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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]

This paper contrasts economic and professional models of physician admitting behavior. Economic models emphasize physician convenience and income maximization, while professional models emphasize physician autonomy and independence. The paper examines the relative power of these models to explain two types of admitting decisions made by physicians: which hospitals to begin admitting patients to, and how many patients to admit to a hospital. Analyses of physician admitting patterns over a three-year period suggest that economic considerations outweigh professional considerations in both decisions. Results are interpreted in light of recent changes in the profession of medicine and physician-hospital relationships. [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]

Cross-functional teams (CFTs) play an increasingly important role in health care. However, despite their potential, CFTs often fail to function effectively. This paper contributes to the literature in medical sociology by examining how the steep and well-defined hierarchy characteristic of the health occupations proves to be dysfunctional in the CFT setting. Previous research has shown that status differences among members of work teams negatively affect their functioning. Yet the specific mechanisms that connect variations in status to poor team functioning remain unclear. We hypothesize that it is the suppression of participation among low status team members that leads to poor CFT functioning. Our theoretical model integrates status characteristics theory and the value attainment theory of job satisfaction to link team members' statuses to participation in team decision-making and, ultimately, to their attitudes about the job. We use causal modeling to test our hypotheses. Our results indicate that relationships between health professionals defined in broader social contexts affect status, roles, and functions within CFTs, and these, in turn, affect the team's interpersonal processes. We suggest changes in organizational structure and in team leadership styles that might make CFTs more effective. [ABSTRACT FROM AUTHOR]

Managed care is cultivating a variety of new work careers within the medical profession, and it is worth asking whether they will function as long- or: shorter-term career options for the individuals who participate in them. This paper uses the specific case of hospitalist physicians to explore how the surrounding social and economic work contexts contribute to two individual-level outcomes that inform the issue of career longevity: the concepts of burnout and intent to stay in the career. The findings of a national survey of hospitalists reveal that job burnout and intent to remain in the career are more meaningfully associated with favorable social relations involving colleagues, co-workers, and patients than with negative experiences related to the economically induced pressures of the job, such as reduced autonomy and the use of financial incentives. In addition, career longevity is enhanced by the extent to which individual physicians pursue intrinsic and extrinsic rewards through their choices to become hospitalists. These findings demonstrate that sociologists should pay greater attention to the career trajectories of contemporary doctors in order to understand larger scale professional stratification within medicine. They also offer empirical support for redirecting our focus towards the relational dynamics that shape these trajectories. [ABSTRACT FROM AUTHOR]

This paper examines the social construction of diagnosis and illness in several ways. First, I discuss the centrality of social construction in medical sociology. Next I discuss the major role of diagnosis in social construction, leading to the need for a sociology of diagnosis. I emphasize controversial and conflictual diagnoses, as a first step toward a more general sociology of diagnosis. Then I put forth a typology of social construction, involving four combinations based on whether a condition is generally accepted and whether a biomedical definition is applied. Next I detail a series of stages in the social construction of a condition. In that process, my primary concern is the initial social discovery, which is essentially a matter of diagnosis, with a secondary emphasis on illness experience. This is followed by stages of treatment and outcome, which recursively affect social construction. I conclude by noting the health policy implications of the social constructionist perspective. [ABSTRACT FROM AUTHOR]

This paper is a revision of the address given by Professor Becker in connection with his receipt of the Leo G. Reeder Award for distinguished service to medical sociology. The address was given August 22, 1992, to the Medical Sociology Section of the American Sociological Association during its annual meeting, held in Pittsburgh, PA. [ABSTRACT FROM AUTHOR]

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 examines a segment of medical social life that has not been studied extensively: formal presentations of case histories by interns, residents, and fellows. Because they are presented by physicians in training to their status superiors, who are evaluating them, case presentations are exercises in self-presentation which serve as a vehicle for professional socialization. This analysis of the language of case presentation is based on case presentations collected in two intensive care nurseries and an obstetrics and gynecology service. Four features of case presentation are identified: 1) the separation of biological processes from the person (de-personalization); 2) omission of the agent (e.g., use of the passive voice; 3) treating medical technology as the agent; and 4) account markers, such as "states," "reports," and "denies," which emphasize the subjectivity of patients' accounts. The language of case presentation has significant, if unintended, consequences for those who use it. First, some features of case presentation eliminate the element of judgment from medical decisions and mitigate responsibility for medical decision making. Second, some are rhetorical devices which enhance the credibility of the findings that are presented. Third, the language of case presentation minimizes the import of the patient's history and subjective experience. Finally, case histories socialize those who present them to a culture or world view which may contradict the explicit tenets of medical education. [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 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 paper utilizes a social constructionist perspective to examine the widespread belief among physicians during the early 1980s that an oversupply of doctors was either present or imminent. It was found that the timing and growth of physician beliefs in a "physician glut" during this period could not be adequately explained by net increases in the physician supply, either on an absolute level or relative to the growth of the general population. Rather, this "fact" of a physician surplus was found to be more fruitfully explored as an emergent social phenomenon grounded in the historical evolution of physician-supply themes and the particular clinical practice environment in which physicians found themselves in the late 1970s and early 1980s. [ABSTRACT FROM AUTHOR]

In this thoughtful paper, Mechanic discusses the differences between quantitative and qualitative researchers, focusing on health-related issues. It should, of course, be evident to readers that the issues he discusses have applicability far beyond medical sociology. The same issues arise in all kinds of social research and the excellent examples he gives can be expanded easily to examples in areas including education, criminology, industrial relations, social stratification, and others. In my reading of his paper, Mechanic discusses both differences between methods at a single point in time and differences in measuring process across time. As a quantitative survey researcher, I will comment on my perceptions of the similarities and differences between observational and survey methods for cross-sectional research. I then discuss some methods for bridging the gap that do not involve diaries. Finally, I discuss procedures for measuring process using observational and diary methods. [ABSTRACT FROM AUTHOR]