McDonaldization: Health in A Fastfood SocietyMcDonaldization, is the term Ritzer derived from the McDonalds’ fastfood chain to describe the state of our society. Ritzer claims our socialinstitutions have become completely dehumanized in the form of a bureaucracy.
Health care is an example of one institution that is characterized by the fourcomponents of bureaucracy: efficiency, predictability, control andquantification.
In the past, health care was more simplistic in nature. House callswere no unheard of, and doctors knew all of their patients and their families ona personal level. The doctor who delivered your parents would deliver you aswell as your future children. Follow-ups were quite normal; doctors wereconcerned with your progress for their own peace of mind.
Over time the modern health care system emerged into the bureaucraticorganization that it is. All the characteristics depicted by Ritzer are easilyseen when one examines health care. From a normal trip to the doctor for aroutine check-up or even a specific ailment to rush trip in the emergency roompredictability, control, efficiency, and quantification are obvious.
Quantification is easily seen when you first step into a hospitalwaiting room and a huge sign tells you a number before you are even able tospeak to anyone. After waiting a while your number is called, you must giveyour health card number to the receptionist before continuing. You are thengiven a file number, which is your only identity for the time you spend withinthe hospital environment. After seeing the doctor you may come out with a fewprescriptions which furthers your nameless ordeal. When you drop namelessordeal. When you drop into a pharmacy to have a prescription filled the firstthing they ask is if you know your prescription number. If you cannot rememberit, your actual name is a secondary possibility as a means of identification.
Before paying you may have to show your Blue Cross card number or otherinsurance cards as well, in all it is a very dehumanizing, impersonal process.
Efficiency is another characteristic that is prominent in the hospitalsituation. To make sure things more smoothly you must call ahead and make anappointment with the receptionist. This appointment is to avoid long lines ofpeople waiting to see the doctor. When making rounds a doctor goes from eachexamining room to another where patients are already waiting. After assessingone patient the doctor visits another one while the nurses bring another oneinto the empty room.
Hospitals are also very time efficient. By having nurses make apreliminary examination (temperature, pulse rate, etc.) simple cases like theflu can be diagnosed without having to wait to see the busy doctor. This savesthe patient from having to wait for a long time as well as giving the doctormore time to look at priority cases.
Another area efficiency is necessary is at the pharmacy. By callingahead to have a prescription filled long lines can be avoided, or in some placesyou can have them delivered to your home with little hassle.
Predictability is a big characteristic. Everyone knows what happenswhen you go see a doctor. First you go to the receptionist to fill out thenecessary papers and inform them you have arrived. You must then wait until anurse comes into the waiting room and announces, “The doctor will see you now”.
Most times this is not true, it really means I, the nurse will take yourtemperature, pulse rate, and blood pressure.
Just like a robot the nurse will measure vital signs and note herfindings with as little conversation as possible. After the nurse leaves youmust wait until the doctor comes in with the nurse’s recordings in her hand.
The doctor then asks a variation of that same old question, “What seems to bethe problem today?”You then proceed to list off all of your symptoms and wait for adiagnosis. The doctor either gives you a prescription or advice to stay in bedand drink lots of fluids. If it is necessary she may request further testingsuch as blood work or x-rays as she sees fit.
If you need further treatment you basically go through the same routineon another day with different people. When prescriptions are required you getthe prescription filled, pay a lot of money (unless you have a drug plan oradditional medical coverage), and listen to the same warnings about finishingall of the prescriptions, side-affects, the dangers of interacting drugs andalcohol, and the instructions stickered on the side of the bottle.
The fourth component of control is very important in the health careindustry. Doctors and nurses have control over our health and physical wellbeing. Although doctors do not have the same kind of power and responsibilitythat they had in the past, their influence is still tremendous. Just by forcingyou to sit and wait for another person exhibits their control over you. Doctorshave supreme control in such places as the emergency room. They determine whichpatient is more critical than the others are. By making this decision they arechoosing who will get treated first. In the end this decision could mean thedifference between life and death.
Yet another area of control is organ transplants. Doctors must evaluateeach case carefully. Once a possible donor is found a doctor may then try toinfluence the patient’s family that harvesting the organs would mean other livescould be saved from their tragic loss. Viable matches must be made from thelist of candidates waiting for a transplant. By looking at such things as bloodtype, doctors must determine who would be the most suitable match. This is anexample of the most ultimate control; who lives and who must continue hoping.
Other health care workers have a subtle control over us that we seldomrecognize as such. When calling for an appointment the receptionist willusually suggest a time that is best for them, one that you must be able to fitinto your schedule. This is much like the McDonalds’ worker who assumes youwill want Cokea with your combo meal.
Those are the four components of bureaucracy, but to meet Ritzer’sstandards of formal rationality it must have irrationality to it as well.
There are many examples of how the health care system is irrational,like by making a specific appointment you try to get there on time to see thedoctor. Only the doctor is usually not ready and you must wait; sometimes forhours.
Another irrationality is how you must take up a doctor’s time to get areferral for a specialist for such things as physiotherapy. It would be muchsimpler to make a referral by phone. The “iron cage” of the health care systemis how people can feel trapped by an overburdened organization of too stressedworkers. When doctors become tired patients may not get the specific attentionthey require to properly diagnose their problem. Patients may feel that thedoctor is not really listening or seeing them as only a faceless file with alist of complaints. There is nothing more frustrating than knowing that thereis something wrong with your body and having a professional tell you it appearsthat there is nothing physically wrong. This misdiagnosis could lead to furthercomplications. In general it also may cause the patient to lose faith indoctors.
One of the biggest irrationalities is that a relationship between doctorand patient, which is very intimate in nature, has become so impersonal. Thischange from human to robot-like health care workers has come in the face of ademand for efficiency and quantification. It is hard to say who is victimizedmost by this dehumanization; the doctors who must deny their humanity or theirpatients who must go to them for treatment.
In conclusion when one applies the four components of McDonaldization toour present health care system one discovers that they are aptly applicable.
Quantification is seen when one thinks about how our medical identity iscomprised of a series of different numbers. Efficiency is supposed to occurwith phone-in prescriptions and appointments. Control is assured by a doctor’scapacity to make life or death decisions. As for predictability it is commonknowledge as to what routine one follows to receive treatment. Theirrationality is how impersonal and inefficient the whole system can becomethrough overworked doctors and other professionals. The iron cage is how thepatients of these stressed doctors feel from these doctors’ ignorance andneglect. In all it is true that the health care system is one socialinstitution that does successfully meet all of Ritzer’s requirements for aMcDonaldized institution.
