Managing Medical Authority: How Doctors Compete for Status and Create Knowledge

329 Pages·2021·7.599 MB·English

by  Daniel A. Menchik

Managing
Medical
Authority

Managing
Medical
Authority
How Doctors Compete for Status
and Create Knowledge
Daniel A. Menchik
Prince ton University Press
Prince ton and Oxford
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Library of Congress Cataloging-in-Publication Data
Names: Menchik, Daniel A., author.
Title: Managing medical authority : how doctors compete for status and
create knowledge / Daniel A. Menchik.
Description: Princeton : Princeton University Press, [2021] |
Includes bibliographical references and index.
Identifiers: LCCN 2021036891 (print) | LCCN 2021036892 (ebook) |
ISBN 9780691223544 (paperback) | ISBN 9780691223568 (hardback) |
ISBN 9780691223551 (ebook)
Subjects: LCSH: Medicine—Practice—Management. | Physicians. | BISAC:
SOCIAL SCIENCE / Sociology / General | BUSINESS & ECONOMICS /
Organizational Behavior
Classification: LCC R728 .M477 2021 (print) | LCC R728 (ebook) |
DDC 610.68—dc23
LC record available at https://lccn.loc.gov/2021036891
LC ebook record available at https://lccn.loc.gov/2021036892
British Library Cataloging- in- Publication Data is available
Editorial: Meagan Levinson & Jacqueline Delaney
Production Editorial: Ali Parrington
Text and Jacket/Cover Design: Pamela L. Schnitter
Production: Erin Suydam
Publicity: Kate Hensley & Kathryn Stevens
Copyeditor: Anne Cherry
Jacket/Cover Credit: Cover photo by David Schalliol
This book has been composed in Verdigris MVB Pro Text and Arial
Printed on acid- free paper. ∞
Printed in the United States of Amer i ca
10 9 8 7 6 5 4 3 2 1
For my parents, Paul and
Bettie, and b rother, Jeremy

Contents
Preface ix
Acknowle dgments xiii
One Introduction: Organ izing Indeterminacy across
Tethered Venues 1
Two Superior Hospital’s Inpatient Wards: Grooming
Patients and Socializing Trainees 36
Three Cardiac Electrophysiologists in the Lab:
Achieving Good Hands and Dividing L abor 62
Four The Case of the Bed Management Program:
Bureaucratic Influences and Professional Reputations 92
Interlude Multiple Stakeholders in Nonhospital Venues 130
Five Fellows Programs: Maintaining Status, Validating
Knowledge, Strengthening Referral Networks,
and Supporting Peers 132
Six Physicians and Medical Technology Companies at Hands-on
Meetings: Strengthening the Occupational Proj ect 161
Seven The International Annual Meeting: Global- Local
Feedback, and Setting Standards for
Prob lems and Solutions 191
Eight Conclusion: Managing Medicine’s Authority
into the F uture 226
Appendix Methods 247
Notes 267
Works Cited 285
Index 299

Preface
It’s a truism, and pervasive trope, that medicine has authority. Under
medicine’s authority we are pried open, prescribed potentially dangerous
drugs, and subjected to risky treatments. We often pay high prices for medi-
cal care, shouldering massive debt to pay off medical expenses. And we ac-
cept physicians’ pronouncements, in concert with those of other medical
stakeholders that range from nurses to phar ma ceu ti cal companies. On oc-
casion, patients may personally and collectively rally to influence the deci-
sions of these stakeholders. And we have the right to decline physicians’
ser vices or propose that they offer us diff er ent ones. Yet, empowered as we
might be in light of new access to information, when on the gurney we’ll
defer. As scholars have shown, this deference is impor tant for medicine’s
control. And so, the strongest symptom of medicine’s authority is that its
stakeholders have created and can manage what counts as sickness and
health, and can continue to define these conditions.
This book takes part in an ongoing conversation about the g reat control
medicine claims over our bodies, minds, and lives, and how doctors and
other stakeholders manage it. So cio log i cally speaking, how medicine man-
ages its control is a question of its authority. Based on the historical rec ord
of the waxing and waning of ac cep tance toward not only specific diagnoses
and treatments, but also over- time shifts in the dominance of the homeo-
pathic and osteopathic movements, medicine is not eternally assured its au-
thority, but rather must continuously renew and reinvigorate it. Scholars of
medicine’s legacy have offered historical evidence of medicine’s victories—
for instance, doctors’ movement of care out of the home and into hospitals
over which they w ere able to maintain control. Even with this retrospective
affirmation of medicine’s dynamism, the scholarship still lacks a departure,
beyond single historical accounts or synthetic treatments, to build a portrait
of ongoing and or ga nized activity among medicine’s stakeholders. And so
I asked, How is the authority of medicine controlled, managed, and socially
or ga nized? This question has become somewhat more impor tant now that
social scientists studying medicine have become more aware of, and have
paid more focused attention to, the huge proj ect of social organ ization that
is medicine itself. How does this proj ect constantly respond to social
changes, whether developments in technology, workplace initiatives, or pay-
ment proc esses?
My interest in the question of how medicine manages its authority was
only amplified as I did my field research. It became apparent that some prev-
alent so cio log i cal understandings about authority had serious limits in