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A question of place: medical power in rural Australia

Author

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  • Kenny, Amanda
  • Duckett, Stephen

Abstract

In Australia, like many countries, government, medicine and the community have maintained an interdependent and symbiotic relationship based on mutual resource dependency and reciprocity. The services of medicine have been indispensable to government and the community and in return medicine has achieved power, elitism and financial gain. Traditionally, doctors have controlled and directed medical knowledge in an absolute manner and this has been the basis of increasing power and dominance. There are, however, claims that medicine's power and dominance over the health care system is being eroded by the emergence of major social trends. The corporatization of medicine, manageralism and proletarianization are touted as factors that are increasingly countervailing medical dominance and power. Whilst it could be suggested that as these trends become more firmly established government and the community gain greater discretionary control over how the resources of medicine can be allocated and utilized, this article argues that the geographic and social dimensions of the community in which doctors practice must be considered. Using a qualitative descriptive approach research was conducted in rural Victoria, Australia. The overall aim of the study was to identify the issues that impact upon service delivery in rural hospitals. The most significant issue that emerged related to medical relationships. The results of this research indicate that in this rural area the power of medicine is strengthened and institutionalized by geographically determined resource control. The sustainability of rural communities is linked to the ability of the town to attract and retain the services of a doctor. Crucial shortages of rural doctors provide medicine with a mandate to dictate the way in which medical resources will be allocated and used by hospitals and the community. Organizations that control critical resources are in an extremely powerful position to control others. Doctors in rural Victoria maintain a position of strength and use their power to exert control over the state, the community and the hospital. Although medical power and dominance may be declining in some areas, in rural Victoria it remains firmly entrenched.

Suggested Citation

  • Kenny, Amanda & Duckett, Stephen, 2004. "A question of place: medical power in rural Australia," Social Science & Medicine, Elsevier, vol. 58(6), pages 1059-1073, March.
  • Handle: RePEc:eee:socmed:v:58:y:2004:i:6:p:1059-1073
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    Citations

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    Cited by:

    1. Lehoux, Pascale & Daudelin, Geneviève & Poland, Blake & Andrews, Gavin J. & Holmes, Dave, 2007. "Designing a better place for patients: Professional struggles surrounding satellite and mobile dialysis units," Social Science & Medicine, Elsevier, vol. 65(7), pages 1536-1548, October.
    2. Kaye Knight & Amanda Kenny & Ruth Endacott, 2016. "From expert generalists to ambiguity masters: using ambiguity tolerance theory to redefine the practice of rural nurses," Journal of Clinical Nursing, John Wiley & Sons, vol. 25(11-12), pages 1757-1765, June.
    3. Agnieszka Bem & Rafał Siedlecki & Paweł Prędkiewicz & Patrizia Gazzola & Bożena Ryszawska & Paulina Ucieklak-Jeż, 2019. "Hospitals’ Financial Health in Rural and Urban Areas in Poland: Does It Ensure Sustainability?," Sustainability, MDPI, vol. 11(7), pages 1-17, April.
    4. Elise Sullivan & Karen Francis & Desley Hegney, 2010. "Triage, treat and transfer: reconceptualising a rural practice model," Journal of Clinical Nursing, John Wiley & Sons, vol. 19(11‐12), pages 1625-1634, June.
    5. Farmer, Jane & Currie, Margaret & Kenny, Amanda & Munoz, Sarah-Anne, 2015. "An exploration of the longer-term impacts of community participation in rural health services design," Social Science & Medicine, Elsevier, vol. 141(C), pages 64-71.
    6. Kaye Knight & Amanda Kenny & Ruth Endacott, 2015. "Assessing clinical urgency via telephone in rural Australia," Nursing & Health Sciences, John Wiley & Sons, vol. 17(2), pages 201-207, June.
    7. Lin, Yen-Ju & Tian, Wei-Hua & Chen, Chun-Chih, 2011. "Urbanization and the utilization of outpatient services under National Health Insurance in Taiwan," Health Policy, Elsevier, vol. 103(2), pages 236-243.
    8. Amanda Kenny & Ann Allenby, 2013. "Barriers to nurses providing psychosocial care in the Australian rural context," Nursing & Health Sciences, John Wiley & Sons, vol. 15(2), pages 194-200, June.

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