628

This thesis addresses a broadly fonnulated question: Why do medical
doctors in Turkey conceive themselves as the voice of authority on a broad
range of social and political issues which extend beyond their professionalmedical
expertise? In pursuing answers to this question, it focuses on three
analytically distinct sets of factors which contribute to the self-conceptions
of medical doctors in contemporary Turkey:
a) the historical experiences and narratives of earlier generations of
doctors who were a part of the nation-building project and who were
important social and political actors in the process of transition from
Empire to nationhood;
b) career experiences of medical doctors in the context of ongoing
changes in the social and political positions of the medical profession as
well as the health sector;
c) power relationships between doctors and their patients in hospital
contexts
Each chapter of the thesis explores one of these complex and
interlinked sets of factors, using information gathered from various
som"ces. These sources of infonnation include autobiographies written by
earlier genera:tions of doctors; interviews wi thmedical doctors currently in
mid-career, as well as observation of doctor-patient relations in hospital
settings.
KISAi>ZET
Tiirk Doktorlan: Tarihi Deneyimler ve Ki!;isel Anlatilar

Bu tez geni~ kapsamh bir soruya verilebilecek r;e~itli cevaplan
incelemekte ve tartI~maktadIr: N eden Tiirkiye'de tIp doktorlan kendi
mesleki-tlbbi ihtisas ve becerileri otesinde; toplumun r;e~itli "dertlerini"
"te~his" ve "tedavi" etmekte kendilerini yetkili ve sorumlu gartlyorlar?
Tezde, giinumuz Tiirkiye'sinde tIP doktorlannm kendilerini nasII
tarumladIklan, ur; farkh analitik etmen r;err;evesinde incelenmektedir:
a) Imparatorluktan ulus devlete ger;i~ siirecinde onemli toplumsal
ve siyasi konumu olan eski ku~ak doktorlarln tarihsel deneyimleri ve
anlatIlan;
b) Giiniimuzde sag-hk sektoru ve tIP mesleginde suregelen
degi~melerin orta ku~ak doktorlarln meslek deneyimleri ustiindeki
etkileri;
/
c) Hastane ortammda doktor-hast a etkile~imi ve otorite ili~kileri
Tez farkh boliimlerinde, degi~ik kaynaklardan toplanan bilgiler
1~lgInda, bu faktorler ve aralarIndaki ili~kileri incelemektedir. Tezde'
kullamlan veri kaynakl an , doktorlarla yapIlan derinlemesine mulakatlar
yanlsrra, eski ku~aklarIn yazdIklarl otobiyografiler ve hastane ortamlnda
doktor-hasta ili~kileri hakklnda yapIlmI$ gozlemleri kapsamaktadIr.
ACKNOWLEDGMENTS
I would like to thank to Prof. Dr. Ay~e oncil: and Prof. Dr. Belgin
Tek~e for their continuous academic guidance and support without which I
would be lost among my broad research interests and large amount of data
I have collected. I would also like to thank to Prof. Dr. Diane Sunar and Dr.
Leyla Neyzi for their advices and comments which were really helpful in
the orgatlization and evaluation of my research findings.
I would like to thank all of the doctors who spent their preCious time
to answer "my endless questions" and helped me to reach written materials
about the history of modem Turkish medicine. Their genuine interest to
my research topic and their patience in answering my questions have
encouraged me further in the research process.
I am grateful to my family, Nuran, Tosun and Derin Terzioglu,
whose emotional support helped me to overcome "the thesis stress". I am
also grateful to Sarit BileVi and Aysim Titrkmen for their exemplary
friendship which made me realize that people can have good times even in
their thesis year. These people knew how to make me "smile again" in my
most difficult times.
Last but not the least, I would like to thank to Cem Tun~el who
displayed a great patience and tolerance to "all of my moods" during the
last seven years and continued to give the emotional support and
encouragement whenever I needed.
TABLE OF CONTENTS
INTRODUCTION 1
Some Broader Theoretical Considerations
CHAPTER I: DEVELOPMENT OF MODERN MEDICINE> 9
IN TURKEY
PART A: Modem Medicine in the Ottoman Empire (1827-1923) 10
Debates on the Language of Instruction in the Medical Education
The Modem Turkish Medicine, Its Ideology and Founders
The Political Role and Activities of Doctors within the Turkish Nationalist
Movement
The Institutionalization and Professionalization in the Health Sector
PART B: Social Mission and Struggles of Turkish Doctors in the 32
RepUblican Period
The Kemalist Project and Turkish Doctors
The Law of Rotation and its Effects on the Social Mission of Doctors
The Preventive Medical Projects
The Female Doctors and their Pioneering Role in the Health Sector
The "1933 Reformation" and the Reactions
Structural Developments in the Health Sector
Health Plans and the Law of Socialization
The Ideological and Professional Differences in the Medical Projects of the 1930's
and 1960's
The Politization in the Health Sector
The Political Activities of the Professional Chambers
The Political Position of Doctors within the Society
Political Tensions and Depolitization in the 1980's
The New Law of Rotation
The Loss of Prestige and Decline of the Educational Quality in the Faculties of
Medicine
The Heterogenization of the Medical Students and Variations in the Career
Patterns
The Professional Solidarity and Increasing Competition
The Activities of Professional Chambers
The Effects on the Rising Islamic View on the Health Sector
Conclusion
CHAPTER II: THE CONCEPT OF SELF AND PROFESSIONAL 73
EXPERIENCE IN THE DOCTORS' ACCOUNTS
Methodological issues: Emphasizing Coherence in Facing Discontinuities
The Periodization of Professional Experience
The Character Traits of Doctors and their Professional Decisions
The Decision to Become a Doctor and Its Consistency with Character Traits
The Conceptualization of Medical Knowledge before Medical Education
The Character Traits and the University Education
The First Encounters with Cadavers, Courage Test and Group Control
Role of Personal and Social Values in the Acquisition of Medical Knowledge
and Practice
Career Planning after the University Education as a Strategy of SelfConsistency
Idealization of Medicine and Management of Discontinuities
The Changes in the Views on Medicine, Routinization and Critical
Moments
Reconstructing Self-consistency and Continuity through Time, SelfReflexivity
Conclusion
CHAPTER III: THE SOCIAL POSITION OF DOCTORS AND 132
THE CHANGING DOCTOR-PATIENT RELATIONSHIP
The Characteristics of Doctor-Patient Relations
The Doctor-Patient Relation in the Past
The Contextual Changes which have Influenced Doctor-Patient Relations
Doctors' Evaluation of their Patients
The Professional and Economic Concerns of Doctors
Influence of Economic Problems and Gender Issues in Maintenance of Patients'
Trust and Respect
The Doctors' Conceptualization of their "Self' in the Medical Realm
The Changes in the Social Concerns of Doctors
The Changes in the Doctors' Relationship with the State and
Political Issues
Conclusion
CONCLUSION 182
APPENDIX: A BRIEF DESCRIPTION OF INFORMANTS
APPENDIX 2: EXCERPTS FROM THE ORIGINAL INTERVIEWS
INTRODUCTION
My initial point of departure in this thesis is a very broad q1Jestion:
Why do medical doctors in Turkey conceive of themselves as the voice of
authority on a broad range of social and political issues which extend
beyond their professional-medical expertise? Or, to state the same question
in a different way: Why do they think they have the authority to diagnose
and cure the ills of Turkish society? Why do they feel responsible for the
health of their country as well as that of their patients? These are obviously
very big questions, which center on the self-conception of medical doctors in
Turkey and the ways in which medical practice is understood as being
engaged in a mission which has to do with the well being of a nation as a
whole. But when formulated in such broad categorical tenus, without
qualification, they immediately raise a series of further questions. Is it
possible to generalize about medical doctors in Turkey as a whole? Do all
medical doctors- young and old, cosmopolitan and provincial, prominent
specialist or general practitioners- conceive of themselves in the same way?
Assuming that most, or at least many do, how is such self-conception
acquired, reproduced and legitimized in the present? What kind of
dilemmas does it pose for medical doctors in different professional contexts?
To try to address all these questions within the scope of a modest
thesis is not feasible or meaningful. My strategy in the present thesis will
be as follows. I will begin with the assumption that there are three
analytically distinct set of factors which interact in complex ways to mold
the self-conceptions of medical doctors in contemporary Turkey: a) the
historical experiences and narratives of earlier generations of doctors who
1
were part of the nation-building project and who were important social and
political actors in the process of transition from the Ottoman Empire to the
Turkish Republic b) the career patterns of younger generations of medical
-
doctors as they attempt to legitimize and/or reconcile their broader selfconceived
authority with ongoing changes in the social and economic
position of the medical profession in Turkey over the past two decades c)
doctor-patient relations which shape and are, in turn, shaped by the selfconceived
authority of the medical doctors.
Each of these complex set of factors necessitates and merits a
re_search project on its own. Instead of focusing on any single one of them
in this thesis, I will try to offer fragments from each. That is, in each of the
following chapters of this thesis, I attempt to capture a small piece of
totality that is highly complex. In my own mind, these different chapters
are like snapshots of the same phenomenon, taken from different angles.
Each chapter constitute a part of how historical experience and current
practices combine to shape the self- conceptions of medical doctors in
Turkey.
In the first chapter, I will focus upon the formative decades of the
medical profession in Turkey using studies on the historical development of
modem Turkish medicine and autobiographical works written by medical
doctors. Through these accounts, I will try to show how such concepts as
rationality, science, medicine and national development became interlinked
in the final decades of the last century and the early decades of this
century, when Turkish medicine had institutionalized. I will also try to
document the ways in which medical doctors acquired considerable social
and political power as the vanguards of such Enlightenment values as
2
secularism, positivism, belief in objective-scientific data and progress. The
argument I will try to develop in this context is that medical doctors
acquired a privileged status among Ottoman-Turkish intellectual cadres
through their access to Enlightenment ideas and values. They were also
highly active in the first nationalist movements and organizations. My
main point of emphasis in this chapter will be that this historical
experience is closely bound with a sense of "mission"- Turkish doctors
must work to improve the living conditions of their society, not only in
tenus of health, but also in social and political terms. Acquired through
professional education and reproduced through the rhetoric of professional
associations and collegial relations, I believe that this mission of being
responsible for the health of the nation and having the authority to diagnose
its ills, continues to be a very important component of medical doctors' self
conception in Turkey, despite the dramatic changes the medical profession
and the health sector mldergone in Turkey over the last two decades. The
major changes in the health sector since the institutionalization of the
medical profession and the present situation of the profession are also
discussed in this chapter. /
In the second chapter, I focus on the present. To draw a straight
line of continuity from the fonuative decades of nation building, to the
present of the medical profession in Turkey would be very misleading. Far
from being static, the medical profession has undergone numerous
changes which cannot be explained by referring to past experience but
must be understood in the context of dilemmas facing the profession at
present, The second chapter of the thesis is an attempt to provide a
snapshot of what it means to be a practicing-doctor in the mid-1990's in
3
Turkey. This chapter is based on the interviews I made with 6 medical
doctors who come from different social backgrounds and specialities, and
all of whom are between 35-40 years of age. Through the narratives of these
doctors about their professional life stories, I examine how they account for
their initial decision to become a medical doctor, how they explain the kinds
of career choices they have made, and the ways in which they
understand/legitimize and/or reconcile these choices with broader selfconceived
"mission" of the medical profession in Turkey. My aim in this
chapter is to explore the kind of dilemmas medical doctors conceive
themselves as confronting, how they formulate these dilemmas, and
narrate them as coherent life stories. Rather than asking these doctors
about the changing parameters of the medical profession as a whole, or
about macro-social events of the past two decades which have had a direct
bearing on the social and political prestige of the profession, I try to
understand how these changes have been translated into career
experiences of individual doctors. Can we still talk about a broader selfconceived
"mission" embraced by medical doctor in Turkey? The life stories
of individual doctors suggest that there is no simple yes or no answer to this
question. My central point here is that regardless of the kinds of career
choices these medical doctor have actually made, and irrespective of their
gender or current "success" in professional terms, they still conceive of
themselves as having the social authority to diagnose them.
The third chapter focuses on doctor-patient relations. Here my aim
will be to examine how professional expertise becomes the basis of a broader
power-relationship between doctors and their patients. Using doctors' own
accounts of how they conceive of their patients and their power and
4
authority over them, I try to understand how the changes in the public
conceptions of the medical profession and patients' attitudes towards them
impinge upon doctors' own self-conception. The main substantive concern
-
of this chapter is how the doctors whom I interviewed cope with the
increasingly negative public image of the profession in recent years"
greedy doctors" who are more concerned in making money than treating
patients. Hence, I look at how the doctors themselves narrate their
relations with their patients-as "guod doctors" who do their best to take care
of the medical and social problems of their patients despite adverse work
conditions.
Each of these three chapters are intended to probe a different set of
factors which mold the self-conception of medical doctors in Turkey.
Rather than providing comprehensive answers to the questions which I
ini tially inspired this thesis, they capture a few fragments from a much
more complex picture. In the last, concluding chapter of the thesis, I will
explain my own understanding of how these different fragments might fit
together. Thus, the last chapter will be an attempt to develop my own
narrative as a researcher,_ on the basis of what I have learned by reading
historical accounts and listening to doctors as they describe their own
professional experiences. My arguments are also informed by my own
observations on doctor-patient relations and doctors' professional
experiences in the hospital setting where I was employed as a researcher
in different research proj ects. Before proceeding with the substantive
chapters below, a few brief remarks on some broader theoretical
considerations may be necessary.
5
Some Broader Theoretical Considerations: This thesis is infonned by
recent developments in the field of medical anthropology where such topics
as doctor-patient relations and different cultural definitions of health and
illness have begun to receive growing emphasis. These have brought into
the foreground such issues as the confrontation between different
explanations of specific health problems. Differences between the cultural
construction of a health problem in tenus of the meaning that is attributed
to it by lay people in society and the medical evaluation of doctors through
the use of "objective-scientific" data in hospital settings have begun to be
explored (Helman, 1990). Although many anthropologists argue that the
different explanations. offered by lay people and doctors are negotiated in
doctor-patient relations or in the way patients interpret and apply the
doctors' advice, they generally admit that explanations of institutionalized
modern medicine dominate the way societies perceive and interpret health
issues. This is related with the development of modem medicine as a
separate field from religion and philosophy and, relatedly, the formation of
the biomedical model which is highly suitable for the "modernized"
societies whose main ideology is to shape all aspects of their lives according
to the scientific and rational values (Figlio, 1977) (Conrad, 1992).
The biomedical model .includes a strict mind-body dualism and
reliance on the the objective-scientific data that is obtained through
measurements conducted at the modern medical institutions. It attributes
a prestigious position to the doctors as the only people who can legitimately
acquire medical knowledge and apply it through conducting these tests and
measurements in order to achieve a final evaluation about the health status
of the patient and advise a treatment plan. Accordingly, doctors, in
6
general, have a highly respectful and prestigious position, and enjoy high
social status and economic power in the societies which adopted the
biomedical model with its values and institutions (Helman, 1990). Since
most of the countries adopted contemporary Western ideologies, values and
institutions through their modernization process, biomedicine which is one
of their basic aspects, also became a dominant explanatory model in most of
the countries in the world, at least at the level of modern medical
institutions and official health sectors.
However, the biomedical model and the social position of doctors are
also exposed to modifications during the process of the adoption of
biomedicine in line with the particular social, political and cultural context
in a country which shapes its health sector according to this model. Since
this model is formed as a result of specific historical and social conditions,
it is also bound to be challenged and changed, even in the Western
countries where it was first developed.
My own attempt to study the self-conceptions of medical doctors in
Turkey is an effort to understand how this "biomedical model", when
adopted in non-Western settings, lends itself to distinctive patterns of social
and political authority in various cultural settings. In trying to understand
how the social and political position of medical doctors as a professional
group is shaped through power struggles vis-a-vis the state as well as "lay
people", the arguments of Turner (1987) have been especially helpful. His
emphasis on the relevance of power struggles in drawing the boundaries of
the medical profession, in maintaining control over professional expertise,
as well as legitimizing the social authority of the medical profession,
provides the conceptual background for the fIrst chapter of this thesis. In
7
the second chapter, where I discuss the professional life stories of a
younger generation of doctors who are currently in their mid-careers, the
work of Linde (1993) has been very useful in trying to interpret how personal
narratives play an important role in achieving consistency between
"individual self' and "professional self'.
8
Chapter 1
Development of Modem Medicine in Turkey
This chapter situates the development of a professional perspective
and a concern with social issues among Turkish medical doctors in a
historical context. The development of a professional perspective ocurred
within the process of institutionalization of modern medicine during which
doctors gained social power and prestige. There were close linkages
between development of modern medicine and broader social changes.
Major reform movements in the Ottoman Empire and the Turkish Republic
influenced institutionalization of modern medicine, and doctors played key
roles in the overall modernization process.
The major problems and dilemmas faced in the modernization
process were also reflected in the development of a modern health sector.
Both of these processes were led by a small group of pioneering
intellectuals. They took their inspiration from the Enlightenment heritage
of progressivist, scientific thinking, and were opposed by concervative
circles with traditional and religious concerns. The state, and the
negotiations over state policies were an important element in both
processes. For the doctors, these negotiations were conducted mostly in
oppositional terms during the Ottoman Empire when reformist movements
were seen as threatening the power of the Sultan, but allies during the
early Republican period.
The process of professionalization of modern medicine, involving the
development of a perspective and a common stance among doctors with
respect to problems of the cmmtry enabled both the fonnation of group
9
solidarity and acquisition of social power. Paul Starr (1982) in his study of
medicine in the United States, argues that "the profession has been able to
turn its authority into social privilege, economic power and political
influence". He adds that this was not a smooth process whereby increasing
"faith" in science and rationality in society conferred an immediate
prestige on the doctors. The process itself was full of power struggles
where the interests of other social groups, organizations, and the state
clashed with one another. In his book, Starr concentrates on issues of
maintaining professional authority, group boundaries, economic interests,
and domination over values and beliefs concerning health. In the case of
the Turkish doctors, I find it more important to study the particular ways
in which their involvement in major social and political movements shaped
their own professional perspective and enabled them to acquire social
prestige and power.
Part A: Modem Medicine in the Ottoman Empire (1827-1923)
Even though it is hard to define an exact date for the birth of modern
Turkish medicine, doctors and science historians agree on 14 March 1827,
the founding of the first modern medical school, Tibhane. The founding of
this school was included in the reformation agenda of Mahmud II.
During his reign (1808-1839), he abolished the Ottoman traditional army,
Yem{:eriOcap, and replaced it with a modern army institution which was
similar to the Western mili tal)' model. It was the needs of this new army
which provided the impetus for the establishment of a school of modem
medicine. The new army needed large-scale, institutional medical services
provided by doctors who were formally educated according to European
10
standards (Unat & Samastl, 1990), (Erdemir, 1996). flbhane also played
an important role in the standardization of medical education which was
given previously in different ways by the Muslim and non-Muslim
institutions.
Before the foundation of TJbhal1e, medical knowledge was taught
mainly in theoretical terms in themeanwe s, which was the name given to
the secondary and higher levels of schools. The teaching consisted of
revision and interpretation of classical Eastern and Western medical texts
such as KanlDJ (Canon) of fbn-j Sin8 (Avicenna) and the works of
Hippocrates and Galen. The new medical texts incorporated
interpretations of these classical texts and some contemporary medical
knowledge from Europe, usually transmitted by the non-Muslim minorities
who had close economic and social contact with the West. In this respect,
the Jews who settled in the Ottoman Empire when they were expelled from
Spain after 1492, brought a new synthesis, which consisted of "Islamic,
French and Greek" medical knowledge as well as their own medical
explanations. Their unique contribution to the medical knowledge
provided a privileged position /to the Jewish doctors, especially in the realm
of the Ottoman court (AdlVar, 1991).
The medical education in medrese s was far from being fonnal and
standard , it mainly depended on a one-to one relationship between the
teacher and the student. This relationship was similar to the masterapprentice
relation where the teacher designed a specific curriculum for
his students. There was no standard course schedule and a specific time
period required for medical education. The teacher tested his student and
when he decided that the student acquired an adequate medical knowledge,
1 1
he was given an ieazet, a written peInlission which authorized the student
to become a doctor and to cure people (Uzun~ar~nh, 1988).
The non-Muslim minority groups had their medical education either
in European countries such as Greece, Italy and France (YIldlnm &
ulman, 1994) or in their own hospitals and institutions in Istanbul (I.A.,
1995). Among these organizations, Kuru~e~me University (1805-1820)
which was built with the permission of Selim III, included a faculty of
medicine with an anatomy laboratory where medical students and doctors
practiced their medical knowledge and made experiments through
dissecting cadavers. Selim III was convinced that a medical faculty
where the students can practice their medical knowledge as in the
contemporary medical faculties in Europe was needed in the Ottoman
Empire. However, he was also concerned about the reaction of
conservative circles who were against the dissection of corpses, since it was
considered contrary to Islamic rules. He solved this dilemma by giving
permission to the Greek-origined (Rum) doctors to open a faculty of
medicine in Kuru~e~me University which admitted only Greek-origined
students. The university was closed (1820) soon after its opening, since the
director of the university, Dimitre~ko Bey, was blamed for participating in
the Greek nationalist movement and executed (Unat & Samastl, 1990)
(AdlVar, 1991).
Medical education and the health system in the Ottoman Empire
were regulated by the Ifekimbll9J, who corresponds approximatively to the
minister of health today. He was responsible for supervising the
professional activities of doctors in the country, including the doctors in the
palace. However, his main responsibility was to maintain the health of the
12
Sultan and the members of his dynasty. Whenever a sultan died from
natural causes and his follower replaced him, according to the laws his
he.kf.l11b~J also had to be replaced by another doctor (Uzunr;ar~Ill, 1988).
Mustafa Behr;et who was the heki.l11b~J of Mahmut II played a crucial
role in convincing him that reformation was needed in the medical
services. Mahmut II and the ruling elite planned a reform program which
would be implemented by the state officials who would adopt a system from
a European country, preferably France (Ortayh, 1983).
Mustafa Behr;et, the he.kimb~J, and Sanizade Ataullah, another
well-known doctor of that time, were highly influenced by Western medical
knowledge and developments and were accused of being atheists by the
conservative circles. Both of these doctors wrote books on medicine, which
combined traditional and contemporary, Islamic and Western medical
knowledge and aimed to establish a new medical tenninology. They both
believed that a movement for modernization and nationa.lization in the
realm of all sciences was necessary. They played a pioneering role in the
formation of modern Turkish medicine and Mustafa Behr;et used his
official power to organize the foundation and development of TIbhane in
which he had a supervising role. In addition to TIbhane, Mustafa Behr;et
convinced Mahmut II to open CeITahane. the military surgery school,
where Muslim students could also participate in the anatomy laboratory.
The Austrian doctor, Dr. Bernard who was a highly prestigious doctor in
Austria and France, was invited to the Ottoman Empire in 1838 by Mustafa
Behc;et and became equally succesful in Istanbul, emphasized that a
proper medical education could not be pursued without an anatomy
laboratory and planned certain improvements in CeITal1ane (Gftrsoy, 1996)
1 3
(Unat & Samastl, 1990) (LA., 1993). However, the anatomy laboratory
could not function properly until the beginning of 20th century since the
students could not find enough corpse and had to steal them from the
cemeteries in the 1890's, and the building for the laboratory was not
properly cared for (Erdemir, 1996). TIbhiine also admitted more and more
students each year and successful students graduating from this school
began to be sent in Europe for further study. In 1838, it had united with
Ce.lTahiine, the surgery school, under the name "Mekteb-i Tlbbiye Adliye-i
Sahane" (Imperial School of Medicine).
Debates on the Language of Instruction in Medical Education:
Since the foundation of Tlbhane, medical education was given in French
and this was an important issue of debate among intellectuals in the
Ottoman Empire. The non-Muslims and foreigners argued for the
education in French on the grounds that it would take time to translate the
major contemporary textbooks, and that in any case medical students
should know French in order to understand the medical tenninology in
Latin. However, for the, Muslim intellectuals, the medical education
should be in Turkish so that the number of Muslim students who decided to
enter the medical school and graduated from this school succesfully
increase and that a close support network among Muslim Ottoman doctors
could develop. Having nationalistic considerations, they were concerned
about the non-Muslim and foreign medical students and doctors who
outnumbered the Muslims students and doctors, and who were better
organized, which made them more influential in the general health
politics. The language of instruction in medical education was considered
14
as a serious problem not only for doctors but also for Muslim Ottoman
intellectuals who participated in the efforts of translating medical
textbooks, preparing dictionaries of tenninology and lobbying for medical
education in Turkish. They were explicitly against foreign and nonMuslim
doctors, as in the example of Mustafa Mtinif Pa~a who called the
foreign doctor "charlatans" who came to the Ottoman State since they could
not be successful in their own countries. The nationalistic and
exclusionary attitudes of the non-Muslim doctors caused reactions on the
side of other Ottoman doctors. Unat and SamastI (1990) tell about these
atti tudes by giving the example of Dr. Zambako who annmIDced that he
was Byzantine and refused to speak Turkish with his patients. This
example also shows that the debates on the language of instruction in the
medical education were embedded with nationalistic concerns of different
groups of intellectuals.
Involved in the language debate, the political agenda of some
nationalist intellectuals who aimed to create and develop "national
positivistic sciences". These intellectuals considered language as an
essential part of the Turkish: identity and as a tool to activate people around
a shared ideal (Mardin, 1985). Therefore, the efforts to create a modern
scientific language using Ottoman Turkish were part of a larger project of
creating a common language which could also be used in propagating
political ideas. For these intellectuals there should be more Muslim
Ottoman Turkish doctors so that they could organize and compete with
others in terms of having access to the patients and· influencing the design
of a health policy in line with their own interests. Having a medical
15
education in Turkish served this goal as well as being the first step to
create modern Turkish medicine and science.
The debates about the language of medical education were at their
peak when Mahmut II made his famous speech at the opening ceremony of
the Imperial School of Physical Education and Sciences: His talk began:
"I have given precedence to this school because it will be dedicated to a
sacred duty- the preservation of human health". He continued by saying
that the language of instruction will be in French, because it would take
years to translate the French textbooks and the existing textbooks in the
Ottoman Turkish had become obsolete. He said that they needed well
trained doctors for their troops and their people, and to have their own
medical language and their own medical literature codified. He concluded:
"Therefore, my purpose in having you study the French language is not to
teach you French as such but that you may learn medicine- and in order to
incorporate science step by step into our language. Medicine will be taught
in Turkish only when this has been done" (Giirsoy, 1996) (Unat & Samastl,
1990).
Although this may seem a conciliatory speech within the debate, it is
important in signifying an end to the medrese education based on classical
medical texts, and to their replacement by modern medical schools in line
with the Westemmodel. Indeed, the new medical school where Muslim
and non-Muslim Ottoman subjects, and foreigners were educated together,
became a place where Western, mainly French, history, literature and
culture were taught. The contemporary ideas in the West, such as
different versions of nationalisms filtered through these teachings. The
Muslim Ottoman intellectuals considered the speech of Mahmut II, as
16
pointing to a mission of creating a modem Turkish science and accelerated
their studies and translations.
A civilian medical school opened in 1866 as a part of the military
school to fulfill the need for doctors in the general population. According to
Unat and SamastI (1990), this school attracted a lot of Muslim students who
were actively involved in the debates on the language of instruction in the
medical education. For the first time, the language of instruction for a
"privileged class" which consisted of the most successful students, became
Turkish. Finally, at the end of the 1860's the language of instruction in the
civil medical school became Turkish, after consultations of the Abdulaziz's
representative in education with the prominent Muslim and non-Muslim
doctors, and the military medical school soon to be followed by. This
resulted in a significant increase in Ottoman Muslim students so that less
than one-third of the graduates from the civil military school were nonMuslims
(Unat & Samastl, 1990). However, Dr. Muzaffer Sezer (1953)
argues that knowing French still remained a crucial advantage for
medical students even though the education was in Turkish, since the
students "educate themselves better" through reading the original French
textbooks rather than listening to the lectures of their professors who
merely repeated the translations of these textbooks. Comparisons of the
state of Turkish medicine with West and the competition with the nonMuslims
in the country still continued to some extent, but Muslim and
non-Muslim groups seemed to build closer and more harmonious
relationships while having the same Western oriented education in the
same schools which had a socially and politically unifying character. This
character also helped the Ottoman doctors organize around their shared
1 7
ideas to acquire a considerable degree of political power. The political power
brought the doctor into conflictual relations with the last sultans of the
Empire, who saw them as a threat to their own power and refonn projects.
The Modem Turkish Medicine, Its Ideology and Founders: In the
medical schools, influence of contemporary Western thought, Wldennined
religious thinking and strengthened nationalistic and scientific ideals. Dr.
Bernard whose views on the necessity of dissecting hmnan corpses, became
more influential when he was charged with organization of the TIMane as
its director. The memoirs of Charles MacFarlane, quoted in Akile Giirsoy
(1996), tells about "a good anatomical theater" in the medical school, which
indicated that the medical students were used to this experience* . When
he asked whether this was not against Islam, one of the Muslim students
laughed at him and answered that this was not the place to look out for
religion. He also reports about a French book lying around which was
considered the "Atheist's Manual" at that time in France. He was
surprised to see that this book was carefully read and highly appreciated by
the Turkish medical students. G-ursoy describes the foundation of modem
medicine in the Ottoman Empire, as "intenningled with the processes of
non-traditionalism, Westernization, nationalism, secularism and may be
also atheism".
Since these processes corresponded directly to a general proj ect of
modernization which was also derived from the Western model, doctors
* As opposed to these memoirs, Dr. Arslan Terzioglu (1992) mentions about a
report written by an Austrian doctor in 1842, where the students in. the
Imperial School of Medicine work with plastic model of organs and animal
bodies in the anatomy labaratories instead of human bodies.
18
and medical students had a privileged position among the intellectuals
because of their immediate contact with Western professors and ideologies.
In addition, the successful medical students had the chance to go to
Western countries, mainly France and Germany for further studies when
they had graduated. The medical schools together with other faculties and
foreign high-schools which were opened in the 19th century, were uttered
by the Ottoman intellectuals as the channels of "direct interaction" with the
Western culture, the result of which is reflected in the process of "cultural
change" experienced by the members of these institutions. (Giiven~, 1979)
(Davison,1963) (AydIn, 1993).
Dr. Tevfik Sag-lam (1981), described the spirit of being from the
Medical School (Ttbbi.reif Rubu) as revolutionary, having the love of nation
and freedom and belief in progress which would be realized by reaching the
levels of developed countries. This spirit was clearly directed to the West as
Sag-lam points out that the medical schools were "the first window" of the
Ottoman Empire opened to the "Western world". In line with this
statement, he says that the members of this school knew the difference
between East and West, and/ felt sorry for the East's "backwardness and
laziness".
In the civil and military medical schools, the Muslim students were
also influenced by the nationalistic movements of the non-Muslim
students. Most of the Muslim Ottoman students entered the medical
faculty not only to learn medical knowledge and fulfil a crucial need for
doctors in the country, but also to pursue a mission to contribute to the
development of modern Turkish science and to national reformation and
modernization projects both in theoretical and practical terms (Unat &
19
Samastl, 1990). The ultimate aim of this mission was to create a modern
"Turkish identity" apart from being a subject of the Ottoman State.
IIi addition to language, religion, and in particular the issue of
whether Islam was compatible with Westernization was an important
source of debate among Muslim intellectual elites. Medical students and
doctors had a particular position in this debate, which could be partly
explained by the relation between medicine and religion. As Bryan Turner
(1996) points out, medicine has a strong secular tradition which goes far
back to Hippocratic and Galeanic medicine. Although this tradition was
subsided by Christianity and its ethics of love and hmnanism in the Middle
Ages, it was the separation of scientific from the religious and
philosophical spheres in the 18th and 19th centuries which shaped the
basic principles of modern secular medicine (Figlio, 1977).
The Ottoman medical schools had to differentiate themselves from
the medrese type of education where medical knowledge was taught in
accordance with Islamic rules both in terms of theory and practice. The
new medical schools adopted the secular and modern medical model,
hence positivism and biological materialism where the material entity is
considered and scientifically studied as the basic substance of all beings ,
became the basic tenets of medical education. Doctors who were also
prominent social and political figures at that time debated whether religion
and "traditional values" could contribute to the project of social progress.
Dr. Be~ir Fuad, who was a strong follower of positivism to the extent that
he committed suicide by cutting his wrists and reported his physical
condition in detail whilst dying, believed strictly in biological materialism.
Abdullah Cevdet who was under the influence of his religious family and
20
training, was more open to religion and tried to combine Islamic values
and social progress (Hanioglu, 1986). However, Hanioglu notes that
medical education modified the views of Abdullah Cevdet who began to
favour biological materialism. He describes the civil medical school as
having a particular socialization function, creating a type of intellectual
who saw religion as an obstruction in social progress.
