Wolinsky F D
Department of Sociology, Texas A&M University, College Station 77843-4351.
Milbank Q. 1988;66 Suppl 2:33-47.
The autonomy of the medical profession, exemplified by its ability to direct the substance of its own work, is a central tenet of Freidson's professional dominance perspective. Critics of professional dominance argue that the autonomy of the profession has eroded because of the loss of its monopoly over medical knowledge and its diminishing authority over patients (deprofessionalization), or because of its loss of control over key occupational prerogatives (proletarianization). The professional dominance of medicine may, however, be more valuable to the profession's own neglect of its avowed public promise to regulate itself than to external forces resulting from changes in the health care delivery system.
医学职业的自主性,以其指导自身工作实质内容的能力为典型体现,是弗里德森职业主导观点的核心宗旨。职业主导论的批评者认为,由于医学职业对医学知识的垄断丧失以及对患者权威的减弱(去职业化),或者由于对关键职业特权的控制丧失(无产阶级化),该职业的自主性已经受到侵蚀。然而,医学的职业主导地位,对该职业自身忽视其公开宣称的自我监管承诺而言,可能比对医疗保健服务体系变革所产生的外部力量更具价值。