teaching hospitals, public health agencies, and other health organizations. They may also work for a government agency, such as the US Department of Health and Human Services or the Centers for Disease Control and Prevention, in the capacity of biostatisticians, researchers, health intervention planners, and administrators.
Straus’s (1957) conception of Sociology in Medicine presented the emergent identity and hopes of a fledgling sociological sub-discipline. His survey of sociologists working on medical topics and in medical settings was one of several early publications (Anderson and Seacat 1957; Freeman and Reeder 1957; Mechanic 1966) that sought to claim a place and purpose for Sociology within Medicine’s rapidly changing and culturally powerful institutional environment. The distinction between sociologists studying medicine from the outside (Sociology of Medicine) and sociologists located inside medical settings and engaged in collaborative work with medical insiders (Sociology in Medicine) remains relevant today. For Straus (1957:203), these two approaches tended to be “incompatible with each other.” Correspondingly, Straus (1957) saw this tension as requiring those in the field to become “chameleons” in order to secure insider acceptance. Straus (1957: 203), argued that “there is a danger in this, for if the sociologist begins to talk like a physician, he [sic] may eventually come to act like a physician and even to think like a physician.”
Straus’ apprehensions were fundamentally about disciplinary identity and the dangers of over-identification with “the other” (i.e. physicians as an occupational group or medicine in general). More broadly, Straus and his contemporaries worried about the integrity of sociological objectivity along with the long-term independence of this new discipline. To read Straus and his peers (Bloom et al. 1960; Freeman et al. 1963) is to take a journey into the birth of a discipline at a time when neither acceptance nor a distinctive scholarly identity were foregone conclusions.
Now that medical sociology is a more established discipline, are Straus’s concerns still relevant? How can we best understand the contributions of sociologists who work in medical settings? What can we say about the training model of sociologists who desire to work in medical settings to address problems of importance to Medicine using a sociological lens?
We believe that sociologists in medicine bring a unique perspective to the table (Constantinou 2015). In what might reflect a form of cultural bias, Medicine tends to define many of its educational and clinical challenges at the level of individuals rather than as reflections of organizational or structural challenges. Examples abound. “Problems” with learning outcomes, as reflected in student test scores on exams such as the National Board of Medical Examiners Licensing examinations, are “solved” by recruiting ever-higher scoring applicants. The recent upsurge of interest within Medicine regarding “burnout” (Dyrbye et al. 2017) has been followed by efforts to provide employees with tools to ameliorate its effects rather than to invest time and resources to address the structural conditions that might give rise to emotionally toxic work environments. Meanwhile, the possibility that organizational units, such as medical schools, might themselves suffer from burnout is not even on the radar. Even Medicine’s recent attention to professionalism has remedially focused far more on teaching trainees and practitioners to be more professional, or to remediate “professionalism lapses” (a preferred term within medicine, but a sociologically evocative one) than on issues of contextual contributors, with concerns of “organizational professionalism” only recently gaining traction. Medicine still requires a sociological perspective to balance the prevailing lens of individualism.
Ospina and colleagues’ (2019) recent study of physician-patient communication is an excellent example of Sociology in Medicine. Using secondary data collected from a random sample of 112 clinical encounters, this study found that clinicians elicit the patient’s agenda in only 36% of encounters, with physicians interrupting the patient’s story 11 seconds into their meeting. Key concepts in this article include “shared-decision making,” “patient-centered care” and “patient-physician communication,” all of which can be linked to broader sociological concerns with the structure and dynamics of dyadic communication exchanges. Furthermore, studies on physician-patient communication remain a staple in the social science literature (Cortez et al. 2019; Oh 2017; Ong et al. 1995, 2000; Stepanikova et al. 2012).
KEY CONTRIBUTIONS
In summary, medical sociology contributes to sociology and other health sciences by examining (1) the social causes of health-related outcomes and behaviors (Social Epidemiology), (2) the social psychological processes that mediate and moderate the social causes and social consequences of health (Social Psychology of Health and Illness), (3) issues linked with health care delivery and health care experiences, medical knowledge, and health social movements, including social inequality, social institutions, and health policy/law (Sociology of Medicine), and (4) problems within institutions of medicine, including medical treatment, health professions, and the marketing of health care (Sociology in Medicine). By distilling our major subfields and key contributions through an efficient and representative structure, we are able to see that medical sociology makes the broader study of sociology more meaningful by establishing explicit links between important sociological concepts (e.g. social structure, social institutions, and culture) and health, health care, and human suffering. Mirowsky and Ross (2003:3) note, for example, that few people would care about social inequality “if the poor, powerless, and despised were as happy and fulfilled as the wealthy, powerful, and admired.” We are also able to discern the primacy of social arrangements and social processes in the study of health and medicine, which is medical sociology’s unique contribution to the health sciences. Specifically, we describe patterns of health and health-related behaviors with greater attention to the complexities of social arrangements than one often sees in fields like public health. We offer unique and compelling analyses of the material and subjective conditions that explain the broader social distributions of health than fields like health psychology and health economics. We contribute more critical analyses of health care systems than medicine. Our discussion of major subfields also suggests a number of ways in which we might further develop as a field.
RECOMMENDATIONS
In this section, we offer several recommendations for a more refined and directed conceptualization of the field. Some of our suggestions stem from our core argument that the sociological study of health could use a more contemporary disciplinary structure that adequately represents the field. Others include more practical recommendations about graduate education. These recommendations are merely offered as possible directions for the field of medical sociology. Although these recommendations occurred to us, we realize they may be controversial to some. Our intent is to inspire even more discussions concerning the implications of our proposed model.
Recommendation #1. Explore explicit disciplinary structures. It is difficult to develop as a field when our disciplinary structure is little more than a collection of concepts and topics under several field identifiers (e.g. Medical Sociology, Sociology of Medicine, Sociology of Health and Illness, Sociology of Health, and Health Sociology). It is true that our field has developed in significant ways. We have accumulated an impressive body of research. We have multiple journals. We have the second largest section in the American Sociological Association. However, our field is underdeveloped in other ways that are also important. As indicated by the range of labels and definitions used to describe our field, we have little consistency in research identities across researchers and in the ways we define the purview of our field. Because medical sociology is often defined in terms of concepts and topics that are often non-unique to our field (e.g. health, illness, medicine, social factors), Sociology in general and other health sciences are often unclear about the nature of our work or our unique contributions to the study of health and medicine. Disciplinary structures that define Medical Sociology in terms of major subfields and key contributions is an important step toward a more efficient and contemporary representation of our unique contributions to the study of health.
Recommendation #2. Consider consistent
