from Rinaldo Octavio Vargas – sociologist

In the modern social imaginary, the physician figure has represented a "objective, scientific & neutral subject". The physician himself shows the tendency to conceive himself in these terms. For an existentialist & sociologist interested in post-modern societies, like me, it seems more realistic to picture the physician as figure related to other figures in a context, as it happens in any human existence.

All the below verbal imagines, indeed, related to situations characterized by a paradox, represent the clinician of nowadays like a person
§ facing an information stream regarding mechanisms that determinate health & disease, and simultaneously, besieged by bureaucratic guidelines & intrusive administrative oversight,
§ trying to conciliate, concurrently, the world of a technologically reinvented medicine in the past half century, that defines patient by laboratory's aggregate findings, generalized understandings & procedures, and the patient's parallel world as an individual belonging to a family & social environment;
§ besieged by technology-based hopes of cures and the ever-increasing costs of these practices;
§ constrained to show his/her face to an euphoric market by the promised therapeutic efficacy and, by paradox, forced to face the decline in the reliability of the physician profession;
§ in a mass media show of scientific breakthroughs and, simultaneously, facing a variety of news regarding dismaying recurrent dysfunctions, aggressively market drugs with unanticipated side effects, regulatory conflicts of interest between pharmaceutical industry & medical practice, and news of epidemic ills linked, seemly & ironically, with aspects of economic growth;
§ facing criticism to a clinical practice considered rushing, impersonal, profit-oriented, fragmented and technologically dependent,
§ uncomfortable in the role the new medicine and its administrative procedures constrain him/her to play facing a patient every day more uncomfortable in his/her part of statistical aggregate and object of a rhetorical discourse about communication & relationship;
§ embodying the paradox of an unrealistic medical expectation and the everyday imperfection.

Definitely, any sociological side view on the physician or clinician figure seems to run into a paradox that synthesises the relationship between medicine & society, between the doctor's traditional imagine of autonomy and an ever-increasing bureaucratization of a medicine dominated by laboratory's findings & profit-oriented.

There is a need of reflection on our present complaint. Medicine remains, yet, what it has always been: an intense personal effort to deal with the pain & incapacity of particular men & women. To overcome this situation, it seems to be necessary to rethink the notions of disease, therapeutic efficacy and the physician's particular role and his/her responsibility in the healing & health care system.

What my view as sociologist grasps is a crisis of authority & control, a crisis of values & orientations that constrains to redefine concepts regarding medicine as human caring, as applied science, as marketplace actor and as object of public policy, and also to redefine the nowadays physician's peculiar responsibilities, a figure that just 100 years ago cared & cured physiological states by the bedside at patient's home.

The picture that fancies the therapeutic decisions made in disembodied intellectual space is unrealistic. Even the clinician, as the journalist in the nowadays TV show battlefields, is embedded in an institutional, intellectual, governmental and corporate complex, in which, we all, physicians and patients, have rested our collective hopes for medical deliverance from pain and premature mortality.

Medicine is not biology, though it applies the laboratory's findings and is legitimated by the power of those findings. Nor is it a market actor alone, though it is certainly that. Medicine has an identity, almost always contradicted, as it happens to any personae in the drama, defined by its moral history and its social role.

I do hope that these notes for reflection constitute an cumulative subject to think that healing cannot be reduced to technical procedures and molecular mechanisms, though this knowledge remains indispensable, to think & organize, in short, medicine, essentially, as a social function. It might also help the single MD to market, with awareness, his/her figure and practice in post-modern societies.