The difficulties facing organized medicine today must be seen against the background of the social change occurring in our society. This change affects the various arrangements through which medicine is practised, with resulting pressure and strain upon the physician. It is true, of course, that although much of present-day social change gives the appearance of disorganization and chaos there is, nevertheless, an underlying order to many of our daily activities. Seemingly, while many significant elements in our social structure change rapidly, others do so at a much slower rate and thereby tend to support the individual as he seeks to...

For their continued economic growth, modern societies depend upon the technical application of an increasing body of scientific knowledge. One of the hallmarks of modernity is the rate of increase in this corpus of knowledge but since the boundaries of the corpus are beyond any one individual’s ability to encompass, application of knowledge today requires specialization and a division of labour of which the professions are an integral part. As members of a profession, individuals perform specialized roles in relation to clientele. In so doing they encounter certain strains; these in part, are resolved both verbally and symbolically by the...

It is within the medical school that the aspiring physician receives most if not all of his formal medical education. As he goes through this stage in his professional preparation, the school will provide him with professional knowledge and skills, and “a professional identity so that he comes to think, act, and feel like a physician.”¹ It is the school’s “problem to enable the medical man to live up to the expectations of the professional role long after he has left the sustaining value-environment provided by the medical school.”²

The organization and content of medical education today are under critical...

One of the continuing myths of medicine is the traditional conception of the form of medical practice. The Royal Commission on Health Services describes it in the following terms:

The physician’s office resembled a parlour rather than a laboratory, with the instruments and medications then available to medical practice assembled in one corner of the room and the text books in another. It was the physician’s office, study, and examining room all in one. The physician - one of two or three professional people in the community - was counsellor as much as professional advisor; his practice of medicine was...

The modern hospital plays a central role in medical care. Fifty or more years ago a hospital was viewed by many as a refuge or as a place to die, rather than as a treatment centre. Today it is the focus of community health care, the physician’s work shop, an educational centre, and a centre for medical research.

Hospitals in Canada are operated by six types of agencies with the dayto-day responsibility for ensuring ability to provide service. These comprise voluntary bodies who may own and operate hospitals on a non-profit basis; municipalities such as a city, town, county, or...

The preceding chapters have indicated the manner in which a physician, as he goes about his day-to-day practice whether in his office, a patient’s home, or a hospital is controlled to a greater or less extent by the formal and informal sanctions of professional colleagues and other health personnel. The range of these controls and the degree to which they actually influence the physician’s behaviour depend, to a significant extent, as we have seen, on the institutional context in which the physician applies his skills. Controls on his professional behaviour are also applied by professional organizations, of which the two...

Many physicians claim that the doctor-patient relationship must remain untouched by the intervention of third parties. The claim ignores the fact that such intervention has occurred throughout history. The code of Hammurabi, nearly 4,300 years old, specified the penalties which a third party may impose should a physician fail to meet public expectations. “If a doctor shall treat a gentleman and shall open an abscess with a bronze knife and shall preserve the eye of the patient, he shall receive ten shekels of silver.... If the doctor shall open an abscess with a bronze knife and shall kill the patient...

The introduction of government-administered medical care insurance in Saskatchewan on July 1, 1962, was the culmination of a series of developments during the preceding four decades. In 1921 the rural municipalities of Saskatchewan were so sparsely settled that they held little attraction for the physician wishing to practise. The population of these municipalities, however, required medical services. As indicated in the previous chapter, a solution to this problem was the introduction of the initial legislation which allowed the organization of municipal doctor plans through which local residents were taxed to provide sufficient funds to pay the salary of a physician,...

The ideology of a profession can be derived from official statements by the organization representing the profession concerning issues which affect the professional status of its members. As noted in chapter 2 the ideology will contain ideas, values, and beliefs concerning the nature of the professional role, its relationship to other social roles, and to the society. When the profession faces change, or when its members are under attack, it will emphasize these ideas, values, and beliefs in its official statements. These elements in its ideology are evident in the statements of the Canadian Medical Association as it sought to...

Throughout the six statements on health and medical care insurance issued by the Canadian Medical Association between 1943 and 1965 certain major themes or propositions emerge which are clearly related to the one central anxiety facing the medical profession: the control by third parties, particularly public medical care insurance commissions or agencies, over the conditions of work of the physician. This emphasis is to be expected in official statements on medical care insurance by the profession. Other themes are also evident which are related to other types of strain in the role of the physician, but limitations of space make...

A person’s ideological beliefs can indicate his preference for a particular side of an argument. The beliefs used in such a situation are derived from the groups of which the person is a member, or aspires to become a member. These reference groups are used as models by the individual with diiferent reference groups usually being used for different subjects of belief.¹ Similarity of ideological beliefs in social groups depends upon the homogeneity of social background of the members of the groups; the greater this homogeneity in social characteristics, such as occupation or profession, class, age, sex, ethnic group, and...