Discourses on Physician Competence

Abstract

Competence in medicine is a salient topic in discourse about and by physicians. Discourses on competence vary with the perspective of the commentator, whether it be from the stance of those within the profession, those who seek its services, or social scientists who study it. The salience of competence talk and the intensity of emotions associated with it by medical professionals and by the lay public suggest the enormity and import of physicians’ being and appearing competent. In this paper, three modes of discourse on physician competence will be explored. First, significant work by sociologists who have studied physicians and whose analyses in themselves constitute a sociological discourse on physician competence will be briefly reviewed. Second, “intra-professional discourse” on competence will be analyzed, focusing on physicians in rural medical communities at different stages of structural change. Third, the paper will address the “reflective mode” of competence discourse among individual physicians, who relate the meaning of competence to their own professional and personal lives. Thus the focus of the analysis is on modes of discourse about physician competence rather than on empirical competence per se. The social and cultural constructions of these competence discourses will be examined, and the complexity of personal meanings that become infused in competence talk analyzed. The research on which this discussion is based was conducted in rural areas in California.