Medical Diagnosis: A ‘Garbage Can' Perspective

Medical Diagnosis: A ‘Garbage Can' Perspective

Robert Leslie Fisher (Independent Scholar, USA) and Joel L. Fisher (Independent Scholar, USA)
Copyright: © 2014 |Pages: 11
DOI: 10.4018/978-1-4666-5202-6.ch139

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Sociologists have extensively studied the diagnostic process from the standpoint of its status in the physician-patient relationship. Talcott Parsons’ (1951) discussion of the norms governing the physician-patient relationship not only heavily influenced much of this research, it has advanced development of social exchange theory, itself one of the major paradigms of medical sociology. A recent supportive example comes from Ann Lukits (2012). She reports on a study in Italy which reviewed diabetic individuals who switched from a non-empathetic doctor to one with more patient understanding. The study found that the patients who switched reduced their risk of complications by 41%, which the study attributed to the physician’s empathetic understanding of the patient’s perspective.

Anne Marie Goldberg Jutel (2011) looks at diagnosis from the standpoint of how physicians choose categories for people whom they see. Her main point is that, as Parsons argues, patients want a diagnosis because it psychologically relieves them of certain obligations of role performance per se in return for some broad cooperation in trying to get better. Jutel’s work mostly focuses on (1) how the medical profession has created new categories of disease over time by finding various bases for illness and (2) some of the societal implications of the profession’s expanding its domain of problems.

A paradigm is an important way of seeing, but it is also a way of not seeing. Parson's perspective directs attention away from the work of physicians-diagnosticians, which only partly requires interaction with patients. Jutel’s work also ignores this aspect of physicians’ role performance. The authors agree with Cockerham's (1988) point that sociologists’ focusing on the physician-patient dyad reflected the idea that medical sociology faced a different set of circumstances in its development than found in most other sociological sub-disciplines, the foremost difference being “the pressure to produce work that can be applied to medical practice and the formulation of health policy” (p. 576).

Further complicating a sociological understanding of the physician's work is that this work has been an evolving “moving target” over the past hundred years. Regardless, there is a need for a sociological understanding of physician work both for intellectual and social engineering reasons, just as there is for other occupations. Many of these work studies are quite old: Litwak (1961) on how the nature of the task influences the structure of an organization; Lawrence and Lorsch for this kind of analysis in the context of business organizations (1967); social anthropologists Raymond Firth (1975) and Bronislaw Malinowski (2009) on how the nature of the tasks performed were central to understanding social arrangements

Key Terms in this Chapter

Computer Assisted Diagnostics (CAD): The use of computers to analyze and array data to provide information that leads to or supports certain diagnoses based on a patient's inquiry, symptoms or complaints.

Diagnostic Process: The process of arriving at a diagnosis using various informational inputs from a patient's inquiry, symptoms or complaints.

Garbage Can Model: A paradigm in organization studies developed by Cohen, March, and Olsen (1972) used to study decision making in organizations under conditions of imperfect information, and emphasizing the role of non-rational and nonrandom elements in the process of reaching a decision.

Irreversible Thermodynamics: The physics of processes and systems which are not in equilibrium states or are constrained not to reach equilibrium states.

Evolutionary Criteria: A set of process circumstances or properties which influence or control the direction of the diagnostic process.

Discourse Analysis: In general, the study of language in context. In the medical diagnostic context it refers specifically to a meticulous deconstruction of the patient's communication including but not limited to the words, tone of speech, facial and other nonverbal gestures and cues the patient uses in response to probes by the physician or volunteers during the course of the diagnostic interview or treatment process.

Cooperativity: A process which arises under special circumstances that causes a system to accelerate to a final state because all of the elements of the system move into a lock step behavior.

Diagnosis: A conclusion or assumption as to which identifies the pathology represented by a patient's inquiry, particular set of symptoms, or complaints.

Nested Computer Algorithm, Nested Algorithm: a computational tool which considers a hierarchy of calculations such that the computation begins with the lowest level in the hierarchy, and following certain logic and decision rules, uses its output systematically to move up sequentially through the levels of the hierarchy until a final output is reached whereupon it is the either the sought final answer or input to another calculation outside of the hierarchy.

Cultural Patterning: A behavior related to traditions, group social interactions and influences, and associated factors which do not necessarily have a scientific or nonrandom basis.

Medical Sociology: A specialty within sociology that broadly addresses two unrelated topics: (A) the structure and functioning of health care/medical institutions in society (aka known as the sociology of health care/medical care), and (B) the social correlates of illness such as mental illness. The latter is sometimes referred to as sociology in medicine.

Evolutionary Trajectory: A vector which tracks the information inputs to the diagnostic process for a particular conjecture diagnosis until a final decision is made as to whether this particular conjecture diagnosis is accepted or rejected.

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