In 2009, Annemarie Jutel called for the investigation of sociology in diagnosis, yet little has been done about the subject since then. This article will summarize her original points, reemphasizing that the medical institution is a part of society. Accepting this can give insight into how we understand illness and health and how it shapes the medical practice and its education. 

Diagnosis is a classification tool, using a pre-existing set of categories to organize medical care and decide what services and benefits an individual may receive. A diagnosis makes it permissible for a person to be sick, exempting them from deviating from the social norm. It eliminates blame, for example, in the late 17th century, witchcraft was classified as a diagnosis. Medical doctors are given jurisdiction to judge what parts of a patient narrative is valid and what is irrelevant. 

So, how do we, as a society, decide what is granted the status of a diagnosis and what is not? First, there are three stages of social construction of diagnosis – the lay discovery, the social movement and the institutionalization. This is illuminated through the inclusion of post-traumatic stress disorder (PTSD) in the Diagnostic and Statistical Manual for Mental Disorders (DSM) III only after an immense political effort. This effort finally acknowledged the psychological distress of Vietnam veterans and the fact that it was different from psychosis or malingering. These stages are not always followed in order, but are met in a variety of timelines.

Next, there is the concept of social authority, where medical doctors are granted the power to designate social resources through diagnosis. This authority has resulted in social wars over the definition of diseases between individuals with different interests, which can be seen between the layman and medical experts or lawmakers and doctors. The power of medicine has been on a slow decline through the introduction of malpractice lawsuits, increasing use of alternative therapies and media portrayal of doctors. A wider access to information has also made patients more willing to challenge doctors, their findings, and seek advice outside the medical institution. This does not necessarily mean medicine no longer holds authority in society, just that medicine is currently in the midst of a shift in jurisdiction. 

This shift is patient-centered, where an illness is the personal experience of being sick and a disease is the biological aspect of the same dysfunction. The materialization of a diagnosis occurs through the conjunction of the narrative of the patient and the doctor. There is a social expectation present in being ill, where the patient is not just seeking care but is surrendering themselves and their identity, permitting the doctor to judge whether there is truth or relevancy to their discomfort. However, doctors tend to detach the living patient from the narrative, interpreting it from an institutional perspective. So, there is an unequal power between the doctor and the patient. If, instead, the medical and patient narratives align, productive outcomes can be established. 

A diagnosis structures the reality of  individuals, clarifying and explaining their experiences. In a world filled with information, the modern patient is an informed consumer, sitting on an equal platform with the doctor. The best clinical encounter is a cooperative interaction where the patient and doctor work together and agree on what the patient is struggling through and what the doctor can do in response. The sociology of diagnosis is an important road to understand the lay experience, patient compliance, public health, medical education etc. Medicine needs to be looked at socially, just as much as it is looked at biologically. Understanding the social frames of the diagnosis can define the field of medicine and allow patients to truly feel cared for and build trust between themselves and their doctors. 

References

Juterl, A. (2009). Sociology of diagnosis: a preliminary review. Sociology of Health and Illness. 31(2): 278-299. doi: 10.1111/j.1467-9566.2008.01152.x