Korean J Med Hist.  2005 Jun;14(1):51-66.

Doctor's identity in modern Western society

• KIM OJ

Abstract

Two centuries ago doctors perceived themselves quite differently as they do today. Doctor's identity in modern Western society shaped from the modernization of medicine starting in the nineteenth century. Modern medicine as practiced today was established from 1800 to the World War I. In the eighteenth century three medical groups (physicians surgeons and apothecaries) struggled to elevate their position and to organize their education. Surgery and surgical education in hospitals developed greatly while physicians tried to theorize their own medical system in the eighteenth century. In the early nineteenth century hospital medicine emerged hospitals moved from the place for the poor and the social inadequate to the center of medical education and research. Especially French hospitals became the birth places of clinico-pathology new diagnosis with stethoscope careful observation and the numerical method. The influence of the hospital medicine spread from France to England. America and other parts of Europe. After the birth of clinic in France laboratory medicine emerged in Germany, France, Britain and the United States. Surpassing other nations Germany developed university-centered laboratory research system. Most of all the reward and status of the laboratory researchers were established so that they could concentrate on their research. Although other countries were influenced by German system and knowledge they did not develop research system at the same degree as Germany. Rise of scientific medicine transformed self-perception of doctors. Science made a great impact not only on the doctors' practice of medicine but also on the public's perception of medicine and doctors. In the late nineteenth century new discoveries and new armament of scientific medicine marched through antiseptic surgery tropical medicine new laboratories antitoxin therapies from immunology the rise of pharmaceutical industry and the discovery of X-ray. Payment system also was changed with the rise of national health insurance system in Europe. Finally the advancement of scientific medicine in the late nineteenth century brought changes in medical education specialization and doctor-patient relationship. One of the important changes in doctor-patient relationship occurred between female patients and male obstetrician. In the mid-eighteenth century childbearing as expressed in the term "brought to bed" was women's business. Midwives and women relatives took care of laboring women. As scientific medicine arose male doctors began to enter the laboring room previously forbidden area to men. As Leavitt showed women began to go to the hospital not passively but rather actively willing to give birth surrounded by impersonal environment and strangers. The emergence of the modern medical education was related to the sociological development of the medical profession. The complex process of the maturation of American medical education occurred over a century and a half and involved interests and ideals of different groups. Back to the mid-nineteenth century several important factors constituted the infrastructure for the development of modern medical education a revolution in experimental medicine in Europe the emergence of an academic elite who had studied laboratory medicine in Germany the emergence of the modern university in America the development of the school system for public education the beginning of some rich industrialists' philanthropy. The medical education reform movement was accomplished not only by a few elites but also by the public and policy makers. Science in the late nineteenth and early twentieth centuries contributed to elevate the social statue of the profession by changing public images of physicians. As a result the public and the state supported the solidification of modern medical education that led to the professionalization of doctors. By the end of the Second World War doctors identified themselves as a highly-professionalized powerful and relatively autonomous group in Western society

Keyword

History; Doctors; Identity; Modern Western Society