Introduction to Sociology: Health Care

 

We shall consider an alternative perspective in thinking about sociology, in particular the micro-level interactions of individuals in social context:

- explore the 'symbolic interaction' school of thought (as developed by Erving Goffman) by considering the medical context of mental patients.

So far we have examined the 'social system' school of thought:

- the social system school of thought focuses on social structures and collective entities and identities;

- e.g., social class, ethnicity, patriarchy, organisations and family; patriarchy and labour market (say, physicians and midwives); and state ‘welfare mix’ (social care provisions).

 

Interactionist perspective – the dramaturgical approach

Goffman focuses on inter-personal relations and ways in which people give meaning to their behaviour and act on it;

- regular/institutionalised form/pattern of behaviour:

i) individuals understand their social roles, learn their scripts - like actors in theatre-plays;

- usually combine multiple social roles (such as mother, wife, voter, professional doctor and self-employed/manager of the practice):

- conflict and stress may emerge in trying to combine these roles such as being a professional doctor (patients’ well being) as well as a manager of the clinic (profitability of the practice).

ii) social action is always a 'performance';

- individuals act out a role, like actors in front of an audience (e.g., a surgeon shows itself by wearing a white overcoat and carrying surgical tools).

iii) roles are learnt, invented and negotiated with others in social settings;

- obtain approval and disapproval of others (a nurse, say, acts in ways that do not upset but gain recognition from medical staff - otherwise face informal rebukes and formal disciplinary actions); and

- imitate others (say, young trainee doctors shadow senior consultants to learn the profession).

iv) individuals present a favourable image of their actions and motives, or rather a particular image;

- presentation of the self to others (though a nurse, say, will have different images: one for patients, another for medical staff, and yet another for hospital managers); and

- impression management (e.g., nurses show their medical care and friendliness towards patients through their body language).

v) 'front and back regions' of a social setting:

- individuals learn to present an idealised image of themselves; i.e., present a front (e.g., a surgeon as a competent practitioner and expert); and

- at the back stage, they can relax (say, at canteens, surgeons admit their mistakes at the operation theatre).

vi) individuals continuously judge themselves and others on how they must behaviour;

- what is expected of them? (usually informed by a medical code of professional ethics); and

- what is right and proper behaviour? (self-examination and scrutiny of others to ascertain what is meant by a ‘good’ doctor);

- moral behaviour rather than forced behaviour of good actions.

vii) social encounters require face-to-face work and 'emotional labour':

- idealised, ritualised and ceremonial behaviour (a ritual order following ceremonial rules);

- e.g., in a doctor-patient relationship, there are proper ways of behaving towards each other in the examination room, and a standard set of questions and actions that a doctor undertakes at the beginning of the examination.

- often asymmetric ceremonial rules reflecting unequal social status;

- e.g., mental patients being deferential to doctors and nurses:

- deference is a ceremonial activity, in which:

- mental patients are not expected to question doctors; and

- patients are overly polite and appreciative in order to maintain their special privileges and avoid disapproval.

- demeanour and posture - outwardly signs and impressions:

- ceremonial and emotional labour in which say doctors and patients create particular appearances and images for others - acting out in a desirable mode of behaviour:

- e.g., mental patients in group sessions publicly confess their failings – otherwise their privileges may be withdrawn.

viii) institutionalised patterns of interaction vary according to the nature of medical setting:

- in the UK, there is a bureaucratic mode of behaviour based on the assumption of professionalism:

- a sense of professional dominance and competence - doctors as caring, competent actors.

- in the US, there is a bourgeois mode of behaviour in private health clinics:

- a high level of politeness and personalised encounters (customised service as patients are paying for their treatment); and

- doctors display their technical expertise; for instance, qualifications on the wall, and a large collection of medical books and medical journals in the doctor’s room.