One of the most important aspects of biological materialism for these
Ottoman intellectual doctors was the separation between matters of the
heart and matters of the brain. Matters of the brain were considered as
scientific points which could be tested and proven by experiment and
observation. Interestingly, according to these intellectuals, these methods
were also applicable for social and political issues, even though they were
derived from positive sciences. Hanioglu gives an example of an
explanation of a political issue with concepts that are derived from positive
scientific terminology from the memoirs of a highly important political
figure in the Turkish nationalist movement, Dr. Rlza Nur. Dr. Nur
believed that people had to unite and pursue an organized struggle in order
to fight the oppressive regime of AbdiIlhamit II. He argued about this
requirement with an example from chemistry where the combination of
two chemical entities, similar to the people who came together, led to the
creation of a new and highly precious entity. This example is also
important in explaining the roots of political activities of doctors.
These views were also shared by a large group of Ottoman
intellectuals, and Ottoman doctors played a significant political role in the
modernization projects led by the Ottoman intellectual elite. Most of the
Ottoman doctors, similar to the other intellectual elite, were from families
21
with a high socia-economic status and a high position in the state
bureaucracy (Unat & Samastl, 1990). Hence, in contrast to Starr's (1982)
description of the heterogeneous class position of the American doctors
during the modernization process, the Ottoman doctors were concentrated
in the upper class division mostly because of their familial backgrounds, so
they had less economic concerns than their American colleagues. Most of
these intellectual elites came from high level bureaucratic families or had
organic links with government. They were concerned about the political
and social decay in the Ottoman State and tried to find solutions to its
problems. Mardin and Klhr;bay argue that the their ideas on
modernization as Westernization differed sharply from the ideas and
lifestyles of conservative masses. However, these intellectuals can be
considered as politically conservative since they did not attack the existing
political system and its legitimacy directly, and their Westernization and
nationalism projects we:re directed toward restoring the power of the
existing political institutions and processes. Their political power enabled
them to publish and disseminate their views, and to organize as groups.
Their modernization project included a mission that they assigned
themselves: They had to teach the masses how to adapt to a new model in
the way they lived and thought (Mardin, 1985) (Klhr;bay, 1985).
Although there were debates on different aspects of the model for
social development, such as the debate on the inclusion of religious values
as we have seen above, the intellectuals agreed on its basic aspects such as
the emphasis on science, rationality and progress. With the aim of
realizing their mission, they organized to acquire political power in order to
influence the reform projects of the state and to stop the decline of the
22
Ottoman power, as in the cases of the first and second attempts to bring in
constitutional law, and the more general, social and cultural reform
proj ect of Tanzima t
The Political Role and Activities of Doctors within the Turkish
Nationalist Movement: In line with the argmnent about the theoretical
and methodological unity of the physical and social sciences, the medical
students and doctors began to consider themselves as the legitimate
pioneers of the modernization mission, due to their privileged access to the
medical knowledge, as well as to Western ideas and resources. They
considered medical knowledge and health matters crucial in the fonnation
of a "nation" as the words of Dr. Adnan Aruvar quoted in the autobiography
of Dr. Sezer (1953) tells us: "The health of a nation should have a priority
over alL.A nation which has a well established health system is also strong
in war, and works with energy. To what extent weak citizens who often
become ill can be useful in their work or in defending their country can be
easily estimated". The views of Dr. Adlvar underline the critical role
health and medicine play in creating strong nations, but also point to a way
of thinking which assumes that knowledge of medical and physical
sciences enables one to understand social and political issues and to react to
them.
In the biography of Dr. Sezer, Dr. Adnan Adlvar talks about the
lively political atmosphere of the civil medical school to his young high
school student (Dr. Sezer) in this way: "This is a sacred place where all
scientific and social cases and issues are merged into each other
(.kaj'.l1~ma.k) and where a lot of young citizens with a fighting spirit are
23
gathered". He implies that the propagation of these views is a part of a
socialization process in the civil medical school through his words:
"Under the roof of the medical school, each person finds himself being
involved with this political movement, without being aware of it at all "
(Sezer, 1953).
For Dr. Achvar, the civil medical school was more actively engaged in
political debates than the military medical school which had a stricter
discipline. Moreover, according to the views of Dr. Adlvar, which were
highly influential among the Ottoman intellectuals in the last decades of
the 19th century because of his high political and professional status, the
future of the country belonged to civil doctors who served people from
different layers of society, in different parts of the country, unlike military
doctors who could merely reach the patients in the anny. He says: " The
medical school is a house of science which leads each of its members
towards the same aim and which matures them in tenns of solidarity,
hannony, sensitivity and keeping secrets. Its principal aim is to serve the
social and medical development of the country". The qualities, mentioned
here, were also crucial for the fonnation of professional solidarity among
the doctors (Sezer, 1953). The doctors who were trained in the military
medical school, such as Dr. Abdullah Cevdet and Ibrahim Temo, also
shared these qualities and their efficiency and discipline in terms of
political organization assured their leaderships in the Young Turk
movement (Hanioglu, 1986).
Doctors shared the dissatisfaction of the Ottoman intellectual elite
with the political situation. This dissatisfaction was the basic motive to
participate in the Young Turk (JelDJ TlD"cs) movement which became
24
increasingly influential in the political realm in the last decades of 19th
century. Some doctors and medical students, such as Ibrahim Temo and
Adnan Adlvar, played a leading role in the fonnation of this movement,
and also influenced their colleagues through propagating their political
and social views. Later on, the movement developed into a well organized
political party, fttmat ve Terakki Cemiyeti (The Committee of Union and
Progress-CUP) where Dr. Abdullah Cevdet was one of its three main
leaders (Hanioglu, 1986).
According to Sina Ak~in (1985), the participants in the CUP had five
common characteristics which helped in defining· their ideology and
actions: They emphasized their "Turkish identity", independent of their
ethnic origins. Secondly, most of them were high school or university
students or recent graduates who were not risking a professional career
that they had pursued for a long time. They came from families who lived
a Westernized "bourgeois style of life". The members of these families were
from the ruling class, meaning they were mostly high ranking state
officials. The last trait. that Ak~in mentions was that most of the party
members were well-educated/in modem Western values and ideas. He
points out that they were mostly from the modem universities in the
Ottoman State, including the two medical schools instead of the met:in:!se s.
These typical traits correspond to the characteristics of medical students
and doctors such that this group can be considered a representative of the
whole party members and the participants in the Westernization and
modernization movement.
The political debates and activities in the civilian and military
medical schools were not always tolerated by the Ottoman Sultans. Even
25
though Mahmut II had assigned to the members of the military school a
privileged status and the mission to found the modern Turkish science.
Sultan Abdfrlaziz (1861-1876) was disturbed by the ideological movements
~
within the military medical school and held the French director and
professors responsible. He replaced the French director with Dr. Robert
Rieder (1861-1913), a German director who was followed by another
German, Dr. Georg Deyche (1865-1938). The period where these two
directors were in charge was later called the "Rieder-Deyche period" where
German doctors improved the military hospitals and brought basic
elements of preventive medicine to the Ottoman army such as vaccination
against epidemic diseases. However, the new discipline did not totally
curb the political movements within the military medical school (Erdemir,
1996).
Abdii:lhamit II (1876-1908) who came into power with the help of the
political compromises he made with the CUP, felt threatened and rivaled
by this party. He closed parliament on the pretext of giving priority to
solving the political and social confusion caused by the Ottoman-Russian
War in 1878. He began to apply an oppressive regime where the activities of
the party were closely controlled and any act of opposition from the Ottoman
intellectuals was punished. Many were sent to European countries on
diplomatic missions or they were paid by the Ottoman State to continue
their intellectual and political activities in Europe. Modem and
cosmopolitan European cities of that time such as Paris and Geneva
became centers of political organizations for the Young Turks who found
ways of escaping to these places even though they were exiled to different
places such as Fizan (Libya) in the case of Dr. Abdullah Cevdet (Hanioglu,
26
1986). In these European cities, the intellectual and political activities of the
Young Turks were influenced by the the policies of the Sultan as well as
the lively intellectual and ideological atmosphere of the cities where they
lived.
In exile, there began to develop a schism among Young Turks,
between a more conservative group who argued for communitarian values
and a group more eager to adopt. the Western ideologies and promoting
individualistic values. Abdttlhamit II tried to persuade some of the leaders
in the first group that he would undertake similar refonns in the Ottoman
State, if they returned. Most of the doctors, however, such as Dr. Sabri and
Dr. Abdullah Cevdet, who had a prominent role in the CUP movement,
favored the second group led by Prens Sab ahat tin. The maj or reason for
this support according to Haniog-Iu (1986) , was that Prens Sabahattin
shared a similar ideology with these doctors, particularly the view that
social facts can be dealt with "in the light of' physical sciences. Hanioglu
says that Dr. Abdullah Cevdet and Prens Sabahattin shared an ideology
similar to "Social Darwinism", arguing for the necessity for struggle and
competition in social and economic life. This struggle was considered as
the "struggle for life" and compared to the Darwinian theory about the
plants and animals which succeed in adapting to their environment,
establishing and reproducing their kind. AI though, these views were
more marginally shared among the Ottoman intellectuals, the second
group's reluctance to reconcile with the Sultan brought them a privileged
position within the movement (Hanioglu, 1986).
According to Dr. Muzaffer Sezer (1953), Abdulhamit was
particularly afraid of and suspicious about the medical students, and he
27
had the new hospital and a larger military school built in an isolated part of
Istanbul at Haydarpa$a. Sezer argues that the new buildings did not only
keep the medical students and doctors away from the palace and the city
center, but also provided an opportunity to spy on. their activities and to
arrest them comfortably without getting an immediate reaction from the
rest of society. Dr. Sag-lam (1981) also argues that the oppressive regime of
Abdii:lhamit was directed particularly to the medical school and caused an
extraordinary solidarity, mutual respect, trust and affection grow among
the students and professors and between the two groups so that it
strengthened the "spirit of being from the Medical School" (TIbbiyeli Rubn)
instead of weakening it.
The Institutionalization and Professionalization in the Health Sector:
The opposition of the Young Turks and its fluctuating relations with
Abdii:lhamit II lasted until the second attempt to bring constitutional law,
when the oppressive regime of Abdii:lhami t II ended. During his reign,
despite his problematic relations with the Young Turks, Abdii:lhamit II,
adopted a development modeL similar to that of the Young Turks. He was
interested in establishing new universities, including medical schools,
where intellectuals, artists and professionals were to be educated in line
wi th modern European ideas and methods. He was also concerned about
the increasing number of medical students and doctors so that he
supported the enlargements and improvements of the buildings of medical
schools and hospitals. He also promoted the specialization of hospitals
which began to acquire an institutional character, and was differentiated
from the charity hospitals (darti$$i/'a) which were part of building
28
complexes centred around mosques. Besides nmnerous small hospitals
which specialized in treating victims of the cholera epidemics, Abdftlhamit
II opened a children's hospital (Etmi Hastahanesi) and a special
institution named Dartilaceze where old people and babies who had no
relatives, would be taken care of (Altmta~, 1998).
The 19th century was also a turning point in terms of large scale
developments in the health sector in line with other social and ideological
developments. Besides modem medical schools, large-scale hospitals such
as Capa and Cerrahp~a were established as a result of serious epidemics,
such as small pox (1843) and cholera epidemics (1893), giving the doctors
the opportunity to practice medicine, both as a part of their educational and
professional experience (Uzun~a~lh, 1988) (LA. ,1995). Military hospitals
also developed primarily as a result of long-lasting, brutal wars of the 19th
century such as the Crimean War (1854-1856) (Terzioglu, 1991-1). Wars
and the increasing foreign population in Istanbul due to frequent social
and economic interactions with the Ottoman Empire led European
communities and the United States to build and enlarge their own hospitals
in the last decades of the 19t1} and early years of the 20th century. Among
them the German Hospital which was builtin 1846 was enlarged at the end
of 19th century and the American Bristol Hospital was built in 1920, mainly
to take care of poor foreign sailors, veterans of the wars, people from their
own community in Istanbul as well as other city residents (lA., 1995)
Crimean War had a particular Significance in terms of the
institutionalization of health sector. Florence Nightingale came to Istanbul
with 40 nurs~s, and started the foundation process of modem nursing
through educating new nurses, contributing to the opening of a nurse
29
school named after her, as-well as her exemplary professional performance
(N asuhioglu, 1975), (\tVoodham-Smith, 1952). The other professions in the
health sector were institutionalized much later. Although the school of
pharmacists was founded a few years after the foundation of the civilian
medical school, it was for the students who were unsuccessful in medical
education in their first years (Unat & Samastl, 1990). Only in 1909, could a
separate school which had three separate divisions for pharmacists,
dentists and mid-wives be built (Erdemir, 1996). With these developments
in professionalization and institutionalization processes in the health
sector were well established; the professions began to have defined
boundaries mostly due to the standardization in education and the
increasing social and political prestige and power of the professionals.
Doctors developed a more organized character in professional as well
as in political terms in the last half of the 19th century and the early 20th
century. The professional duties and social boundaries of this group began
to be defined with more standard and regular terms so that they gained a
communitarian aspect whereby most of the doctors knew, communicated
with and supported each otller. The first professional journal with both
Turkish and French versions, Vekayii-7}bbiye (Medical Cases), was issued
in the military medical school in 1849 (Nasuhioglu, 1975). The first
professional organization, Cemiyet-i l1bbiye-i Osmaniye (1866), was
founded in the civil medical school with the goal of encouraging medical.
education in Turkish, and its members prepared a list of medical terms in
Turkish, besides planning and promoting the translations of Western
medical textbooks (Unat & Samastl, 1990). However, during the reign of
Abdulhamit, mainly non-Muslims became the members of this
30
organization, because of his oppressive regime which particularly affected
the Young Turk doctors (Topuzlu,1945). E£IlaJia.hmer, an equivalent of
"red cross" in the Western countries, which was responsible for health care
especially within the army, was founded in 1858 (ozden, 1945). This
organization became particularly efficient in the last wars of the Ottoman
Empire and the War of Independence, and this increased the social
prestige of doctors further.
The fIrst course in medical history and ethics was given in the 1860's
and in the 1870's, respectively, by Dr. Nouridjan who described the primary
duties of doctors in his ethics courses and who became highly influential in
shaping the doctors' professional perspective. He stressed that the virtues
of doctors should be derived from the "love of duty" which would help them
to overcome the difficulties of the profession, and a "love of science" which
would guide doctors in learning every aspect of the human beings,
improving the human condition and providing social development
(Terzioglu, 1993). In 1902, the same course was given by Zoeros Papa, who
was also employed by the Ottoman Court and founded the first institute for
Rabies (1887) of the East in !stanbul, in the light of his studies with Louis
Pasteur in Paris. His courses on medical ethics covered medical history,
the characteristics which doctors should have, such as paying attention to
their appearance, being honest, patient and tolerant, and duties such as
spending the necessary effort to heal any sick person, including enemies,
and giving adequate infonnation to the patients on their health condition
(YIldInm &ulman, 1994).
In 1909, the graduates of the medical school and the pharmacists'
school took a professional oath for the first time in their graduation
31
ceremony. The oath was based on the laws of Hippocrates and reflected the
basic medical principles that the students had learned in their ethics
courses (Unat & Samastl, 1990). In 1908, The civilian medical school
became a part of Da.rttlftinlDJ, the first major tniiversity in the Ottoman
Empire which had opened in the 19th century.
PART B: Social Mission and Struggles of Turkish Doctors in the
Republican Period
The political prestige and power of the doctors increased considerably
during the early years of the Turkish Republic. In contrast to political
opposition towards the Sultans and their traditional ruling system, the
doctors acquired a broader, unifying social mission in line with Kemalism,
the official modernist and nationalist ideology which shaped the social and
poli tical transformation proj ects during the early decades of the RepUblic.
As we have already seen, the Ottoman intellectual elites had varying
proj ects of modernization which included different aspects of nationalistic
thinking, and the values they promoted varying from traditional, religious,
communitarian values to the scientific or individualistic ones. Suavi Aydm
(1993), argues that all of these ideas were incorporated into the official
Kemalist ideology which envisioned a broader, more concrete project of a
major transformation in various sectors in the newly defined "Turkish
society", where a new identity of "Turkishness" was described. In this
framework, the Kemalist project was similar to that of the Young Turks in
terms of its positivist and progressive perspective which leads to the
adoption of Western social system and institutions.
32
The Kemalist Project and Turkish Doctors: Professional groups had
a crucial ftmction in the Kemalist modernization project. As Atatitrk (1930)
stated, all of the occupational groups should have a sense of duty of serving
the welfare of their country while working. He had a functionalist view of
the occupations, since he believed that a country's existence depended on
the work, help and contributions of "its children". He also stressed that not
all of the citizens contribute to the country in the same amount and
significance. Having nationalist concerns which dominated the whole
Kemalist ideology, he praised the Turkish doctors and tried to motivate
them through inculcation of a professional self-confidence. Since the early
decades of the 18th century, the Turkish doctors had struggled to build up a
modem and national medical sector and science through the adoption of
the Western scientific ideas. Atatiirk aimed at institutional development
in all sectors so that Turkish institutions and their members could
compete with their counterparts in the West. He preferred to be under the
care of Turkish doctors until his last years and expressed this preference
with his famous words which could be translated as "Leave me in the
hands of Turkish doctors". ,This sentence became a professional motto
written on the entrances of almost every medical school and hospital.
Medical education was also totally nationalized with the abolition of the
educational activities in the hospitals of foreign and non-Muslim minority
groups. The Turkish government passed a regulation which defmed these
as private hospitals with a special status and prescribed that their boards of
directors should include Muslim Turks, and that the government should
approve their administration, similar to the status of foreign high-schools
in Turkey (I.A., 1995).
33
Halit Ziya Konuralp, a famous aesthetic surgeon, who went to
medical school in the 1920's mentioned in his talk that medical education
also improved since surgical education and dissection of cadavers were
considered crucial by Cemil Topuzlu, who was in charge of the health
system and politically influential both in the last period of Ottoman Empire
and the first decades of the Turkish Republic. In the 1930's, he became the
Mayor of Istanbul, and his activities in this position, such as opening public
parks and gardens, were highly appreciated. Hence surgical operations
and dissection of cadavers became an essential part of medical education
(Konuralp, 1996). Starr's (1982) remark about the early period of the
modernization of American medicine where the physicians mainly dealt
with the theoretical aspects of medicine, and had higher social position and
prestige than the surgeons whose main duty was to be involved with dead
and living bodies, is also valid for the Ottoman case where involvement with
dead and living bodies were traditionally conceived as an inferior activity,
which even barbers could deal with, especially when it was compared to
the scholarly or academic work. This differentiation was gradually
abolished with the increase in the courses on surgery in the medical
schools, and the success of surgeons especially during the wars at the end
of the 19th and the beginning of the 20th centUIy.
Doctors who already attributed to themselves the mission of social
and cultural propagation of nationalistic and scientific values and
applications in their occupational realm, now gained an officially
legitimized duty to transmit and teach these values to the rest of society.
Most of the doctors mentioned here such as Dr. Adnan Adlvar and Tevfik
Sag-lam witnessed the development of Atattirk's political ideology and
34
participated in its fonnulation and implementation both before and after
the foundation of the Republic. They took active political roles in the first
parliament and cabinet as the ministers of health and education. The
overlap between doctors' professional ideology and values with the trend in
national politics also increased the social power and prestige of doctors who
began to play a more active role in political decisions taken on various
topics. Among these deciSions, expanding the law of rotation (\.Vhich is also
largely known as the law of obligatory duty) in the health sector was
especially important in providing the ground for the missionary- like
activities of doctors.
The Law of Rotation and its EfIectson the Social Mission of Doctors:
Originally, the law of rotation was issued during the first decade of
the 20th century, so that the students in the military medical school could
perfonn their military duty by practising their profession in towns or
villages for two years and obtain a higher military rank. At the end of the
1920's, this law included the graduates of civil medical schools, as a result
of the concern for the lack,?f doctors in provinces. The rotations were good
opportuni ties for the doctors to be in touch with ordinary, uneducated
people who had local and traditional values, so that besides providing
health care, they could propagate Western scientific and progressive
thinking in the name of Kemalism to these lay people. As the
representatives of Kemalist ideology, the doctors pursued these two equally
important professional missions which were completely merged with each
other and which solidified the general professional motive of "serving the
country".
35
Dr. oncel (1951) in his memoirs, describes the first group of doctors
who went to their obligatory duty as "the new country's first members who
had an unlimited energy". He was among the same group who was highly
"proud and excited about taking active roles in the name of the state in
order to bring health (facilities) to the children of the country, who had
longed for a doctor for a long time". As Dr. Sezer (1953) puts it, their duty
included the education of "ignorant" village people whose way of life and
thinking were still under the influence of the old (Ottoman) times. The
educational process which was pursued under the name of "propagating
medical science", aimed to instill among village people the progressivistic
view which would motivate them to improve their lives and to alter their
religious perspective in explaining "matters of life, illness and death".
According to Dr. Sezer (1953), in order to fight against lay people's
traditional, religious ways of thinking and to improve their poor living
conditions, "a doctor should primarily know about geographical, social and
economic situation of the place where he lives". Hence, during their
professional practice, Turkish doctors began to acquire knowledge about
national or local conditions ,as a complement to their medical and Western
scientific knowledge which was essential for their professional mission, as
it legitimized their role as "teacher" and confirmed their powerful position.
The Preventive Medical Projects: Another activity which
encouraged the idea of a professional mission was the struggle with
endemic diseases in Anatolia such as malaria, syphilis and tuberculosis.
These public health activities were a part of the national project of creating
a young, powerful and healthy society. Several medical students who
36
graduated with high scores were sent to EtITopean countries such as
Germany, France and Switzerland mainly to specialize in these illnesses.
After their rettrrn, they began to implement the preventive medicine in the
places where these illnesses threatened pUblic health. The measures
varied from drying marshlands in Adana in order to fight the mosquitoes
which caused malaria to collecting blood samples in the villages of the
South-East region in order to detect viruses (Sezer, 1953).
While the relations of Turkish doctors with their European
colleagues increased and became more regular, these projects also
provided an opporttmity for doctors who were mostly educated in Istanbul to
learn about the social and economic conditions of Anatolian people.
However, for the newly graduating doctors, obligatory duty in Anatolian
provinces and specialization processes in EtITope meant two contrasting
experiences in terms of professional opportunities and living conditions.
Obligatory duty consisted of a constant struggle with scarce medical
resources and large numbers of patients with severe health conditions,
whereas specialization in EtITope meant that the doctors acquired valued
medical knowledge which ~rought them an advantageous position among
the Turkish doctors on their return. This contrast damaged the
professional solidarity and communi tarian aspects amongst doctors by
arousing feelings of jealousy and injustice. The feeling of injustice was
directed to the "corrupted" policies of the ministry of health in particular
and to state politics in general, since the decisions about professional
careers of graduates were determined by them. Hence, besides
undermining the relations within the professional group of doctors, the
37
variation in career paths also affected negatively the otherwise harmonious
relations between the government and doctors (oncel, 1951).
Female Doctors and their Pioneering Role in the Health Sector:
Another interesting factor about the large-scale preventive medical proj ects
of the 1930's and 1940's was that they were mostly planned and carried out
by female doctors who were also parliament members at that time. They
had a pioneering position both in terms of being among the first
parliamentary members and women doctors. Both of these roles made
them "powerful examples" of Kemalist modernist principles which they
both represented and acted accordingly with a social mission of
transfonning the society in line with scientific and progressive thinking.
In fact the concept of a Turkish "female doctor" is a product of the Turkish
Republic, since woman were allowed to study in the civil medical school
first in 1924, although they had several unsuccessful attempts before that
time. Abdulhamit gave a pennission for women to study medicine forthe
first time, but this pennission was rescinded a few years later (TUmerdem,
1996). The Kemalist view ,stressed that Turkish women have to be fully
present in the public sphere, and that women are able and should do all of
the jobs and tasks that men do. Therefore, the women who preferred a
profession which was not open to them before and which was highly valued
by Kemalism, were more than welcome by the first governments. The first
women who graduated successfully from the medical school, were invited
by AtatUrk himself to the general elections.
Among these parliament members, Dr. Fatma Memik devoted her
political career to drafting legislation for the struggle against malaria,
38
which included drying up marshlands, building high walls on the banks of
major rivers to prevent floods, and providing clean water to drink. Dr.
Makbule Dlblan was involved in a similar struggle against tuberculosis
and for this purpose she founded a large-scale efficient organization which
still functions today (Ve.rem Sava$ .De.l71egi - The Association for the
Struggle Against Tuberculosis). She worked actively until the 1970's for
the prevention of tuberculosis and intestinal parasites, pioneered the
foundation of modem tuberculosis clinics with X-ray machines all aroUnd
the BI~ck Sea Region, and followed the intensity and development of the
disease in that region. She stressed the social aspects of tuberculosis and
worked for implementation of the social and economic measures against
this disease, such as providing cheap houses, adequate and nutircious
diets, and building of railways in order to rapidly transport the people who
are ill. Besides these activities, she was also a powerful representative of
the women's rights. She was among the founders of the League of Turkish
Women and participated the World Congress of Women where she gave
several talks about the social conditions under which Turkish women lived.
Another socially and politic?lly active parliament member was Dr. Saade
Emin Kaat<;llar. Although she was a parliament member for only a short
period of time (1943-1946), she worked for the institutionalization of a public
insurance system for workers, since worker's health was the main concern
in her activities. Previously, the insurance sector was in the hands of
private foreign based companies, the customers of which were mostly
businessmen and other people of high socio-economic status (Gfuldiiz,
1998).
39
Despite the contributions of female doctors to improvement of health
in Turkey, they experienced problems particularly when they entered
medical school for the first time. In this profession -which was totally male
dominated, there was a prevalent male cultu:r=e with strong stereotypes
against women such as women, are weak and fragile people who could not
endure the difficulties of medical education. One of the first well-known
female doctors, YIldlz Ttimerdem (1996) mentioned in her talk in a
conference, how male medical students felt uncomfortable in studying with
"hardworking and brilliant" female students and the jokes they played in
order to make them leave medical school, such as secretly putting some
parts, such as the ears of cadavers, in the pockets of their uniforms.
Ttimerdem said that these stereotypes and jokes only increased their
strength and determination to become good doctors. Hence, the difficulties
of being pioneers within a professional group which had a highly
established cultural and social order, and the responsibilities of being one of
the major representatives of the Kemalist principles were important
incentives for women doctors to work hard to accomplish their social
mission of serving the new 90untry.
The "1933 Reformation" and the Reactions: Despite the positive
developments in the health sector and other fields, political struggles and
oppositional cliques began to occur both within the parliament and
government. Due to the single-party system where the only party,
Republican People's Party (RPP) , had the ultimate power, these struggles
were interfering with the implementation of reform projects. The groups
in opposition argued that the members of RPP abused its power in the
40
appointment of high-ranking state employees and in oppressing the
opposition's movements. In 1933, these argmnents reached their peak and
created a turbulence in the attempt to improve university education in the
only university which existed at that time, IJa.rtilftinun.
In the 1920's and 1930's, projects about refonn in education were
planned and some of them were realized at all levels of education.
However, Tunt;ay and Qzen (1984), who discuss the characteristics of the
1933 refonnation and the debates around it, stress that university education
in IJartilliinun was particularly criticized in terms of the low quality of
education, low level of published academic works, low level of students who
knew foreign languages, and their lack of opportunity to apply what they
had learned in the university due to the poor conditionS of laboratories.
Some of the professors' credentials and ability to teach were questioned as
they represented the older educational system. Besides, some of the
professors, particularly in the literature department, were actively involved
in the political debates, and were considered as threats to RPP politics.
Some people in the academic circles believed that university reform would
be carried out in order to eljminate this opposition and turn the university
into "an organ of their government" by replacing the potentially dangerous
professors" with "their own people". The critiques increased after
Dr. Refik Saydam took charge of the university refonn. He was the
minister of education and a person who was criticized both within and
outside the RPP because of his strategies which were considered as too
selfish and ambitious at that period. Saydam who had been politically
active since CUP later disagreed with the politics of this party and became
their major opponent in the Republican period.
41
Besides Refik Saydam's control, another controversial issue was
that the reformation would be conducted according to a report prepared by a
Swiss doctor, Mr. Malche who planned to replace the professors who had
been taught under the Ottoman educational system by Jewish origined
German professors who had to escape from their countries. Dr. Malche
was a member of a European organization who saved Jewish professors
and placed them in other countries. The high level of involvement of
foreign opinion and expertise in this project brought reactions from
nationalist students and professors, especially in the medical school which
had been one of the most important cradles of Turkish nationalism since
the 19th century. They argued that a foreign professor like Dr. Malche
cannot fully understand the Turkish educational system and values, and
the professors he brought to Turkey would first think about their own
benefits rather than serving this country. In addition to the nationalist
concerns, the objection to the project was particularly strong in the medical
school , because it was one of the main targets of this reformation; highly
skilful and prestigious Jewish doctors came to the school to replace 18
professors who were request~d to leave their job. Some of these professors,
such as Tevfik Saglam, who held a high academic and professional
standing and were greatly respected by the students and other members of
the medical school.
Dr. Ekrem Kadri Unat who was a student with nationalistic
concerns, at the school at that time, told about how they distrusted these
German doctors and organized among themselves in order to boycott
classes until their "real" professors returned (1996). However, the distrust
was not shared by all of the doctors and medical students, such as in the
42
case of Dr. Burhan oncel (1951) who hoped that scientific concerns as
opposed to political interests would at last dominate in the medical school.
These hopes led him to work with the Gennan origined professors in the
medical school but he soon realized that most of these professors could not
prevent the administrative corruptions in the medical schools and
hospitals; their main responsibility was academic and they did not know
enough to understand the administrative processes. Dr. Manizade (1976)
in his memoirs, claims that these doctors could not change "the oriental
mind" that was dominant in the administration of the medical school.
Some of these Gennan doctors stayed after the Second World War, even
until the 1960's and 1970's and their valuable contributions to the medical
sciences were highly appreciated by the Turkish doctors (Unat, 1989),
(Minkari, 1993) .
Despite Refik Saydam's claims of creating a totally new institution,
the "33 Reformation", could not be completed due to his early death after a
sea accident. (G.A.,1986). The professors, such as Tevfik Sag-lam who
were highly respected by the students, were re-appointed to their positions.
Especially in the medical school, this increased the number of teachers,
specializations, but also created sometimes conflicts between older and
new medical knowledge and teaching methods, and problems in dividing
sections where some medical subjects overlapped (Unat, 1996). Another
change which was brought by the 1933 refonnation is that the name of the
university, OartilftizuDl, was considered as an old Turkish word left over
from the older Ottoman educational system and which did not fit with
Kemalist innovations in the Turkish language and education, therefore, it
was changed to Istanbul University.
43
In 1934, after several complaints from students and professors in the
medical school, about its location in Haydarpa$a which was away from the
main urban areas of Istanbul, several clinics where the research and
applied medicine were conducted, were moved to Cerrahp~a. This started
a gradual process which had been completed in the 1960's when all the
educational sections had been moved to Cerrahpa$a. Cerrahpa$a
gradually became a compact medical center "Where the members had the
opportunity to conduct and benefit from both theoretical and practical
medical education and research. The opportunity to work in the hospitals
and clinics while studying medicine increased, since there were a lot of
small hospitals and clinics in the district around the Cerrahpa$a hospital.
Moreover, the medical school re-built close ties with city life and the social
and political movements within the city (Unat, 1989).
Stmctural Developments in the Health Sector: The 1940's and 1950's
were the decades of structural changes. The projects of preventive
medicine were gradually abandoned and and law of rotation was abolished.
This was partly due to the mass mobilization of the anny for Second World
War, when many doctors joined military camps as anny doctors. Another
reason for this abolition can be related to Starr's (1982) argmnent on the
large-scale public health projects, which were almost always against the
interests of private companies and organizations, since the state spends a
large sum of money for these projects instead of companies benefiting.
Hence, according to him, when the state's policy was to support and develop
the private sector public health projects diminished and this is also valid for
the Turkish case in the 1950's and 1980's onwards. Interference of the
44
government in the values and regulations around which university
education had been shaped were criticized and debated a lot in the
academia~ especially among the professors of the medical school after the
"corruption stories" of the appointments of newly graduating doctors and
the unsuccessful 1933 Refonnation project. In 1946~ these criticisms led to
the legislation of the "autonomy law" which restricted government's
intervention into university education. However, this law was not
considered enough to ensure a pure autonomy for the universi ties~ it was
criticized and had to be reshaped at different times in forthcoming decades.
y et~ the increasing number and capacity of hospi tals~ clinics and the
medical schools had brought the need for an efficient central regulatory
system which would also be in charge of the implementation of preventive
medical projects and health security system throughout the country. The
Ministry of Health and Social Aid was reorganized for these purposes and
its working system and responsibilities remained almost unchanged until
1984.
