Sick Doctors: The Social Construction of Professional Deviance

Abstract

It has only been in the past decade that organized medicine has open acknowledged the extent to which drug addiction, alcoholism, and psychiatric disorders among doctors affect professional performance. The conceptualization of substandard performance as a medical rather than a legal, moral, or educational problem has led to the development of programs and policies that integrate medical rehabilitation with professional peer review. This paper identifies the assumptions underlying the concept of physician impairment, outlines the characteristics of impaired physician programs and policies, links organized concern for sick doctors to social, legal, and political pressures for professional accountability, documents the emergence and diffusion of the concept of impairment and identifies its early and active supporters, and explains the rapid acceptance of medical control of problem doctors in terms of its compatibility with professional values and interests. This analysis highlights the importance of examining the social and cultural components of professional self-governance.