McDonaldization, is the term Ritzer derived from the McDonalds’ fast food chain to describe the state of our society. Ritzer claims our social institutions have become completely dehumanized in the form of a bureaucracy. Health care is an example of one institution that is characterized by the four components of bureaucracy: efficiency, predictability, control and quantification.
In the past, health care was more simplistic in nature. House calls were no unheard of, and doctors knew all of their patients and their families on a personal level. The doctor who delivered your parents would deliver you as well as your future children. Follow-ups were quite normal; doctors were concerned with your progress for their own peace of mind.
Over time the modern health care system emerged into the bureaucratic organization that it is. All the characteristics depicted by Ritzer are easily seen when one examines health care. From a normal trip to the doctor for a routine check-up or even a specific ailment to rush trip in the emergency room predictability, control, efficiency, and quantification are obvious.
Quantification is easily seen when you first step into a hospital waiting room and a huge sign tells you a number before you are even able to speak to anyone. After waiting a while your number is called, you must give your health card number to the receptionist before continuing. You are then given a file number, which is your only identity for the time you spend within the hospital environment. After seeing the doctor you may come out with a few prescriptions which furthers your nameless ordeal. When you drop nameless ordeal. When you drop into a pharmacy to have a prescription filled the first thing they ask is if you know your prescription number. If you cannot remember it, 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 other insurance cards as well, in all it is a very dehumanizing, impersonal process.
Efficiency is another characteristic that is prominent in the hospital situation. To make sure things more smoothly you must call ahead and make an appointment with the receptionist. This appointment is to avoid long lines of people waiting to see the doctor. When making rounds a doctor goes from each examining room to another where patients are already waiting. After assessing one patient the doctor visits another one while the nurses bring another one into the empty room.
Hospitals are also very time efficient. By having nurses make a preliminary examination (temperature, pulse rate, etc.) simple cases like the flu can be diagnosed without having to wait to see the busy doctor. This saves the patient from having to wait for a long time as well as giving the doctor more time to look at priority cases.
Another area efficiency is necessary is at the pharmacy. By calling ahead to have a prescription filled long lines can be avoided, or in some places you can have them delivered to your home with little hassle.
Predictability is a big characteristic. Everyone knows what happens when you go see a doctor. First you go to the receptionist to fill out the necessary papers and inform them you have arrived. You must then wait until a nurse 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 your temperature, pulse rate, and blood pressure.
Just like a robot the nurse will measure vital signs and note her findings with as little conversation as possible. After the nurse leaves you must 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 be the problem today?”
You then proceed to list off all of your symptoms and wait for a diagnosis. The doctor either gives you a prescription or advice to stay in bed and drink lots of fluids. If it is necessary she may request further testing such as blood work or x-rays as she sees fit.
If you need further treatment you basically go through the same routine on another day with different people. When prescriptions are required you get the prescription filled, pay a lot of money (unless you have a drug plan or additional medical coverage), and listen to the same warnings about finishing all of the prescriptions, side-effects, the dangers of interacting drugs and alcohol, and the instructions stickered on the side of the bottle.
The fourth component of control is very important in the health care industry. Doctors and nurses have control over our health and physical well being. Although doctors do not have the same kind of power and responsibility that they had in the past, their influence is still tremendous. Just by forcing you to sit and wait for another person exhibits their control over you. Doctors have supreme control in such places as the emergency room. They determine which patient is more critical than the others are. By making this decision they are choosing who will get treated first. In the end this decision could mean the difference between life and death.
Yet another area of control is organ transplants. Doctors must evaluate each case carefully. Once a possible donor is found a doctor may then try to influence the patient’s family that harvesting the organs would mean other lives could be saved from their tragic loss. Viable matches must be made from the list of candidates waiting for a transplant. By looking at such things as blood type, doctors must determine who would be the most suitable match. This is an example of the most ultimate control; who lives and who must continue hoping.
Other health care workers have a subtle control over us that we seldom recognize as such. When calling for an appointment the receptionist will usually suggest a time that is best for them, one that you must be able to fit into your schedule. This is much like the McDonalds’ worker who assumes you will want Coke with your combo meal.
Those are the four components of bureaucracy, but to meet Ritzer’s standards 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 the doctor. Only the doctor is usually not ready and you must wait; sometimes for hours.
Another irrationality is how you must take up a doctor’s time to get a referral for a specialist for such things as physiotherapy. It would be much simpler to make a referral by phone.
The “iron cage” of the health care system is how people can feel trapped by an overburdened organization of too stressed workers. When doctors become tired patients may not get the specific attention they require to properly diagnose their problem. Patients may feel that the doctor is not really listening or seeing them as only a faceless file with a list of complaints. There is nothing more frustrating than knowing that there is something wrong with your body and having a professional tell you it appears that there is nothing physically wrong. This misdiagnosis could lead to further complications. In general it also may cause the patient to lose faith in doctors.
One of the biggest irrationalities is that a relationship between doctor and patient, which is very intimate in nature, has become so impersonal. This change from human to robot-like health care workers has come in the face of a demand for efficiency and quantification. It is hard to say who is victimized most by this dehumanization; the doctors who must deny their humanity or their patients who must go to them for treatment.
In conclusion when one applies the four components of McDonaldization to our present health care system one discovers that they are aptly applicable. Quantification is seen when one thinks about how our medical identity is comprised of a series of different numbers. Efficiency is supposed to occur with phone-in prescriptions and appointments. Control is assured by a doctor’s capacity to make life or death decisions. As for predictability it is common knowledge as to what routine one follows to receive treatment. The irrationality is how impersonal and inefficient the whole system can become through overworked doctors and other professionals. The iron cage is how the patients of these stressed doctors feel from these doctors’ ignorance and neglect. In all it is true that the health care system is one social institution that does successfully meet all of Ritzer’s requirements for a McDonaldized institution.
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