Another institution, Turk TJp KurlD11u (Turkish Medical
Institution) was founded in/1940 for the purpose of providing solidarity
among doctors and supporting them through their careers by playing
effective roles in their appointments. Unlike the type of institutions which
existed in the Ottoman era, this was a large- scale institution with a large
number of participants~ most of whom had close connections with the
administrative body of Istanbul University~ the Ministry of Health and the
government (Gok~ay~ 1998)~ (G.A.~ 1986).
The eXisting inequalities between Istanbul and other parts of Turkey
in tenns of access to the medical facilities were considered more critically
45
than in the Ottoman era because of the project of creating a new country
with a young and healthy population in all parts of Turkey. Special
importance to Anatolia which was considered neglected during the
Ottoman time and, to Ankara, since it was the new capital and an
Anatolian city. With these concerns, the University of Ankara was
established in the middle of 1930's right after the 1933 reformation. The
faculty of medicine was formed in 1945, and it became a part of the
university in 1946. At that time, the military medical school which moved
to Ankara together with other main army institutions, took the name of
II Gtilhane Askeri TIp Akade.l11isi" (GATA) in 1952. The military medical
school became closely connected with other military institutions in Ankara,
and it was differentiated from the other medical schools in terms of
professional procedures, perspective and experience. These late 1940's and
early 1950's projects of improvements in the infrastructure of the health
sector also included the maj or hospitals in Istanbul such· as Cerrahpal?a,
~apa and Haseki which were enlarged and modernized at that time (G.A.,
1986).
In the 1950's, after the transition to the multi,;,party system and the
election of the Democratic Party (DP), private sector was encouraged and
large number of doctors became self employed or open small-scale,
specialized private clinics where 5-10 doctors and nurses worked together.
The private medical sector was concentrated in the large cities, and its
share in the whole health sector, including the hospitals which are run by
foreign groups and minorities, did not increase beyond one-fifth until the
1980's. (TTB, 1965), (Ministry of Health, 1973).
46
The growing health sector required standard regulations which
would systematize the appointments of the newly graduating doctors and
provide a balanced distribution of health care facilities throughout the
country. Such regulation would also prevent the problems and criticisms
about the injustices in the appointments and the inequality in the
distribution of health care. Having these considerations in mind, in 1950,
the doctors were divided as general practitioners and specialists, and
standard criteria to become a specialist was defined by a regulation.
According to this regulation, newly graduated practitioners should work
for two to five years in the hospital section in which they wanted to
specialize, depending on the specialization field, and with the consent of
their superior colleagues. This regulation functioned similarly to the law
of rotation since most of the practitioners went to the newly built or
modernized Anatolian clinics and hospitals. (Konuralp, 1996), (TTB, 1965).
Health Plans and the Law of Socialization: D espi te these
regulations, problems in the Turkish health sector resisted. The urgent
demand for more health care facilities and for public health projects in
Anatolia, brought the need for an overall health plan which would give
priority to the prOvincial places in Turkey. Before the 1960's, two different
plans were made with these concerns. Their aim was to build clinics in the
villages which would be responsible for primary health care, such as
vaccinations, emergencies and births. However, these plans were
unsuccessful because of the reluctance on the side of doctors to work in
prOvincial places and thus the scarcity ofhealth personnel in these places.
47
A larger scale and more carefully organized health plan which
would be implemented step by step wi thin a period of time was designed in
1961 by Nusret Fi~ek, the undersecretary of th~ Ministry of Health. This
plan was different from the two previous attempts not only in tenns of scale
and organization, but also in tenns of social considerations. The difference
in the social perspective of the last plan was mostly related to the
environnient prevailing after the military coup of 1960. Most of the
intellectuals and university students acted together with the army to
overthrow the Democratic Party which they considered responsible for the
political problems and economic inequalities in society. The new
government and the constitution followed more closely the Kemalist
principles and proj ects which had been formulated in the 1930's, but now
acquired a more leftist and populist tone.
Most of the doctors supported the new government and constitution,
and again played an active political role in the implementation of the new
laws both within and outside of the parliament. In this framework, the
1961 socialization law, was based on the criticisms of the policies of the
1950's when the application "of the public health measures "Which were
started in the 1930's diminished. Therefore, the aim to fight epidemic
diseases such as malaria, syphilis and tuberculosis lost its momentum in
the 1950's, and the rates of these diseases and the number of deaths as a
result of these disease remained at high levels. Another important
international criteria for level of health in a country, the infant and
maternal mortalities, were also at high levels in the villages (TTB, 1973).
The socialization law gave a priority to the most disadvantaged parts in
terms of access to the health care facilities based on the idea that the main
48
duty of the state was to provide a health service to all its citizens, including
the ones who live in the most remote village of the cmmtry. The provinces
were given a priority in this health plan, since the most disadvantaged
people were thought to live there, and their population was considerably
higher than the urban population. According to the plan, several
provinces would be covered by the law each year. The provinces which
would be covered in the first three years (1963-1966) were socially and
economically the most backward places which are situated in East and
South-East Turkey. These provinces would serve as "pilot provinces" in
terms of testing the success of the plan for the decisions over its
continuation. The plan consisted of opening health facilities of varying
sizes from those serving a group of village to those in the province centres
with referals up through the system. The personnel in the health centers
had to follow up the general health condition of the popUlation in which
they were responsible for. They had to provide primary health care and
send the patient to a higher level facility when necessary. The socialization
plan included opening and improvements in existing hospitals in these
provinces and professional schools which trained supporting para-medical
personnel.
After 1965, the socialization plan began to lose its momentmn due to
the problems of administration and coordination, the lack of
standardization in the payments of the health centers' personal and other
health employees and the social and economic unattractiveness of pilot
provinces for the doctors who were mostly raised and educated in big cities.
However, in the late 1960's two important dimensions were added to the
concerns of the socialization process. First of all, considering the poor
49
social and health condition in the squatter areas expanding in the outskirts
of the three main cities, Ankara, Izmir and Istanbul, health centers which
fimctioned in a similar way to the ones in the pilot provinces were opened.
These centers also provided internship opportunities for the medical
students who were in their final year. The second concern was
demographic. A general consensus was reached among the members of
the health sector that an increase of the population should be controlled in
order not only to reach a better· health status by decreasing mother and
infant mortality rates and by preventing the spread of epidemic diseases,
but also to ensure social and economic development which would bring a
better quality of life. With these concerns, particular attention was paid to
the health conditions of infants, children and mothers and family planning
in the new health centers and hospitals. Clinics which dealt with the
regular check-ups for the infants and children were opened in the
university hospitals and major health centers.
The major reasoning behind these preventive measures was that the
families would spend much more effort to maintain their children's
general health condition with regular. vaccinations and tests against
diseases and other malfunctions so that they would acquire the idea that
having fewer children meant providing better living conditions for them.
These conditions not only included health but also education, job
opportunities and other economic benefits. Promoting these ideas were
especially important for the squatter areas and villages which had poor
living conditions in tenns of access to the social and economic benefits.
The hospitals in the cities and the health centers in the villages and
provincial places began to educate women on the issue of family planning
50
and implement birth control methods, particularly IUD since it was seen
as the least risky method (Ministry of Health, 1973).
The Ideological and Professional Differences in the Medical Projects
of the 1930's and 1960's: Doctors such as Irfan Gok9ay (1996) and YIldlz
Ttimerdem (1996), -who are interested in the history of modern Turkish
medicine tend to compare the 1960's with the 1930's. In these decades, the
governments carried out large-scale preventive medical projects which
gave doctors an opportunity to interact with different groups in society, and
a professional base to act according to their political and social concerns
while pursuing their profession in various parts of the country.
In the 1960's, most of the doctors who were still under the influence
of the Kemalist principles and who believed in the usefulness of the 1930's
projects, supported and cooperated with the socialization initiative. Social
concerns were embedded in this medical project, since it concentrated on
villages and squatter areas with the mission of improving the poor living
conditions and transfonning the traditional life styles into a medically
"healthy" life, and it promoted an ideal healthy family type where the
parents would use family planning to create modem, small and nuclear
families suited to modem society. Despite the similarity in the basic aim of
improving the general living conditions of society with a medical, scientific
and Western view which was in accordance with the professional
perspective of the Turkish doctors, the medical projects of the 1930's and
1960's were quite different from each other.
The medical projects of the 1930's, such as the rotational law and
"1933 Refonnation"project were mostly planned by the parliamentary
51
members who were well-known doctors, respected as influential political
figures. However, the students and professors in the faculty of medicine in
the Istanbul University, which was the only civilan medical school at that
time, did not fully cooperate with these projects which required radical
changes in the system of medical education and professional experiences of
doctors, such as the changes in the course schedule, replacement of
professors and two years of obligatory duty in a remote village. The lack of
full cooperation on the side of medical students and their professors led to
the inefficiencies in the implementation of these projects. In contrast,
1961's socialization law was developed and implemented with the close
cooperation and guidance of the professors of the faculties of medicine,
particularly the faculties of medicine at ~apa and Hacettepe.
Secondly, although these university members seemed to work in
close collaboration with the state organs in the 1960's, strong political
movements which had an oppositional character began to shape in the
faculties and affect the professional perspective of the medical students and
doctors. Similar to the 19th century's political atmosphere which helped to
build the "spirit of being from the medical school", in most of the 1960's
political movements instigated by university members especially students of
medical faculties played an active role. The movements of university
students began as mass protests against the educational system and the
medical students were one of the groups who complained the most. They
protested against specific educational processes, such as the large number
of exams and the long course hours. (Gokc;ay, 1998), (Tftrker, 1998). Dr.
GfilC;in Tftrke~ (1998), who is now a professor and former department head
in the faculty of medicine at Capa, gave a detailed accmmt of these protests
52
while talking to me and told that she also had an active role in them.
According to her, the medical students protested in a more organized way
and acted with a particular solidarity since they were aware that all of
them were sharing the same troubles during their education.
The Politicization in the Health Sector: Dr. Ttirker observes that the
students movements became more political in the 1970's, under the effect of
political debates and conflicts that dominated the social situation in Turkey.
The youth began to organize according to different political ideologies,
differentiated as mainly leftists and rightists. According to Dr. TUrker, the
medical students and doctors were well acquainted with the problems of
their society and learned to approach these problems "humanistically"
through their immediate interaction with their patients. Additionnaly,
their exposure to the most "underdeveloped parts" of Turkey after 1960,
helped transform their humanistic approach into leftist political views
which dominated the faculties of medicine. The members of the faculties of
medicine who usually shared similar political interests, also began to
divide among themselves into different fractions within the leftist ideology
such as Lenninists, Maoists. Another explanation about the leftist
political tendency of members of medical faculty came from Dr. Irfan
Gokc;ay (1996) who argued while talking to me, that the scientific,
posi tivistic and progressive values embedded in medical education, makes
them more prone to leftist ideologies which are compatible with these
values.
Besides the different political groups in the faculties of mediCine, the
chambers of medicine which developed out of the Turkish Medical
53
Association, became institutions around which political activities were
organized. The nmnber of members increased considerably and their
political profile represented the ideological variety in the faculties of
Medicine. The elections to boards of these chambers became a competition
among different political groups. These organizations although they
claimed to include different ideological groups, tended to act according to
the political tendency of the members of their boards. These chambers also
cooperated with other professional chambers and groups such as the
engineers' chambers and worker's unions to organize large-scale mass
protests. According to Dr. GOkc;ay (1996), (1998), who was an active member
and fonner director of the Istanbul Chamber of Medicine in the 1970's and
1980's respectively, in line with the general politicization in Turkish society
in the late 1960's and 1970's, the chambers of medicine developed a more
sharply political discourse which was not limited to the problems and the
inequalities in the health sector.
The PoHtical Activities of the Professional Chambers: Another
political development of the late 1960's and 1970's which affected the health
sector was also related to the increasing power of the chambers of
medicine. The fact that they were in close contact with the political groups
in the cities and the loss of momentum in implementing the socialization
law in the villages led them to direct their social and political concerns to
the most disadvantaged groups among the urban dwellers. These groups
were workers and the dwellers of the squatter areas. Although most of the
factory workers had health insurance since the foundation of the
"Institution of Social Security" (SSK) in 1965, its hospitals and other health
54
facilities were not adequately organized in order to give health service to
such a large number of patients. In addition, the laws and regulations
governing the work process, were far from being favourable for the
worker's health both in the public and private sector. The workers who
became ill or pregnant women could only take short leaves of absence, only
one month in the case of pregnant women, and after the long bureaucratic
process of obtaining a medical report from an SSK hospital. The criticisms
of the chambers were not restricted to the health system, they were also
blaming the government's general policies for creating strong inequalities
in other areas such as education and work life (Gokr;ay, 1996),
(Gokr;ay, 1998).
While being involved in the oppositional movements, the doctors also
had considerable importance in the government. Sadi Innak, who was a
physiologist, a parliament member and a strong supporter of Kemalist
ideals, was called by the president, to become prime minister and form a
cabinet in order to avoid further political crisis in 1974 (Terzioglu, 1991-2).
This period was similar to the period between 1850 and 1900, when the
Ottoman doctors were involved in the Turkish nationalist movement
through their activities of creating "a modern Turkish medicine", in terms
of using medical or health issues in making political arguments and being
politically active. However, in 1970 the doctors and medical students were a
much larger, highly institutionalized and established professional group
which could be organized better around social and political problems.
Besides being from the well-educated, upper socio-economic status group,
these doctors, especially the older ones who began their career in the first
decades of the Ttrrkish Republic, had gained considerable social prestige
55
because of their being representatives of Kemalist principles and proj ects
through their careers and professional perspective. In general terms, the
support and prestige they had received from the society together with their
ability to organize, led them to have a privileged position among the leftist
groups and a leading role in the political debates and activities of the 1970's
similar to the period of 1850-1900.
Political Tensions and Depolitization in the 1980's: In 1980, the
conflictual but lively political situation in Turkey changed dramatically
with the military intervention which brought an oppressive regime. The
political activities of parties and organizations including the professional
chambers were stopped by decree. The leaders and the leading members of
these organizations were jailed and most of the rights which had allowed
the development of political organizations in the 1960's and 1970's were
abolished. A period of strict censorship began, where the development of
any kind of oppositional thought and movement is not allowed.
The new regime tried to justify itself through condemning the
politically active groups of the last two decades and stressing its efficiency
in terminating a politically tumultuous period. The president of the
mili tary regime criticized the leftist groups, and among them he blamed
particularly the doctors by saying that they did not possess any "love for
their nation". He said that the doctors were raised and educated in the best
way with all kinds of opportunities that were provided by the state, but they
did not appreciate this generosity, instead they criticized the government
severely and organized themselves in order to bring about anarchy and
destruction (Anoglu, 1996), (GOkCay, 1998).
56
The doctors who could not politically organize themselves again until
the mid 1980's, displayed their reaction to the military regime by individual
acts of protest. There were allegations about systematic torturing of
political prisoners and suspicious deaths in the police centers fueled these
allegations. Although the allegations were denied by the military rule,
many doctors refused to cooperate with the new regime by not giving false
reports on the health condition of prisoners, particularly in the case of
autopsies, which showed the effects of a systematic torture on the bodies in
detail. Only, some of these reports and stories were published in the
newspapers because of censorship and the doctors who prepared the
reports were "exiled" to the small villages of Anatolia. Dr. Altay MartI
who gives examples of these events in his memoirs, tells that these were the
first reactions against the oppressive regime, and they increased the
tension between the rulers and doctors (MartI,1995), (Marti, 1997).
The New Law of Rotation: In 1983, the political tension between the
two groups had reached its peak when the president and other generals in
the ruling group issued a new law of "obligatory duty" similar to the former
law of rotation which required that the graduates of the faculties of
medicine work two years in disadvantaged places, away from the major
cities. The president explained the reasoning behind this law by saying
that the doctors just like the soldiers should know all the truths about their
own country and learn to love these truths. However the law was
considered as a punishment by doctors since after a long and difficult
period of university education, they were sent to places which had scarce
resources concerning health and living conditions. Most of the health
57
centers in towns and villages had been built in the early 1960's and had not
been improved since then. The doctors who went to the East and South-East
of Turkey, witnessed the increase of terror that was born out of ethnic,
political and territorial conflicts through "endless cases of autopsies",
particularly in the last half of the 1980's. Similar to the first
implementation of the law of rotation in the 1930's, the nnnours of political
and professional corruption in the "lottery" by which places of
appointments were selected surfaced (Sahip, 1996) (MartI, 1995).
When censorship decreased after 1984, the doctors narrated their
experiences in this type in press. The negative experiences during the
obligatory duty and political tensions between the doctors and the
government began to affect society's view of doctors in the sense that being a
doctor came to mean struggling with social and political problems of the
country during and after medical education besides coping with the
academic difficulties of long and hard time of study. The faculties of
medicine, similar to the professional organizations of doctors, were
represented as one of the main centers of political conflicts and
confrontations both by the press and the ruler's discourse. This was also
another reason for avoiding the faculties of medicine just like other
faculties where the members were actively involved in political activities.
The Loss of Prestige and Decline of the Educational Quality in the
Faculties of Medicine: The government's harsh oppression of political
activities and its promotion of depolitization affected the general social
perspective on politics and political ideologies. Political and social concerns
relinquished their places to the economic and individual worries. The
58
government began to implement a policy of economic development and
privatisation as solutions to the political problems of Turkey. The efforts to
revitalize and internationalize the economy increased the prestige of
professions related to economy and management and after 1985 the
administrative and engineering faculties began to be preferred more than
the faculties of medicine (Sahip, 1996) (Anoglu, 1996).
The faculties of medicine have also changed shape as a result of new
politics. Government started a rather unplanned process of expansion in
the health sector where several hospitals and four new faculties of
medicine were opened in different cities, and the student capacity of the old
faculties were more than doubled. The infrastructure of these new
faculties and hospitals were not fully considered and the efforts of doctors
and professors to improve them could not be realized because of the
financial difficulties since the share of health sector in the budget dropped
considerably after the 1980's. This led to a visible decline in the quality of
medical education and health services in the public sector (Gakc;ay, 1998),
(DPT, 1989).
When becoming a doctor was preferred less as a career choice in
society, the pOints that the students should have in the central university
examination in order to enter to the faculties of medicine started to decline,
and entrance to these faculties required much less competition than
entrance to the faculties of engineering and administrative departments.
In line with the economic considerations, the last group of faculties were
also preferred since they required a shorter and easier study period than
medicine and they allowed an earlier work experience. Hence, more and
more high-school graduates who were from the high-socio-economic status
59
background and who went to private, foreign origined high-schools,
preferred departments of management, economy and various departments
in the engineering faculty instead of the faculty of medicine which had been
a prevalent choice among this group before that time.
The Heterogenization of the Medical Students and Variations in the
Career Patterns: Since this situation happened at the same time as the
large increase in the number of faculties of medicine and medical students,
the increasing student capacity was gradually filled by people coming from
lower socio-economic backgrounds and who lived outside the three major
cities until university or high school. They preferred this faculty since they
considered they would have a good job when they graduated and could
improve the economic condition of their family. Medical students became
much more heterogeneous in terms of background and less politicized
since the new group of students' was interested mainly in graduating as
soon as possible and with the highest grades so that they could get a well
paid job (Goke;ay, 1998) (Gene;, 1997).
Since the significance of having a medical education in terms of
social stratification, changed from an elite recycle to the chance of upward
mobility, the career patterns of the newly graduating medical students also
began to vary. Academic career, although it became more competitive due
to the increasing number of students, was preferred less because of the poor
conditions in the universities and their hospitals since the government
allocated very little to the health sector. The government promoted private
clinics and hospitals which became highly prevalent in the 1980's and
onwards. Working in a private hospital which is economically less risky
60
than opening one's own clinic became a more preferred career path for the
new graduates. The private sector also brought new economic
opportunities for the doctors such as working in the research and
marketing sections of the large-scale foreign based drug companies.
Besides working in the private sector, as a reaction to worsening the
conditions in the faculties and hospitals in 1980's and 1990's, many people
left medicine or did other "paramedical" jobs after their education, which
varied from opening money exchange offices to directing movies. AI though
the number of doctors working in the private sector or doing paramedical
jobs became common practice, it was not compatible 'With the altruistic
values that the doctors attributed to their profession before and during
medical education. Besides, the radical depolitization among the medical
students and doctors, brought "generational conflicts" between the earlier
generations of the Republic whose professional perspective was shaped
much more by a social mission and the more recent individualistic and
materialistic generation.
The Professional Solidarity and Increasing Competition: The
professional solidarity and the sense of being a part of the corporate
professional body were also undennined in the recent generation of doctors
who came from highly different backgrounds. Because of the overcrowding
of the medical students, they were involved in a much more competitive
educational process in order to specialize in a medical field or to obtain an
academic promotion. In 1984, a central examination was instituted for the
final year medical students who planned to specialize in a field instead of
staying as practitioners, under the name of TUS, meaning "the
61
examination of specialization in medicine". Before the examinations,the
students listed the field they wanted to specialize in and the hospitals in
which they would train as assistants during this specialization period
accordingto the scores that those hospitals and their specialization clinics
required. The listing was also crucial in the choice of academic career
since the university hospitals had higher points and the specialization in
those hospitals also required a research thesis.
Over the years passing the TUS examination became more difficult
and staying as a practitioner became less advantageous. Although the
practitioner's job was considered as one of the heaviest, since they had to
work mostly in the emergency sections of the clinics and had to know all of
the medical practices that were required in the primary medical care, they
were paid much less than the specialized doctors. Another disadvantage of
staying as practitioner was working for two years outside major cities as
required by the law of obligatory duty which had lost its "punitive
character" and only included practitioners after 1985. Besides the reaction
of medical students to the difficulty of TUS which required a heavy study
period dominating their last year when they should be improving their
medical practice. The TUS examination which was becoming more
difficult each year, resulted in an increasingly large number of graduates
remaining as practitioners who either would have less preferable jobs in
the health sector or must study for the next examination. Hence,
graduating from the fa cui ty of medicine did not mean a desirable and
guaranteed job, since the jobs for practitioners were limited and
unsatisfying for professional development and economic benefits.
62
The reaction against the TUS examination was further increased in
1989, when the Ministry of Health made an agreement with the foreign
universities mostly in the countries of the former Soviet Union and Eastern
European bloc, to send its graduating medical students to these countries
for their specialization period without the TUS examination. Although
this agreement was implemented for only few years, the doctors who took
the TUS examinations criticized the ones who had specialized abroad, since
they had used their monetary advantage in order to study less, did not gain
adequate professional experience in the foreign countries and were unfairly
favored by the state in their appointments to the hospitals when they
returned. The agreement was regarded as a pity by many Turkish doctors
who thought that it was taken by the parliament members to favor their
own family members studying medicine at that time (Uslu, 1996), (Gok~ay,
1998).
The administrators of the well-established faculties of medicine,
such as Cerrahpa~a and Hacettepe began. to be concerned about the ways of
improving medical education in order to attract higher quality students
and to be recognized in the ~international academia. With these concerns,
those fa cui ties opened a new section where medical education was in
English and this aroused a lot of reaction both from the nationalists and
intellectuals who came from the leftist tradition. Nationalists such as Dr.
Ekrem Kadri Unat (1989) recalled the efforts of the last centUry to change
the language of instruction from French to Turkish in the medical schools
and argued that that process of nationalization which had been
accomplished under many difficulties had now reversed. Another group
criticized the application from a populist point of view, saying that once the
63
students pursued medical education in English, they could not
communicate properly with their patients and, therefore, became isolated
from them and from the whole of society. Despite these debates which
continued for a long time, the application became successful as these new
_sections attracted a lot of good-quality students who had learned a foreign
language usually in private high schools and who had much higher scores
in the central university examination than the students of the Turkish
section. However, this stregthened divisions among medical students in
terms of their different socio-economic backgrounds, and by affecting their
chances of finding a good job in private or other well-knmvn established
hospitals. The economic situation of doctors became similar to Starr's
(1982) depiction, since doctors came to have varying socio-economic status
both in terms of their familial background and the benefits of their careers.
In addition, the heterogeneity in the job choices in terms of economic,
academic and professional benefits also increased the competition among
the doctors who depended more and more on the market and the demands
from the private section of the health sector. This affected negatively the
solidarity among doctors ami their social and cultural authority by making
them more dependent on the market. The social image of doctors as a
united and powerful group with an influential social mission was
undermined.
Another controversial act of legislation in the health sector occurred
in 1992. This was the implementation of the "green card", a card for people
who were too poor to afford the health services and did not have any health
insurance. However, the criteria to obtain the card were not clearly
dermed and it was distributed to gain political favor by the party in power.
64
Dr. Tiirker (1997) notes that many of her patients with the green card did
not deserve it in terms of economic status, and doctors joked among
themselves that even patients 'Who came to the hospital with their own cars
and 'Who used mobile phones had that green card.
The Activities of Professional Chambers: The professional
perspective of the earlier generations of doctors was now represented in the
chambers of medicine which were opened again and became politically
active in the mid-1980's. Although these chambers did not have the same
political power as in the 1970's to mobilize the masses, they also organized
the first large-scale protests after the military regime. They protested
against the government's financial neglect of state institutions in the
health sector and government's intervention in the cadres of the faculties
and hospitals. The members of these chambers were concerned about the
increasing share of the private sector in health, thinking that it had been
done in an unplanned way without considering the situation of the
economically disadvantaged patients, and it was leading to
commercialization of issues Df health 'Which should be one of the basic
human rights provided by the state.
The professional chambers were also concerned about the newly
emerging heterogeneity among the doctors both in tenns of background and
professional perspective. They tried to rebuild a sense of political
opposition and professional solidarity among the doctors and to revitalize a
sense of social mission. With these concerns, several chambers prepared
studies and organized conferences on Turkish medical history, where they
tried to revitalize the "spirit of being from the medical school" and talked
65
about the 1930's and 1960's as "golden ages" when governments gave
priority to the public health activities and preventive medical projects.
They also stressed the Kemalist nationalistic concerns, especially when
theycriticized the prime minister, Turgut ozal who went to the US for his
medical operations and contrasted this behaviour with those of Atatiirk.
For them, AtatfIrk had undertaken a large number of medical projects in
order to improve the Turkish health sector and general health conditions,
whereas ozal accepted the superiority of the United States and did nothing
significant to improve the health sector in Turkey.
Another concern of the medical chambers was to defme standardize
rules and regulations in order to provide similar quality of care in the
medical services in different institutions of the health sector. In the last
two decades, the crucial problems in hospitals such as overcrowding and
malpractices of doctors began to be covered frequently in the Turkish
media, and this caused loss of prestige and trust in doctors in the eyes of
patients. The chambers are concerned about such news and stress that the
state should design a systematic plan in order to improve the health sector
instead of leaving it to the commercial private hands. These chambers are
also interested in attracting the doctors who work in the private sector as
members, and to include them in their activities "in order for them not to
forget the basic hmnanistic principles of this profession" (GOk~ay, 1996).
However, most of the yOIDlger doctors do not participate in the activities of
the chambers and come only to participate in the elections to support their
candidate. Most of them are critical of their politics and think that they are
inefficient in protecting doctors' interests and affecting state politics
(Gokc;ay, 1996) (ArlOglu, 1996).
66
The Effects of the Rising Islamic View on the Health Sector: The
rise of Islamic ideology and movement at the end of the 1980's contributed to
the heterogenization within the health sector. The faculties of medicine
which had excluded religious thinking since the early 19th century where
the first medical school had been founded, became one of the main secular
castles that should be conquered by the students who adopted Islamic
thinking. The first groups of medical students who adopted Islamic view
were faced wi th a strong negative reaction from the university
administration and their teachers. The Islamic view of these students
were usually identified through their veils in the case of women, and type of
beard in the case of men. Some of the teachers and administrators who
were against their ideology, tried to prevent their attendance at the faculty
and the examinations that were held there. The number of medical
students with an Islamic view has increased in the 1990's and the
boundaries of their ideology were clarified. Most of these students had a
background of religious education and tried to combine their religious
knowledge with what they had learned in the faculty. They accepted the
prevalent medical knowledge and practice as long as they were compatible
with their faith, such as claiming that a veiled female doctor did not
prevent her performance in her profession. Despite their compromisation
with the Western origined biomedicine, they were not accepted by the
academia who had a strict professional ideology and perspective and by the
administrators of the main hospitals when they had graduated.
The Isiamicist medical students may pursue their profession mainly
in the hospitals which were recently established by various economic and
67
social organizations and which and gave a priority to Islamicist doctors in
chosing their staff. These hospitals functioned in accordance with
Islamic rules and were mostly built near the neighbourhoods such as Fatih
and uskudar where mostly Islamicists lived and where there were very few .
health centers and hospitals. Their gynaecology and child's clinic were
especially developed since the female Islamicist patients, including the
pregnant women and mothers, preferred to be taken care of by female
doctors during the examinations and operations.
Together with the increasing numbers of that type of hospital, some
Islamicists tried to revise the medical knowledge and theory in order to
incorporate into it the religious sources' view of medicine. Having a
religious perspective, they were concerned about bringing a hmnanitarian
and ethical aspect to the medical knowledge and practice, since they
claimed that modem sciences have become increasingly devoid of these
aspects. Some of them pointed out to the parallels between the Islamic
rules on medicine and the contemporary medical knowledge and argued
that these rules are still valid in dealing with health problems. In contrast
to other doctor's from the/ previOUS generations, who wanted to transform
the lives and thoughts of the people according their own scientific values,
the Islamicist doctors considered themselves as representing the views and
needs of a particular social group whose voice has been heard more and
more in the 1990's. Although the introduction of the Islamicist beliefs and
practices into the health sector is relatively a new factor, it has aroused a lot
of debates and reaction from other doctors since it was considered as
shaking the ideological foundations of their secular professional
perspective.
68
Conclusion: The social and political movements and debates in the
Ottoman State and Turkey for the last two centuries have been highly
influential in shaping the institutionalization process of the health sector
and the professional perspective of Turkish doctors. The debates and
dilemmas which ocurred during the modernization process of Turkey
fOWld their immediate cOWlterparts in the doctors' social concerns about
having the role of a guide or teacher in helping the Turkish society to adopt
a secular, scientific and progressivistic perspective. This perspective is
originally a product of Western thinking, particularly of Enlightenment.
The doctors adopted this perspective earlier and more readily than other
intellectual groups, because of their familial background which could be
characterized with high socio-economic status and Western values, as well
as their medical education where the major aspects of Western culture
was also taught. One of these aspects was the idea of nationalism which
led the efforts of the doctors towards the nationalization of medicine. The
nationalistic ideas of doctors led them to have a pioneering role in such
movements which supported political modernization and which drew the
Sultans' reactions. Hence, questioning of and opposition the existing social
and political situation became an essential part of the professional
perspective of doctors during that period.
However, the professional perspective of doctors involved a mission of
transforming society according to the values they represented and
supported; combined with the Kemalist prinCiples and projects after 1923.
The doctors' high degree of involvement in shaping and implementing the
state's projects and ideology during the first decades of republic were
69
overshadowed by the politically corrupted inte:rventions by the state in the
professional appointments and attempts at the refonn in the university.
The relations between the state and doctors involved more tensions when
the doctors became more active in political terms in the 1960's and 1970's
when the debates about educational and political autonomy in the faculties
of medicine and hospitals were still going on. The socialization period of
the 1960's and politicization in the 1970's brought an additional dimension
to the social mission of doctors such as focusing on the health and living
conditions of the most disadvantaged groups in the society, a systematical
implementation of preventive medical services and issues on family
planning and birth control.
These developments were abruptly cut with the 1980's military
intervention which led to a period where the political and social concerns
about society in general were subordinated by the economic and
individualistic concerns which became dominant also in shaping the
career patterns and professional perspective of the new generation- of
doctors. With this new development the social missionary aspect of
professional perspective was criticized and largely replaced by alternative
ideals by the new generation of doctors. The new generation of doctors were
also a much larger and heterogeneous group than the fanner ones, due to
the unplanned expansions in the faculties of medicine. The doctors became
a heterogeneous group in terms of their economic and social background,
professional career patterns and cultural formation as in the case of the
doctors who tried to combine their Islamic view into their professional
perspective. These developments have negatively affected the professional
group's communitarian aspect which connected them to each other in
70
terms of solidarity and their common social values around which their
professional perspective had been shaped.
Although the new generation of doctors ~ took a critical distance to the
idea of the social mission which they become acquainted with as a part of
their professional socialization during and after their medical education,
they can not fully ignore this idea since it also gives them a "legitimate
power" to make judgements on the social and political situation in Turkey.
