Profession of Medicine

In this first section, Freidson explores the history of medicine from a sociology perspective contrasting modern medicine with that the Greeks, Renaissance Medicine, and witch doctors in Africa. He distinguishes professions that help people solve problems, including lawyers and doctors, from those that pursue, such as academic scholars.[4]^: 22

Freidson contrasts modern medicine to the Zande medicine of East Africa documented by E. E. Evans-Pritchard.[4]^: 6 In Zande medicine, the role of the doctor was to be a third party who established the causes of illness, as well as "leechcraft" that consisted of administering drugs, and the supposed removing "magical pellets" embedded in the body. The Zande people believed that witchcraft was an innate property of individuals passed hereditarily but potentially inactive.[4]^: 8 If an individual was found to be practicing witchcraft they could apologize, claim lack of intent and beg for their witchcraft to "cool". Zande witch-doctors were not very respected, Freidson hypothesizes this is because their divinations of the causes of ailments were not very effective. Freidson argues that in the past western medicine had a similar role to this witch doctoring.[4]^: 11

Freidson argues that the study of the history of medicine does not give an accurate portrayal of the profession, since the study tends to only identify times at which medicine discovered things that are now considered true, rather than considering the ineffective treatments that were considered best practice in the past. Historians also fail to distinguish between the history of medical discover, and medical practice, noting that scientific discoveries did not necessarily form part of medical practice.[4]^: 13 He argues that medical practice in the past consisted of a number of conflicting theories for the cause of disease, where untrue theories such as the humoral medicine would sit beside more scientific viewpoints.[4]^: 16

Freidson notes the 1860 discovery that anthrax was caused by a bacteria as a significant turning point in the practice of medicine, followed by a period where a theoretical model established a cause of a number of diseases. This allowed empirical treatments to be replaced by treatments based on the actual cause of the disease, or the prevention of the disease by the likes of Koch and Pasteur.[4]^: 16

Freidson explores medical workplaces in this section.[4]^: 90

Freidson follows Luckmann and Berger's, The Social Construction of Reality, to consider how illness can function as a social rather than biological state.[4]^: 206 Illness is explored as a form of social deviance.[4]^: 205 Freidson looks at the construction of illness from a professional, lay, and societal perspective.[4]^: 205

Freidson notes that the role of medicine had increased in American society taking over roles that had previously been filled by religious concepts.[4]^: 248 Citing Thomas Szasz, e argues that defining problems as medical problems rather than moral one's risks removing individuals rights to judge moral matters oneself drawing comparison to the individuals right to interpret scripture for themselves.[4]^: 250

Freidson argues that professions should have autonomy to make decisions that are technical, but they should not make decisions in areas where they do not have expertise, and that on moral or evaluative questions lay people should have as same involvement in decision making as experts.[4]^: 338

Freidson distinguishes between codified expert knowledge and theories, which is stored in textbooks and publication, and the practice being an expert. This distinction is termed research versus practice.[4]^: 339 Freidson argues that since the practice of expertise happens in a social environment, the practice of knowledge is a social and socially biased activity.[4]^: 339

Regarding the practice of knowledge, Freidson distinguishes four aspects of medicine: germ theory, the classification of disease, the analysis of prevention or reversing disease states, and the management of when the techniques of disease prevention are applied.[4]^: 340 Freidson notes that the use of medical technology, in the sense of diagnosis and treatment, has social meaning and so is a social activity.

Freidson thinks germ theory is an expert activity in which the layman is not involved.[4]^: 342 However, Freidson argues that the identification of disease is in part a moral activity. Drawing analogy to law, a doctor may be an expert in what is or is not a disease, but not whether the diagnosis and treatment is moral, since it is a moral question to decide whether a particular state is undesirable or not.[4]^: 343