Medical Work in America


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Essays on Health Care

Eliot Freidson

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Present-day health care policies in the United States are moving toward a system in which patients will be treated like industrial objects by doctors forced to work mechanically, says the distinguished medical sociologist Eliot Freidson in Medical Work in America. He offers a number of controversial proposals designed both to reduce costs and to avoid such dehumanization.
In a series of essays that includes some of his classic work as well as significant new material, Freidson discusses the doctor-patient relationship, relations between physicians in various forms of medical practice, and the forces now reorganizing medical work. He shows how increasingly restrictive health insurance contracts insert a new, problematic element into both doctor-patient and colleague relations, and how bureaucratic methods of controlling medical decisions affect those relations. Finally, Freidson advances some basic principles to guide health care policy. He emphasizes that the physician's freedom to exercise discretion is essential if patients are to be treated as individuals rather than as administratively defined diagnostic categories. His recommendations include eliminating fee-for-service compensation, controlling health industry profits, and limiting the external administrative regulation of medical decisions while organizing medical work in such a way as to maximize effective and responsible self-governance.

"Control, at least in Friedson’s hands, is a simple but remarkably powerful concept. Most important, Freidson’s preoccupation with control is based on an equally profound appreciation of the potential for conflict in medicine: between doctor and patient, among physicians, between physicians and a diffuse public. . . . Without his work, it is hard to imagine that a large body of critical literature on physicians would dominate the sociology of the medical profession so thoroughly as it now does."—Robert Zussman, Contemporary Sociology

"An important collection of essays on a variety of topics that provides in one volume an overview of the ideas of one of the most influential medical sociologists of the past generation."—Kenneth M. Ludmerer, Annals of Internal Medicine

"This collection reminds us that [Freidson] is one of the most penetrating writers on medical organizations."—Robert Dingwall, Social History of Medicine

"Freidson concludes that we need to develop a new health care system, serving all and preserving and enhancing individual potential and autonomy. He provides basic principles to guide health care policy and the potential means for their realization."—Jeffrey Michael Clair, Journal of the American Medical Association

"For physicians who wish to learn how sociologists understand the work they do and the settings in which they do it, Eliot Freidson’s work is an ideal starting place."—Annals of Internal Medicine

"Those immediately attracted to this book will be medical sociologists and behavioral scientists. . . . A fresh and timely book on critical biomedical health care issues. . . . The book has four substantive sections: ’Doctor-Patient Relations,’ ’The Organization of Colleague Relations,’ ’The Present Status of the Profession,’ and ’Health Care in the Future.’"—Jeffrey Michael Clair, Journal of the American Medical Association

"This book, a collection of essays . . . proposes a direction for reform after meticulous examination of the system, from individual’s interactions to the relationship between the public and private sectors. It is only with this comprehensive, longitudinal view of health care in America that physicians can understand the rationale for changes and participate in their development. . . . This volume is an excellent study of American health care with much supporting evidence for the policy reforms the author proposes. It is a thorough, concise treatment of the subject, yet requires little prior knowledge of medical sociology. Especially useful is the author’s blending of theories concerning the position of physicians in the health care system and models for distribution of goods and services with the details of individual relationships to provide a complete view of the system. . . . This book provides one sociologist’s view of the system and his proposals for reforms and is an excellent place to begin to formulate one’s own ideas about future health care policy."—Ellen M. Smith, Yale Journal of Biology and Medicine

"Medical Work in America: Essays on Health Care reprints many of Eliot Freidson’s important articles on the structure of medical practice, the practice of medicine, and the doctor-patient relationship, and provides critical linkages between these works to allow us a better understanding of medical care today. . . . From time to time, it is important for health services researchers and those who teach about medical care organization to remind themselves and their students about the origins of their ideas and try to link such origins to current thinking. Medical Work in America brings under one cover a rich array of work by a very distinguished medical sociologist. Freidson’s previously published work is, indeed, very fresh in 1990. Under one cover, the essays in this book are readily available for students of medical sociology and health services administration. Readers of this book will come away with a strong recommitment to the health care systems that provide the opportunity for high quality professional work and patient care."—Eugene S. Schneller, Medical Care Review

"Provides interesting and insightful observations and analyses of the choices facing those involved in current medical practice. The discussion of issues surrounding the need to preserve and enhance individual potential in health care has immediate and future applicability to policy decisions. Clearly written."—Choice

"Freidson is one of the most interesting and best known medical sociologists and his thinking continues to have applicability to current and impending issues."—David Mechanic, Rutgers University

ISBN: 9780300041583
Publication Date: September 10, 1989
304 pages, 6 1/8 x 9 1/4