美国医生的专业权威是如何建立的

How is the professional authority of American doctors established?

本文是美国耶鲁大学社会学系教授Paul Starr的经典名著《美国医学的社会转型》(The SocialTransformation of American Medicine,1982),一书的"导言"部分。该导言是全书的理论基础,提供全书的理论分析框架。该文首次从医学社会史的角度,运用医学社会学和权力社会学理论,从权威与合法性角度,由文化权威与职业控制,依赖性与合法性的关系,美国医学权威的形成,从医学权威到经济权力,医生在现代卫生保健体系中战略地位与捍卫自主等层面,首次全面、系统、精辟、深刻和历史性描绘美国医学专业权威与专业统治模式的历史演变过程,这对正确认识中国社会结构转型方向和规律,深化医药卫生体制改革,构建和谐医患关系,推进健康中国建设,大力发展中国特色现代健康与精神健康社会工作实务体系,构建中国版医学社会学理论和专业化社会服务治理模式等,均具有重要的参考、借鉴意义。

This article is a part of“the Introduction”to The Social Transformation of American Medicine(1982)by Paul Starr,professor of sociology at Yale university.The introduction part contains the theoretical basis and provides a theoretical analysis framework of the book.From the perspective of social history of medicine,on the basis of medical sociology and sociology of power,this article describes the historical evolution process of American medical professional authority and professional domination pattern for the first time in a comprehensive,systematic,incisive,profound and historic way.And this evolution process is outlined in different dimensions:from the point of view of authority and legitimacy;the relationships between the cultural authority and professional control,dependence and legitimacy;the formation of the American medical authority;from medical authorities to economic power;the doctor strategic position in the modern health care system and defending the independent and other dimensions.Analyzing the evolution process can contribute to the correct understanding of direction and laws of Chinese social structure transformation,to deepening reform of the medical and health system,to the construction of a harmonious doctor-patient relationship,to pushing forward the construction of“Healthy China”.It offers some reference and practical meaning to developing the practice system of modern health and mental health social work with Chinese characteristics.And it helps to construct the Chinese version of medical sociology theory and professional social service governance model.