Role of science and technology in the process of medical specialisation
The practice of medicine has undergone profound changes over the past fifty years. Many aspects of this change have been dramatic and sane of the techniques used in 1985 belonged to the realm of science fiction only a decade ago. The incorporation of developments in science and technology into medicine has widened the scope and range of interventions available to doctors, and this is reflected in their practice. This thesis explores the general belief that scientific and technological developments have- not only had a general influence on medicine, but that they have affected the internal division and social organisation of this profession. The thesis begins with a section which explores the substantive areas of sociolology which have relevance to this analysis. The sociology of the professions and the'sociology of medicine are studied as well as the approaches on the interaction of technology and society. The development of the analytical framework drew on the work of both the symbolic and technological interactionists as well the work connected with power and control, and incorporated the metaphors of the ecologists. The framework is based on the complex concept of territory and though this concept is not new, I have extended it and made it central to my work. The second section of the thesis examines the developments that have influenced medical practice over the past fifty years or so. It is divided into two chapters, one being concerned with diagnosis and the other with treatment. The concept of physical chemical and biological manipulations is used and the imaging devices which extend the senses -are described. The section ends with sane details on 'the changes in disease theories. The area of medicine selected for detailed analysis was that of reproductive medicine. The conflicts between obstetricians, paediatricians, medical geneticists and other groups are explored and the specific role of scientific and technological developr nts as resources in these battles are focused upon. The recent developments in this field are charted and contentions over the perinatal period are described. -The work of the second section enabled me to set reproductive medicine within the general practice of medicine, and show a commonality of both practical and philosophical approaches. Throught the thesis the emphasis has been very strongly on the intra-professions conflicts in medicine and on the influence of scientific and technological develop ents upon than. I have , however, indicated in several places that there are other factors which influence specialisation. I have also pointed, albeit it briefly to the conflicts with para-medicals, especially midwives.