LO: Describe the historical, social and cultural context of the professionalisation of doctors, nurse and other therapists

• Hierarchy of medical resort: God, physicians, surgeons, apothecaries, nurses, midwives, others

Physicians

• Wore costly university professor robes to demonstrate their prestige and education
• Followed a theoretical liberal arts education at university - saw themselves as intellectually superior
• Attended patient's home or based in the royal court or baronial household

Surgeons

• Wore practical craftsmen clothing
• Trained as craftsmen through guild system in larger towns or attended university, nearly always literate
• Often writing surgical texts
• Urban areas had premises where they treated patients
• When combined with barber, usually a shop-type environment
• Some surgeons travelled with armies

Apothecaries

• Typical merchant and grocer clothing
• Little formal education, sometimes taught through apprenticeship
• Included in grocer's guilds/corporations which regulated their trade
• Ran a shop/market stall
• Attached to royal or baronial households or monastic institutions

LO: Analyse the concept of the sick role in modern healthcare

Formation and role of General Medical Council (GMC)

• Before 1858: doctor's professional qualifications were local
• 1858: GMC formed, take charge of medical education and professional registration
• 1975: Merrison commitee report restructuring of the disciplinary process
• Introduction of regulation affecting professionals with serious mental or other ill health
• Development of specialist and GP registration

Medical autonomy

• Medical profession had been granted autonomy to decide who can do its work and how that work can be done
• Autonomy achieved by creating self-regulation

Medical dominance

• Profession's authority to determine what is to be counted as sickness
• Medical dominance over patients
• Medical dominance over other professions in terms of division of health related labour

Decline

• Rise of managerialism in health service
• Developments in nursing practice
• Increasing importance of patient voices in health
• Changing social conceptualisations of expertise
• Social movements

Sick role

Social system

• Structural functionalist perspective - society as a complex system, each institution plays a unique role or function in maintaining social stability
• Illness seen as a threat to the smooth functioning of society
• Doctor and patient play a role

Role of the patient

• Obligations: demonstrate motivation to get well, seek technically competent medical help and co-operate with the clinician
• Rights: exemption from normal role responsibilities, not to be held responsible for their sickness

Role of the doctor

• Obligations: technically competent, affectively neutral and objective (prioritising patient's welfare and excluding personal or commercial considerations)
• Rights: to be treated by society as a professional (with a degree of independence), to be allowed access to taboo areas such as the sick person's body

LO: Describe the role of the doctor in diagnosing and legitimating illness

Parson's model

• Illness is temporary 'deviance' within a society that is oriented towards work and productivity
• Doctors act as gatekeepers to the sick role
• Legitimate sick role through naming and diagnosing illness