知识即权力?——英国医生的话语建构与发展趋势(1800-1948)

Knowledge is the Power? The Establishment of Doctor's Discourse Power and Development of the British Medical Profession(1800-1948)

19世纪至20世纪中期是英国医生依托专业知识构建话语权力的关键时期。临床医学的进步推动了医生话语权力的塑造。医疗空间的变化造成惠顾体系的瓦解和诊疗方式的转变,确立了医生在医患关系中的家长式权威。医学专业化造成全科与专科的分离,专科医生凭借知识与技术优势后来居上,改变了过去以全科医生为主的行业格局。两者之间在医疗观念与利益上的冲突,加重了行业内部的竞争和分歧,但也让他们认识到了分工与合作的重要性。1948年国民健康服务体系的建立,是英国工党政府通过国家干预规制医生权力,挽救了知识—权力语境下全科医生群体的日趋衰落,同时促使医生职业在资本利益与人道主义之间做出平衡。从知识—权力话语主导下的家长式权威到医学人文精神的回归,表明英国医生的职业发展呈现出以患者为中心的新趋势。

British medical profession rely on professional knowledge to establish the discourse power from the 19th century to the middle of the 20th century. Advances in clinical medicine promoted the shaping of the doctors~ discourse power. The change of medical space brought the collapse of the patronage system and changes in diagnosis and treatment,which established the parental authority of doctors in the doctor-patient relationship. Medical specialization caused by the division of general practitioners and specialists. Specialists with technical superiority became a new intellectual monopoly class in the medical industry, and changed the general practitioner-based pattern. Conflict between medical concept and benefits aggravates the competition within the medical industry, but also makes medical profession realized the importance of division of labor and cooperation. The Labour government through the state intervention of the NHS to regulate the power of medical profession, changed the decline of general practitioners group and made the doctors make a balance between the interests of capital and medical humanities. From the paternalistic authority with knowledge power returns to the medical humanistic spirit, the development of British medical profession presents a new pattern of patient-oriented.