Present-day health care policies in the United States are moving
toward a system in which patients will be treated like industrial
objects by doctors forced to work mechanically, says the
distinguished medical sociologist Eliot Freidson in Medical Work in
America. He offers a number of controversial proposals designed
both to reduce costs and to avoid such dehumanization. In a series
of essays that includes some of his classic work as well as
significant new material, Freidson discusses the doctor-patient
relationship, relations between physicians in various forms of
medical practice, and the forces now reorganizing medical work. He
shows how increasingly restrictive health insurance contracts
insert a new, problematic element into both doctor-patient and
colleague relations, and how bureaucratic methods of controlling
medical decisions affect those relations. Finally, Freidson
advances some basic principles to guide health care policy. He
emphasizes that the physician's freedom to exercise discretion is
essential if patients are to be treated as individuals rather than
as administratively defined diagnostic categories. His
recommendations include eliminating fee-for-service compensation,
controlling health industry profits, and limiting the external
administrative regulation of medical decisions while organizing
medical work in such a way as to maximize effective and responsible
self-governance.
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