They derive their social power and prestige from their professional
perspective which was shaped from 1827 onwards with the high level of
involvement in the social and political debates and movements. The
doctors' involvement in the political activities during the modernization
process of Turkey shaped their relations with the rest of society and the
state through creating a professional perspective which foresees a typical
doctor and patient image. According to this image which is rooted from the
period corresponding to the birth of modern Turkish medicine, the doctor is
a well-educated intellectual person whose major professional concern is the
improvement of the living and health conditions of the society in general,
and the inculcation of the /modern, secular,positivistic, progressivistic and
scientific values as opposed to traditional and religious ones. The typical
patient, according to this perspective, pursues a life which is dominated by
traditional, religious values and is mostly less educated than the doctors.
However, the historical developments, particularly after the 1980's,
distorted these typical images and relations between these two groups,
which were supposed to be shaped by the teaching and guidance role of
doctors, in line with the changes and variations in the professional
perspective. The recent generation of doctors still make use of these
71
stereotypical ~ages and view their social role as a "guide" or "teacher",
but they are also aware of the recent variations among patients and doctors.
Hence they classifY doctors as "good" and "bad" doctors according to their
own professional perspective and attribute the right to guide the society to .
the "good doctors" which usually include themselves.
In this chapter, I examined how the professional perspective of
doctors have developed and varied throughout the history of the modern
Turkish medicine. This professional perspective has involved different
social missions which have shaped and have been shaped through the
changing relations of doctors with the rest of the society and the state.
Independently of the degree and the type of involvement, the doctors I long
time engagement in social and political debates and movements in the
Turkish society. led them to develop a social missionary project and
therefore provide a legitimate ground for making social and political
judgements on society. Another source of legitimation is related with the
ways in which the new generation of doctors differentiate themselves from
other people by suggesting a particular relationship between medical
knowledge and power, which will be covered in the next chapter.
72
Chapter 2
The Concept of Self and Professional Experience
in the Doctors' Accounts
As a result of the drama tical changes that have happened in the
Turkish social structure and its health sector since the 1980's, the young
doctors have lived different professional experiences and developed different
professional and social concerns out of these experiences. This has also
led them to look for new sources to establish a position of social authority in
line with their changing social concerns. The way the young Turkish
doctors relate their personal characteristics to their professional
experiences has become an important source for this position since it helps
them to differentiate themselves from the other people and to shape their
professional perspective which includes new social concerns. The doctors
whom I interviewed about their professional views and experiences
stressed a considerable number of character traits such as being clever or
hardworking. According to their own accounts, these traits played a
crucial role in their decision to become a doctor and in overcoming
difficulties they encounter in their professional life. The particular way of
stressing on these traits also helps these doctors to attribute themselves an
outstanding social position, since, in the interviews, . they presented
themselves as a small distinguished group of people who have the talent
and strength to reach a difficult professional goal.
The young doctors generally interpreted the problems they had
experienced in the faculty of medicine and hospital as an immediate
73
reflection of general, social, political and economic problems that are
experienced at country level. The interpretation of professional problems in
linking them to a much wider social context and the doctors' particular
way of stressing the professional perspective and personal traits in
overcoming these problems help them to attribute themselves a legitimacy
to mak.e judgements on the social and political conditions and plan a
missionary project to improve these conditions.
In studying the ways in which the new generation of doctors relate
their character traits to their professional experiences, I have mainly
benefited from Charlotte Linde's (1993) conceptualization of coherence. In
her study about life stories, Charlotte Linde speaks about the need of
representing "the self" in a coherent way both in individual and social
terms (Linde, 1993). She means by "coherence" here, a consistency between
the characteristics and behaviour of a person, and a general sense of
integrity of self -which was provided in the oral and written narratives about
one's self and life story. In narratives, coherence is maintained through
establishing adequate causal links for one's acts and providing a sense of
continuity over the temporal and causal elements of the narrative.
According to Linde, three major subjects can be used as elements of
coherence. These are "the continuity of the self through time, relation of
the self to others and the reflexivity of the self". In line with her
categorisations, I will try to describe how the young doctors closely relate
their character traits with their career patterns and the crucial decisions
they have made during their professional experience. I will also study how
this way' of creating coherence implies a hierarchy and power relation
74
between the doctors and other people, as well as among the doctors
themselves.
Methodological Issues: Emphasizing Coherence in Facing
Discontinui ties: The main reason which led me to concentrate on the
young doctors' efforts in establishing their social authority in the second
and third chapters, is that these doctors try to balance their· individual and
economic concerns which mostly emerged in line with the social
atmosphere in Turkey in the last two decades and the professional
perspective of the older doctors, which they acquire during their university
education in an idealized way. This perspective inculcates a doctor image
according to which the doctors are a small group of privileged people who
do their best in order to maintain their people's health and improve their
social and living conditions. However, their social and professional
problems which mostly stemmed from the crises in the health sector after
the 1980's as I have mentioned in the first chapter, and their new
individual and economic concerns led them to question this altruistic doctor
image. Despite this questioning, they cannot consider it as totally invalid,
since it is an important source of social authority which was shared both by
doctors and lay people from the birth of modem Turkish medicine until the
1980's. Therefore, the young doctors whom I talked to, often referred to the
professional perspective of the older doctors, although they question and
modify some of its aspects. However, in order for these references to be
represented as valid, my infonnants have to emphasize a continuity
between their individual traits and the altruistic doctor image that is
imposed by the professional perspective, and to relate these traits with their
75
major professional decisions. In doing this, they display that their
professional experiences are shaped mostly through their individual traits
which are suitable for a "good doctor" according to their professional
perspective, rather than through the professional conditions that changed
dramatically after the 1980's. Therefore, the fact that they emphasize
coherence and continuity in describing their professional experiences and
concerns, stems from their efforts of relating themselves to the idealized
doctor image as a part of the professional perspective which had been
developed by the older doctors who enjoyed a high social status and respect
in line with this image.
Besides benefiting from the social authority of older doctors and the
sources of this social authority, this helps my infonnants to differentiate
themselves from the bad doctors 'Who shape their professional experiences
and concerns according to the external conditions in the health sector and
subordinate their individual and economic concerns to their professional
perspective. The older doctors argue that this type of bad doctors are much
more prevalent in the new generation of doctors who adopt the external
conditions in pursuing the profession and forget the basic principles of
their profession (Anoglu, 1996). Irfan GOkt;ay (1997), who was the director
of "Istanbul Chamber of Medicine" for a long time, stated that this led to a
kind of generational conflict between the new generation of doctors and
their colleagues from the fonner generations. Several publications I
looked at in this chamber, also refer to "the generational conflict" so that I
have understood that this theme is shared among the older generation of
doctors to a large extent, at least among the leading members of this
professional chamber who are devoted to maintain and inculcate the
76
professional perspective and the altruistic doctor image. in this
framework, my informants' emphasis on the coherence between their
individual traits and professional experiences can be considered as efforts
to situate their personal and professional "self" as " a good doctor" in the
society, and , therefore, claim a position of social authority like other good
doctors who are mostly thought to belong to fonner generations.
This chapter is based on semi-structured interviews with six doctors
mainly from the younger generation whose ages varied between 30-37. I
was already familiar with most of the doctors whom I talked to, before
making the interviews, since I have met a number of y01mg assistants in
the faculty of medicine at the Capa Hospital, when I was involved with
another research project. Building close relations with these doctors
helped me to reach the doctors who work in different hospitals, since most
of these doctors' friends or spouses are also from the same professional
group. The doctor I talked with, explained this fact half-jokingly as they
rarely have the opportunity to meet with people other than doctors during
their intensive and long medical education and professional career, or only
another doctor can tolerate these doctors' tired and "shabby"appearance
after the long hours of work.
These doctors had different professional perspective and concerns.
These differences were also related with their socio-economic background
where considerable variations could be fotmd. Despite their differences
these doctors used to meet in their leisure time and often discuss about
their professional experiences and concerns. I had· the chance to listen and
become involved with these discussions and, meanwhile, I have learned
more about their particular professional and individual characteristics. I
77
collected adequate information about the professional and personal
characteristics of the young doctors I have met at Capa and the doctors
whom they suggested to me, and I used my other personal relations in
~
order to decide whom to interview in order to reflect the existing variations
among the younger generation of doctors. I also paid attention that my
informants have different specialization fields, except the two
gynaecologists, since this is another factor which influences professional
experiences and concerns. Gynaecology, being the most prefered
specialization field, is represented by two doctors from different gender
groups. The gender distribution of my informants is also balanced, since
the gro-qp of informants consisted of three female and three male doctors.
I prefered to conduct interviews in my informants' houses, since they
were more likely to talk about their individual experiences which they
considered as unrelated to their "professional self" in their houses.
Therefore I could obtain more information about their individual
characteristics and the clues which would help me to understand their
socio-economic background more clearly, such as the decoration and the
way they dress. In the /hospital setting, their professional self is much
more· dominant so that they relate everything they say to their profession,
and moreover, the interviews were often interrupted with the noise in the
hospitals and the patients who came without an appointment.
In general, the doctors were very cooperative during interviews and
forced themselves in order to find elaborate answers to each of my
questions. They mostly considered me as a young SOCiologist and displayed
a genuine' interest in my questions, since they argued that the social and
hmnanistic aspects of medicine and medical professions should be
78
emphasized more among doctors and in society. The fact that I am a
master student led them to have a particular concentration on their
university education and their assistantship in their accounts where they
had a tone of older brother or sister since they are at least five years older .
than me and considered themselves as highly experienced and informed
about the fOITIlal and informal rules and regulations of the university
system. The female infoITIlants could talk about their concerns about their
private life, such as their worries about their being late in finding a
husband and have a child, more comfortably, since they view me as a young
female student who might have similar worries. However, during our
interviews, they were fully aware that they were presenting their
profession, their views on it and their way of pursuing it, to a person who is
an outsider to this professional realm, like me. Their efforts in depicting a
highly coherent picture in their narratives about their individual
characteristics, professional concerns and experiences and in describing
themselves as "good doctors" can be also explained by the fact that the
listener and main interpreter of their narratives would be me, a person
whose job is not a part .of the medical realm. If the interviewer were a
doctor, they would depict a less coherent picture through telling more about
the deviations from that picture and caring less in rmding reasons for these
deviations.
In the interviews, the deviations were narrated usually as stemmed
from the external factors such as inefficiencies and corruptions in the
health sector and problems with patients' behaviours. However, some of
the deviations from the professional perspective that is established by older
doctors, may indicate the development of a new professional perspective
79
where the old categorisation of good and bad doctors is no longer valid.
Instead of taking this categorisation that is largely accepted among the
professional group and presented to the lay people as a main reference
point, the yotmg generation of doctors might underline their different
individual concerns and benefits in pursuing their profession. Relatedly,
another topic to study would be how these doctors differ their own
professional concerns and experiences from other doctors and present their
personal and professional self more like "individuals" rather than
belonging to a professional group. How they develop their own category
about good and bad doctors out of the established category would be another
interesting subject to study. One might also ask how the young doctors
might question and criticize the established professional perspective and its
category of good and bad doctors without refering to the external factors
which have effected their validity. It is possible to find clues to answer
these questions in my informants' accounts about their professional
experiences and concerns.
AI though I had prepared a list of questions beforehand, I also asked
a considerable number of questions that were shaped during the course of
interviews. I tried to collect as much as infonnation I could, about the
professional experiences and evaluations of my infonnants. I also let them
talk about their individual characteristics, even if they did not seem to be
related with their profession, and I paid a special attention on how they
connect these two issues during the interview. The interviews lasted about
3-4 hours. All the interviews were tape-recorded and transcribed.
Pseudonyms are assigned to interviewees for ethical reasons. The
characteristics of these interviewees are briefly summarized in the
80
appendix. I have the transcriptions for several times and I applied the
method of "thematic field analysis" (Rosenthal, 1993) which is particularly
useful in understanding how a narrative is "temporarily and thematically
ordered". In studying these interviews according to this method, I have
taken into account the changes style of presentation such as
argumentation, narration and describing and thematic shifts where the
infonnants change the subject of their accounts sometimes by themselves
without being interrupted by a new question. These kind of shifts provided
valuable clues to see how they connect different subjects which might seem
as unrelated on the first instance.
The Periodization of Professional Experience: The causal
consistency between the character traits and professional decisions persists
through the the consecutive periods of the doctors' professional experience.
This periodization also helped me in shaping my interviews as well as their
analysis. The periods can be broadly defined as the high-school education
where usually the decision to become a doctor is taken, the university
education where the person first gets acquainted with medical knowledge
and practice and plans a career as a doctor, the early years of the
professional experience, where the person is no longer a student but a
doctor who is exposed to the rules and hierarchy of the professional group,
and the later years of professional practice where the doctor internalizes
the professional rules. The doctors whom I interviewed were mainly in the
first years of their third period. This was a conscious choice by my part,
since the doctors from the fomth period used to speak less in individual
tenns, but rather prefer to make general statements about their profession.
81
Moreover, the doctors from the third period still remember and were tmder
the influence of the fIrst two periods where the professional perspective was
acquired and two important decision making processes are involved. These
processes are the decision to become a doctors and the choice of a medical
field for specialization. In this chapter, I will mainly concentrate on the
first two professional periods of doctors and, a part from these periods,
some of the findings of the background questions which I asked before the
questions about the doctors' professional lives will also be mentioned with
respect to their effects in career planning and the formation of a
professional perspective.
The Character Traits of Doctors and their Professional Decisions:
The doctors' stress on their character traits in relation to the two crucial
decision making processes also implies that being a doctor and specializing
in the chosen field are particularly in accordance with their
conceptualization of themselves in the oral accounts. Their individual
characteristics and professional choices are interwoven in a highly
consistent way to the extent that the professional decision seemed to be the
obvious path for these people to follow. Linde (1993) applied her categories
on her research about the career patterns of middle-class American
professionals and she also fotmd that character traits are mentioned as an
adequate explanation for professional choice according to common sense as
a widely used coherence system. However, the doctors' consistency between
their character traits and professional decisions provides more than
temporal and causal continuity. It also implies a different causal
relationship where people with certain positive characteristic traits, such
82
as perseverance and courage, have the chance to acquire highly valuable
medical knowledge and enter this "sacred" profession in contrast to others
who fail to have these characteristics. Besides this exclusionary aspect, this
consistency suggests a categorisation among doctors, since by showing how
their individual characteristics are harmonious with their profession, the
interviewees imply a definition of a "good doctor" where their own cases are
also included. Hence, the power relations between the doctors and other
people and within the doctors themselves are accounted to be shaped
through the consistency between the requirements of the profession and the
individual traits.
In this chapter, I am planning to focus on the representation of the
"professional self' through the accounts of personal exPeriences of doctors,
and benefit from the Linde's "continuity of the self through time" and
"reflexivity of the self' concepts. How doctors relate themselves with other
people in the professional realm and lay world will be covered in the next
chapter. I will also study the two processes of decision-making which play
an essential role in displaying the consistency between the doctors'
personal traits and professional position. The accounts of these processes
also help us to understand the interviewees' general views about being a
doctor in the current Turkish medical context and their particular position
in this context, including relations with other doctors, patients and with
other lay people. These accounts are about the professional experiences
which cover the last two decades, since I mostly interviewed the last
generation of doctors who are in their early years of professional practice.
83
The Decision to Become a Doctor and its Consistency with Character
Trai ts: In this section, I would like to show the ways in which the
coherence is maintained through representing the self as an integrity. In
the interviews, the integrity is mainly achieved through explanations and
examples which show how decisions to become a doctor and to specialize in
a specific field of medicine fit the character traits of these doctors. The
reasoning behind this way of achieving integrity is to justify these decisions
which play an essential role in their life course. In some explanations, the
justifications are so richly made that the professional decisions seemed
almost as the "natural" paths to follow in the life course given the people's
character traits.
In the interviews, the doctors represented themselves as being
successful and having an outstanding position with respect to the rest of the
people in their environment since their childhood. The success and
outstanding position were stressed increasingly more as the doctors went
on narrating their medical education and professional experiences. The
doctors mentioned several character traits as evidence for their outstanding
position which also implied the required character traits in order to become
successful as· "a good doctor". Among these character traits, one of the
most emphasized one was being hardworking. Several of the doctors
connected this characteristic with their decision to be a doctor in a more
direct way. Some of them emphasized more specific criteria and gave
external or official evidence which justified their working hard. The
examples given as evidence of being hardworkingvazy from having "a red
ribbon" in the primary school (an award for the students who learn to read
well in a short period of time) and having a high honours degree (takdir)
84
each year in the high school as in Dr. Merir;;'s examples, to Dr. Sakin's
reading whatever she found even it was not related at all with her studies
in the primary and high schools.
However, being hardworking is not the only character trait which
was stressed as a criteria to become successful especially before the medical
education. For example, Dr. Saral implied his cleverness and his special
skill to get the average grades in a private and highly competitive high
school without working too much and admitted that he used to despise the
people who studied too much with "the typical vanity of the people who went
to private high school":
"Everybody in the Austrian high-school were chosen people .. I never
had failing grades .. .1 had a grade average which could be considered as
successful considering I am from the Austrian high-school... I had the
typical vanity of the people from private high school (koieJii burnu
btiJ'llldtigti). I believed I could get satisfactory grades without working too
much". 0)*
During the inteIView, he constantly stressed that his studies and
work are not the most important aspect of his life and he has to have diverse
interests such as playing football in order to become relaxed and refresh his
concentration for more work. Similarly, Dr. Caglar mentioned that he
always had and should have diverse interests such as sports and
commercial activities but he stressed that these activities did not prevent
his being responsible in his main work. Both of these doctors emphasized
that they took their studies and work as a game where they knew its rules
quite well and played accordingly in order to continue in the game
* Excerpts from the original interviews are in the "Appendix 2".
85
successfully. Similar to Dr. Sarol, Dr. Cag-Iar also implied that his being
intelligent or clever and his aim of benefiting from this trait were one of the
main reasons for choosing this profession. He said that his main aim for
the future was to understand and apply a knowledge which was perceived
as difficult by other members of the society, for their benefit. This wish also
includes a comparative aspect where Dr. Caglar implicitly attributed
himself an outstanding position in the society through emphasizing his
cleverness.
According to these doctors, rather than working too hard, they
astutely worked enough to have satisfactory grades in order to be evaluated
by themselves and by others as "successful". Although, both had many
diverse interests in life, they stressed several times that they gave a general
priority to their studies and work in contrast to other students who also
have diverse interests. Besides their cleverness or astuteness in tenns of
knowing the rules of the game and playing it successfully, the concept of
resp9nsibilityas it was used by Dr. Caglar is another important trait which
was much emphasized by him and by other doctors in the accmmts of their
experiences in the medical school and hospitals which correspond to the
later period of their life course. Hence, responsibility as a character trait
which helps differentiate doctors from the others, will be examined below,
in the study of the accmmts about the later periods of the educational and
professional life course.
According to their accounts, either by being hardworking or by
planning the life and studies skilfully and cleverly, the doctors became
successful in their education. Their educational success was appreciated
by everybody in their environment, and their decision to go to the faculty of
86
medicine seems like an ultimate confinnation of their success. Most of the
doctors referred to the difficulty of entering the faculty of medicine, a
process 1Nhich involved severe competition. AI though the doctors did not
directly mention about their being competitive,their explanations of their
becoming successful implied that they were content to be more successful
than the others, since they assumed that they obviously deserved being
successful thanks to their character traits. Dr. Meri~, a female
pediatrician, told about a direct relationship between being hardworking
and the decision to enter the faculty of medicine by saying that the
hardworking students, like herself, have that "psychology" (she most
probably means motivation) to enter a faculty of medicine -without any
exception, since it is the most prestigious place to enter for university
education:
"The hardworking students have the psychology to obtain the highest
scores (in the university entrance examination) under any condition and
become a doctor. In general being a doctor brings a prestigious position in
society. Every parent wants their child to become a doctor". (2)
The last argument of Dr. Merit; is also consistent with her own
family who mobilized their scarce financial resources so that she could
study medicine comfortably without being aware and suffering from her
family's economic problems. Dr. Sakin, a female gynaecologist, spoke
about the same relationship for a specific period of time, the early 1980's
where "doctors still had a prestigious position in society", which also
included the year she entered the faculty of medicine:
87
"In our time, all of the successful students used to enter into the
faculty of medicine ... The year was 1983 ... Entering the faculty of medicine
was a big event" (3)
Similar to the doctors who emphasized their working hard, the ones
who were skilful and clever enough to play "the game" successfully, also
mentioned about their success in the examination in a consistent way with
their own character traits. Among them, Dr. Saral mentioned that he had a
hard time in deciding about the major he wanted, but, he added that, once
he had decided to enter a faculty of medicine, the rest was very easy, since
he answered the exact number of questions in each section in order to enter
that faculty without any problem. All of the inteIViewees talked about their
success in the University Entrance Examination (OSYS) in detail and they
remembered the precise scores that they had in each section of the
examination, despite the fact that they had had this examination at least
ten years ago. Their emphasis on this examination and on their being
successful at it, is significant since it signifies not only the first step to the
profession, but also an initial stage to be admitted to a highly respected
professional group.
Bryan Tmner's (1987) arguments on the power relations within
professional groups and on the internal strategies they use to maintain
their professional boundaries and control, are helpful in explaining the
importance of this initial stage which involves a large amount of
competition. The competition is related with the principle of social closure
where, in the case of doctors, they maintain their occupational control
through their role in deciding who will participate in their own group
(Turner, 1987). He argues that this principle "in a society based on
88
knowledge, depends on university education as the basis for
credentialism". This statement is particularly relevant for the Turkish
university examination system where in the 1980's, people had to have the
-
highest scores in order to enter into the faculties of medicine CTTB- 1990).
Being successful in medical education and fulfilling the criteria required to
specialize in the profession are other difficult and competitive stages where
medical students had to be tested by their professors in the faculties of
medicine in order to take part in their professional group. In sum, both
before and during the university education, being outstandingly successful
through uslng different strategies which are consistent with these doctors'
particular character traits, is presented as both the key element in shaping
professional decisions and as a major criteria in realizing these decisions.
In the interviews, when entering one of the faculties of medicine was
stressed as difficult and competitive,the doctors also felt challenged since
they saw this as a test for the confirmation of their outstanding
characteristics. However, this challenge was reflected in the fonn of an
enj oyable game in the interviews, since all of the doctors had overcome this
entrance examination successfully a long time ago.
The Conceptualization of Medical Knowledge before Medical
Education: Another aspect which is related with the challenging aspect of
the profession and which makes the profession attractive for my
interviewees, is about the characteristics that were attributed to medical
knowledge before entering the faculty of medicine and in the fIrst years of
medical education consistently. In this section, I concentrate on their views
on medical knowledge, which they reported they had before medical
89
education. However, since these evaluations were recently made by today's
doctors on their personal views of the past, they were also shaped by their
current professional position and concerns rather than merely belonging to
the past.
Among the strategies of occupational control and monopoly, Turner
(1987) writes about the first dimension in which these strategies take place:
" .. the production and maintenance of a body of esoteric knowledge which
requires considerable interpretation in its application". This point becomes
especially relevant in the case of medical knowledge where the terminology
is mainly in Latin and the professional experience and personal skills
forms an essential part of the application of the knowledge. Learning the
medical terminology is discussed through the metaphor of "learning a
foreign language" in Good and Good's (1993) article, where they argue that
learning this language corresponds to "the construction of a whole new
world". The motivation to acquire this "esoteric knowledge" in order to take
part in the construction of this "new world", can be easily tracked down in
Dr. Sakin's reasons to choose the medical profession and the subject she
would specialize in. Dr. Sakin also emphasized that she was familiar with
how doctors worked and used their medical knowledge even before the
medical education, since her father is a well-known pharmacist in Denizli
and his pharmacy was often visited by doctors who spent long hours there
conversing with her father. She answered a question about her
expectations in her decision to enter the faculty of medicine:
"Medicine seemed to me as something different from everything else
. .1 don't know, you read certain things, you are interested a little bit in
certain things, like management etc .. But it seemed to me that not
90
everybody can study medicine, be a doctor, tmderstand medicine .. .1 liked
the terminology that is used, the prescriptions .. I could not believe at all, it
was a very important business for me, how they keep all of drugs in their
mind, how they diagnose the illness ... He [the doctor] says that this man
has this [illness], gives a drug and the man is cured .. .ln fact being a doctor
seemed highly incredible to me, it seemed highly unreachable too. But I
said that I will try whatever I can in order· to reach my aim and I persisted
in what I said". (4)
The acquisition of medical knowledge became attractive for my
interviewees not only through its level of difficulty which meant the
necessity to re-test and prove their positive character traits, but also
through its unique aspects which strictly differentiate it from other types of
knowledge and which also ultimately confinns the outstanding position of
doctors. Hence, the quotation of Dr. Sakin displays another common aspect
about the doctors' presentations of themselves in relation to their
professional position: The more difficult realizing a certain goal is, the
more motivated the doctors become and the less tmderstandable a kind of
knowledge is, the more challenged they feel in order to acquire that
knowledge and reach that goal. This can be partly explained by their
characteristic of being hardworking, since it forces them to reach "the
highest point". However these doctors believe that they deserve to reach this
point since they made a courageous decision to study something ''which not
everybody can study". In the above quotation, the mystification of medical
knowledge by defining it with such adj ectives as "incredible and
unreachable" implies that there is a highly exclusionary competition which
only the deserving attain. By describing the examination process as a
91
mystic ritual through the eyes of a lay person, with the sentence, "he says
that the man has this, gives a drug and the man is cured" , Dr. Sakin also
attributes almost a magical power to medical knowledge, which is used to
heal people as if in a highly automatic manner without any difficulties in
the healing and medical process. Attributing a great value to the medical
knowledge is also another indirect way of confirmation of the outstanding
position of doctors. What is "unreachable" is reached only by a few people
as a result of their diligence, cleverness, responsibility, courage and
decisiveness which differentiate them from other lay people.
The Character Traits and University Education: The doctors'
accounts about their university education correspond to the second part of
their professional life course according to the periodization designed for the
study of these interviews. This period is important not only in terms of
displaying the continuity through time since the character traits that were
mentioned for the first period were repeated even with a stronger
emphasis, but also in more clearly differentiating the doctors and others
since it signifies the beginning of the acquisition of a professional
perspective as well as medical knowledge and practice.
In line with Bryan Turner (1987) who stressed the relevance of
university education to the formation of the "esoteric knowledge, as we have
seen above, Carr-Saunders (1964) also believes in the importance of
university education for professionals, since the students learn about "the
ideals and nonns" of a profession through "professional socialization". The
concept of the professional socialization is a significant concept of the
professionalization theory of which Carr-Saunders is one of the followers.
92
In this theory, as we will study in more detail later, it is assmned the
professionals are a corporate body of people who are tied to each other
through solidarity. The solidarity stems from acquiring a unifying
professional perspective where the members of the profession share the
same concerns and ideals about their profession and the world which is
shaped through this profession. However, the professionalization theory
which has an idealistic view of professions,· is now evaluated in critical
terms, and the process of professional socialization is not considered as a
smooth process of learning as it was assmned by the theory. In contrast,
the doctors whom I interviewed, questioned some of the aspect of this
process, even if it requires self-criticism made through self-distancing.
They mentioned that they internalized some basic aspects of the
professional perspective, such as the idea of being useful for people and the
prevalence of the objective scientific criteria that were given in their faculty
on condition that these aspects were suitable with their character traits.
When we study the character traits emphasized in the accounts of
medical education, we see that the traits that Were mentioned for the
former period, were muca more stressed through direct comparisons with
other people, since a process of differentiation had started. This fact is
especially true about being hardworking which was represented as one of
the basic requirements of medical education. Dr. Meri~ who also stressed
her being hard working in the high school, consistently said that she had to
give up all of her hobbies such as drawing picttrres and playing the piano,
since she had to study "extremely hard". Accordingly, she compared the
medical students including herself with the other university students, by
saying that because of their studies they had no time to learn about, discuss
93
and organize around the political issues that were debated in Turkey at that
time, in contrast to others who were more politically active and organized.
Although she had a regretful tone in accounting that her studies prevented
her other interests, she emphasized that she had to study hard in order not
to be "eliminated" in the fIrst two years "like almost half of the students".
If We take into account that she was speaking about the mid-1980's
since she was born in 1967 and went university around 1985, a strong
tendency of depoli tization could be perceived in most of the social and
professional groups in society including doctors. As I have also mentioned
in the first chapter, the particular political conflicts between the rulers and
doctors in the early years of the 1980's, also became highly influential in
the depolitization process of doctors who had often played an active role in
politics mostly with an oppositional political character since the early years
of modern Turkish medicine. Their political character was also highly
influential in shaping their professional perspective from the early years of
the modern Turkish medicine until the mid-1980's. However, in making
her comparative argument, Dr. MeriJ; did not refer to that contextual
situation at all, rather she/consistently took a conscious distance from the
general political issues during the whole inteIView, and the only reason she
mentioned for this, is that like all of the medical students in her
surroundings, she had to work too hard to spend time on political issues.
The other reasons of the majority of the last generation of doctors' critical
evaluation of.the idea of being politically engaged to an idea or organization
will be discussed in the next chapter, but, it is interesting to note here that
being a hardworking student in the faculty of medicine was given as a
reason for not being interested in politics like other university students.
94
The particular internal dynamics and personal relations in the
faculties of medicine also helps to develop an "individual responsibility" to
be hardworking. This is especially valid after the second year of medical
education where the students first contact patients and learn about the
examination process in groups led by a professor~ Dr. Sakin. described the
psychological situation of students in this session as suffering from great
tension since they-including her- felt themselves "as being in a shop
window" . This metaphor comes from the fact that the professor
individually asked the students certain questions and not being able to fully
~swer these questions or making a slightest mistake in the examination
process. closely watched by the group. resulted in the professor's getting
furious and other student's depreciation of the ''wrong-doer''. Dr. Sakin
said that the students also felt tension because of the patient who did not
understand the dynamics of this process:
"When you take care of patients for the first time. you behave in a
very careful .way. Your dear professor and your friends judge you (She
laughs) ... When your professor ask you a question, you have to answer it
correctly ... Slowly. you begin to feel the tension. It is enjoyable and stressful
at the same time. the stress is related with your avoidance of being
ashamed .. .In the clinic. you are among people all the time. The professor
asks you something and you do not know the ansWer (She raises her voice).
What a big shame in front of your friends! (She laughs). At the same time
you will feel ashamed in front of the patient. it is annoying as well ... You
have to read a lot in this periOd, because in one way or another you have to
learn these things, and then the panic starts ... You also have to avoid the
scoldings of the professor ... (In case you cannot answer the professor) The
95
professor may even kick you out of the clinic and tell you not to touch the
patient". (5)
This is related to the particular group dynamics where the students
"
watch or control each other, and force each other to work harder under the
main control of the professors and the university system. This is also
related to the notion of mutual responsibility among students as well as
between the students and professors.
The process of learning through the examination of the patients in
the classes is also important since it shapes one of the main professional
activities of doctors. In this process, the students must learn how to treat
the patient and how to gain the patients' trust through their behaviour and
their appearance, from their professor who is a much· more experienced
doctor. In this respect, according to Dr. Caglar who did not stress his
being hardworking but his responsibility in giving priority to his work in
general, the medical student really internalizes the rule of being
responsible. He said that, since " a doctor cannot say to the patient, oh, I
can't diagnose your illness, I don't understand what is happening in your
body," the students who answered their professor as "I don't know" in the
examination session, were not tolerated at all by the professor and the
class. Dr. Caglar added that the only thing that the student should do is, his
or her best to find an answer and ask for one or two days at the end of which
he or she would give a detailed and complete answer after studying
extreme ly hard.
He generalized the way the students' handle this problem, for the
whole process of acquiring medical education whereby the students were
faced with a strong notion of moral consciousness. By way of comparing,
96
he explicitly said that since the medical students, including him, were
more clever than the other university students, they could acquire the
responsibility of medical duty and complete their task even if at the last
instance. If they had one day or few days left to do it, he added, they stayed
awake all night or for several nights to complete it.
Another doctor who emphasized the importance of being clever as we
have seen for the first professional period, Dr. Saral, criticized the medical
student who came fram "the provincial places" and who had low socioeconomic
status, since they did not nothing but studying for "twenty-four
hours per day" and got the highest grades in contrast to his average grades
in most of the classes. He said that medical education was their most
important social and economic hope for the future and his remark is
interesting in tenus of evaluating the heterogenization of medical students
and the differentiation of professional career patterns and perspective after
the mid-1980's, as we have seen in the first chapter. Unlike the student who
came from the provincial places, Dr. Sarol said that he was not devoted to
all of the courses in the university, but that he gave a priority to a few
medical fields which included surgery, in which he was highly interested
and at which he found himself particularly skilful in learning and
applying.
According to the interviews, for a clear-cut success in t..~e faculty of
medicine, the students had to be much more hardworking and clever than
before, partly because of the in-group control and competition, as we have
seen above, and partly because of the level of difficulty of the knowledge that
had been learned.
