women who deviate from traditional femininity through  e.g. female contraception, medicalising childbirth and post natal depression, menstruation and menopause have beeen neglected by biomedicine, the giving of tranquilisers of housewives with depression which does nothing to address the real problem
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  • Oakley obstrecians tend to see pregnacy as a medical problems whereas women see it as a natural process
  • Induction of labour and ceaseran sections are often seen as a matter of covenience for hospitals rather than for the good of the rmother and baby
  • Doyal has shown how the development of the medical profession has involved the wrenching away of medical knowledge from women by men
  • The higher up the medical occupational scale, the more men dominate- occupational vertical segregation
  • medical professional as legitimisng inequalities and controlling women e.g. hysteria in the past
  • women are marginalised within the medical professiona and as objects of medical attention
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criticisms of feminism

  • it ignores the harm that medicine can exercise over men as well as women e.g. there has been very little publicity or awarness campaigns for prostate or testicualr cancer which are increasingly contributing tto the male mortality rate
  • women still live longer than men
  • Functionalist theory
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