"Medical Professionals and the Organization of Knowledge" conveys how medical people shape and organize the knowledge, perception, and experience of illness, as well as the substance of illness behavior, its management, and treatment. It is now well established that the unique symbolic equipment of the human animal is intimately connected with the functioning of the body. Freidson and Lorber believe that the proper understanding of specifically human rather than generally "animal" illness requires careful and systematic study of the social meanings surrounding illness.

The content of social meanings varies from culture to culture and from one historical period to another. As important as the content of those social meanings, is the organization of groups who serve as carriers and, sometimes, creators. In the case of illness, a critical difference exists between those considered to be competent to diagnose and treat the sick and those excluded from this special privilege--a separation as old as the shaman or medicine-man. Such differences become solidified when the expert healer becomes a member of an organized, full-time occupation, sustained in monopoly over the work of diagnosis and treatment by the force of the state and invested with the authority to make official designation of the social meanings to be ascribed to physical states.

The medical profession in advanced nations is in a vise between professional needs and political demands. Its organization and its knowledge establish many of the conditions for being recognizably and legitimately ill, and the professional controls for many of the circumstances of treatment. It thus plays a central role in shaping the experience of being ill. With this fact of modern life in mind, this collection on the character of experts or professionals in general and of medicine as a profession in particular is uniquely fashioned.

Eliot Freidson was professor emeritus of sociology in the Graduate School of Arts and Science of New York University. He served on scientific advisory boards for the Social Security Administration, the National Institutes of Health, and the National Center for Health Services Research.

"Judith Lorber" is a professor emerita of sociology at Brooklyn College and the City College of New York Graduate Center. She is author of "Gender Inequality: Feminist Theories and Politics, Breaking the Bowls: Degendering and Feminist Change," and "Gender and the Social Construction of Illness."

This book appears at an opportune time in the history of evaluation. Its detailed and up-to-date account of the organization and use of evaluation in eight Western, democratic countries-Canada, Germany, United Kingdom, United States, Denmark, Holland, Norway, and Switzerland-shows how evaluation functions at different levels of development. Focusing on the national or federal level of government, this volume presents a systematic and comparative view of eight nations at different stages of the development, institutionalization, and utilization of evaluations. All of these original contributions have been written by academics and government officials involved in the production and use of evaluation findings. Each shows how their respective country has moved to institutionalize evaluation at the federal level, and each explores the reasons for that institutionalization. Among them are managerial accountability, the increased complexity of the decisions facing policymakers, federally sponsored social change that needs to be tracked and assessed, and the increasing recognition that political power comes to those who possess such information. Program Evaluation and the Management of Government is tightly integrated. The contributions share coherence, a common analytic framework and use of key terms, resulting from the authors' three-year dialogue as members of the Working Group on Policy and Program Evaluation sponsored by the International Institute for Administrative Sciences located in Belgium. Their shared commitment to working together has given us the first systematic effort to assess evaluation across such a large number of countries. It will be of interest to applied social scientists and policymakers, especially those interested in comparative research.

Eliot Freidson has written a systematic account of professionalism as a method of organizing work. In ideal-typical professionalism, specialized workers control their own work, unlike the free market, where consumers are in command, and bureaucracy, where managers dominate. He shows how each method has its own logic, encouraging different kinds of knowledge, jobs, work careers, educational institutions and ideologies. Then he discusses the way historic and national variations in state policy and professional organization, as well as the demands of different kinds of work, influence the strength of professionalism. In appraising the embattled status of professionalism today, Freidson discusses the ideologically inspired charges of monopoly, credentialism and elitism made by both economists and populists. He concludes that professional institutions are too useful to capital and the state to be seriously weakened by such charges. What they do weaken is the ethical independence of professions, their ability to resist use of their specialized knowledge for maximizing profit and efficiency and to insist on providing its benefits to all in need.

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.

"Must be judged as a landmark in medical sociology."--Norman Denzin, "Journal of Health and Social Behavior"
""Profession of Medicine" is a challenging monograph; the ideas presented are stimulating and thought provoking. . . . Given the expanding domain of what illness is and the contentions of physicians about their rights as professionals, Freidson wonders aloud whether expertise is becoming a mask for privilege and power. . . . "Profession of Medicine" is a landmark in the sociological analysis of the professions in modern society."--Ron Miller, "Sociological Quarterly"
"This is the first book that I know of to go to the root of the matter by laying open to view the fundamental nature of the professional claim, and the structure of professional institutions."--Everett C. Hughes, "Science"

"This is an immensely useful book for sociologists working in a wide range of sub-fields. It confirms Freidson's status among the leading exponents of the old Chicago tradition. This book is catholic in its reading, sophisticated in its arguments and cautious in its judgements."--Robert Dingwall, "Sociology"
"As an attempt to provide a complex, wide-ranging account this book should be essential reading for specialist students, and it should act as a stimulus for the extension of both empirical research and theory."--Alex Faulkner, "Sociological Review"
"Freidson's book is a concise introduction to the professions, challenging specialists with its puncturing of theoretically induced misconceptions and offering general readers a clear but critical entree to the theoretical literature concerning this central aspect of modern society."--Andrew Abbott, "Science"
"This is a stimulating and well-written book which opens up a new perspective on the professions as well as contributing to existing debates."--David Podmore, "Times Higher Education Supplement"

In this book, Eliot Freidson explores several broad questions about professionalism in Western industrial societies today; how to theorize about it, what its future is likely to be, and its value to public policy. In analysing these problems, Freidson develops an original and compelling interpretation of the professions and the role of the professional. Professionalism is understood to be based on the occupational control of work. As such, he shows, it is quite distinct from either bureaucratic or market-based forms of structuring work.

Freidson also discusses various predictions about the future of the professions, pointing out that virtually all of them have mistaken practitioners for the profession as a whole and ignored members who generate new knowledge, set and implement policy, and communicate with the public through the media. He predicts a reorganization of the professions in which practitioners lose some of their independence and become accountable to standards established and administered by a professional elite.

In contemplating the political, economic, and ideological forces that exert enormous pressure on the professions today, Freidson departs from most writers by defending professionalism as a desirable method of providing complex, discretionary services to the public. He holds that market-based or bureaucratic methods would impoverish the quality of service to consumers and suggests how the virtues of professionalism can be reinforced. This book will appeal to the growing international body of historians, political scientists, sociologists, and policy analysts who are concerned with studying and theorizing about the professions.