97
The First Encounters with Cadavers, Courage Test and Group
Control: As we saw in the accmmts about education before university,
being courageous was implied with respect to persisting on becoming a
doctor, which was presented as a difficult goal which only a few people
could consider reaching. In this framework being courageous is related
with the students' fearlessness and even enjoyment about the challenging
and competitive aspects in the first steps towards their goal. However,
during the university education, they had to "endure" a much more
difficult courage test for proving their emotional and intellectual capacity
which is strictly required in order to become a doctor. In their third year of
university education, the medical students had to dissect cadavers in the
anatomy laboratory.
According to Good and Good (1993) , it is a process whereby the
medical students learn to "reconstruct the person as an object of medical
gaze"and attribute new meanings to the human body. Good and Good
argue that while exploring inside bodies, the student develop new manners
in interacting with these bodies, and accordingly their perception of their
own body and self change considerably in this process. For them, this twosided
reconstruction process is "essential for students to become a
competent physician". Similarly, LelIa and Pawluch (1988) stress the
importance of this process in tenns of its role in differentiating the medical
students from the lay people through signifying " a rite of passage into the
hallowed realm of medicine" and enhancing the sense of privilege of
becoming one of the chosen few. LelIa and Pawluch claim that, besides its
differentiating role, dissection of the cadavers has also an integrating
function for the medical students. They learn to integrate their
98
professional and personal self through suppressing their personal feelings,
stressing the objective-scientific benefits to be gained by dissection and
developing scientific and medical concerns in all aspect of their lives.
Similar to the findings of these studies, the informants also
dramatically expressed how they felt during the dissection process. Dr.
Sakin spoke in a detailed way about the "horrible" conditions in the
laboratory such as the smell of formoldehyde which preserves the deadbodies
and the half-opened eyes of some of the cadavers. However, she also
added that she eventually learned to suppress her fear and disgust since
these are not suitable for a future doctor. Dr. Meri~, Dr. y~ and Dr. ~aglar
mentioned that they tried to build an empathy with the cadavers by asking
themselves whether they wanted to be in the place of their cadavers, what
kind of people were these cadavers, whether they had any relatives and
what were the conditions which had brought them to this anatomy
. laboratory. These questions were based on the students' concerns about the
invasion of the private life of an tmknown person which is also stressed in
the article of LeIla and Pawluch (1988). However, they were aware that they
had to learn how to struggle with this concern too, since invasion of private
life of an unknown person would cover an important part of their
professional practice. Hence, these students had to be courageous not only
in terms of tolerating the horrible material conditions in the laboratory
such the blood which was spilt and the dissected orga.ns spread out
everywhere, but also being able to find a comforting solution for their
psychological and philosophical worries about dissecting cadavers.
Among these doctors, Dr. Meri~ suppressed her concerns and rationalized
her acts in the laboratory as what she did with the cadaver, did not mean
99
anything to the person whom this body belonged to, since he or she was
dead long ago, and all the things she had done in that laboratory was in the
name of science and medicine.
Dr. y~, a male orthopedist, brought another explanation for the
suppression of feelings, which is related with the group dynamics and
rules among the medical students similar to the Dr. Sakin's account about
the classes where they learned about the examination process. Dr. Ya~
who stressed that he could not even bear seeing blood, felt a "disgust" at the
beginning of this process, thought it was against his "humanitarian
values"and had to have a one year break from university because he could
not tolerate working in the anatomy laboratory. However, he also added
that he should not display his thoughts and feelings to other students:
"It was actually like a game. First we went around these places with
a feeling of a nausea in our stomachs, we had never seen a dead body
before. We were afraid of the fear which we might feel when we first see the
dead bodies. Would I be ashamed in front of my friends, would I faint out of
fear, with these worries I was afraid more because of the paranoia of fear.
I tried not to be afraid and projected my fear by looking happy. I took the
ann of the dead body and raised it saying' Ah, this man is dead' ... I did not
even wear gloves. In fact I was trembling out of fear, but I did not show my
fear to anybody. But,then, it affected my studies, I quit the school at that
period for one year". (6)
In his account, we again see that the medical students became a
group wherein certain rules were set according to the medical and
scientific professional perspective in line with the biomedical model. The
students, if not fully internalized, were fully aware of these rules and seem
100
to comply with these rules at least when they were among the other medical
students. Hence, the students maintained their courage either by
subordinating their stress and fear to their faith in science and medicine or
by pretending that they went beyond this stress through jokes as in the
quotation above. However, several of them also mentioned that a
considerable number of students failed this courage test and had to leave
the faculty of medicine.
Role of Personal and Social Values in the Acquisition of Medical
Knowledge and Practice: The doctors continued to differentiate medical
knowledge and practice from other types of knowledge and attribute a
mystic character to this knowledge and practice in the accounts of
lmiversity education. As we have seen above, the report of this view selVes
as a way of emphasizing their courage and outstanding position in tenns of
their persistence to reach a goal, the difficulty of which partly comes from
its unrelatedness with other types of knowledge. The difference of the
medical knowledge from the common-sensical understanding of health
issues has been particularly emphasized in the accounts of medical
education. Dr. Caglar stated that one of the first things he learned in the
classes was that all of the statements about the health issues that he had
heard from various people, such as "Don't drink cold water, you will get a
cold" or "Drink linden tea to get better", were completely wrong. He added
that he learned that these issues had much more complex aspects and
experienced a great surprise while learning these aspects.
101
The complexity of medical knowledge was not only surprising but
also fascinating for the students such as Dr. Ya~ who reflected his
fascination about this process in this way:
II ... .1 saw how complex even a finger ~ can be. When I studied the
autonomous nervous system. I was totally shocked .. ! was saying: "Oh my
God, oh my God. how amazingf" .. You began to make religious judgements
in a particular way. Probably each medical student ask questions about
God and existence. while studying pathology. physiology and anatomy ...
because a finger has a much more complex structure than a thousands of
computers and when you think about the honnonal system, it is incredible
how they [the hormones] balance each other .. how they are controlled in the
brain .. It is incredible. When you could not believe it, you say [to your self]
that there is probably a God (He laughs)". (7)
This quotation is particularly interesting in showing how in a rather
emotional impression about medical knowledge. medical knowledge and
religion are interconnected in contrast to the dominant biomedical
approach where these two spheres are considered autonomous (LelIa and
Pawluch. 1988). In contra~t to the biomedical view of medicine which also
shaped the contemporary medical education in Turkey, the particular
complexity of medical knowledge led Dr. Y~ to perceive it in a way which
transcends the "gap between medical science (indeed science generally)
and other fonns of cultural expression". The quotation of Dr. Ya~ can be
also examined as an example of Foucault's (1970) term "scientific
consciousness", since it shows how medical knowledge is acquired in the
form of "personal knowledge" through the attribution of "personal
meanings" which led to "the construction of medical knowledge as an
102
intersubjective reality" (Good and Good, 1993). The construction of medical
knowledge also includes the construction of "the medical body" which is
defmed by Good and Good as "quite distinct from the bodies with which we
interact in everyday life". They argue that "the intimacy with that body
reflects a distinctive perspective, an organized set of perceptions and
emotional responses". In line with their argumentation, the quotation of
Dr. Yal} is an example of the construction of the "medical body". Here, he
stressed the complexity of the systems in the body and compared these
systems with those of computers. However, in contrast to this technological
metaphor, his reaction to what he has learned-his surprise and his
questioning the existence of God- are more emotional and spiritual rather
than rational.
In general, Dr. Ya~ has a more critical view on medicine and
doctors than the rest of my infonnants. This is partly due to the fact that
his mother forced him to enter the faculty of medicine, since she had
several chronic illnesses and expected him to take care of her and to solve
the economic problems of the family to a certain extent by being a doctor.
Dr. Y~ admitted that he J:ould never like his profession like other doctors,
nevertheless, that he did his best to become a "good doctor".
In the process of the acquisition of medical knowledge, it is
interesting to note how Dr. Ya~ attributes a personal meaning to what he
had learned, rather independent from the biomedical perspective that is
taught in his faculty. He had learned about and interpreted the medical
knowledge consistent with his own values and thoughts. This also proves
that the 'inculcation of the biomedical model and the professional
perspective accordingly, is not a smooth process, especially after the 1980's
103
where the biomedical model is criticized in line with the discussions about
the problems and boundaries of modern medicine, and the ethical concerns
about the generally assumed predominance of biomedicine over other
health models.
Similar to medical knowledge, medical practice is also mystified by
attributing it certain tenns from other spheres of cultural expression. For
example, Dr. Sakin spoke about her professor of gynaecology who calls the
two fingers which are used to examine the abdomen of a pregnant woman
as "eyes" and teaches the students to "see" everything which is going on
inside the womb through. correct touches with the "eyes". Dr. Sakin said
that she really liked this spiritual terminology since this "specific
knowledge" led her to understand highly complicated body processes with
just two fingers.
The comparison of medical knowledge and common-sense views on
health issues and the acquisition of medical knowledge from the
perspective of personal values seemed as if related to the recent concerns
about health and medical models. However, in the interviews they also
served to prove the idea, that these doctors were not just hardworking
students who internalized whatever they had taught without questioning.
In contrast, in line with having a strongly coherent personality, the way
they acquire this knowledge was accounted to a realisation in accordance
wi th their own values and ideas.
Career Planning after the University Education as a Strategy of Selfconsistency:
The third period in the professional life course begins after
university education. This period is largely shaped by the students'
104
decisions on their specialization in a medical field and career patterns.
The decision on the specialization field is usually taken in the last three
years of medical education where the students deal with the patients in
most of the clinics and learn about their particular rules and relationship
patterns. In deciding, the students consider the particular characteristics
of the clinics, their own medical interests and skills, the medical and
popular demand for the fields, and accordingly the fields' required score in
the specialization examination (TUS) that they take immeadiately after
their graduation. Before taking the examinations, the students fill out a list
of their preferences of two or three related medical fields and hospitals they
would like to work in as assistants. The doctors who prefer to pursue an
academic career, choose tmiversity hospitals and after being admitted to
these hospitals they write a research thesis in their field besides taking care
of the patients who visit the clinic of their own branch during the
specialization period.
The choices of the field of specialization and the clinic the doctors
work in, in this period were highly influential in shaping the further
developments in these doctors' professional life and these decisions cannot
easily be changed since the doctors would have to take the TUS examination
again in order to change their specialization field, which is something
largely protested against by the new graduates and professors since, they
negatively affect the chances of new graduates who take this examination
for the first time. However, changing the workplace where the doctors
specialize is becoming easier thanks to the variations in the alternatives
and an increase in the number of different types of hospitals since the mid-
1980's, as we saw in the first chapter. In tenns of work place, there are
105
several alternatives such as private hospitals where patients are in general
"from higher socio-economic status", private clinics owned by the doctors
themselves, which require more professional experience and money to
spend, public hospitals which are usually evaluated as inadequate in terms
of medical facilities, and university hospitals which are for the doctors
whose skills and ambition are evaluated as adequate to pursue an academic
career. The choice among these alternatives depends on the doctors'
economic concerns, professional experiences they had in different clinics
before the TUS examination * and career plans they had in line with their
professional perspective. The realization of their choice is also related to
their relationships with the more experienced doctors who are either
professors in the university or their superiors in the hospital during their
assistantship. If as a student or assistant they make a a good impression on
their superiors through their display of interest and high quality work,
then they are able to begin to work with these superiors in the same
hospital. Hence their choice of work place is also highly affected by the
relations with their superiors and the professional decisions of these
superiors about the work place where both of them will work as "a team".
Considering all of these external and individual factors which
influence the choice of the specialization field and the plans about career
patterns as a doctor, the choices of my interviewees are accounted to be,
particularly consistent with their individual traits. This consistency is
built as continuous through time since the character traits which had been
* Most of the students and assistants work in private hospitals and clinics on. a
part-time basis or at nights in order to have an. extra source of income and
more professional experience. Although this was criticized by few doctors and
the laws forbid the state employee having other jobs. it cannot be fully stopped
since a large number of doctors work in this way.
106
influential in the decision to become a doctor, were also mentioned with
reference to the doctors' career plans. In the accounts of the first two
professional periods, the doctors differentiated themselves from lay people
through underlying the outstanding position that they had reached thanks
to their being hardworking, clever and courageous. In the accounts about
the third professional period, the doctor's main concern in their own
representation shifted so as to now they stress the consistency between their
careers and character traits, or in other word, their personal self and
professional self as a proof of their being "good doctors". Hence, after the
differentiation of doctors and lay people, a further social differentiation
occurs among the doctors in line with their professional plans.
In the first period the general social views on being doctor and
medicine, such as "Hardworking people enter the faculty of medicine" was
stressed as influential in the informants' choice of profession. In the
second period the medical students' character traits and professional
perspective were largely influenced by the group dynamics and control of
the members of the faculty, including other medical students. The
accounts about the third period differ from the fIrst two periods since in this
period, the doctors' professional decisions and plans were represented as
based on individual concerns rather than the general professional
perspective which was acquired through social relations in the first
periods. Accordingly, the character traits that were emphasized in
relation to the decision on the specialization field are somewhat different
than the traits of the first periods, since they reflect more individual
characteri~tics and seem to be more independently developed from the
general social attributions to a doctor's characteristics.
107
For instance, doctors' are attributed an exceptional place in society
because of their profession which deals with the vital matters of the peoples'
lives such as health and illness and requires an intensive educational and
working process. In the first part of this chapter, we saw that the doctors
whom I interviewed were highly aware of their exceptional position and
justified it through underlying the character traits which were required in
order to deserve that position. However, this sense of exceptionality gained
another dimension in the accounts of Dr. Sakin who wanted to have full
control about her working process. Her claim of having independence and
full control over her work is also relevant in terms of the theoretical
arguments on professionals, since according to Turner, the professional
groups claim to have more initiative in setting and maintaining the rules
and regulations of their own professions, defining the boundaries of the
professional group, and therefore having full control over their occupation.
Their reason behind these claims is that professionals evaluate themselves
as experts on all aspects of the professional process since they pmsue this
profession and experience its problems directly and on an immediate basis.
These claims bring om power struggles with the other sources of power
such as state and private institutions which have different interests in
intervening the professional process (Turner, 1987). Accordingly, Dr.
Sakin confronts the state regulations about the working process of its
employees, which makes doctors "dull state employees" who have to work
from nine-to-five every weekday. She also said that these regulations
seriously limits the choice of work place, if doctors "insist on working in a
state hospital".
108
Dr. Sakin who decided to be a doctor with the thought that not
everybody can learn medicine and be a doctor, as I have mentioned above,
chose the field· of gynaecology as a specialization with the same concern of
having full professional control and autonomy: She said that her field is
highly "specific", and even if doctors from different fields can treat each
other's patients, they cannot do the same thing in gynaecology since they
will not be able to apply its specific methods. She added that the doctors
from other specialization fields became so unsuccessful in treating the
patients who should have been treated by a gynaecologist, that even these
patients complained about them saying they did another doctor's business.
She claimed that the gynaecologists, however, can also check the liver and
some other internal organs since they know the "particular way of
touching" the abdomen of patients with their fingers that her professor
used to call "the eyes". Therefore, through the choice of her specialization
field, she also gains an outstanding position among the doctors and acts
according to her wish to be independent in work in a way consistent with
her aims in the past.
Another gynaecologist, Dr. Saral correlated his character traits with
his professional decisions in a highly skilful way, so that these decisions
seemed as "natural" paths to follow in his life course, given his character:
"First, I thought about a profession through which people whose only
capital is their brain, can earn money in order to continue their lives under
any conditiony. Secondly, I wondered about the professions where people
can work independently ... I would like to have a job which is not
monotonous and which people have respect. In fact the whole issue was
this: I would either playa team game or do an individual sport. I would
109
chose to be a goalkeeper ... of a football team or to be a tennis player ... When
there is a team spirit, you have to hide other people's mistakes a little bit, or
you have to take the responsibilities of what other people do and I think that
their bad perfonnance would also effect your success. At the end, with
these considerations, I decided to become a doctor". (8)
Through these statements and metaphors, similar to Dr. Sakin, he
stressed his wish to be a successful and independent individual in all
aspects of his life including his work. However, whereas Dr. Sakin
emphasized her outstanding position among doctors through her
specialization field's particularities and broad coverage of medical
practices, Dr. Sarol did the same mostly through stressing his own
cleverness and outstanding individual skills in surgery. By working as an
independent individual, Dr. Sarol would not be responsible for the low level
of professional perfonnance and mistakes of others and, thus, be able to
fully display his skills and cleverness. Besides, in line with his emphasis
on his independence, Dr. Sarol stressed that he had decided to become a
doctor without being influenced by any other people. He said that he came
from a relatively well-off family where his father and brother expected him
to become a businessman like them. He argued that being a doctor was not
considered by his family members as a socially prestigious and
economically beneficial profession in contrast to other families with low
socio-economic status, who expect social and economic benefits from their
children who became a doctor.
Dr. Sarol also stressed his diverse interest~, his dynamic character
and dislike of monotony both in his professional and daily life. His dynamic
character is also represented as essential for his particular field, where he
110
"can hardly finish his meal" each time because of an emergency call for an
IDlexpected delivery. He generalized this dynamism to all gynaecologists
by saying that one can recognize the field of doctors from their manners,
and gave the example of fonnal buffet dinners of doctors from specific
fields: He said that doctors usually make a line by the table in a proper way,
whereas gynaecologists rush towards the table in order to be the first
person to have the meal. This notion of dynamism is also related with the
concept of courage as used by Dr. Sarol, since he said that a good doctor,
just like him, should not avoid any medical cases even though they include
vital risks. He also said that he liked the "excitement" in his profession, of
which he compared the enj oyment of bungee jmnpers.
Gynaecology, for him, involves a great deal of surgery that provides
the necessary ground for him to prove his personal skill and courage in
addition to his theoretical medical knowledge. He combined his emphasis of
his individual skills and courage with his field of specialization by drawing
an analogy between the job of a bomb disposal expert and that of a surgeon,
since the slightest mistake in decision making or in an application process
may lead to extremely serious trouble ot the death of more than one person,
and only the correct application can lead to a "happy ending" in both jobs.
The linkage between particular character traits and the choice of
specialization field was drawn by Dr. Caglar, in a similar way with Dr.
Sarol, since he also spoke about his avoidance of monotony in all aspects of
life. He stressed that he always had to have diverse interests in life and
accordingly he chose to become a general practitioner, also known as
family doctor and which consists of five main specialization fields
111
including gynaecology, pediatrics and psychiatry and pointed to his wish to
become pioneer:
.. When you want variations (in your profession), you may choose to
become a family doctor where you may either concentrate on one of its fields
or work in all of the five fields at the same time. This means there are
variations in your application of medicine, there are variations when you
take care of your patients. I thought that nothing could be better than this.
Besides, it is a new field where people create new things .. J mean like the
pioneers -who went to America, this kind of thing seems suitable for me."
(9)
Dr. Caglar said that being a doctor was the first step in this aim of
his, since in this profession he acquired a knowledge which is too difficult
for a lot of people and helped many of these people with this knowledge.
Being a family doctor was the second step -which was consistent with the
first one, since this specialization field was recently founded in Turkey, in
the mid- 1980's which means only four years before his decision on
specialization and the debates about the organ.ization and boundaries of this
field are still going on. He evaluated himself as successful with respect to
his choice in the specialization field, since he defined success as doing
something before everyone else does. This skill can be related to being both
clever and farsighted which are the two character traits which he believed
he possessed according to his statements about himself in different parts of
the interview.
Dr. Merit; drew a more indirect linkage between her being emotional
and concerned about the helpless living beings and her becoming a
pediatrician. She considered herself as highly emotional and related this
112
characteristic with her sign in the horoscope (cancer). She drew a
connection between this character trait and her emotional and professional
concern about babies who seemed to her the most fragile and vulnerable
beings in the world. She also mentioned about the babies who did not
understand what was happening and why they were hurt when they were
vaccinated, for stressing their vulnerability, and therefore her being
attracted by them.
The doctors' decision on the specialization field is followed by a
specialization process where they work from two to six years according to
their field, in the clinics as assistants under the supervision of specialists
or professors in the case of university hospitals. The accounts of this period,
as we have seen above, included many examples which show the
consistency between the character traits of the doctors, the decision to
become a doctor and the choice of the specialization field. This consistency
also justifies the choice of field where the doctors used mostly their own
initiative in deciding. Unlike this choice, the decision on the work place
depends much more on the external factors and social relations, and
providing a similar consistency is more difficult. These factors and
relations may not always fit with the professional perspective which the
doctors have acquired in the first two periods of their professionalHfe and
with their character traits which seemed in accordance with this
profeSSional perspective.
When the assistants realize that they are no longer medical students
but doctors who are a part of the "actual" power relations in hospitals, a
discontinuity through time may appear in the sense that the positive
characteristics which were attributed to the profession and its members
113
can be replaced by bitter remarks as a result of disappointing professional
experiences with other doctors and patients. The awareness of the limits of
medical knowledge and practice in the hospitals also causes further
disappointment in " ambitious" assistants in Dr. Sakin and Dr Meri~'s
terms.
Idealization of Medicine and Management of Discontinuities: In the
accounts about the first two professional periods, we see that medical
knowledge and its potential are highly idealized. Dr. Meri~ said that before
her medical education she viewed medicine as something perfect, which
can cure every illness. In this remark, she emphasized the value of
medical knowledge which is another source of motivation to obtain it. The
value she attributed to medical knowledge is also consistent with her
expectations in becoming a doctor: She said that her ultimate goal is to be
able to help people who are really in need of help, such as children and
people who suffer from "starvation and infectious diseases" in the remote
parts of Anatolia. She called this romantic view of medicine as "its
humanistic dimension". This view is more common and elaborate in the
previous generations of doctors as in the example of Prof. Dr. Tfirkcan, a
well-known female ophtalmologist from the second generation of doctors,
who spoke about how her idealism about the profession developed in her
youth:
"At that time, we used to read a lot of novels by Cronin. I was a
different type of young girl. Medicine attracted me more than other things.
I dreamt that I would be useful to people (by being a doctor} .. .I mean, I
thought I would be useful in the development of the Turkish society by
114
studying medicine. I was highly idealist at that time, now I am not that
idealist". (0)
This view of medicine is highly consistent with the Durkheimean
approach to the professions. Durkheim argues that the professionals act
mainly with altruistic values for the general well-being of their society,
rather than considering their. own personal benefits (Turner, 1987). This
argmnent is criticized because of its neglect of power relations both among
the professionals and between the professionals and lay people. The concept
of benefit is divided into two categories, material and symbolic benefits
(Hughes, 1958) and Freidson (1970) stressed the social closure in terms of
occupational control and monopoly. These criticisms and elaborations led to
the emergence of the concept of professionalization which is a process
where the degree of being professionalized is determined by "display of
social altruism, professional competence, social responsibility and service
to the client". Turner (1987) criticizes this view since it reflects the
dominant view of the profession itself, ignores the role of power relations
and has a unilinear evolutionary approach. Within the framework of these
developments on the sociological approach to the professions, Turner's first
criticism is especially relevant for this study, since it allows us to find out
whether Turkish doctors share the same "idealized" view .
If we return to the examples of Dr. Merit; and Dr. Ttirkcan, we see
that they idealize their profession mainly before and during the medical
education. The unpleasant experiences they had during professional
practice and their general living conditions affected not only their views
about medicine, but also their professional plans. However, in terms of
idealization, in Linde's (1993) tenns, a sense of continuity through time
115
could still be fOtmd in the accounts. In order to study how this notion of
idealization is distorted and reformulated in a different way, we have to
study how the accounts of Dr. Merir; and Dr. Tiirkcan's professional life
story continued.
Dr. Merir;, whose ultimate aim was to help the people who are really
in need, such as children as I have mentioned above, became frustrated
during her specialization period, when she understood that doctors cannot
cure every illness and they cannot even be totally certain about the outcome
of their medical practices. Her dramatic narrative about an unexpected
death of a baby because of an extremely rare allergy to a treatment was
evaluated by her that medicine is not like a "machine" where "the
usefulness or harmfulness is measured". According to her, there is an
important element of uncertainty in medicine to the point that "chance"
plays a crucial role. In the case of the death of that baby, she implies that
she was mainly unlucky, however, she said that she felt "devastated" :
"It was actually a very sorrowful death for me .. .It stemmed from a
medical fact which you cannot even detect with a microscope. It was not a
case of doctor's malpractice. But I was a new assistant and until this was
checked I wanted to die. I tried to resign and thought that this profession is
not suitable for me" (11)
This event took place during her assistantship where a transition
from being a student to a doctor is realized. The account of the event stands
as a tInning point in the course of both her professional experience and the
interview which continues mostly with limits of medical practice and
professional problems in the medical realm .
116
Dr. Meri~'s idealized view about medicine is replaced by "bitter
realities" also due to the application of "non- academic"- mainly personal
and political- criteria in choosing chief assistants, the extreme bureaucracy
in the hospital she works and the lack of a patient's trust in doctors. The
first point is highly elaborated, since she is also among the people who
could not stay as a chief assistant in the university, despite her being
hardworking and her ultimate aim of pursuing an academic career.
According to Dr. Meri~, these accounts indicate that idealization of the
profession is compromised when a person is faced with actual power
relations and occupational control after the medical education where
professional solidarity and communal ties were much more pronounced.
She claimed that each medical student thought that everything worked
perfectly in the hospital and university until they began to work there as
assistants. She also added that the professors were much more helpful and
supportive during the education.
Dr. Meri~'s claim about these criteria is in line with Linde's
argmnent on professionals: "Reasons for unsuccessful choices are either
shown to be external.. or / specifically evaluated as undesirable because of
speaker's character traits". Linde says that she has never encountered a
sentence like "I was bad at it" among the reasons for leaving a career
choice in her interviews. Similarly, Dr. Meri~ mentioned a mnnber of
interrelated factors which led to her leaving the university hospital at Capa
and her academic career:
"It was imposible for me to stay at Capa .. .1 was not an ambitious
assistant .. .! mean in terms of getting close with professors, anyway I am
not that type of person who shows off. They had never viewed me as a
117
valuable assistant. I was an average assistant, 'Who always did whatever
was asked of me and stayed silent. However, the criteria for staying in the
university was highly different, they were nothing to do with how you did
your work and your knowledge. The doctor who was working with me at
that time had a very highly level of medical knowledge ... He used to read
much more than me. He had the top score in the TUS examination, they
did not accept him either. He was not suitable for their criteria.Their
criteria was not making research or dealing with patients ... Their criteria
were too political. It is the same "oriental mind" which you can find
everywhere in Turkey. they chose people who are like them.
Unfortunately, this may even be in tenus of physical appearance ... The ones
who look good, show off, are charismatic, have a high socio-economic
status and who are from private high-schools (are chosen) ... We could guess
in advance who would be chosen and 'Who would not .. .I do not know how
they collect this much information on you. Each time some of the
assistants get particularly close to the professors and spy on you for these
professors". (12)
She also added that 'She did not want to stay in the university at that
time, since she considered the economic difficulties of her family and saw
that the material benefit would be inadequate in the academic career.
Coming from a family who immigrated from Bulgaria about twenty-five
years ago, Dr. Meric experienced severe social and economic difficulties
with her family and is a good example of a recent heterogenization of
medical students and doctors in tenus of socia-economic background as we
saw in the first chapter. Hence, she felt economically and socially
responsible for her family which strongly supported her education since
118
she was the only person who went to university, and said that now in her
turn, she has to give a priority to economic concerns to support her family.
She viewed this situation as another reason for her leaving academic life
and starting to work in a private hospital.
Considering that all of these explanations are given as reasons for
her inability to pursue an academic career as she had planned, the large
variety of the reasons indicate that she has often thought about this issue
which affected her self-confidence, her professional and self presentation.
Linde calls this kind of accounts as "multiple non-contradictory accounts",
where a "rich multiple causality" is maintained through using different
type of explanations which support each other. The explanations of 'Dr.
Merir; also function as reasons for a highly unexpected break in an
unquestioned causal relationship between being hardworking and
successful, which is especially found in Dr. Merir;'s accounts. This is about
a general ideology which states that being hardworking will ultimately lead
to success as I have discussed at the beginning. This ideology is related
with the idealization of the educational system and health sector in the
sense that the scientific' and academic- therefore "neutral"- criteria are
dominant in determining professional positions and relations. This notion
of idealization and the belief in the immediate linkage between hard work
and success, were no longer valid in Dr. Meri~'s case, during her
assistantship due to the deviations from the scientific criteria.
The deviations from these criteria through using individual or
"poli tical" preferences in the appointments has been a common accusation
in the health sector through the history of modem Tm-kish medicine, as we
have seen in the first chapter. However, the recent political
119
heterogenization among the members of the health sector, alleviated these
debates on corruptions in appointments. Although the use of non-academic
criteria is criticized through relating it with the "oriental mentality"therefore
implying its irrationality -, Charles L. Bosk (1979) states that one
of the most important normative criteria in promoting the assistants in an
"elite teaching hospital" in the US, is the assistants' maturity which is
measured by their relationships with the nurses, other doctors and
patients, and their "general level of enthusiasm" in working. Therefore,
the criteria that led to Dr. Meri~'s complaints, are by no means peculiar to
the Turkish aca9.emic and medical realms as she argued, but a normative
rule which can be generalized in different contexts. However, in this
context, deviation from· the idealized view and practice of medicine mainly
through the external professional conditions, is skilfully presented as a
personal choice to modify a career plan rather than a failure in adapting to
the medical system and professional relations enacted wi thin this system.
Accordingly, her being hardworking which is a frequent motive in the
interview, acquired an additional meaning of perseverance, since she
always worked as much / as she can and, because her work was not
appreCiated as she expected, changed her workplace to continue to work as
before in order to cope with external problems.
Despite the fact that her idealized expectations about the profession
have not been met, Dr. Meri~ still provided a continuity through time by
mentioning her future professional plans which are in line with her aims
in being a doctor. Although the "non-academic evaluations" in the
academic environment and economic difficulties led her to give up the ideal
of reaching the highest point, i.e becoming a professor, she still maintain
120
one of her aims in being a doctor and choosing a specialization field: She
consistently wanted to help the living beings who really need help, such as
babies and baby animals, through her daily and professional life.
Accordingly, working in remote parts of Anatolia where people are much
more hopeless in tenns of their health condition, is still among her plans
for the futme, when she will have more money to take care of her family
with whom she has very close emotional and material ties.
Dr. Ttirkcan who had more general social concerns than Dr. Meri~
in becoming a doctor, has lost her belief in the sincerity of her patients after
certain events which she narrated as a turning point in a similar way with
Dr. Meri~. Dming the first years of her assistantship, she realized that her
patients deceived her by pretending that they were much poorer than they
actually were in order not to pay the treatment costs. Due to these events
where the patients abused her good intentions, her "idealism" was
compromised and turned into a "materialism". She is also disappointed by
the patients who never really appreciate her medical treatments and want
more care mostly through unacceptable ways such as the patients who
wanted her to take care of them even during her vacation. Nevertheless,
her ideal of "being useful to the Tmkish society" has continued with her
stress in the "university professor and scientific researcher" part of her
professional identity. When she lost belief in the sincerity of the patients for
whom she wanted to improve all aspects of their life, including their
health, she shifted the focus of her interest to her students whom she now
fully supports through providing research opportunities in her private
clinic and giving all kinds of academic help in order to raise "many new
121
doctors who will be useful for society". Her patients also became her objects
of scientific research rather than subjects of care.
The Changes in the Views on Medicine, Routinization and Critical
Moments: The routinization of work is another factor which undermines
the idealization· of medical knowledge and practice. All of the doctors say
that after a certain point their profession becomes "routinized" and that
they are used to its positive aspects such as the" pride and joy" of saving
someone's life as in the example of Dr. y~, who worked for five years in
the emergency section before he became an orthopedist, and its negative
aspects such as the inefficiency of the Turkish medical system. The
negative aspects are represented mostly as external factors that are beyond
the control of these doctors. Especially the problems in the medical system
and hierarchical relations between doctors are seen as deviations from an
ideal scientific order from which they had expected to benefit all through
their professional life, since they evaluated this order as suitable for their
character traits which brought them success and an outstanding position
in the first two periods of their professional lives.
Before becoming directly involved in the professional relations, these
doctors are, in general, more inclined to view their profession as having a
high degree of professionalization where altruistic values are considered as
the main prinCiples, due to the influence of social values that were
attributed to doctors and professional socialization that they underwent in
the faculty of medicine, as I have discussed above. However, actual
professional life is accounted to be full of non-academic, non-scientific,
bureaucratic and even commercial (mostly in the case of private hospitals)
122
applications which prevent the maintenance of altruistic values, and make
doctors compromise their ideal view of medicine and their altruistic
professional work, in favour of "materialism". These applications which
obstruct the development of professionalization are related with the abuse
of power relations mostly by the professionals in superior positions, whose
decisions are crucial for the career of their subordinates.
