CH. 2

The evolution of the role of the physician is the main focus of this chapter. In readings from the first chapter of Williams & Torrens, their chart was broken into several components that affected change, one of which was the social organization of the culture and society to handle health care. It is interesting to see the mapping out of cause and effect laid out by Starr regarding social organization and how it shaped the role physicians played and how it freed and constrained their abilities.

For example, Starr describes the advent of hospices and mental institutions and how they were originally institutions of isolation and how their transformation facilitated the evolution of the medical physician's position. Previous to this you can consider health provision as being an omnipresent concept--health was everywhere and never in one place. Health was practiced by every family, doctors traveled wherever they were summoned, or a location had its own doctor on staff. Physicians were at the beck and call of circumstance. But the creation of mental institutions and hospices centralized health, creating a domain of ownership in which physicians were rulers of their own services and where power became focused--it is almost metaphysical to consider the way in which creating a locus of their abilities facilitated the transformation of physicians into figures of power. Of course, this may have been more circumstantial than purposive, but I find the transformation to be quite amazing.

While calling it metaphysical may seem odd, another way to describe it may be to portray it in the light of modern business and marketing theories. Medical practitioners existed in the role of being available and subject to patient's control. The establishment of a base with which to be sought is a basic principle of pro-action and marketability. Though it was not purposive, medical practitioners were elevated to a higher status by shifting the paradigm of their services and availability. In essence, they created demand for their services and in a new way that forced patients to seek them out in a power exchange.

It is also interesting how the creation of a physical location shaped the medical profession in other ways. Starr describes most medical professionals of the time also having other equivalent or more important professions besides medical care. He also explains how many medical practitioners held positions that made them powerful or respected members of society. By tethering medical professionals to hospices and mental institutions, the requirements of the profession, the time commitment, and the responsibility probably made it less and less feasible to hold a second or primary profession outside of medical care. Medical professionals probably had to devote more time to being medical professionals and the added time and attention probably contributed to the expansion of knowledge and consideration for the practice itself. Thinking about the various effects of the environment and institutional changes on the direction of a profession (one in which medical practitioners are full time work or more) is fascinating and a definite highlight of this chapter.