新冠肺炎(Covid-19)在2020年造成全球重大的經濟與生命損失，也改變了人們習以為常的生活方式。原本以為只有極權國家才可能出現的封城令，居然也普遍地在歐美上演。自由與人權在疫情恐慌下讓位，居而代之的是口罩與社交距離，防疫優先成為政治正確的無上律令。不只進入醫院要量體溫，連上學、上班、甚至吃飯都乖乖地排隊量測體溫，足跡要被監控，上夜市也要查1968，醫療的凝視滲入生活的每一個細節，我們要如何以社會學的視角加以看待？
Parsons將醫師與病人作為一種社會體系，以生病角色的概念，分析醫療的社會功能，在1950年代晚期將醫療社會學帶進社會學理論之中，美國社會學學會也於1962年成立醫療社會學部門，Journal of Health and Social Behavior成為ASA的正式刊物。2010年，Journal of Health and Social Behavior醫療社會學50年專刋，Hankin於導論指出可以從以下幾個主題進行研究，包括：1. 健康照護的種族族群差異、2. 健康不平等的基礎原因、3. 壓力與健康、4. 社會關係與健康、5. 疾病的社會建構、6. 醫病關係與求診行為、7. 醫學專業的社會變遷、8. 健康照護研究、9. 科技、10. 生物倫理(bioethics)、11. 健康再造(health reform)。指出未來的研究方向應該更關注醫療改革所帶來的意圖與非意圖後果。
醫療社會學是一門應用性高而且在地性很強的學科，牽涉到個人、專業人員、醫療組織、社會文化、國家體制等面向，各種醫療現象與組織發展有其歷史脈絡與文化背景，不分階級貴賤都脫離不了生老病死的問題，無論從醫學或是從社會學出發，皆透露著強烈的現實關懷。70年代以後，社會學對於專業主導的醫療體制提出許多批判，生物醫學知識如何建構疾病和健康的概念，直接挑戰了專門化知識主導的醫療權威。基於對醫療專業與生物醫學模式的批判，醫病之間互動的關係，也不同於Parsons所描繪客觀中立的醫師，將科學知識傳遞給被動無知的病人的模式。醫師與病人之間的關係，其實是帶有衝突性質的動態協商過程，雙方都力圖傳達彼此對情境的定義。現在，醫界面臨了全球性經濟衰退，人口老化與新興科技帶來醫療費用高漲的財務困境，加上消費者意識抬頭，使醫病關係緊張甚至出現對醫療專業的信任危機，開始了以病人為中心的轉向，非醫療相關的社會因素越來越受到重視。身為社會學者無法再將醫療單純視為一個用來解釋社會現象的案例，而是要有能力解讀生物醫學資訊，了解醫療體系運作的邏輯，才有資格挑戰醫療專業權威，深入醫病互動過程的核心。
本課程分為健康與醫療兩大部分，醫療的目的在維護生命與健康，但社會所產生的各種力量，往往比個人自身的決定與醫療行為更能影響我們的健康。第一個部分要討論健康在幾個主要面向的社會因素，包括階級、性別、種族等，以及人口結構如家庭、生活型態、老化等因素對健康的影響。其次是探討健康與疾病的關係，從生病經驗與病人角色出發，討論社會學是如何理解健康、如何定義疾病，並將醫療化與生活風格醫療放入課程，思考醫療在現代社會中對個人生命治理的影響。第二個部分討論醫療的現代性，介紹現代醫院的運作方式，了解醫療品質以及病人安全的概念對醫師與其他職系專業化歷程的影響，醫療風險如何改變醫病之間的互動關係，希望有助於對醫療議題有興趣的同學在進行醫院的田野時，能夠較為熟悉與去除陌生的恐懼感。除了健康、疾病、醫病關係、醫院組織幾大議題，最後會將焦點放在政府政策，特別是全民健保以及未來可能的長期照護政策，對提供照護的組織，以及照護者或受照護者的行動與經驗將產生的影響。
Covid-19 has caused major global economic and life losses in 2020, and has also changed the way people think they are common. The city lockdown order, which originally thought only by an exclusive country, was also widely staged in Europe and the United States. Freedom and human rights have been in power amid the pandemic, and replaced by masks and social distancing. Epidemic prevention has become a politically correct and unjust law. Not only do you need to measure your temperature when entering the hospital, but you also need to check your temperature when you go to school, work, and even eat. You must be monitored and check your night market in 1968. How should we view your medical gesticism from the perspective of social science?
