Hafferty F W, Light D W
Department of Behavioral Sciences, University of Minnesota-Duluth, School of Medicine 55812-2487, USA.
J Health Soc Behav. 1995;Spec No:132-53.
The organization and delivery of health care in the United States is undergoing significant social, organizational, economic, political, and cultural changes with important implications for the future of medicine as a profession. This essay will draw upon some of these changes and briefly review major sociological writings on the nature of medicine's professional status to examine the nature of professional dynamics in a changing environment. To this end, we focus on the nature of medical work and how this work impacts on and is impacted by medicine's own internal differentiation and the presence of contested domains at medicine's periphery. We trace this dynamic through a number of issues including the multidimensional nature of medical work, the role of elites in that work, and how changes in the terms and conditions of work can exert changes at medicine's technical core. We close with some thoughts on the relationship of public policy to medicine's professional status, the role health policy might take in shaping a new professional status, the role health policy might take in shaping a new professional ethnic for medicine, and the role sociologists might play in this process.
美国医疗保健的组织与提供方式正在经历重大的社会、组织、经济、政治和文化变革，这对医学作为一门职业的未来具有重要影响。本文将借鉴其中一些变革，并简要回顾关于医学职业地位性质的主要社会学著作，以审视在不断变化的环境中职业动态的性质。为此，我们关注医疗工作的性质，以及这项工作如何影响医学自身的内部分化及其外围存在的争议领域，同时又如何受到它们的影响。我们通过一系列问题来追溯这种动态，包括医疗工作的多维度性质、精英在该工作中的作用，以及工作条件和条款的变化如何在医学的技术核心层面引发变革。最后，我们对公共政策与医学职业地位的关系、卫生政策在塑造新的职业地位中可能发挥的作用、卫生政策在塑造新的医学职业伦理中可能发挥的作用，以及社会学家在这一过程中可能扮演的角色进行了思考。
