Appendix 69 - Hierarchy

by Michael Greger, MD and United Progressive Alumni

[ Medical School Resources | Appendices | Discussion ]

All professions are conspiracies against the laity - George Bernard Shaw

From The Cultural Crisis of Modern Medicine:

[The radical 60's community movements] developed a growing skepticism about professionalism.... They discovered professionalism was often a defense of occupational and class privilege rather than of high standards... a defense of power and privilege against the needs of other health workers and the community....

Although doctors and other health professionals have defended professionalism as a bulwark of quality, it has functioned more effectively as a mechanism to protect the professionals from scrutiny, to limit access to the occupation, and to medical knowledge, and to preserve doctors' control over the health system.... Possession of professional skills did not have to imply a socially unequal relationship between doctor, patient, and nonprofessional health worker.[824]

From an excellent feminist analysis of the professional development of medical students in the December 1998 issue of Academic Medicine:

I believe that our current professional development efforts cannot accomplish what we agree is needed as long as we concentrate on the individual quest of students as they move through a medical education process that says it values compassion, reflectiveness, social responsiveness, autonomy and diversity but all the while is rewarding and sustaining practices based on competition, hierarchies of authority, fixed spheres of practice, bottom-line thinking, and economic privilege.

Most conceptions of professional development do not take into account the social and political effects of organizational hierarchies [which] 'concentrate power in the hands of a [few]... while relying on the obedient service of a vast body of subordinate female (mostly white) nursing staff, who, in turn, retain authority over a large, mostly minority, nonprofessional support staff.

From Getting Doctored:

Albert Wesson, who did a study some time ago of communication between doctors, nurses and other health workers on the ward of a hospital, detailed what he called 'an almost caste-like set of segregatory patterns....' He concluded that there is 'a well nigh universal tendency for those of high social rank to be freed from the obligation to interact with those of lower degree except on their own terms.'

The way doctors treat other female doctors, nurses, technicians, maids and dietary workers is clearly an oppression of women. But it is an oppression of women combined with class oppression.... Indeed, the very use of the term 'ancillary,' from the Latin ancilla, a maid-servant, carries a double-edged implication of exploitation and sexism.[825]



[824] Ehrenreich, JH. The Cultural Crisis of Modern Medicine New York: Monthly Review Press, 1979:28.

[825] Shapiro, M. Getting Doctored Santa Cruz, CA: New Society Publishers, 1987:110.



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