Transformation of physicians' public identities in Taiwan and the United States: A comparative and historical study of ambivalence, public policy and civil society.

Abstract

How have social, cultural, and historical processes that constitute relations between professional groups, civil society and modern states transformed physicians' public identity? Can similar trends of professional dominance be seen in states whose political and cultural histories differ? These questions are explored by comparing the public discourse about physicians' rights and responsibilities in the United States and Taiwan during three time periods, when the civil society in each country was posing similar challenges to both the state and to physicians, and when the two states had adopted almost identical policies to control utilization of physicians' services. In contrast to most studies of professions which focus on the structural position and work of doctors, I demonstrate that the modern form of the medical profession, although a derivative of modern discourse throughout the world, can only be understood when rooted in both local historical genealogies as well as in the broader dynamics of modern state building and nation formation. Drawing on concepts from the post-structuralist tradition, and Ortner's practice-centered framework in particular, and by deploying a contrast-of-context comparative design, I locate physicians' identities in Taiwan's cultural conflict between an alien state and nativist civil society, and in the USA between a schema of individualism and one based on communitarianism. This broad comparison is analyzed in three stages: the Golden Age of Medicine, in which the physician's public identity is institutionalized and transformed from profession-in-itself to profession-for-itself in each country; during physician manpower planning, where a new conjuncture allows the contest over the physicians' definition to emerge, with the larger cultural conflicts defining the terms of debate; and during the move to comprehensive health centers, in which discursive formation between physicians' public identities and national identities in both countries becomes more apparent. By identifying the organic or traditional intellectual ties of physicians and by placing physicians in their historical conjunctures alongside international transfers of health planning experience, this study helps us understand that cultural logic which shaped the distinct transformation of physicians' public identities in Taiwan and the USA.