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

• DOI: https://doi.org/10.1108/S1521-6136(2010)0000015010
• Published date: 21 December 2010
• Pages: 149-169
• Date: 21 December 2010
• Author: Victor Lidz

SOCIAL CONTROL IN

DOCTOR–PATIENT

RELATIONSHIPS: SIMILARITIES

AND DIFFERENCES ACROSS

MEDICAL SPECIALTIES

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

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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.

THE DOCTOR–PATIENT RELATIONSHIP

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.

VICTOR LIDZ150