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This paper reviews the author's experience in becoming a medical sociologist before the field had become formalized. The contributions to medical sociology of sociologist Selden D. Bacon and physician and medical educator William R. Willard are described. The relationship of medical sociology to medical behavioral science, as experienced at the University of Kentucky, is discussed. Finally, the thesis of the author's 1957 paper on the nature and status of medical sociology is re-examined. [ABSTRACT FROM AUTHOR]

The introduction to this special issue of the Journal expands the scope of research on "the sociology of medical education" to include studies of the institutions in which physicians are trained as well as studies of the socialization of the physician throughout the life cycle. Research since the 1960s is reviewed briefly and the papers in this issue are discussed. Studies of the macropolitics and micropolitics of academic medicine are called for as well as comparative analyses of the settings in which physicians are trained and research on the relative effects on physicians' attitudes and behavior of different sets of experiences, professional and nonprofessional, over the course of their life cycle-all in the context of massive changes in the organization of health care. [ABSTRACT FROM AUTHOR]

This paper probes two aspects of the medical profession in Singapore: its structure and its social position. The first section reviews the relevant concepts concerning the structure and the social position of the professions that may be applied to medicine in Singapore. The second section looks into the structure of the medical profession in Singapore from an historical perspective. The third section deals with the internal organization of the medical profession. The fourth section focuses on its social position. The paper concludes with a summary of the main points and a brief comparison of the situation in Singapore with that in other countries. [ABSTRACT FROM AUTHOR]

This article responds to the comments of Edward E. Brent on the article "Processes of Continuity and Change During Socialization for Medicine in Israel," by Judith T. Shuval and Israel Adler, in the 1977 issue of the "Journal of Health and Social Behavior". It seems the Brent misunderstands the nature of correlations and is therefore led to a further nonsensical conclusion. This concerns his criticism of the proposed strategy to induce change. His suggestion that influence should best be exercised over a long period of time is contradicted by the data which show that whatever change is induced at any early time is largely wasted, since it is unlikely to show much carry-over to later times, i.e., correlations between distant times are weak. On the other hand, recency shows that change introduced at any given time is best carried over the next subsequent time.

This paper explores the effects of computerized medical information systems on the occupational communities of health care professionals in hospitals. Interviews were conducted with informants from the pharmacy and nursing departments at two hospitals currently using medical information systems for communicating physicians' medication orders from the nursing station to the pharmacy. Results showed changes in tasks for both pharmacy and nursing, resulting in increased interdependence between the two departments. This interdependence was accompanied by improved communication and cooperation, providing an opportunity to encourage better working relationships between departments. The use and maintenance of the common computerized data base became a superordinate goal for the two groups, with the computer system itself as the topic of communication. [ABSTRACT FROM AUTHOR]

Using recent first-hand accounts by Klass (1987), Konner (1987), LeBaron (1982), and Reilly (1987), this paper examines "insiders' "experiences of medical school. Medical education emphasizes disease, technical procedures, and technological medicine, with scant attention to "caring" aspects of doctoring. Students struggle to learn medicine and to maintain a humanistic or patient-oriented perspective, but the social environment of medical training militates against humanistic doctoring. Toward the end of medical school, students undergo a transformation by adopting the medical-clinical perspective and shifting their identification from patients to doctors. The doctors who maintain a humanistic orientation to medical care appear to be individuals who had developed this orientation before they arrived at medical school. Thus, to increase the number of humanistic physicians, the best strategy may be to alter medical school recruitment and selection policies. [ABSTRACT FROM AUTHOR]

This paper is a revision of the address given upon receipt of the Leo G. Reeder Award for distinguished Scholarship in Medical Sociology. It was presented on August 19, 1987 to the Medical Sociology Section of the American Sociological Association during its annual meeting held in Chicago. [ABSTRACT FROM AUTHOR]

This article comments on the article "Processes of Continuity and Change During Socialization for Medicine in Israel," by Judith T. Shuval and Israel Adler, in the 1977 issue of the "Journal of Health and Social Behavior". Shuval and Adler are concerned with the processes by which the normative image of the physician changes and develops over time during socialization for medicine. However, the authors have presented a groundless theory. It is a theory based neither on experience nor on some logical framework, having no explicit statements and having only one very vaguely understood concept, socialization, which functions as the guiding metaphor for their study.

The organization and delivery of health care in the United States is undergoing significant social, organizational, economic, political, and cultural changes with important implications for the future of medicine as a profession. This essay will draw upon some of these changes and briefly review major sociological writings on the nature of medicine's professional status to examine the nature of professional dynamics in a changing environment. To this end, we focus on the nature of medical work and how this work impacts on and is impacted by medicine's own internal differentiation and the presence of contested domains at medicine's periphery. We trace this dynamic through a number of issues including the multidimensional nature of medical work, the role of elites in that work, and how changes in the terms and conditions of work can exert changes at medicine's technical core. We close with some thoughts on the relationship of public policy to medicine's professional status, the role health policy might take in shaping a new professional status, the role health policy might take in shaping a new professional ethnic for medicine, and the role sociologists might play in this process. [ABSTRACT FROM AUTHOR]

The current situation in health care organizations, among providers and for people, dramatically challenges the "business as usual" roles of medicine, government, insurance companies, the community, and the university. Health care reform marks the first attempt in a century to consider a reconstruction of the social contract between society and medicine. While sociology stands as one of the earliest social sciences to systematically study the health care arena and create a health-focused subfield, there is a perception, not without support, of a desertion of identity from within, an encroachment by other areas from without, and abandonment by the parent discipline. We argue that these situations in medical arenas and in research fields require serious rethinking. The key lies in understanding how these phenomena are related to each other and to larger social forces, and how they offer opportunities, rather than signal limitations, to medical sociologists. We turn to the theoretical tools of sociology to help unravel the complicated challenges that face both policymakers and researchers. After framing these issues in a sociology of knowledge perspective, we use the case of "utilization theory" to illustrate the connections between society and systems of care (as well as studies of them) and to create a future agenda. We end by raising three basic questions: (1) Why is a sociological perspective critical to the understanding of change and reform in health care? (2) Why is medical sociology critical to the survival of the general sociological enterprise? and (3) Why is general sociology critical to the research agenda in medical sociology? [ABSTRACT FROM AUTHOR]

The relationship between physicians and physician extender occupations is considered in light of the stratification of medical care workers. Professional dominance between various medical occupations and professional competition among physicians are considered. Data from a national sample of physicians taken in 1981 are used to determine 1) under what conditions physicians are likely to consider the employment of physician extenders helpful for improving quality of care and 2) which characteristics and available resources are associated with the belief that the employment of physician extenders will improve medical care. Of four different service populations considered, physicians are most likely to think that the use of physician extenders to care for the urban poor will aid care and are least likely to think that their employment will improve care for obstetrics and pediatrics cases. The results indicate that physicians' beliefs regarding the employment of physician extenders are dependent on the clientele as well as on the relative position of the two occupational groups in the hierarchy of medical care occupations. [ABSTRACT FROM AUTHOR]

Although both gender and professional socialization determine physicians' values, attitudes, and behaviors, the relative importance of each varies. Physicians' career paths demonstrate gender differences: women tend to choose primary care fields and rarely enter surgery, they are paid less and are less likely to be self-employed, and they are underrepresented in positions of authority within medical organizations and in academia. Data on practice style reveal striking similarities in physicians' attitudes toward patient care, knowledge, and clinical behavior, but recent work on physician-patient communication reveals important gender differences. These differences suggest that although medical socialization determines most aspects of practice style, a physician's gender can have an important influence on medical practice. [ABSTRACT FROM AUTHOR]