Social Change and Medical Organization in the United States : A Sociological Perspective

Health holds an important place in the scheme of American values and attitudes. Among leading values are the capacity for valued contributions through achievement, universalistic access to opportunity for such achievement, and the responsibility of the individual extending even to his own capacity. Health is highly valued as a condition of achieve ment, and the co-operation of the individual in maintaining health is stressed. Against this background, the development of "scientific medicine" has impact as part of the trend of industrial society, as well as upon medical education and the organization of medical care around the hospital. The center of gravity of health care, however, has remained in private practice, which has been associated with family and residential community. American values favor a stress on intimacy and the "personal" touch. This seems to have played upon the general idealization of independence and the small town and, coupled with the strains imposed upon large classes of the population, to have tipped the balance of political affiliation of organized medicine to the right. The present position of organized medicine otherwise seems paradoxical in the light of its affiliations with science and the types of social organization most closely associated with the development of science-based technology.