Besides routinization and non-scientific criteria, there are also
challenging critical moments in medical operations where the doctors
become aware of the limits of medical practice in the sense that it fully
depends on the particular initiative and skills of doctors. Dr. Meri~ and Dr.
Sarol differ highly in terms of their views on the critical moments in
medicine. Their personal and professional approach to these vary mainly
because of their professional experiences: Dr. Meric; stressed the elements
of tmcertainty and chance in medicine and told about the death of a baby
during her assistantship in a highly dramatic way, as we have seen above.
Dr. Sarol also mentioned a critical point where medical knowledge by itself
is inadequate, and an outstanding degree of skill and experience are
required. He compared doctors professional experiences in these moments
to the work of bomb disposal expert, as we have seen above in terms of how
they both lead directly other people living or dying. However, there is a
crucial difference between these do.ctors with respect to their emotional
reaction towards this critical point: Dr. Meric; who. always struggled to
reach the highest place, becomes anxious when she is faced with a critical
moment because of the fear of doing something wrong or in an inadequate
way, whereas Dr. Sarol who evaluated himself as highly skilful and
successful, feels a "special pleasure" in these moments where he can
123
demonstrate his skill to the participants of the operation. Several times in
the interview, as if to give an external proof of his skilfulness, he talked
about a large amount of people varying from highly experienced doctors to
nurses who participate in his operations in order to learn from his skills or
just to admire his skill. Although the difference in reaction may be partly
explained in tenns of different degrees of self- confidence, it is mostly due to
different ways of experiencing the social closure within the professional
realm: Dr. Sarol who is well accepted in professional circles and
appreciated by his superiors, did not talk about experience of a professional
failure. However, Dr. Meric;:'s major aim. of being a professor has not been
realized because of the "non-academic" criteria that are used in choosing
the chief assistant, according to her.
Reconstructing Self-consistency and Continuity through Time~ SelfReflexivity:
The doctors whom I interviewed, do not want to represent their
professional life as "drifted" by the external conditions which I have
mentioned above, in line with the Linde's discussion about the American
professionals' accounts about their career planning patterns. So far, we
have seen that the doctors used several strategies to indicate their initiative
in providing the consistency between their character traits, professional
perspective and experiences at work in the third period of their professional
life. They also gave examples of " bad doctors", such as "the assistants who
spied on their colleagues for their superiors" as in Dr. Meric;:'s example.
These "bad doctors" complied with the professional rules or adapted to the
"external factors" even if they are not consistent with their character traits
and professional perspective,. In contrast, the doctors whom I
124
interviewed, stressed the consistency between their character traits and the
particular specialization field they chose, solved a case of inconsistency
between their professional perspective and external relations by changing
the workplace in order to work in line with the scientific criteria they were
used to and activated different parts of their professional identity in order to
reach their professional aims.
However, these efforts of rebuilding self-consistency are not smooth
processes as they are presented in the interviews. They involve a selfreflexive
perspective which can particularly be found in the accounts about
the modifications in a career plan or professional perspective and identity,
which happened due to the inconsistencies between the ideals and external,
"real" conditions. This is also related with the maintenance of the moral
value of the self, since the doctors re-built a continuity through time with
respect to the relationship among their character traits, professional
perspective and professional experience. Hence, by doing it that way, they
would like to indicate that their individual and professional self are still
consistent, therefore they are always "good doctors" as they had envisioned
to be before and during the medical education, despite the problems coming
from "the external factors" in the work life.
Linde (1993) determines self-reflexivity as the differentiation of self as
the "narrator" and the "protagonist" in a narrative, so that the former can
evaluate the latter with the critical perspective of "an outsider". Selfreflexivity
allows editing of certain aspects of the self in relation to the time
dimension by differentiating protagonist of the past and narrator of the
present. This is especially relevant in building a relationship between how
they see themselves and how they think they are seen by others, especially
125
by their superiors. For example, there is a tone of self-criticism in Dr.
Merie;'s evaluation of herself as a silent, modest assistant who merely
accomplished her professional duties. The alternative is to be
"charismatic"- which means good looking and sociable according to her
definition- and to form close personal relations with professors as a part of
their strategy to impress them. However, this categorisation of assistants
does not involve a pure self-criticism, since Dr. Merie; was against being a
"flatterer" type of assistant , since this does not fit her principles about her
scientific and academic work. She also said that she maintained her
professional principles and began to work in a private hospital where she
can pursue these principles.
Dr. Tiirkcan also has a self-reflexive style, in telling how her
professional views have changed from "idealism", expressed as being
useful to patients and to Turkish society, to "materialism" where she does
not let her"romantic concerns" interfere in her relations with her patients.
She related her idealism to her youth, to her romantism, to her interest in
the novels of Cronin and to the humanistic political tendency prevailing in
the university where she was a student. During the inteIView, she
evaluated that period of time and located herself within that period from the
point of view of a middle-aged woman with a highly established scientific
career. The main cause of the change in her professional
conceptualizations in time is given as her loss of belief in the sincerity of
patients and the economic and administrative problems she has
experienced during her professional career. Nevertheless, for her, she
seems to balance her past ideals of becoming useful for the general
improvement of the society, and her actual professional position with her
126
contributions to medicine through her scientific research and with her
academic career where she educates many new doctors "who will be useful
for Turkish society".
Unlike Dr. Tiirkcan, Dr. Sakin has not yet accomplished a balance
between her ideals about her profession and her professional position. As a
primary reason of her decision about being a doctor, she mentioned her
envy of the doctors who used to visit her father in his phannacy, since they
work independently and seem to have highly flexible working hours. She
said that her main aim in entering the faculty of medicine was to work
independently, as those doctors, in the future. She now evaluated this
reasoning as "childish" and admitted that she did not know that she would
become an assistant in a state hospital after university education, and
therefore be a state employee whose professional practice is strictly limited
by rules and procedures. However, in order to establish continuity through
time with respect to her professional plans and perspective, and
consistency between her professional experiences and plans, Dr. Sakin
mentioned that she was planning to realize her ideal of independence by
opening their own private/ clinic. She also talked in detail about how much
money she had to save for this purpose and argued that she clearly had to
work in a private hospital in order to collect that sum. This shows that she
had not given up this idea totally, even though she evaluated it as
"childish". In this case, we see that, in terms of time dimension, the
inconsistency between the professional plans of the past and the present
professional position is reconciled by mentioning future plans which are in
line with the ones in the past. Therefore, the continuity in time in terms of
the presentation of the self and professional plans is maintained.
127
Conclusion: In general, the doctors whom I interviewed presented
themselves in a highly self-consistent way both in personal and
professional terms, despite the gap between their professional expectations
of the past and their current views about their profession. They try to fill
this gap through various strategies of career planning such as choosing a
specialization field that is consistent with their own character traits, trying
to find the type of hospital where they can work according to their
professional principles or underlying different aspects of the identity of a
"good doctor".
During the first period of professional life which involved the decision
to become a doctor, the interviewees mostly reflected the social attributions
to this profession, and underlined their success and outstanding position
among other people, with respect to their character traits of being
hardworking, clever and courageous. These character traits were also
implied as being required to be a doctor both for the first as well as the
second period of professional life which consist of the medical education.
However, these traits were more affected by the group dynamics among the
members of the faculty of medicine. In the third period the character traits
were similar to the ones which were emphasized in the former periods, but
they acquired a more individualistic significance. In this period, the maj or
consistency was drawn between these character traits and the choice of a
specialization field. In contrast, this period also involves disappointments
that stemmed from the "external" views and practices that are thought as
deviations· from the idealized, altruistic image of the profession. However,
this image is also determined to change as the professional career of the
128
doctors becomes established, since "idealization" and mystification of
medicine are subordinated with "materialism" and "routinization" 0
The doctors whom I interviewed eventually notice that
professionalization, as it is discussed in Turner, can not be fully realized
mainly because of the complexity of power relationships which are based
not only on scientific or academic criteria, but also on a hierarchical order
where the super!ors have the right to impose their "personal" rules and of
the state's restrictions or the bureaucracy in private hospitals which
routinize the profession. These "external problems" were not experienced
particularly by my interviewees, but, as we have seen in the first chapter
they were among the main problems in the Turkish health sector in the
1980's and onwards when my interviewees mostly began to pursue their
profession. These problems also influenced the process of professional
socialization which my interviewees and other doctors from their
generation had undergone during and after their medical education.
Accordingly, even though they mostly accepted the basic aspects of
professional perspectives they had been given, they have also questioned it,
in line with their individual experiences, character traits and particular
social conditions. Despite the fact that they question the professional
perspective and that they sometimes take a personal distance from it, they
are generally well aware of it and often refer to its basic aspects such as the
prevalence of scientific criteria, the idea of social progress and doctors
important role in this process, in their comments about their professional
self, their profession, the health sector and society. Hence, they indicate
that they fully internalized the basic aspects of the professional perspective,
which were also consistent with their individual character, so that, in line
129
with this professional perspective, they can make legitimate political
judgements about their society and have a social mission to improve the
general social condition.
Despite the problems, these doctors still present themselves as "good
doctors", since their professional decisions are mostly shaped by their
major character traits and idealized views on medicine and science, rather
than a passive obedience to the "external" professional. applications which
they do not approve. Through their character traits which were presented
as major requirements to be a doctor, they had reached the outstanding
success of entering the faculty of medicine, the first step to be a doctor, and,
therefore, they have differentiated themselves from lay people and
attributed themselves a higher position. In the following professional
periods, the interviewees differentiated themselves from the other doctors,
by implying that they are "good doctors" because of the consistency between
their individual and professional self which means a harmony and
continuity through time with respect to their character traits, professional
perspective, professional experience and future plans. The outstanding
position these doctors attributed to themselves both in relation to lay people
and other doctors, and their overcoming external social and political
problems which they have experienced in their workplace, without
compromising their character traits and professional perspective on the
last instance are presented as two important sources of legitimacy for them
to make social and political judgements and to have a social mission about
the health sector and society in general. They also generalize their views
and experiences on the health sector in order to make comments about the
social and political condition of the country, since they stressed that all of
130
the problems encountered in Turkey are reflected in or find their
counterpart in the Turkish health sector.
In the last chapter, I would like to study how the recent social
problems of the country are reflected in its health sector, particularly in
terms of the changing social position of doctors and, accordingly changing
relations between doctors and patients. Through their experiences in the
health sector, the doctors understood that the typical images of doctor and
patient, and the view about the ideal relationship between these two people
which were given them in the process of professional socialization, were no
longer valid. In the next chapter, I would like to study how these images
were changed, and how the doctors still built a legitimate power position for
themselves despite these changing relations and images. Again, as in this
chapter, I will mainly benefit from the interviews and try to find out the
interviewees' ways of establishing legitimacy to make social judgements
from their accounts on the place of doctors in society and on the
relationship between doctors and patients.
131
Chapter 3
The Social Position of Doctors
and the Changing Doctor-Patient Relationship
In this chapter, the ways in which the new generation of doctors
maintain and secure their position of social authority with respect to the
changes in the social view on doctors and in doctor-patient relations will be
covered. In studying these issues, I will mainly benefit from the interviews
I made with a group of doctors mostly from the younger generation, as in
the previous chapter. The social structure and cultural values in Turkey
have undergone a period of rapid transformation since the 1980's, which
have influenced particularly the sectors of health and education. The
ability to provide and benefit from all types of medical seIVices have become
a conflictual issue in society because of the increasing economic inequality
among different groups of p/eople and the recent variations in the type and
quality of medical services. In this framework, Helman's (1990)
conceptualization of the medical system as "an expression of- and to some
extent a miniature model of- the values and social structure of society from
which it arises" helped me to study how the changes in the general social
structure and values affected doctors as a professional group and their
social position.
Helman indicates how the dominant ideology in a society may
influence the views on health and medical care, and, therefore the policies
132
which are conducted in line with these ideologies and views. He argues that
depending on the dominant ideologies of the society such as capi talis~ the
welfare state or socialis~ the health and medical care may be viewed as a
source of profit and "a commodity to be bought by those who can afford it"
as opposed to many poorer members of the society who are excluded from
this syste~ or as a basic right of citizenship where very old and poor people
are particularly provided "with free or relatively inexpensive health care"
(Helman, 1990).
However, the dominant ideology and social view on the health care in
Turkey cannot be labeled in such definite terms and have changed
particularly in the last three decades. Particularly, the governments'
efforts to fully adopt the contemporary Western capitalist system with all of
its poliCies including privatisation after the mid-1980's, are a distinct
departure from the health policies of the 1960's and 1970's, which were in
line with the socialization law and political concerns of that time, and
which favoured the access of socially and economically disadvantageous
groups to medical services. Hence, despite the efforts of the medical
chambers to bring back the, view of the health care as a basic citizenship
right, the view of health care as a commodity and the policies in line with it
have become more prevalent especially among government members, and
among businessmen who have begun to make considerable investments in
the health sector (Gokc;ay, 1996) (Anoglu, 1996).
These changes have led the doctors to evaluate their professional
group and its social position in new terms, since their professional
perspective 'has been shaped mainly by the view of health as a basic
citizenship right during their professional socialization in the university.
133
The changes in the professional concerns and perspective of doctors have
affected negatively the social image of this professional group and negative
images in the society such as "greedy doctors" have become prevalent. The
professional experiences of doctors are influenced by the changes in these
views and policies, and the doctors try to incorporate their newly developing
economic concerns into their professional perspective. The doctors whom I
talked to, argued that their relations with their patients have altered
dramatically in line with the changes in the social image of doctors.
Therefore, doctor-patient relations have become a crucial domain for the
doctors to display their professional and social concerns in order to
maintain their position of authority despite the negative social view of them.
The Characteristics of Doctor...;Patient Relations: Doctor-patient
relations is a multidimensional issue where the two groups have different
conceptualizations of health and illness and interact in accordance with
highly unequal relations of power and authority (Helman, 1990). Parsons
(1951) is among the first social scientists to conceptualize medicine as an
institution of social control,in a modern society where deviant behaviour
can be legitimately considered as an illness providing that the deviant
person acts according to the socially dermed "sick role". This role includes
certain rights and obligations that the "sick" person should be in
compliance with, such as being diagnosed as such and a treatment plan
which is designed in accordance with the prevalent medical model and
methods which are applied by the doctors. In stun, in a modern
medicalized society where the biomedical model and techniques dominate
the health sector, the patients have to subordinate their own views about
134
their health condition to the doctors' medical explanations and fully obey
the treatment plan which is designed by doctors (Conrad, 1992), (Helman,
1990). Therefore, Helman views the doctor- patient relations as
"transactions which are separated by social and symbolic power" since the
doctors' social and symbolic authority and power come from the fact that
they are socially considered as the only people who can make valid medical
judgements and treatments particularly in a hospital setting thanks to
their medical education and experience.
In addition to these statements on the doctor-patient relations, which
are made in general terms, Helman also argues that the context where the
doctor-patient consultation takes place is also influential in shaping "the
types of communication between doctor and patient". He mentions two
aspects of this context: The internal context which consists of "prior
experience, expectations, cultural assumptions, explanatory models and
prejudices (based on social, gender, religious or racial criteria) that each
party brings to the clinical encounter" and the external context " which
includes the actual setting in which the encounter takes place and the
wider social influences acting upon the two parties-such as the dominant
ideology, religion, or economic system of the society-and which in turn
helps to define who has the power in consultation and who does not".
Therefore, the patients' full compliance to the medical explanations and
treatments is not always guaranteed, but rather depends on the contextual
elements that are mentioned here. Besides, doctors and patients negotiate
their explanations of health and illness to some extent since the doctors
have to b~ aware of and act according to the cultural values and social
135
status of the patients in order to build a common communication pattern
for an efficient treatment.
In the last two decades, the patients have suffered from the problems
in the health sector and a negative social view on doctors became prevalent
in Turkey. As a result, the patients' attitudes and behaviours towards
doctors have been transformed from one of compliance to distrust and
disrespect. Therefore, Turkish doctors began to look for new ways of regaining
their social prestige and providing patients' compliance such as
contradicting the negative images of doctors through their professional
concerns and experience. Before studying how the doctor-patient relations
have changed, I would like to briefly tell about the doctor-patient relations
in Turkey before the 1980's.
The Doctor-Patient Relations in the Past: When describing the
doctor-patient relations in the past, the doctors whom I talked to, gave
examples from an idealized period of time when their own family's
behaviour and attitude towards doctors were completely based on the
feelings of respect and trust in line with what they have learned as a basic
rule in the faculty of medicine. They compare and contrast these examples
of the past with today's professional experiences in order to bring a
historical explanation to the changing doctor-patient relations. These
examples also serve them to differentiate their own family from their
patients in terms of their attitude towards doctors. For instance, Dr. y~
told about how his mother scrupulously prepared him for his visit to the
doctor wh~n he was a child, even though his parents were quite poor and
had a low level of education similar to his patients. He gave a detailed list of
136
what his mother did to him and his brothers before they saw a doctor, "in
order not to experience a shameful situation in front of the doctor":
"In my childhood, when my mother took me to the hospital, even
though it was only for vaccination, she even used to cut our nails, change
our underpants. We used to take a bath, (since she said) perhaps the doctor
would want you to undress my son. In order not to experience a shameful
situation (in front of the doctor), we used to wear our most beautiful clothes
which were bought for holidays (bl!JTamlI./c eJbise). hence we had that
considerable feelings of respect and timidity when we were going to visit a
doctor". (13)
Dr. Tttrkcan, whose account about her family's attitude towards
doctors dated at least twenty years before Dr. Y~'s account which was
pertaining to the late 1960's, spoke about the family doctors who visited the
families in their houses and had a close relationship with the members of
the family:
"The house used to be cleaned before the doctor came to our house.
Even his payment was put in an envelop beforehand ... the coming of Cahit
Sami Giirsoy was like a festive event for the household members; my father
used to pick him up from his private clinic and people used to say "thank
you" several times to him. Now, of course, these kind of things have
disappeared. The doctors also do not go to their patients' house, I mean they
do not like to go there, unless they know the patients well and have close
re lations with them. But now they do not go often, they do not have time".
(14)
The accounts of the memories of the past which constitute a sharp
contrast with the evaluation of today's doctor-patient relation, implies that
137
crucial changes have happened in the contextual factors, in Helman's
terms, due to several interrelated reasons. The reasons were also given by
my infonnants in order to display the disappointments of doctors during
their professional experiences. They are also important in showing how the
doctors balance their economic and humanistic concerns with respect to
their relations with patients. The doctors from the former generations
played an active role in shaping the major social and ideological
movements wi thin the society since the birth of the modern Turkish
medicine. Thanks to this active role which had been shaped in accordance
with the process of the professional perspective's fonnation, these doctors
gained a considerable social prestige and position of authority in the society.
Relatedly, an idealistic image of doctors became dominant in the society, as
people who are altruistically devoted to saving people's lives, to improving
their health and having active social roles in shaping the modernization
process of the country along their progressive and scientific lines. This
socially privileged position was also reflected in doctor-patient relations
where a completely respectful and trustful attitude was almost taken for
granted by doctors, as we see in the accounts of Dr. Ya$ and Dr. Ttirkcan
above and in the written autobiographical accounts of the past where the
patients, besides the payment of the bill, gave valuable presents to the
doctors such asa ram in order to thank them and the families invited them
to their picnics (Sezer, 1953) (Minkari, 1993). As we saw in the first
chapter, the economic power of doctors was also consistent with their
privileged social position, since most of them came from families with a
high socio-~conomic status and their own income was also satisfying.
Although doctors began to express their wish to earn more from their
138
profession in the last half of the twentieth century. the economic problems
and fluctuations in the country did not seem to be highly influential in
shaping the doctor-patient relations until the 1980's (oncel, 1951) (Gokcay,
1996).
In these conditions, the doctors enjoyed a prestigious position and in
line with this position they acted with a missionary professional perspective
which included working toward transformation in the living and thinking
patterns in society according to the objective-scientific values of
contemporary Western societies. Therefore, the missionary professional
perspective of doctors and their social prestige as opposed to economic
concerns of both doctors and patients became the dominant factors in
shaping doctor-patient relations in the past. Dealing directly with
monetary issues in relation with doctors would be an indicator of the
patients' disrespect towards them and were socially evaluated as
unsuitable behaviour considering the doctors' social prestige, and this is
the reasoning behind the Dr. Ttirkcan's father's giving money to the doctor
in an envelop. However, the interrelated contextual changes in society
have altered the balance of social and economic concerns of doctors and
affected the patients' attitude towards them.
The Contextual Changes which have Influenced Doctor-Patient
Relations: One of the contextual changes which has influenced the
patients' attitude is the decline in the quality of medical education and
medical services after the 1980's due to the state's p0licy of privatisation in
the health sector which played an important role in lowering the sector's
share in the state's budget.
139
Together with the decrease in financial support to health. the rapid
and unplanned expansion in the numbers of faculties of medicine and
medical students caused a decline in the quality of medical education
(G6k~ay. 1996). (Sahip. 1996). Most of the doctors whom I interviewed.
complained about the crowded classrooms and laboratories• which
particularly hampered their active participation in the dissection of
cadavers and examination of patients. As a result. these doctors did not
view themselves as competent in terms of medical practice. and even felt
anxious and doubtful about the ways they would care their patient. This
situation is also a general problem for the last generation of doctors who
started their professional careers in the 1990's. Hence. the problems in
medical education have directly affected the doctors' professional
experience and the quality of their professional service. Some of the doctors
whom I inteIViewed confessed about their uneasiness in the examination
and treatment processes. which stemmed from lack of practice.
With respect to the medical seIVices. the typical result of the
governments' politics is the public hospitals' becoming overcrowded with
patients who wait for hours/in line in order to be examined, or who manage
to get an appointment for weeks later in order to be hospitalized and have
an operation. As a result of the growing economic problems of the public
health sector. it is becoming more and more difficult to open new state
hospitals and clinics, and enlarge the old hospitals in an efficient way in
order to respond to the medical needs of a rapidly growing population in big
cities like Istanbul. Moreover, the economic problems also lead to a
decrease in the number of personnel in the state hospitals. More and more
talented and yO'llllg doctors who have recently specialized in their fields
140
prefer to work in the private hospitals due mostly to economic and
individual concerns. Personnel are not replaced when they retire, since
their wages cannot be paid because of the state's policy to decrease the
professional positions in the state hospitals. The insufficiency in personnel
and in clinical facilities such as hospital beds are also accompanied with a
high-level of bureaucracy experienced in the admission of patients whiCh
adds another difficulty for the patients in the state hospitals. Most of the
doctors whom I interviewed said that the patients who had to endure a hard
and long time because of the large number of patients and bureaucracy,
before seeing them in the hospital, blame all of the problems that they had
encountered in the hospital on the doctors. For Dr. y~, patients ignore
the problems in the health sector, see the doctors as responsible for the
difficulties they experienced in the hospital, since they think that the
doctors have much more control over the hospital system and that they can
listen to their complaints and fmd solutions to them.
However, according to other doctors, there is another reason for the
patients' blam.ing the doctors for their problems in the hospital. For Dr.
Ttirkcan and Dr. Gok<:ay the particular political clash with the military
regime and doctors that were highly active in politics before the military
coup, as I have mentioned in the first chapter, led the military regime and
particularly Kenan Evren to campaign against this professional group with
defamatory speeches. These doctors said that these speeches presented the
Turkish doctors as giving a priority to their individual concerns rather
than worrying about the health condition and social situation of their
patients. Evren also criticized the former political activities of doctors for
undermining national unity and leading the country into terror and
141
anarchy (Gok~ay, 1996) (ArlOglu, 1996). Dr. TUrkcan said that these
speeches were largely covered by the state television and influenced general
public opinion.
The media has also continued to influence the public opinion on
doctors and remained as a contextual element in shaping doctor-patient
relations in the 1990's through "reality shows" which depicted poor
conditions of the hospitals and cases of mal practice in a sensational way.
The doctors whom I interviewed highly criticized these programs; they
agree that the people have a right to be informed about the mal practices of
doctors, however, they stressed that these programs merely point out the
negative and sensational aspects of doctors and hospitals, but never give
examples of the happy events experienced in hospitals. Especially, Dr.
Meri~ said that she was very frustrated by the negative image given by
these programs and had even thought about writing a critical letter to one
of their directors. However, she also added that she has taught herself not
to let these programs frustrate her by avoiding watching them. All of my
infonnants agree on the crucial role of the media in propagating negative
images of doctors, such as "greedy doctors" in Dr. Caglar's tenns, whose
economic concerns dominate their professional experience and unskilled
doctors who are frequently involved in malpractice cases. However, the
doctors whom I talked to also implied that the malpractice cases might
actually became more frequent due to the decline in the quality of medical
education and admitted that the economic concerns of doctors have
increased due to heterogenization of doctors in terms of socia-economic
background.
142
As I have mentioned in the previous chapters, as more people who
were born and raised outside of the three main cities and who have low
socio-economic status began to chose and enter the faculties of medicine.
The economic concerns became highly influential in the changing
professional perspective and career patterns in line with it (Gokc;ay, 1996)
(Gokc;ay, 1997). The heterogenization among doctors has also gone
parallel to the process of differentiation in hospitals. In line with the
policies for the privatisation in the health sector, the number of private
clinics and hospitals has considerably increased. These hospitals have
become an attractive choice for the young doctors whose economic concerns
are dominant in planning their professional life. However, the doctors'
preference of the private sector has other, more complicated reasons which
stem from the changes in their political position and their relations with
the state, which will be discussed later. Despite the recent heterogenization
of doctors in terms of their socio-economic background and professional
career patterns, the doctors whom I talked to, still continue to view and
describe their patients as a totally different group from themselves, and this
also selVes as an explanation to the problems in doctor-patient relations.
Doctors' Evaluation of their Patients: The doctors whom I
interviewed, generally talked about the negative social attitude towards
their professional group with respect to its reflection on the behavioms of
their patients. In line with their argwnent about the social, economic and
poli tical problems of the country which fmd their immediate cmmterparts
in the health sector as we have seen iIi the first chapter, the doctors
evaluate the social attitude towards themselves through their experiences
143
with the patients. This also helps them to make generalizations about the
patients and to view them as an undifferentiated category. The image of the
patients is drawn by the doctors in very different terms than those used to
construct an image of themselves.
Although the doctors admit that the patients also differ in terms of
their socia-economic status and attitude towards doctors, they mainly
describe them from their own stereotypical images of the people who have
low-socia-economic status. Dr. Y a~, a male pediatrician who works in a
state hospital, argued about the importance of precautions that lay people
have to take in order to maintain their health status and prevent illnesses.
For him, the people who are not educated and intelligent enough to
understand the importance of these precautions, or who are too poor to
practice them, become ill much more often and visit hospital. Accordingly
he said that the people who are "rich, intellectual and have high social
status do not often become ill" in contrast to "the poor people who live in
squatter areas and who struggle hard to gain their bread-money" and who
constitute" ninety-percent of the sick people" who visit the hospital.
Similarly, Dr. Meri~ said that dealing with the rich patients is less
problematic, because they in general know how to take care of themselves
and their health and have the opportunity to benefit from all types of
medical seIVices any time they like.
Dr. T-urkcan, a female opthalmologist, stressed that she had felt
highly alienated in dealing with the patients in her early years of work.
The reason for her alienation lay in the difficulty of achieving a shared
comm:mrication with her patients, due to the differences "in their familial
backgroun~ their educational level and life style". She gave examples of
144
her misunderstanding of patients due to their low level of education: The
illiterate patients who try to identifY the letters from a distance, may call the
letter "E" as fork, since they may not know the concepts of left and right,
they may tell the directions of letters with the names on the wings that blow
from that direction.
The problems of different languages is also mentioned in several
interviews, since most of the patients in the state hospitals are recent
migrants from the South-Eastern cities and know only Kurdis~ due to the
recent mass- migration from the South-Eastern region. Although most of
the patients are generally accounted as having a low socio-economic
background and a low level of education, particular references to these
migrants prove that this group has other disadvantages such as linguistic.
Dr. Sarol, a male gynaecologist, said that in addition to their lack of
understanding. of Turkis~ these patients and their families do not know
anything about the rules of the hospital; for instance, in the middle of an
surgical operation of a pregnant woman, her husband may suddenly enter
the surgery room in a calm manner. Dr. Sarol said that if the doctors like
himself, tell the husband to leave the room in a polite manner he would not
understand anything and not quit the room, in contrast to the doctors who
shout at the husband angrily and make him go out immediately. He argued
that the migrant patients are more offended when they are not treated there
by the doctors or when they can not be hospitalized because of the
overcrowding of the patients, since they think that they are particularly
rejected by the doctors because of their ethnic identity as Kurds. Dr. Sarol
also stressed their ignorance and lack of intelligence as difficulties in
building a communication pattern. He said that most of his patients in the
145
state hospital did not really understand his explanations about their own
health condition, for instance, he could not properly explain the
menstruation cycle since he saw that "they do not have this intellectual
capacity" to tmderstand it. Similarly, Dr. Sakin, a female gynaecologist,
said that most of her patients cannot remember when they had their last
menstruation period and ask their husbands who record this period in
respect of birth control.
Dr. Sakin not only said how she viewed the patients, but also
commented about their familial relationships which put her patients in a
socially disadvantageous po-sition. For her, the young brides are oppressed
by their mother-in-law and husbands at home, hence, in order to attract
their attention and to be cared, for the young women pretend to faint and
their husbands take them in their arms and immediately bring them to the
hospital. Dr. Sakin and Dr. Caglar stressed that they often accept patients
alone in the examination room, which is highly unusual since most of the
patients are accompanied by their relatives and neighbours everywhere in
the hospital. In this way, they argued that they are able to diminish the
negative effects of these people to the patients' social and medical condition
to a certain extent and that they can talk with the patients privately and,
hence more openly, about their medical situation. Dr. Merir;, a female
pediatrician, also said that, one of the reasons why she preferred to deal
with children is that the adult people complain about their health problems
which mostly stem from their psychological rather than physical condition.
Both of these doctors said that these patients should go to a psychiatrist
rather than a doctor.
146
These two doctors' clear separation of psychological and physical
problems both in tenns of conceptualization and treatment is related with
the perspective which they acquired in their medical education and
professional practice and which enables them to make legitimate medical
judgements on the patients' health condition by "medicalizing deviant
behaviour as well as many of the normal stages of the human life-cycle ", in
Helman's terms (Helman, 1990). Doctors scrutinize their patients' social
and psychological situation in addition to their health status in line with
their medical knowledge and professional perspective. Helman gives
examples from the critics of modern medicine such as Hlich, who argue
that the doctors through labelling their patients as ill, incurable,
malingering or hypochondriacal, try" to control the behaviour of the
population". Conrad defines this concept of medicalization as a process
which occurs at the conceptual level where the problems are "defined and
ordered" in medical terms, the institutional level where specialized
organizations where doctors have effective roles, may adopt a medical
approach to treating a particular problem, and finally at the interactional
level where doctors are most directly involved in the definition ofa problem
as medical or social. In the last level medicalization occurs as part of a
doctor-patient relationship where the doctor has legitimate authority and
power to make a judgement on the physical condition of the patient
(Conrad, 1992). However, in the examples above, the medical perspective
which was given to the doctors leads doctors to go beyond the aspects of the
physical condition in their evaluations about their patients. It also shapes
the doctors' judgements about the psychological traits, social relations and
life-style of the patients. The doctors who define themselves as having a
147
modern life-style in accordance with the scientific and positivistic values
that they have acquired since their medical education, talk about their
patients in opposite terms, such as having traditional and religious life
patterns, lacking a scientific mind and education, finding temporary and
primitive solutions to their social and medical problems and acting with
their emotions rather than their limited reasoning capacity. The doctors'
observation of the family members of the patients who accompany them in
the hospital and of the social relations between these family members and
patients also provide clues for doctors in order to make judgements about
the social position of the patients.
The medical perspective which is first given in the faculties of
medicine, is in line with the "basic premises" of the biomedical model
where a clear-cut mind and .pody dualism is conceived (Helman, 1990).
Other basic aspects of the biomedical model as given by Helman, are also
implied in these doctors' examples. The doctors evaluated the real reason
behind the patients' complaints as psychological through conducting
scientific and objective tests. Complying with the premises of the
biomedical model, the doctors' do not consider a complaint about health
status as a physical problem that is to be cured by medicine, unless it is
scientifically detected by the objective medical tests (J ackson, 1994). Hence,
they gave priority to the explanations which are made according to
scientific rationality and objective, numerical measurement. However, in
evaluating the results of these medical methods, they go beyond making
medical judgements about the health condition of the patients through
evaluating and trying to improve the social and psychological condition of
the patients.
