Social control in doctor–patient relationships: Similarities and differences across medical specialties

Published date21 December 2010
Date21 December 2010
AuthorVictor Lidz
Victor Lidz
The study of social control as an area of specialization in sociology does
not usually encompass the practice of medicine and the doctor–patient
relationship. However, this is an artificial narrowness of vision, which
the present essay seeks to counter. My point of departure follows up two
analytical arguments that Talcott Parsons began to develop (Parsons,
2010[1939]) in the years following publication of The Structure of Social
Action (Parsons, 1937), that he formulated more comprehensively in The
Social System (Parsons, 1951, chap. VII), and that he elaborated in some of
his later essays (Parsons, 1978, chap. 1;Parsons, Fox, & Lidz, 1978[1972]).
The first argument is that social control is a universal, an aspect of every
social relationship. Tendencies to deviance are so ubiquitous in social life
that relationships cannot be sustained unless elements of social control
are embedded within them. The second argument pertains specifically to
medical practice. It hypothesizes that the practice of medicine has the social
function of returning the sick patient to health and thus capacity to fulfill
the duties of everyday social roles. It is in the effort to return the ill from
Social Control: Informal, Legal and Medical
Sociology of Crime, Law and Deviance, Volume 15, 149–169
Copyright r2010 by Emerald Group Publishing Limited
All rights of reproduction in any form reserved
ISSN: 1521-6136/doi:10.1108/S1521-6136(2010)0000015010
incapacity to everyday social activities that the social control function of
medicine is rooted (Parsons, 1951, chap. X;Parsons, 1978, chap. 1). We will
begin by examining this second hypothesis.
Chapter X of The Social System is often cited as the ‘‘charter’’ for the
specialty field of medical sociology. A notable feature of its analysis is the
argument that the physician is an agent of social control in relation to
the patient. This argument grounds the application to medical practice of
Parsons’ general conception that social control is an aspect of all social
relationships. Parsons started by addressing the situation of a patient who
assumes the sick role and then becomes the patient of a physician. The sick
role involves a suspension of at least some of the performance expectations
associated with a person’s everyday social life, such as expectations of
working productively at one’s job, attending the meeting of a civic
association, or caring for one’s family members. But in assuming the sick
role, an individual encounters new expectations that he or she should try to
get well. For minor illnesses this may involve only resting, drinking fluids, and
avoiding stress. For more serious illnesses, given our culture’s valuation
of scientific medicine, it typically involves placing oneself in the care of a
physician. It then becomes the physician’s duty to offer treatment and
guidance to restore one’shealth and enable one to return to meet expectations
of everyday roles. Thus the physician becomes an agent of social control.
There is an hierarchical aspect to the doctor–patient relationship. In his
later writings (e.g., Parsons, 1978) the hierarchical aspect is linked to what
Parsons called the ‘‘competence gap,’’ the difference in understanding of
medical matters between the physician and the patient. The physician has
studied medical science for years and gained practical training in clinical
settings before becoming licensed. The study and training create expertise
that in general patients cannot claim. The competence gap is even greater for
physicians who are specialists in areas that require lengthy post-graduate
training and cultivation of rare physical skills, for example, neurosurgery.
The hierarchy created by the competence gap is functionally specific, limited
to the relationship between doctor and patient, as a patient may be a person
of higher status and prestige than the physician. The president of the
United States remains the subordinate of his physician in the doctor–patient
relation, although his physician likely treats him with great respect. The
hierarchical relationship that arises from the competence gap is a resource
for the physician in exercising social control over patients.

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