Parsons used doctors and patients as a social system, using the concept of sick roles to analyze the social functions of the doctor. In the late 1950s, he brought medical society into social theory. The American Society also established the Medical Society Department in 1962, and the Journal of Health and Social Behavior became the official publication of the ASA. In 2010, Journal of Health and Social Behavior Medical Society has been specializing in 50 years. Hankin pointed out that research can be carried out in several topics, including: 1. Ethnic differences in health care, 2. Basic causes of health inequality, 3. Pressure and health, 4. Social relations and health, 5. Social structure of disease, 6. Medical relations and clinical practice, 7. Social changes in medical profession, 8. Health care research, 9. Science and Technology, 10. Bioethics, 11. Health reform. It is pointed out that future research directions should focus more on the intent and unintentional consequences brought about by medical reform.
Medical and social science is a highly applicable and highly local subject. It involves individuals, professionals, medical organizations, social culture, national systems, etc. Various medical phenomena and organizational development have their own historical and cultural backgrounds. No matter whether they are of grade or valuable, they cannot escape the problems of birth, old age, sickness and death. Whether developed from medicine or society, they all reveal strong concerns. After the 1970s, society has made many criticisms about the professionally-led medical system. How biomedical knowledge constructs the concept of disease and health directly challenged the medical authority directed by specialized knowledge. Based on the criticism of medical profession and biomedical model, the interaction between medical diseases is also different from the pattern of Parsons's visually neutral doctors, who pass on scientific knowledge to passive and ignorant patients. The relationship between the doctor and the patient is actually a dynamic consultation process with conflicting characteristics, and both parties strive to convey each other's definition of the situation. Now, the medical interface has faced a global economic recession, population aging and Xinxing Technology have brought about financial difficulties with rising medical costs, and coupled with consumer awareness, it has caused medical relations to be tight and even a crisis of trust in medical professions, and has begun a patient-centered turn, and non-medical-related social factors are increasingly being valued. As a social student, he can no longer view medical orders as a case to explain social phenomena, but instead he must have the ability to understand biomedical information and understand the logic of the operation of the medical system so that he can have the qualifications to challenge medical professional authority and go deep into the core of the medical interaction process.
This course is divided into two parts: health and medical care. The purpose of medicine is to maintain life and health, but the various forces generated by society often affect our health more than individuals’ own decisions and medical behaviors. The first part discusses several major social factors that health is mainly targeted, including level, gender, race, etc., as well as the impact of population structure such as family, lifestyle, and aging on health. The second is to explore the relationship between health and disease, develop from the disease experience and patient role, discuss how social science understands health and defines disease, and puts medicalization and lifestyle medicine into the course, and think about the impact of medicine on personal life governance in modern society. The second part discusses the modernity of medicine, introduces the way modern hospitals operate, understands the impact of medical quality and the concept of patient safety on the professionalization process of doctors and other jobs, and how medical risks change the interaction between medical diseases. It is hoped that students who are interested in medical issues can become more familiar with and remove unfamiliar fears when they are in the field of hospitals. In addition to the major issues of health, disease, medical relations, and hospital organization, the focus will eventually be on government policies, especially universal health insurance and possible long-term care policies in the future, which will have an impact on the caregiver’s and the actions and experience of the caregiver or the caregiver.
William C. Cockerham（何斐瓊譯），2013，《醫療社會學》（Medical Sociology 12/E），雙葉書廊。
William C. Cockerham, 2013, Medical Sociology 12/E, Double Leaf Library.
| 評分項目 Grading Method | 配分比例 Grading percentage | 說明 Description |
|---|---|---|
| 課前閱讀、出席課堂課前閱讀、出席課堂 Read before class, attend class |
30 | 學生務必出席課程，並依課綱進度所列文本擇一進行預習。出席狀況、隨堂的參與度、討論的發表等都將納入平時成績評分標準。無故曠課者, 每次扣學期總成績五分。 |
| 分組報告分組報告 Sub-group report |
30 | 各組自行從每周的思考問題中選擇一個主題，上台導讀並帶領討論，分享如何以社會學的角度來看這個問題。 |
| 期末報告期末報告 Final report |
40 | 從本學期的課程主題中選擇一個主題，也可針對某一醫療社會學文獻進行讀書心得報告。一千五百字以上。 |
