Medicalization

1. Medicalization • Renee Fox and the classic article in the field • Conrad and the extension of medicalization • Medicalization means that medicine assumes control over previously social, cultural and political issues and makes them fit medical diagnoses, treatment and social control patterns • Example—alcohol as disease

2. Medicalization • We make a social action as disease, categorize it, give it symptom complexes and means of “cure” • Make people who “suffer” from it the victims and thus take away social responsibility for their actions and allow them the sick role, perhaps permanently—removes individual social responsibility

3. Medicalization • Makes the “disease” more socially acceptable and also at the same time makes the disease more stigmatizing • Labeling of social issues as medical • Labeling theory

4. Critical Perspective • Medical institutions as powerful and power hungry • Stigma as social tool • Promoting inequality—if you make someone a victim are they equal? • Oppressive • Counter-therapeutic • Restrictive of the “right to be different”

5. Therefore • Medicalizing some social action • Brings it under the purview of medicine • Allows medical labels and methods to control the discourse about it • Has significant social consequences for the future of the “disease” • Gives more power to medicine and Medical Industry

6. Application? • How does this concept of medicalization apply to social and psychological “aberration” • Example • Drug abuse • Alcohol • Domestic abuse, child abuse • Anger • Obesity

7. Demedicalization • The reverse process • Assumes we are all responsible for our own well-being • Makes the reverse assumptions about medicine and its ability to manage and help social ills • Frees the individual from the sick role and makes them more personally responsible • Makes society more responsible for “curing” social problems as social problems

8. Consequences of demedicalization • Eliminates hierarchical doctor-patient relationships—more negotiation of health • Patient required to be competent in medical matters, knowledgeable, negotiator and responsible • Requires the doctor to be more communicative and less power oriented • Who loses when this occurs—health institutions and governments—they lose control!

9. McDonaldization of medicine • George Ritzer concept • McDonalds has a specific way of doing things that gets their product, service to market • Medicine is both market and service as well • Fast, clean, client oriented, ordinary, unchanging (standardization) and not employee centered • Breaks up employee tasks into small repeatable things that are boring and easily controlled

10. Fast • We all want speed and immediacy in our care • Where do we go? • Now oriented—less responsibility on the patient, more of a client/customer

11. Clean • New facilities and better technologies • Less hands on • Less art and more science

12. Client oriented • Patients as customers • Patient satisfaction as a measure of outcome • Distasteful for most medical people and a measure of the industrialization of medicine

13. Ordinary • Everyone gets the same impersonal care and products • No nuance • Not personal compassion and art of care

14. Unchanging • Standardization • Protocols • Standards of care determined by national organizations, industry financiers and courts • Medical controls of treatment diminishing

15. Not employee oriented • Doctors do not control care • Money increasingly implies level of care received • Power in the institutions and the government • Technology rules, not art

16. AND • Increasing specialization, less personal relationships, doctor shopping • We do not venture outside our narrow knowledge base—less Eureka! Moments • We believe that this is better medicine

17. Downsides of this • Less personal interaction and trust • Grocery store mentality of patients • Lack of personal responsibility on ANY party to the medical interaction and on the controllers of that action—no one runs the store

18. Examples • Emergency medicine • Boutique hospitals • Heart scans • Primary care