Employment, Theory and Practice in Qualitative Medical Sociology

Applied qualitative medical sociology is almost an unheard of phenomenon. When it is done, however, It is usually accomplished by sociologists employed in academic institutions. Here we discuss the possibility of such a specialty, building upon the established literature and resources, as a potential area of employment and expanded sociology practice. Three "types" of approaches: symbolic interaction, phenomenology and Marxism are used to suggest the diversity and resources available in qualitative sociology. Few sociologists are comfortable with the concept of "applied medical sociology." There is a paucity of textbooks and monographs on the subject, little formal training is available, and a kind of "poor relations" stigma is attached to an approach which incorporates value statements in its process. Yet, strong incentives provided by government funding for the development of applied medical sociology, at a time of increasing scarcity of job openings in academia, have made it a significant field of interest to professional sociologists. We find, therefore, that this gap in existing knowledge is presently being rapidly filled by positivistic policy evaluation studies and programs. This is a logical step for a discipline which is positivistically oriented, whose statistical findings lend themselves to the type of schedule expectations and demands made by contracting agencies. This rather rational partnership, though, has serious consequences for the field of applied sociology. Other theoretical paradigms and critical, political critiques remain abstract, receiving little implementation and development. At this juncture, we see a relatively new area developing whose dominant perspective tends to ignore ymbolic interactionism, phenomenological and critical Marxist theory. There are other perspectives which could be listed, for example, exchange theory, ethnomethodology, or reflexive sociology, but due to limitations here, we shall concentrate on the potential for former theoretical frameworks and their practice in health institutions. * An earlier draft of the paper was presented at the American Sociological Association Meetings, Sept. -9, 1978, San Francisco, California. In the following discussion we shall briefly introduce the theories and then discuss some problems encountered in training, obtaining professional experience, and being employed. Next, we take a gigantic leap over these dilemmas and show that despite difficulties in these areas some promising work is being done, primarily by sociologists employed in academic or academically affiliated settings. And finally, we will suggest some ways to handle the problems of employment for applied medical sociologists using qualitative research methods. A BRIEF OVERVIEW OF THE THEORIES & PRACTICES SUGGESTED No attempt is made here to claim that symbolic interaction, phenomenology, or Marxism share paradigm assumptions (Kuhn, 1970). These approaches were slected because of the author's familiarity with them, and because they exhibit some of the major problems encountered in nonpositivistic applied medical sociology. THey also show very strong evidence of potential benefits to be gained from their application. Only the barest sketch of each will be given here so that we can move on to a discussion of their application in health institutions. Symbolic interaction, a loosely associated body of theory, assumes that man is a product of social interaction. The world gains meaning that is derived from human action, and sustains it through interaction. The development of the self, the ability to take the role of others (Mead 1962), to define a situation and act on this definition (Thomas, 1923; Thomas and Thomas, 1928), and to communicate with others on all facets of human behavior, are each crucial components in this framework (see Manis and Meltzer, 1972; Stone and Farberman, 1970). Phenomenology assumes that human experience is the primary data for the sociologist. The social construction of everyday life defines and categorizes these experiences with "recipes" or customary ways of looking at the world around us. The words we use, our explanations of life and behavior, and our place in reference to others (or identity) are clues to the social meaning and actions found in everyday life (Schutz, 1967; Berger and Luckan, 1966). Marxism is based on a model of social conflict between classes which differ in their control over capital: one group, the bourgeoisie, obtain excess capital through the exploitation of labor of the other group, the proletariat. An ideal society would be based on economic equality (Marx, 1906). Although each of the above models has varying theoretical assumptIons. It illustrates some problems that applied medical sociologists have in common. These shared hurdles are discussed in our next section. INSTITUTIONAL PROBLEMS There are five major hurdles for the applied sociologist here: training, access to institutions for data collection, publication of the findings, and getting a job. Each of these obstacles 'is examined below.