148
Another premise of the biomedical medical model is "the emphasis
on the individual patient rather than on the family or community". This is
not or probably can not be realized in Turkey, since doctors have to consider
the characteristics of the family or community members who have a
considerable influence over the patients' decisions on their health condition
and who often accompany the patients in the examination room. For
instance, Dr. Sakin angrily spoke about her patients who compare the way
they are treated in the hospital with the treatment of their neighbours and
want the same treatment as their neighbours even though they do not have
the same illness, since they trust their neighbour's medical evaluations
more than the prescriptions of their doctor. Through their comments on
the family and commmlity ties of their patients, the doctors also make
generalizations about the social relations in Turkey, and therefore enlarge
the scale of their social judgements.
The doctors' judgements about the poverty, low level of education,
ignorance about science and medicine, traditional views and life patterns
in society through their evaluations of the patients' behaviours and
illnesses contradict with ope of the most important criticisms of the
Western medical system, in the sense that it ignores that "much of the illhealth
in Western society may be caused by other factors- such as poverty,
unemployment and economic crises" because of "its main focus on the
individual" (Helman, 1990). This criticism is not valid for the Turkish
medical system where the doctors are highly aware of their patients'
economic and social problems. This is highly related with the Turkish
doctors' active roles in shaping the social and political developments in the
country since the birth of modem medicine, as I have mentioned in the flrst
149
chapter. This active role is also influential in shaping the professional
perspective which has traditionally included social concerns for the whole
society. Moreover, in contrast to the general picture of Western doctors as
a privileged group who have a high social status and economic power
(Helman, 1990), Turkish doctors are influenced by the social economic
problems of the country daily since they are reflected in the hospital
structure as a lack of enough medical equipment or personnel. Their social
status and economic power are also lower than medical doctors' in the
West and have tended to decline in recent decades. Therefore, they have a
more immediate understanding of the social and economic problems in the
country than the doctors in Western countries, since these problems playa
more influential role in shaping their professional perspective and
experience. Especially, considering the inflation rates, the "real value" of
the wages of the doctors who work in the state hospitals have dropped
considerably in the last two decades, because the states' policies of
privatisation in health sector (Anoglu, 1996).
Despite the recent heterogenization of the doctors in terms of socioeconomic
background and pI:ofessional career patterns, they depicted the
patients not only by making a high level of generalization but also by
representing them as a totally different group than themselves in terms of
their social and cultural background. All of the doctors mentioned or
implied that they come from higher socio-economic backgrounds than their
patients, they are obviously much better educated and have much higher
intellectual capacity and concerns. However, besides these general
remarks, when answering specific questions about the differences among
the patients with respect to the type of hospital they attend, the doctors also
150
accepted that there is also a heterogenization among the patients with
respect to their social background and attitude towards the doctors
accordingly. Several of the doctors argued that the patients who come to the
private hospitals and clinics are from a higher socio-economic status and
have a higher education level. They added that these patients demand
more detailed infonnation about their health condition and the doctors are
more likely to have closer relations with them.
Dr. Saral who is highly satisfied with working in a private hospital,
said that his profession even helped him to build close and personal
relations with some of his patients whom he also meets outside of the
hospital. He argued that as a gynaecologist he becomes an "essential
person" in some of his patients' lives, since they may need him any time
during the day and they owe much of their happiness and life to him. For
him, these patients really appreciate his professional skills and "the real
value" of his operations, and they always do more than just saying thank.
you and paying a high price for their medical treatment, like bringing him
flowers and thanking him through announcements in newspapers.
Similarly, Dr. Sakin says that the patients who come to the university
hospital are more concerned about their health condition and behave more
respectfully towards the doctors. Dr. Ttirkcan made a similar
differentiation between the patients who come to the university hospital by
making an appointment by telephone and the patients who come without
giving any notice.
Despite these comments about the different kind of patients, the
overall evaluation of the patients as an uneducated group with a low socioeconomic
status is much more common in the doctors' oral accmmts. This
151
type of evaluation supports their prevalent argument which is about the fact
that the patients and the society in general, do not have enough intellectual
capacity to appreciate the value of the doctors' professional efforts and
skills. The degree of doctors' differentiation and alienation from the
patients is so high that the doctors are surprised when they encounter a
patient with a similar social background and interests as them. For
instance, Dr. Sakin who saw that one of her patients was reading "AkttieJ H
( a popular weekly magazine) in her hospital bed, said that she was very
surprised and called her colleagues to witness the situation. She said that
all of the doctors were so happy in seeing "that kind of patient" that they
gathered around her and asked several times about her health and whether
she wanted anything from them. These type of patients are usually
evaluated as nice surprises and exceptions, particularly in the accounts
about the professional work in the state hospitals. These accounts are
prevalent in all of the interviews, since in their specialization period which
lasts from two to six years, all of the doctors must work in the state
hospitals. The doctors acquired a considerable professional experience in
the state hospitals, and although most of them work in the private hospitals
from time to time on a part-time basis and in infonnal ways as I have
mentioned in the first chapter, working full-time in a private hospital is
still a recent phenomena about which the doctors have certain professional
doubts. Therefore, the generalization about the patients in tenns of their
education level and social background is partly due to their common work
experience in the state hospitals where the patients are more in accordance
with the stereotypical images of the doctors'than the patients in the private
hospital. However, these stereotypical images of patients also help the
152
doctors to explain the problems they have encountered in their relations
with patients. With their low socio-economic background and education
level, the patients cannot evaluate the professional performance of doctors
properly and may think that the doctors get more money than they deserve
under the influence of the "greedy doctor" image that has become prevalent
in society and that is propagated by the media. The doctors whom I
interviewed were highly concerned about differentiating themselves from
the negative images in society, which also contradict with their idealized,
altruistic view of their profession. Although, they admitted that there
actually are doctors who fit these negative images, they have put them in
the category of "bad doctors" which is generally an exceptional category and
does not include themselves in any way.
The Professional and Economic Concerns of Doctors: As we have
seen in the last chapter, the doctors whom I inteIViewed, stressed how hard
they had worked, what kind of difficulties they had to overcome, and which
aspects of their personal lives they had to compromise in order to become
doctors, in order to legitimize the fact that they deserve an outstanding
position in society, since only a small group of people have the ability to
reach this professional position. In line with their outstanding position,
they also expect a high degree of social prestige which should be reflected
in the patients' respectful and trustful attitude towards the doctors.
Moreover, according to the doctors' accounts, from the beginning of their
education in the faculty of medicine and onwards, they have learned to
evaluate their 'social position in that way, as a part of the professional
perspective that they have acquired. This perspective basically taught them
153
that their profession is one of the most sacred professions and the doctors
should act as "the hands of God" since they are dealing with life and death
matters. The "sacred" aspect of the professional related with the fact that
they save people's lives and maintain their health, "the most valuable thing
they own", in Dr. Sakin's tenns, is preserved. For Dr. Sarol, doctors have
an essential place in all people's lives because everybody badly needs a
doctor at some point of their lives.
It is interesting to note that the classification of good and bad doctors
is still mostly done by the informants through the idealized view of the
professional group in line with the professionalization theory as we have
seen in the second chapter. Accordingly, good doctors including the
informants themselves, are generally presented as doing their best to
preserve and improve htnnan health in contrast to the bad doctors who give
priority to their economic and individual concerns. My informants speak
about the professionally wrong behaviour of bad doctors such as
demanding unnecessary medical tests and performing unnecessary
surgical operations in order to make more money. Dr. Ttirkcan said that
there has always been a group of "greedy doctors who acted against medical
ethics" in trying to gain more money than the actual costs of treatments in
several illegal ways.
A similar kind of criticism of these kind of doctors came from Dr.
y ~ and Dr. Caglar, who said that a doctor should always consider the
economic and social condition of their patients and design a treatment plan
which costs less in the case of poor patients. However, they added that,
there are very few doctors including themselves, who paid attention to this
issue, since most of the doctors' only concern is "to get rid of the patient as
154
soon as possible" , since there are so many other patients waiting to be
examined in the state hospitals. These informants think that a greater
maj ori ty of the doctors are so concerned with themselves and their
economic situation that they are not really interested in their patients'
heal th and economic problems. For them, the economic and health
problems of patients are interrelated, since the patients who cannot or do
not want to afford the prescribed treatment, go to different doctors with a
hope of a less costly treatment or stop seeing any doctor with the thought of
they cannot afford any medical treatment. Both ways lead to a high level of
inefficiency in the medical treatment which is a frequent case with the
patients with a low socia-economic background who constitute the majority
of the patients especially in the state hospitals. Dr. Yru;; presented his
concerns as a striking contrast to that type of doctors, since he argued that
he can predict everything about his patients' family, economic conditions
and social background at first sight. He also gave an example of his correct
predictions that he always understands when he sees a female patient
entering his examination room, whether her bra is fastened with a pin
or not from the way this pa~ient is dressed.
For my informants, in contrast to the economic situation of the
patients, the economic situation and concerns of the doctors should always
be subordinated to their altruistic aim of improving the health of as many
patients as possible. This aim is also supported by the emphasis on the
sacredness of medicine and the professional activities of doctors, which
stems from their active role in saving people's lives and preventing diseases
and deaths.' This concept of sacredness also brings a social prestige to the
doctors and legitimizes their socially outstanding position. However, "the
1SS
bad doctors" who give priority to their economic and individual concerns
are the exact opposite of with this idealized image of altruistic doctors.
Accordingly, when trying to balance individual or economic problems with
altruistic concerns, all of the informants stressed that the satisfaction of
serving people dominates their economic concerns.
Even though, some of the doctors claimed that 'they deserve to earn
more money from their work, they always justified their demand by
pointing out that they had studied really hard to pursue this profession or
that they deal daily with crucial matters such as health, illness, life and
death. Dr. Sarol's case may seem to be a contradiction in what other
doctors said, since he emphasized his individual' and economic concerns
the most among the informants. He said that he tried to build an individual
professional perspective for himself, which is independent of any social
concerns, including the motto "serving the people", and that money is
required to maintain "a certain life standard" which includes
entertainment opportunities at bars and restaurants. However, in the last
instance, he added that he needs these entertainment opportunities to get
rid of his stress at work and to return to his work in the morning with "a
clear head". Hence, similar to what Dr. Ya~ said that he should not deal
mentally with his economic problems when he is with his patients, Dr.
Sarol stressed that money brings a certain living standard which offers
opportunities for him to get rid of his individual worries and stress in order
to work better in the hospital.
However, the doctors' stress on their economicconcems for different
reasons can 'be also explained by the recent heterogenization among doctors
in tenns of socia-economic background after the mid-1980's. The doctors
156
who come from families with a low socio-economic background and who
are materially supported by their families only to a limited extent in
contrast to their colleagues from the previous generations, have to support
their families themselves after being a doctor. ~ Dr. Merit; who came from a
family who migrated from Bulgaria two decades ago, is a typical example
of these doctors. She said that her family was already poor in Bulgaria and
had severe economic problems when they came to Istanbul. However, her
sisters and mother did not let her suffer from these problems during her
medical education by giving all of their extra money for her expensive text
books and other medical items. Now, being a doctor thanks to their
support, she feels that she owes a lot to her family whom she has to look
after also in material terms. This is also presented by her as a reason for
her quittance of an academic career and her entering a private hospital, as
stated in the previous chapter.
Privatisation in the health sector is another contextual factor which
has changed the doctor-patient relationship, particularly with respect to the
doctors' and patients' economic concerns and interactions. Privatisation
and the doctors who work in private hospitals on a regular basis are also
criticized by some of the informants, since they believe that the health
services are too essential and crucial activities to be commercialized. Even
though mostef the doctors work in private hospitals and clinics on a parttime
basis or on night-shifts ( gEce nobeti) , they conceive full-time work in
private hospitals as being a tiny part of a huge commercial system, the
main aim of which is to make as much as profit as possible rather than
improving the health condition of people in general. Dr. Meri~ admitted
that she had a hard time in explaining her colleagues the reasons of her
157
working in a private hospital. She angrily said that a colleague of hers,
even though he had also some work experience in private hospitals, blamed
the full-time doctors as their profession becomes similar to prostitution,
since they "sell" their medical skills.
Dr. Caglar, made a more moderate and refined criticism of
privatisation in the health sector by saying that the general logic of
privatisation which is "it leads to a competition which will eventually
increase the quality of health services", is not valid for the health sector
where all hospitals should achieve a standard level of "high quality" in
their services. Similarly, Dr. y~ said that in ideal tenns private hospitals
must be better than state hospitals only in terms of the minor services
which he called "hotel services" which are related to the decorative aspects,
such as the uniforms of nurses and the paintings in the wall rather than
medical treatment of the patients. In line with the professional perspective
they have received, most of the doctors argued for an ideal health system
where the patients who have the same illnesses should have the same
treatment with the same medical "quality", independent of their paying
ability. However, these doctors admit that when they began to work in the
hospi tals, they saw that the current health system is very far from this
ideal goal.
In criticizing privatisation, the doctors acted in accordance with the
professional perspective they had acquired during medical education,
which includes social concerns especially with respect to the necessity of
providing health services to the socially and economically disadvantaged
groups. Even the doctors who support privatisation, argue that there
should be means like a more efficient general security system, whereby
158
these disadvantageous groups can benefit from all kinds of health services
easily and with low costs. The doctors' criticisms of privatisation is also
effected by the media's and society's negative view towards this professional
group, with respect to their ambition to earn more money, which
dominates their professional perspective and career. In order to oppose
this image, my informants stressed several times that they can still take
care of patients with low or middle incomes even in the private hospitals
and make monetary arrangements in order to make their treatments less
costly, usually in informal ways, such as giving free the drugs that they
received as a promotion from the drug companies, to these patients. As
opposed to the media's frequent news about the doctors who reject the
patients who are in a critical health condition, but who cannot pay the
treatment costs, the doctors whom I interviewed stated that they can always
make monetary arrangements in order to treat them such as using other
patients' health insurance.
These arrangements may even lead some patients to deceive the
doctors by acting as if they are much poorer as we can remember from the
previous chapter. Dr. Tftrkcan had one of her first professional
disappointments in her assistantship when she spent a great deal of effort
to make arrangements for a patient in order for him not to pay for his
treatment, since he said he did not have any money. When she accidentally
heard from the family members of this patient that they had cleverly
deceived her, she said that she gut angry with herself since her attitude
towards her patients was so naive and well- intentioned. She also gave
several examples of patients and other lay people who try to abuse her wellintentions
by demanding professionally inappropriate favours such as
159
wanting to obtain a better room or bed in the hospital and to be medically
treated by her during her vacation time. Besides the patients' abusing the
professional concerns of doctors, the patients can not appreciate the
professional and social concerns of doctors and refuse to comply with the
doctors' advices and display distrustful and disrespectful attitudes.
Influence of Economic Problems and Gender Issues in Maintenance
of Patients' Trust and Respect: One of the major problems that my
informants complained about in their relations with their patients is the
patients' becoming less trustful towards them. Doctors mostly blame the
media for fostering a negative image of doctors and for indicating doctors as
responsible for the problems of the health sector and hospitals. Dr. Sakin
drew attention to these programs' particular effects on most of her patients
who have a low-socio-economic status and a low level of education who view
doctors as enemies" and come to the clinics as "in an armoured way". She
also said that the patients, before seeing the doctors prepare themselves to
oppose whatever the doctors will say to them.
The doctors whom I interviewed considered the patients' distrust
towards doctors as a crucial problem since this affects treatment process.
According to Dr. Meri~ and Dr. Ya~, this leads to a vicious circle since the
doubtful patients tend to visit many doctors in order to compare different
treatments and receive different medical advices which may even
contradict with one another. Dr. Y ~ blames partiCUlarly the "greedy
doctors" for these contradictory treatment plans, since they may urge a
costlier treatment such as an operation even if it is not medically necessary
or urgent.
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The distrustful attitude of patients also negatively affects the doctors
confidence in themselves and their medical knowledge. The doctors who
think that they did not have enough medical practice and experience with
the patients during their university education, as I have mentioned at the
beginning of this chapter, may become highly anxious during the
examination with the fear of a possible negative feedback from the patients.
Dr. Sakin thought they did not take full responsibility for the patients nor
feel comfortable during their medical education when their examination of
the patients was strictly supeIVised and supported by their assistants and
professors. She said that she had a highly stressful time full of
uncertainties about the details of the treatments, such as the type of drugs
to use, when she was suddenly left alone with her patients in her obligatory
duty after the university. Dr. Merie said that she has become "extremely
prudent" (ll$U"J temkin) in talking about the health condition of patients
and has taught herself not to talk in an optimistic way about it in advance,
before seeing all of the test results. According to her, talking optimistically
may ruin the lives of doctors and patients, since the smallest possibility of a
bad result may be happen. / She considers the health condition as something
which cannot be reversible and she admits that she fears the way the
media stress these type of malpractice cases. For her, the tension which
stems from the fear of doing something wrong or incomplete in the medical
treatment of patients, especially in the tests of babies and children since she
had a bad experience on this issue as we have seen in the second chapter,
has highly influenced her professional life. She added that she is also
under the effect of this extreme prudence in her daily life since she always
analyses the advantages and disadvantages of a certain act beforehand and
161
has become sceptical in tenns of feeling the necessity of seeing the negative
aspects of anything. Similarly, Dr. Sakin explained that because they
studied psychiatry as a part of medical education and met with "all kinds of
people" as patients, she immediately understands who is lying about
anything or exaggerating while talking both in her daily and professional
life.
Besides the problem of trust, the disrespectful attitude of the patients
towards doctors creates problems for my informants. Most of the doctors
complained that a lot of patients do not even say a mere "thank you" to the
doctors so that they become highly disappointed in thinking that they spend
that time and effort on the patient "in vain" in Dr. Sakin's tenns. Another
example of disrespect is given by Dr. Meric,;, as some patients have chewinggum
in their mouths while talking to her and she considers this as
something unacceptable and argues with the patients about it.
The doctors also complained about the extreme rudeness of some
patients and their family members which goes as far as saying bad words
to the doctors and beating them when the patients' health is damaged or the
patient dies in thehospital~ Another common complaint of doctors about
the disrespectful behaviour of patients is that they ignore the strict
hierarchical order according to different academic titles of doctors which
indicate the years they have pursued this profession, (ladem) in the
hospitals, especially in the university hospitals where the professors also
teach in the faculties of medicine. Several informants said that they warn
the patients before entering a professor' s room to knock the door, to button
their jackets and to speak politely to the professors. Dr. Ttirkcan implied
that these warnings are effective so that the patients are slightly more
162
respectful towards the professors in the university hospitals. Gender of
doctors is another factor which influences the respect of patients towards
doctors as we can see in Dr. Sakin's example where the patients in the
~
gynaecology clinic confuse female doctors with nurses and mid-wives, and
do not see the difference between these people even if it is explained to them.
She also added that the patients often call the female doctors as Mr. Doctor
(.Doktor BeI), since they are used to or expect to be treated by male doctors.
However, we also understand that the doctors also evaluate the professional
performance of their colleagues under the influence of gender stereotypes
such as Dr. Sarol's argmnent about the female doctors who cannot be good
surgeons because they panick at the slightest complication in surgical
operations. The doctors spoke about these kind of cases in a vivid and
detailed way also to display that they are working under difficult conditions
but that they can still enjoy treating patients even if there is no external
financial and psychological motivation.
The doctors generally consider the patterns of economic interaction
with their patients as a reflection of the patients' trust and respect towards
them. The increasing economic concerns of doctors and patients, and the
"greedy doctor image" are also other aspects which lead to the patients'
distrustful and disrespectful attitudes. As we have seen in the Dr.
Tftrkcan's account about the doctor-patient relations in the past, her father
gave the doctor his money in an envelop which was prepared in advance, in
order not to desecrate the altruistic aspects of his profession and his social
status by letting him be involved in a direct monetary interaction with his
patients. Coming to the current professional experiences, although my
informants expressed their wishes of not discussing the monetary aspect of
163
the treatment with their patients, they complained that their wish is rarely
realized. Dr. Merie; and Dr. Sakin said that they were particularly offended
when the patients claimed that the doctors spent very little effort (iki tJk tJk
ofr pJk pJk) during the examination of the patients, but demanded a high
price for that effort. Dr. Merie; said that even though the doctors seem to do
very few things during the examination, learning these "few things"
requires a long and intensive education which only a minority of
hardworking and clever medical students can endure. However, instead of
explaining that she deserve this money in detail, she prefers to be silent on
this issue, since she thinks discussing monetary affairs will damage her
social authority over her patients and their respect towards her.
Dr. Caglar considers the ability of building social authority over the
patients "extremely important" by saying that fifty-percent of the treatment
of all illnesses is realized in psychological terms, in cases where the
patients are totally convinced that they will recover after a particular
treatment. He explained that if doctors could not gain the full compliance
of their patients in the medical treatment plan they had designed, they
would not be evaluated as successful doctors even if they have an "immense
medical knowledge". This idea which indicates the crucialness of doctorpatient
relationship is shared more or less by all of my informants.
However, Dr. Caglar gave a more detailed explanation of why and how the
economic concerns of doctors should be repressed and excluded in building
relationship with patients. For him, the doctors have to pretend that they
have no economic problems and on the contrary act as if they are really
prosperous and hide the facts which show up their poor living conditions,
such as living in a poor neighbourhood, using public transportation and
164
staying in a very dirty and small place during the night-shifts in the
hospitals. Otherwise, they may damage their social authority over the
patients and their respectful and trustful attitude, and support the patients'
negative view on doctors as acting according to their economic concerns.
In line with Dr. Caglar's rule that doctors have to act as if they are
prosperous when they are with their patients, he also believes that doctors
should be presentable in the hospital, in the sense that they have to wear
clean and tidy clothes, they have to shave everyday and keep their body,
especially their faces and hands clean. He said that the rule of being
presentable is taught in the medical school where the professors strictly
controlled the requirements of this rule. He quoted from one of his
professors who told them that the doctors have to present themselves to the
patients with the consideration that the patients will open their most
intimate secrets to them and ask them to build an empathy with the patient
with the questions of "To what sort of people would you prefer telling your
intimate secrets?" and "To what sort of doctor would you prefer taking your
sister or mother?". Dr. Caglar said that these rules fit "his nature"
perfectly since he mostly enjoy wearing good quality, fonnal clothes and
looking presentable instead of wearing jeans. To highlight his concern
with being presentable, Dr. Ya~ said that since he sometimes used to stay at
his friends' house to study during the whole night when at the faculty of
medicine, most of the days he did not always wear clean clothes and did not
shave. He said how he was ashamed of the way he looked, when he was
wi th patients, and particularly with the female patients in the gynaecology
classes.
165
Gender is another factor which influences the doctor-patient
relations as mentioned above. As we also saw earlier in Dr. Sakin's
example of a patient as a young bride who was oppressively controlled by
her husband and his family, especially his mother, doctors frequently use
the gender stereotypes which are prevalent in society. Doctors usually view
mothers as responsible for their child's health and development as the
statement of Dr. Caglar "The main cause which leads children to have a
low IQ is that they have a mother with a low IQ" indicates. These
stereotypical gender differentiations also affect the behaviour and attitude of
the doctors towards their patients. Dr. Sarol, who is a young male
gynaecologist, said that one of the main advantages of his field of
specialization is that he is dealing with female patients, cins-i Jatif on his
own terms with whom he can build "a bond" more easily, because he has
been taught to behave well and be kind towards the girls since his
childhood. Hence, he tells that he gets angry with a patient or shows his
anger less frequently.
Dr. Sarol evaluates his relations with his patients also in personal
terms and considers his profession as providing an opportunity to meet
new people, some of whom he continues to meet outside the hospital setting.
Unlike Dr. Sarol's comfortable manner in talking about his close
relationship with his patients, which goes far beyond the general doctorpatient
relations, Dr. Sakin, being a female gynaecologist, was more
careful in separating doctor-patient relations from other social relations.
This difference is also due to a reality show which was shown on TV few
weeks before my interview with Dr. Sakin and which was about a male
doctor who sexually abused his female patient and proposed having sexual
166
relationship with her without knowing that he was being watched by secret
cameras. This program aroused a fervent debate, about doctor-patient
relations and medical ethics in different social groups including doctors,
and Dr. Sakin also seemed highly influenced by it, since she insisted
several tilnes that the doctors should always be conscious of and act
according to their professional identity in the hospital setting. Hence, for
her, even if a doctor examines his girl-friend their relations should not go
beyond doctor-patient relationship in the hospital. She also argued that this
type of wrong behaviour of doctors attracts the attention of media further in
order to foster another negative doctor image
The maintenance of trust and respect towards doctors is crucial for
doctors not only for securing patients' full compliance on their doctor, but
also for the acknowledgment of the social authority and powerful position of
doctors in their relationship with their patients and in society. In addition
to the problems in the health sector, the changing concerns of the doctors
from social and political to the more individual and economic ones, and
accordingly their decreasing active role in shaping social and political
developments in the country have also affected the general social attitude
towards doctors and their social status. In my informants' accounts about
the "good old past", the patients fully trusted and respected the doctors
without questioning their professional concerns, knowledge and skills.
They think that the doctors whose professional perspective was dominated
by economic concerns were rare, there were fewer malpractices since the
doctors had a higher opportunity to practice medicine during the medical
education, and these cases of mal-practice were only heard of by a few
doctors instead of being subjects of sensational reality shows. Through
167
talking about the doctor-patient relations in the past in idealizing ways and
relating the recent changes in the patients attitude towards doctors with the
historical changes that have taken place place in the larger social
structural context in the last two decades, my infonnants implied a
continuity in the sense that they still believe that they nevertheless deserve
high social status, because of their profession and their concerns in
pursuing their profession.
The Doctors' Conceptualization of their -Self" in the Medical Realm:
In line with the Linde's argmnent about the presentation of the self
"as separate but related to" the other people, my informants did not, in
general, differentiate their generation of doctors from their colleagues from
the fanner generations even though the latter group is suffering from the
negative attitudes and behaviour of the patients. In this framework, the
doctors who have more professional experience deserve the full respect of
the other doctors in obvious terms, since Dr. Merie,;: and Dr. Caglar
indicated that medical practice is as valuable as acquiring medical
knowledge since a· lot of new things can be learned through medical
practice and the professional skills are refined in this process. Dr. Caglar
argued that a person who has more professional experience (./adem, as it is
used among doctors) are usually called "older brother" or "older sister" by
the other doctors in the faculties of medicine and hospitals, even though
they may be younger than the doctors with less professional experience.
Dr. 8akin said that the doctors who have less professional experience
deal with the patients when they first come to the university hospital, if
these doctors cannot treat these patients' they send them to the more
168
experienced doctors who have more responsibility and higher professional
rank in the same hospital. She also added that the doctors with less
experience and lower academic ranks such as assistants deal with the
medical students in much more immediate terms. She said that this
hierarchical order is so important especially during the medical education,
that the whole educational system is built on it and that the slightest
distortion of this order may cause severe warnings and scoldings. Through
such accounts, my informants implied that they have really internalized
the hierarchical order as opposed to patients who cannot understand and
act according to this order.
In this framework, Linde's argmnent about the Use of pronouns
such as "I" and "we" in displaying how the people relate themselves with
other people provide us with clues about how my informants organize their
social positioning and relations with other people. For instance, in line
with my argmnent that the doctors implied the existence of a more solid
professional solidarity and a communal organization during the medical
education, where all of the responsibilities are shared among the students
as well as between the students and their professors, and the professional
socialization take place, my informants used a lot of "we" in talking about
their experiences in this period. Especially Dr. Sakin told about how "they"
studied and spent their leisure time together with other medical students.
The "we" pronoun is also used for comparative purpose with the students
in the other faculties as in the quotation of Dr. Meri~ "We did not have time
to be interested in politics like the other university students, because we
have to work really hard".
169
The "we"s turned to "J"s in further professional periods when the
doctors make individual choices in their professional life. This is in line
with Dr. Merie's and Dr. Sakin's argument that the doctors suddenly feel
very alone in their professional world and professionally responsible as
individuals after they have completed their university education. This also
relates with the recent heterogenization of career patterns of doctors with
the opening of different types of hospitals, and accordingly, the increase in
the doctors' alternatives of work place such as these hospitals and drug
companies. Having this variety of alternatives, the young doctors who now
consider their economic and individual concerns more than the former
generations of doctors, plan their career and experience the consequences
of this plan on more individual tenns.
Despite these variations in the professional career patterns and
experiences, to some extent the doctors still view their professional group
as a united body of people, and refer to this group as "we", particularly in
defining their professional boundaries and outlining their different
characteristics with the other people. The doctors always used the
pronoun "they" in talking about the patients and reflected the conflictual
relationship between them and the patients with the frequent use of "we"
and "they" in the same sentence. They rarely used the pronotnl "we" in
referring to the doctors and the other personnel in the hospital together,
and these "we"s are used mainly with reference to the activities which are
outside of the professional setting such as Dr. Merie's quotation: "We are
planning to go to a ballet this week-end" in referring to the nurses and
doctors of the hospital she is working. The doctors' talking about their
professional group as a corporate body with clearly dermed boundaries, also
170
help them to identify themselves and their professional concerns with the
fonner generations of doctors, and establish a continuity in that sense with
these "good doctors" despite the recent heterogenization of doctors in terms
of the socio-economic background, professional concerns and experiences.
In identifying themselves with the fonner generation of doctors who were
highly respected and trusted by society until the 1980's, the informants
differentiate themselves from the recently appearing "bad doctors" whose
professional skills are poorly developed or whose professional lives are
dominated by their economic concerns, and imply that they also deserve the
trust and respect of their patients and society unlike the bad doctors.
The Changes in the Social Concerns of Doctors: Despite all of the
crucial factors which led to the changes in the social view on doctors, the
attitude of patients' towards this professional group and doctor-patient
relations, the doctors whom I interviewed, stressed that they still have
social concerns and plans for the social development. This emphasis may
be partly due to their efforts of differentiating themselves from the recent
negative doctor images of/the doctors whose professional experiences are
dominated by individual and economic concerns, that are prevalent in the
society. However, it also allows the doctors to make judgements about the
living and thinking patterns of the members of the society, and therefore to
rebuild their position of social authority, at least within the framework of
the interview. Despite this continuity in tenns of having social concerns,
the type of social concerns that the doctors has also changed, especially in
tenns of scale, in the last two decades.
171
The doctors whom I interviewed, acquired a sense of social
responsibility in the process of their professional socialization during their
university education, and often referred to it in the interviews in order to
indicate that they still have social concerns, despite the problems that they
have encountered during their practice. As we have seen in the second
chapter, the theme of continuing to have social concerns in professional life
after medical education not only provide a temporal continuity and a
character consistency in Linde's (1993) terms, but also a legitimate ground
for doctors to make social judgements and to confinn their socially
outstanding position and authority. However, the social concerns of my
informants, that are usually summed up by them as the general aim of
serving the people in order for them to have better health status and social
living conditions", mostly include their patients rather than the whole
society as opposed to their colleagues of the fonner generations. This
difference is also related with the changes in the social view on doctors and
the doctor-patient relations where a full compliance of the patients is not
guaranteed any more. Hence, as opposed to the social authority of the
doctors from the fonnergenerations which was built on a much wider level
of the whole society and re.flected itself in the doctor-patient relations, young
doctors derive their social concerns from their experiences with their
patients, since the doctor-patient relationship is their "new battleground"
in order for them to re-establish their socially prestigious position and
contradict society's negative views on doctors.
This issue is often referred to and problematized in the interviews
with respect to the doctors' efforts to find a common communication pattern
whereby the patients fully understand and follow doctors'
172
recommendations. Dr. Ya~'s case is a good example of these efforts, since
he said that he stubbornly tries to convince his patients about the
importance of providing the necessary social and medical conditions to
prevent illnesses in maintaining a better health status in line with his
general medical view which favours preventive medicine. He said that he
always tells the patients and their families to heat all the rooms of the
house equally so that the members of the family, especially children do not
catch cold going from one room to another. Similarly, Dr. Sakin said that
she advises her patients who are mostly young and uneducated women,
that they should always know when they had their last menstruation and
should be ashamed if their husbands were the only people who knew about
the menstruation dates. The accounts of these efforts also imply the
perseverance of doctors who still try "to reach" their patients despite their
disrespectful and distrustful attitudes and prove their loyalty to their
professional perspective. Hence, these doctors mainly express and realize
their profeSSional perspective and their social concerns in line with it,
through the attempts of educating their patients, rather than through a
large-scale mission for the whole society. On the other hand, as in the case
of Dr. Titrkcanwho began to think that her aim of serving for the good of
society cannot be realized through her patients, who do not appreciate or
even try to abuse her well-intentions toward them, some doctors realize
their social aims in giving priority to their teaching and researching
activities. The transformation on the type and scale of the doctors' social
concerns is also related with the changes in the doctors' views on politics
and their relations with the state as I will try to explain in the next section.
