ndant institutions during the 1850s to the 1930s. Note that, during the 19th century, certain physicians acquired personal authority due to their level of education and status in society, as well as their knowledge of various patients and their attitudes toward these patients and serving society. Within this framework, the role of the independent physician became institutionalized, particularly given that few men were during this time educated to the same, or similar, degree. With this, the role of the institution further cemented the consolidation of the medical profession. That is, as patients were increasingly admitted to hospitals, they became more dependent than when they were treated in their homes. Further, with the solidifying of certification and licensing procedures for the medical profession, physicians gained more control over the healthcare of their patients. This is particularly noticeable relative to the prescription of medications that could not be provided by laymen. Here, patients were confined to seek such healthcare from physicians, and not those laypersons who did not possess the indicated certification and licensing. Moreover, laymen could not provide prosthetics, which could only be legally prescribed by physicians. Thus, the role of patient dependence upon the independent physician had been set. Note the following as evidence of the social structure that have evolved between independent physicians and their patients.
In their combined effect, the mechanisms of legitimation (standardized education and licensing) and the mechanisms of dependency (hospitalization, gatekeeping, insurance) have given a definite structure to the relations of doctors and patients that transcends personalities and attitudes. This social structure is based, not purely on shared expectations about the roles of physicians and the sick, but on the institutionalized arrangements that often impose severe costs...