MEDICINE, SUPERSTRUCTURE AND MICRO-POLITICS

How are macro-level structures of domination and oppression reproduced in the everyday micro-level interaction of individuals? This paper examines this theoretical problem through observations of doctor-patient encounters. A review of recent theoretical advances leads to the proposition that face-to-face interaction between health professionals and clients helps maintain broad patterns of ideology and social control. A theory is proposed that links professional-client interaction with ideology and consciousness, social institutions, social relationships of daily life, and the material conditions and class relationships of the workplace and economic system. Quantitative data from an empirical study of doctor-patient interaction are analyzed with reference to this theory. Qualitative analysis from the same study reveals themes of ideologic reproduction and social control concerning relations of production, class relations, the role of science under capitalism, and medical control of everyday life. Counterhegemonic strategy suggested by this work includes challenging the assumed objectivity of medical science, clarifying the partly political nature of messages that clients receive from professionals, and working against domination based on expert knowledge. © 1979.