173
The Changes in the Doctors' Relationship with the State and Political
Issues: As opposed to the doctors from the fanner generations who took
active roles in shaping the political ideology and developments in Turkey,
the more recent generation of doctors, in general, take a distanced view of
political issues in the last two decades. This is also related with the doctors'
political confrontation with the state after the military intervention of 1980
and the general political apathy in society. As we will see in the quotation of
Dr. Sakin below the term "political" is generally used with a negative
connotation in order to indicate the conflictual interests of different power
groups particularly in influencing the governments' policies in the health
sector. Dr. Sakin criticizes these policies in this way:
"Political, it is all political..What I mean by this, is that nothing is
actually done with the consideration of hwnan health in Turkey, nothing
is done for humans. Everything is done merely for politics. Whenever a
new government comes, a new policy is applied".
My infonnants criticized the governments' recent rather popUlist
policies on the health sector, such as issuing a green card which would
ideally provide free access to the medical services for the poor patients , but
was only distributed to a few people most of whom were active members of
the government's party, as they are applied in order to gain "more votes"
and "favour the members of their party" as Dr. Sakin's and Dr. Tiirkcan
argued in the interviews. The privatisation policy of the governments is
also criticized by the doctors whom I interviewed, as it makes economically
disadvantaged peoples' access to the medical services even more difficult.
However, these doctors do not play an active role in the medical chambers
174
where these policies are protested in an organized way, and some of them
even criticized the activities of these chambers. Dr. Sarol said that the
doctors in these chambers do not have the right to represent the doctors in
Turkey since their activities such as demanding the liberation of prisoners
who were condemned from political reasons, are totally ideolOgical. The
tenn ideological has a similar meaning to the tenn political as used by Dr.
Sakin in the above quotation, and this meaning is stressed by Dr. Sarol who
said that the activities in these chambers are organized by the doctors who
subordinate their professional experience and concerns to their ideological
views. For him, these doctors must have worked for fewer hours in a day
than the doctors like him, so that they have plenty of leisure time to
organize and participate in these activities.
Through his criticisms, Dr. Sara I also indicated that the doctors'
professional concerns should be separated from their ideological views.
This view is also stressed by Dr. Sakin, Dr. Merie; and Dr. Caglar in other
contexts, and it is important in terms of highlighting the difference between
the professional and social concerns of the new generation of doctors and
their colleagues from the fonner generations. As we have seen in the first
chapter, the professional perspective of doctors has always included
political and ideological aspects which led them to take active roles in
Turkish politics, from the birth and institutionalization of modem
medicine until the 1980's. Their active role in politics reached one of its
peaks in the 1960's and 1970's conflictual political movements where
different ideologies clashed. The medical chambers which were highly
influential, in organizing these political movements at that time, still
represent the populist and leftist ideology through its current directors and
175
members who took an active role in the movements of the 1960's and 1970's.
This is also negatively evaluated by the young doctors who were influenced
by the period of depolitization in the 1980's when particularly leftists
intellectuals and doctors were criticized ~ by the rulers and media.
Accordingly, Dr. Sara I, views the active members and directors of these
chambers as a small and marginal group who are the residues of the
1970's.
Another criticism shared by most of my informants is about the
ineffectiveness of these chambers with respect to governments' health
policies. Dr. Sakin said that membership in the medical chamber of
Istanbul only provides "psychological sUpport" to the doctors, by making the
doctors feel that they are not alone in their professional world and with the
help of chambers, can protest against it if they are appointed by the
government to a place they do not like to work. However, she added that, a
doctor cannot be influential in changing the governments' policies even
with the support of the medical chambers. This view is also shared by most
of my informants who do not consider that anything can be done to
influence and change the state's policies on the health sector even though
they complained about and criticized these policies because of their negative
influences on their professional experiences.
The doctors whom I interviewed and their colleagues from the same
generation of doctors, as far as I could detect from their oral accounts and
bibliographical works, speak about political issues only with reference to
their effects on the health sector and their own professional experiences
(Sahip, 1996) (Marti, 1997). The recent political issues which aroused
fervent debates are also discussed by these doctors in tenns of their effects
176
on the hospital setting and their social and economic aspects in shaping the
doctor-patient relations. For instance, the opening of private hospitals
where the medical services are provided in accordance with the basic
Islamic rules, such as treating female patients by female doctors is
commonly seen as indicators of the political rise of the Islamic movements.
In contrast, my informants viewed these type of hospitals mainly as a
social and economic necessity in supplying the demand of a considerably
large group in society. The doctors with Islamic views are also evaluated
in terms of the effects of their religious view on their professional concerns
and performance. They are tolerated by the new generation of doctors as
long as they give priority to their professional concerns over their religious
views, unlike one of the most frequently given example of a female
gynaecologist who refused to perform a caesarian operation since she knew
that a male baby would be born and avoided touching him.
My informants said that they can work with the doctors with Islamic
views, with whom they share the same professional concerns, and Dr.
Merit; who now works in the hospital of an Islamic association criticized
the doctors of the state and university hospitals who do not accept these
doctors amongst themselves. In contrast, Dr. Sakin considered these
doctors as an interest group who are becoming increasingly powerful and
threatening for other doctors. However, she also generalized this
argument for each ideological view, since she said that when a new
government comes with a new ideology and its followers, the directors and
chief-doctors of the state hospitals are changed for the new doctors
accordingly, without considering their professional experiences and this
leads to further inefficiencies in these hospitals. She viewed Islamic
177
ideology as having that potential and gave examples of state hospitals
where the doctors with the Islamic view are appointed as chief-doctors.
The young doctors in general think. that they cannot be influential in
shaping and altering the state's policies on the health sector and hence in
establishing control over their working process. They view the policies of
the state as bureaucratic arrangements which severely limit the
professional efficiency of doctors and as enacted with "ideological" or
"political" interests as opposed to social and medical concerns. In both
cases, the doctors do not want to be involved in any political activity which
would have an effect on the issuing of policies, since they do not want to be
a part of the political interests groups and blame the policy makers as they
do not care about the social, economic and professional problems of the
doctors.
They particularly criticized the fact that the working process of the
doctors who work in the public sector are tightly shaped by the same laws
which are applied to any state employees (memllT') . For Dr. Sakin, these
laws are far from providing the flexibility the doctors need in their
profession, since they impose fixed working hours and seriously limit the
doctors' initiative on the choice of the hospital where they will work. As we
have also seen in the second chapter, Dr. Sakin argued that the doctors
have to be different from any other state employee, since they have to have a
much greater degree of professional autonomy and control. She claimed
that only she would know the best conditions under which she would work
in the most efficient way, because she knows best how to profit from her
own working capacity and medical knowledge.
178
These views are also in line with Turner's argmnents on the
professional groups Who wish to define their botmdaries by differentiating
themselves from lay people as we see in Dr. Sakin's efforts to differentiate
the doctors and state employees in different parts of her oral account, and to
maintain an autonomy and control over their working process which is
largely prevented by the state (Turner, 1984). Working in private hospitals
as Dr. Sakin is planning to do is an alternative to avoid partly the limiting
laws and procedures of the state. However, for Dr. Caglar, the doctors can
still create a space where they have more initiative in their working
patterns in the state hospitals, by thoroughly knowing their rights and
responsibilities that are imposed by the laws and by building their own
informal system in managing personal relations skilfully in the hospital
settings. For instance, he told about how he gave infonnal permissions to
leave the hospital earlier to the nurses who work well and allow other
doctors to quit work when they have important things to do outside of the
hospital, so that they also allow the flexibility in his own working patterns
in return, particularly during his obligatory duty .
Hence, the doctors do not want to deal with the problems that they
/
consider "political" or "ideological", but rather try to find individual
solutions in order to increase their control over their working process, at
least in their own small-scale hospital setting. In shaping their
professional and social concerns, they distance themselves from the
political debates and issues, but also find their own ways of altering the
inefficient and problematic bureaucratic system in the hospitals they work
which, according to my infonnants, reflect the political and social problems
of the country in general. For instance, most of my infonnants said that
179
they try to build a system where the doctors arrange a day and time for the
patients before they come to the hospital and where they can see less
patients in a day in order to spare more time for each patient. The patients
with economic difficulties are also helped by my infonnants in quite
infonnal ways, such as giving free the drugs that were given by the drug
companies to these doctors as a gift and using other patients' health
insurance for the treatment expenses of poor patients.
In addition to the inefficient bureaucracy in the state hospitals, the
poor medical conditions, such as the lack of personnel and medical
equipments are also discussed in political terms by my informants, since
they are aware that the problems stem from the governn'lents' low rate of
health expenses. Although most of my infonnants said that they are used
to these inadequacies and inefficiencies to a large extent, the ones who did
their obligatory duty on the provincial· places complained more and in a
bitter way about these issues. The quality of medical services are much
lower in the hospitals of the Anatolian towns and villages, and the living
conditions of the doctors who go there to do their obligatory duty are much
more difficult. There, they usually stay in the lodgings or pensions that are
provided by the state and Dr. Sakin and Dr. Cag-Iar speak in detail about the
"terrible condition" of these houses. Dr. Sakin said that the house, "the
state thought that she deserves after all these years of education", had
windows without glass in them and broken doors. At that moment, she
tmderstood that the "state is not interested in doctors and does not consider
under which conditions they live at all" doing her obligatory duty. Despite
the fact that she managed to be appointed to a better place in the second year
of her obligatory duty, her views on the state and its lack of consideration on
180
health matters and doctors have stayed the same since she stresses them at
different times in her accmmts about her further professional experience.
Additionaly, the doctors who did their obligatory duty not only have a more
negative view of the state policies and worse professional experiences, but
also gained more experience in terms of having more professional initiative
vis-a-vis the inflexible and limiting state's laws and procedures, as we have
seen in Dr. Caglar's case which is mentioned above.
Conclusion: In stnn, the doctors prefer to distance themselves from
poli tical issues in shaping their social and professional concerns and view
the efforts to confront the state's policies as totally unnecessary since they
would not be able to change these policies. Rather than trying to find large
scale solutions to existing social, political and health problems of the
country, they find it more useful to work out small-scale and individual
solutions, where they make little modifications" in the rules of the game"
that they know pretty well, in Dr. Caglar's terms, usually in informal
tenns. Despite this informality which may sometimes mean illegality, as
Dr. Caglar and Dr. Sarol implied as in the case of using other peoples'
health insurance, they never blamed themselves, since they always
stressed that they used these infonnal procedures and little modifications
in this system always for the good of their patients. In this context, Dr.
Sarol's giving priority to his "individual ethical system" rather than to
"social ethics" which is, for him, full of double standards where people are
evaluated according to their economic condition is understandable. This is
important in indicating that the social concerns which the medical
profession internalized in its dominant perspective has become to be shaped
181
in more individualistic tenns, and when beyond the individual, encompass
a smaller scale of responsibility such as the hospital system where they
work.
CONCLUSION
The doctors in Turkey are generally known as a professional group
who have played an active role in shaping major political and social
movements and issues in the country. They share a particular professional
perspective which includes social concerns such as improving the living
conditions of the members of the society through inculcating their own
values and ideas that were mainly developed during the professional
socialization period which starts during the medical education. These
values and ideas stemmed from the basic principles of the biomedical
model which is a product of Enlightenment and which was adapted to the
Turkish context during the institutionalization process of the health sector,
that correspond to the second half of the Nineteenth century. These values
and and ideas include the transfonnation of society in accordance with a
scientific, positivist, progressivist and secular perspective where the
traditional and religious views are subordinated with science and
rationality. The doctors who had an easier access to the Western world
th.an the rest of the Ottoman intellectuals, had a privileged status in the
adoption of the prevalent values and ideas in the West, that are mentioned
above and that also includes nationalism. The concern of having a leading
role in that kind of a social transfonnation led doctors to design and share a
182
missionary project for the whole society which would be enacted by them as
a part of their professional experience and concerns.
The social missionary role that the doctors attributed themselves,
constitutes a "legitimate ground" for them to make social and political
judgements about their society and act according to these judgements in
their professional and social life. It also shaped the doctors' position in the
society and their relations with the state. However, this missionary project
was developed as a result of particular historical and social conditions
where the political issues and debates not only affected the health sector
and the professional experiences of doctors , but also washighly shaped by
the social concerns of doctors. The missionary project of the doctors has
also been modified in line with the variations in their professional and
political experiences under the influence of social and structural changes
through time. Especially in the 1980's and onwards, large-scale
missionary project has been replaced by smaller scale social concerns that
were shaped through the doctors' individual characteristics, particular
professional experiences and priorities. This transfonnation has happened
as a result of various historical changes in the social and political context of
the country and in the health sector, such as conflictual political
confrontation between the doctors and the military regime in the early
1980's, depolitization, heterogenization of the doctors in tenns of their socioeconomic
background and professional experience, the rise of economic
and individual concerns as opposed to the political ones in shaping the
career patterns of doctors, as well as other members of the society, the
increase in the number of private hospitals in line with the policies of
privatisation and the birth of Islamic hospitals, the changes in the social
183
view on doctors and in the doctor-patient relations relatedly. The social
view on doctors has been transformed from the pioneering intellectuals
who always work to improve the medical and social conditions from the
"greedy doctors" whose careers are dominated by individualistic and
economic concerns and doctors who did not have adequate medical
education and who are known for their malpractices. This transfonnation
has also affected the doctor-patient relations where the full compliance of
the patients which shows itself in terms of trust and respect is not
guaranteed any more.
In this framework; my basic premise was to study how these rapid
and radical changes in the social structural context have influenced the
professional perspective and the social concerns as a part of this
perspective, of the last generation of doctors whose professional careers
have been largely shaped through these changes. How are they
differentiated from the fonner generation of doctors in terms of the scale
and type of their social concerns? In what ways are these social concerns
enacted in shaping the particular professional experience and perspective
of the last generation of doctors? How do these doctors still refer to the
missionary professional perspective that they have been taught mainly
from the doctors from the fonner generations in the accounts of their own
professional experiences, despite their different social concerns? How do
the doctors express their social concerns in order to attribute themselves an
outstanding social position and to provide a legitimate ground to make
judgments on the social issues despite their recent negative image in the
society as "greedy" or "malpractising" doctors?
184
In order to explore these questions, first I studied the social and
political dynamics which led to the formation and institutionalization of
"modern Turkish medicine", as opposed to the traditional Ottoman health
services and the dominance of the Non-Muslim minorities in the
contemporary health sector. The doctors' politically active role in this
process has also continued in accordance with the social and political
developments and debates which have found their immediate counterpart
in the modern institutionalized health sector, and became highly
influential in shaping their professional perspective. This role has also
become an important source of legitimacy which the doctors attributed
themselves in order to make judgements about the social and political
problems of the society and design missionary project in order to solve these
problems as a part of their particular professional perspective. In studying
the history of modern Turkish medicine with respect to the doctors'
involvement with the social and political issues and debates that have
shaped the country's structural context, my main aim is to clarify the
particular social and political conditions which led doctors to develop their
own professional perspective through which they gain a considerable social
authority and political power.
I would like to point out that the social and political role of doctors in
the formation of "the modern Turkish Medicine" and the provision of the
sui. table contextual conditions for this formation, is one of the basic sources
of legitimacy that they have attributed themselves in expressing their social
concerns and acting according to them. However, this source of legitimacy
lost its validity considerably in the 1980's and onwards, since most of the
doctors from the last generation no longer have large-scale social
185
missionary proj ects which shapes their professional perspective and
concerns mostly due to the social, political and economic changes that have
happened in Turkey. This led these doctors to look for other sources of
legitimacy in order for them to re-built their social authority, this time in
more individual and less political terms. In particular, the last generation
of doctors have a common way of describing their individual self through
their knowledge of medicine. This type of description involves a
relationship of power and hierarchy, where these doctors draw the
boundaries between their professional group and lay people through the
defini tion of the required characteristics, such as being hardworking,
clever and persevering which are necessary in order to acquire medical
knowledge and practice medicine.
These doctors describe their "individual self' and "professional self"
in highly consistent terms so that in their oral accotmts, they have
presented their decisions on their professional career as obvious, "natural"
paths that they have to take considering their character traits. Their
particular character traits help them not only to become "good doctors" but
also to gain success and a socially outstanding position which they deserve
through overcoming the problems they have experienced through their
professional life. These problems largely stem from the large-scale,
economic and bureaucratic problems in the health sector, and the increase
in professional competition and individual responsibility in the later
periods of the professional life. In these periods, the doctors question their
idealized view of medicine and medical practice which they had acquired
before and during the medical education, when their professional activity
has become routinized, and they do not receive the full compliance of the
186
patients that they think they deserve through their socially outstanding
posi tion. However, the way they deal with these difficulties are also
accounted as a test of their character traits that are suitable to be a doctor
and their ability to take individual initiative to ~organize their professional
life according to their own professional and social concerns rather than
being "drifted" by external conditions. The doctors whom I interviewed,
have "passed these tests" through the choice of their specialization field the
reasons for which are highly consistent with the reasons they use to
explain their decision to become a doctor and their character traits, and
through their choice of hospital that they are currently working in, in line
with their professional perspective and concerns.
Hence, the way these doctors overcome the difficul ties in their
professional life is another source through which the doctors attributed
themselves a legitimacy to make social judgements, since
they view these difficulties as stemming directly -from the large-scale social,
economic and political problems of the country and they have overcome
these difficulties without compromising their character traits and
professional perspective that are in line with these traits. This helps these
doctors to view themselves as "good doctors" whose main professional and
social concern can be summarized as "serving for the good of their society"
despi te all the difficulties. As being good doctors whose professional life is
still dominated by this concern, the doctors attribute to themselves social
authority and an outstanding place in society and expect that this social
position is also acknowledged and respected by society and their patients.
However, in the 1980's and onwards, the increasing social and
economic problems of the health sector, the heterogenization of the doctors
187
in terms of their socio-economic backgrm.md and professional perspective,
the political campaign against doctors and the influence of the media
where the reality shows particularly concentrates on the problems in the
health sector and describes doctors as lacking appropriate skills and
knowledge to practice medicine, and as giving priority to their economic
concerns, negatively affected the social view on doctors. This has also
influenced the doctor-patient relationship where the patients' full
compliance as mentioned in my informants' accounts about the past, is
replaced by their highly distrustful and disrespectful attitudes and
behaviours towards doctors. The doctors from the last generation talk about
these negative attitudes and behaviours in detail and describe them as
frustrating as they prevent their professional satisfaction to a large extent
similar to the other social, economic and bureaucratic problems that they
have encountered in their professional life. However, despite the patients'
negative attitudes and behavim.rr, the doctors said that they still do their best
in order to improve not only the medical or health condition of their
patients, but also their social conditions. The last generation of doctors,
differentiate themselves from the "bad doctors" who see their patients as a
source of material benefit, since they emphasize that they try to tlIlderstand
and improve the living conditions and social relations of their patients in
order to achieve a solid doctor-patient relation which will lead to an efficient
medical treatment and the prevention of further diseases. . The doctorpatient
relationship is largely discussed and problematized by them, as a
major way of expressing their social concerns to the patients, guiding them
to have better living conditions, and therefore re-establishing their position
of social authority at least over their patients, if not over the whole society.
188
The last generation of doctors took a critical distance to the political
issues and debates because of the 1980's depolitization in the society which
involves the criticism of the 1960's and 1970's political movements where
the doctors played an active role, and the conflictual confrontation between
the state and the doctors. For the fIrst time since the fotmdation of modern
Turkish medicine, the professional perspective of doctors does not include a
large-scale political agenda according to which the doctors shape their
political actions. My informants criticize the governments' policies on the
health sector in that their real concerns are to gain more votes in the next
. elections rather than improving the working conditions of doctors and
increasing the health status of the society through providing easier and
cheaper access to the medical services. However, they prefer not to be
involved in an organized political opposition or in an association with such
characteristics as medical chambers, since they evaluate these kind of
organizations as ultimately dominated by different political power groups,
whose main interests would not be medical improvement and increase in
the health status.
Instead of a large-scale social mission which involves the inculcation
of the scientific, secular and positivistic values to the whole society, the
doctors develop and express their own social concerns during their
medical education and professional experience as a result of their
interactions with other doctors and their patients. Their social concerns,
although consistent with the above mentioned values that all of the doctors
should promote as a part of their medical and profeSSional perspective,
differ from the social mission of the former generations of doctors, since
they do not include a political aspect and the last generation of doctors give
189
priority to their individual professional experience in defining their social
concerns. Therefore, instead of the political arena where different power
groups fight over their conflictual interests, the hospital setting where the
doctors are currently struggling to re-gain the patients' respect and trust,
and relatedly the social recognition of their outstanding position and
authority, has become the new "battleground" for the new generation of
Turkish doctors in order to provide a legitimate ground for themselves to
make social judgements and act according to them.
The doctors referred to their individual characteristics and
experiences much more than a historical social position of a professional
group, in talking about their efforts to re-establish their social authority
over their patients. This is also related with the fact that the professional
group's communitarian aspects have almost vanished due to the increase
in the number of doctors and heterogenization of the doctors in terms of
socio-economic background and professional perspective. Currently, the
doctors have different career patterns in line with their
different social and economic concerns, and in their particular professional
experience they are exposed to professional competition more than
professional cooperation. Therefore, building a legitimate position of social
authori ty is represented by the new generation of doctors as their individual
concern and responsibility. For these doctors, not all the doctors from their
generation have this concern and responsibility in equal degrees since
increasingly large number of doctors give priority to their economic
concerns, rather than spending effort to build a position of authority over
their patients and in the society.
190
My infonnants believe that they deserve to have social authority and
legi timacy to mak.e social judgements mostly since they have the specific
character traits and professional perspective that are suitable to acquire the
"precious" and "sacred" medical knowledge after an intensive and long
education, and to practice medicine in the best way despite the problems
that stem from the political and bureaucratic processes in hospital, patients
and other doctors. Overcoming these difficulties and still having social
concerns for the patients are the basic criteria which my informants
mentioned in order to be included in the group "good doctors" like them.
This group includes most of the doctors from the fonner generations whose
professional perspective is not deteriorated by the problems that have been
experienced in the health sector since the 1980's. Although, the young
generation of doctors question and criticize the professional perspective of
their colleagues from the fonner generations, because of its inclusion of
large scale social missionary project, its political aspect and its idealistic or
altruistic view on the profession and society, they are also effected by it
since it became a base for them in order to build their own professional
perspective during and after the medical education. They also refer to the
social authority and professional perspective of the former generation of
doctors in order to argue that there should be a continuity among the
generations of doctors in this sense and that the changes in the social
posi tion and concerns in many doctors of their own generation are caused
by the particular social and economic conditions at the larger contextual
level.
However, the sense of continuity among the generation of doctors in
terms of making use of the same type of social concerns in order to achieve
191
social authority may be damaged with the rise of Islamic medicine where
the doctors with an Islamic view try to combine the biomedical model with
the religious rules. Although my informants evaluated the rise of Islamic
medicine and hospitals as merely responding to a demand by the religious
groups in society, with more economic than political concerns, some of
them felt threatened by the fact the doctors with Islamic view have begun to
organize as a powerful interest group which would impose its own system
and values in the health sector. The rise of Islamic hospitals is a recent
tendency which started in the mid- 1990's, but it has developed fast enough
to produce important criticisms of the biomedical model, such as its
emphasis on "medicine as a science" which damages the hmnanistic side
of medicine and its own rules in the hospital setting, such as female
patients being taken care of by female doctors. I would like to cover these
issues in detail in this study in order to find out the ways in which they
claim a social authority and develop their social and professional concerns
in relation with other doctors. However, this topic is broad enough to be the
subject of another study, and Islamic medicine is developing rather fast in
different directions as different religious groups and organizations build
their own hospitals.
For further studies on these issues, it would be interesting to study
whether the continuity among the generations of doctors in terms of
claiming social authority through social concerns would remain despite
the rise of economic concerns and differentiation in the professional
perspectives and experiences of doctors. One might argue that the
professional socialization during the medical education would still be
influential in reproducing this continuity, because of the initiative of the
192
former generation of doctors to elect the new members of the academia in
the faculties of medicine. However, as the mnnber of the new generation of
doctors with new professional concerns increase and as they begin to claim
their social authority more through their increasing professional
experience and success rather than referring to the social authority of their
colleagues from the former generations, they may acquire a new type of
authority through their professional success in improving the medical and
living condition of their patients, rather than their active role in shaping
the social and political issues in society. This position of authority would be
maintained and secured by doctors as individuals rather than a
professional group or community, because the new generations of doctors,
in line with their particular professional perspectives,. would also differ
from each other in terms of their sources through which they claim social
authority, such as the way they treat their patients, economic power,
religion, the social authority and the professional perspective of the former
generation of doctors.
193
REFERENCES:
- Adivar, Adnan A. , 1991, Osmanh Ttirklerinde Ilim, (Science in the
Ottoman Turks), Remzi Kitabevi.
-Ak!Jin Sina, "Jon Ttirkler", Tanzimattan Cumhuriyete Ttirkiye
Ansiklopedisi, 1985, v:3, lleti!Jim Yaymlan. 1985.
-Altmta!J, Ayten, "TIbhane-i Amireye Adlm Adlm", (Step by Step towards
the Military Medical School), Tarih ve ToJiliIm, v: 171, Mart 1998, pg. 4-9,
lleti!Jim Yaymlan.
-Atattirk, Mustafa Kemal, 1930, Yurtt~hk Bilgileri, (The Information on
Citizenship}, Cmnhuriyet Yaymlan.
- AydIn Stiavi, 1993, Modernle~me ve Milli)reictlik, (Modernization and
Nationalism), Gfindogan YaYlnlan, Ankara.
- Bosk, Charles L., Forgive and Remember: Managing Medical Failure,
The University of Chicago Press, Chicago, London, 1979.
- Carr-Saunders A. M., Professional Culture, The Professions, A. M. CarrSaunders
and P. A. Wilson (eds), 2nd edition, Frank Cass & Co. Ltd., 1964.
- Conrad, Peter, 1992, "Medicalization and Social Control", Annual Review
of Sociology, v: 18, pg. 209-232.
194
- Davison, Roderic H. ,1963 in AydIn Suavi, 1993, Modernle~me ve
Milliy...e.tr;.ilik, (Modernization and Nationalism), Gtindogan YaYInlan,
Ankara.
-Erdemir, Ay~egttl Demirhan, 1996, Tibbi DeontolQji ve Genel TIp Tarihi,
(Medical Ethics and General History of Medicine, Gtine~&Nobel, Bursa.
- FigJio, Karl, 1977, "The Historiography of Scientific Medicine: An
Invitation to the Human Sciences", Comparative Studies in Society- and
History-, v: 19, No:3. pg. 262""286.
- Foucault, Michel, 1970, in Byron J. Good and Mary-Jo Delvecchio Good,
"Learning Medicine, The Constructing of Medical Knowledge at HalYard
Medical School", Analy-sis in Medical Anthropgl.Q~, S.Lindenbaum and
M. Lock (eds.), University of California Press, Berkeley, 1993.
- Freidson, 1970, in B. Turner, Medical Power and Social Knowledge, Sage,
London, 1987.
Good, Byron J. and Good, Mary-Jo D. "Learning Medicine, The
Constructing of Medical Knowledge at Harvard Medical School",
Knowledge., Power and Practice: The Anthropology of Medicine. and
~y Life, pg. 81-104, S. Lindenbaum and M. Lock (eds.), University of
California Press, Berkeley, 1993.
195
- Gunduz, Feryal Saygl11gil, "Sag-11k Alanlndan Gelen Ilk Kadln
Parlamenterler", (First Woman Parliament Members from the Health
Field), Tarih ve Tophnn, v: 171, Mart 1998, pg. 15-20, Ileti~im Yaymlan.
-Gfirsoy, Akile, "Beyond the Orthodox: Heresy in Medicine and Social
Sciences from a Cross-cultural Perspective", Social Science and Medicine,
1996, V:43, N 0:5, pg.590-620, Pergamon.
-GtNen(:, Bozkurt, 1979 in AydIn Suavi, 1993, Modemle~me ve Mil1iy~ili.k,
(Modernization and Nationalism), Gfindogan YaymlarI, Ankara.
- Haniog-lu, M. SukrU, 1981, Bir Siy-asal DU§iinfir Olarak Doktor Abdullah
Cevdet Bey- ve Donemi, (Dr. Abdullah Cevdet Bey as a Political Philosopher
and his Time), u(:dal N e~riyat, Istanbul.
- Helman, C. , 1990, Culture, Health and Societ)l,. pg. 86-126, Wright, Boston.
- Hughes, 1958, in B. Turner, Me.dical Power and Social Knowle~ , Sage,
London, 1987.
- Jackson, Jean E, 1994, "After a While No One Believes You: Real and
Unreal Pain", in Pain as Hmnan Experience: An Anthropologkal
Perspective, Mary-Jo Delvecchio Good, Paul E. Brodwin , Byron J. Good,
Arthur Kleinman (eds), University of California Press.
196
- Klhr,;bay, Mehmet Ali, "Osmanh AydInI", (The Ottoman Intellectual),
Tanzimattan Cumhuriyete Ttirkiye Ansiklopedisi, 1985, v:l, Aydlnlar,
(Intellectuals), Ileti!}im Yaymlan.
LelIa, Joseph W. and Pawluch, Dorothy, Medical Students and the
Cadaver in Social and Cultural Context, Biomedicine Examined, pg. 125-
153, M. Lock and D. R. Gordon (eds), Kluwer Academic Publishers,
Dodrecht, Holland, 1988.
- Linde, Charlotte, Life Stories: The Creation of Coherence, pg. 12-19, 98-
162, Oxford University Press, New York, Oxford, 1993.
- Manizade, Dervi!}, 1976, fiS....-y-Ilhk Cerrahpal;?a Hastahanesi (39 Yllda
GOrdiiklerim ve Du'y-duklarunl, (The 65 year- old-Cerrahpa!}a Hospital- The
Things I Have Seen and Heard in 39 Years), Matematik Ara~tlrma
Enstirusii, Baskl Atolyesi, Istanbul.
- Mardin, Serif, "Tanzimat ve Aydmlar", (Tanzimat and Intellectuals)
Tanzimattan Cumhuriyete /Ttirkiye Ansiklopedisi, 1985, v:l, Aydlnlar,
(Intellectuals), Ileti!}im Yaymlan.
- MartI, Altay, 1995, oldtirmenin Erkek YUzii, (The Male Face of Killing),
Leman YaYlnlarl.
- MartI Altt;ly, 1997, Saya~ ve Kalbim, (War and My Heart), Leman
YaYlnlan.
197
- Minkari, Tank, 1993, Bir Cerralun AOllan, (The Memoirs of a Surgeon),
Milliyet Yaymlan.
- Nasuhoglu, Ilhami, 1975, TIp Tarihine Kisa Bir Bakl~, (A Brief Study of
the Medical History), AYYlldIz Matbaasl, Ankara.
- Ortayh Ilber, 1983, Imparatorluggn En UZtnl YUZyIlI, (The Longest
Century of the Empire), Hi! YaYlnlarl.
- oncel,Burhan, 1951, Bir Beyaz Gmnleklinin RomanI, (The Novel of a
Person with White Coat), pg. 9-13, 174-182 Nebioglu Yaymevi, Istanbul.
-ozden, Akil Muhtar, 1945, Canii Tarihler, (Living Histories), Tiirkiye
YaYlnevi, Istanbul.
- Parsons (1951) in Conrad, Peter, "Medicalization and Social Control",
Annual Review of Sociology, v.18, pg. 209-232, 1992.
- Rosenthal, Gabriele, 1993, "Reconstruction of Life Stories: Principles of
Selection in Generating Stories for Narrative Biographical Interviews" in
The Narrative Study of Lives, R. H Josselson&A. Liebblich (eds), pg: 19-91,
London& Beverly Hills, CA: Sage.
198
- Saglam, Tevfik 1981, NasIl Okudmn?, (How did I Study?), pg. 40-45,
Istanbul universitesi, Cerrahpa!?a TIP Fakultesi, Atatfirk'fin Yuzfincfi
Dogum Ylhru Kutlama Yayrnlan, ozel Seri 4, Istanbul Matbaasl, Istanbul.
- Sezer, Muzaffer, 1953, Hekim ASkl, (Love of a Doctor), pg. 42-48 Istiklal
Matbaasl, Istanbul.
- Starr, Paul, 1982, The Social Transfonnation of American Medicine, Basic
Books, Harper Collins.
- Terzioglu, AsIan, "KInm Harbi Esnasmda Osmanh Hastahaneleri ve
Dunya Hastahaneciligine Etkileri ", (Ottoman Hospitals and their
influences on the World Hospitals during the Crimean War), Tarih ve
Toplum, v:85, Ocak 1991-1 , pg. 39-47, Ileti!?im Yaymlan.
- Terzioglu, AsIan, "Sadi Irmak ve Hfimanizm", Tarih ve ToIiliIm, v: 86,
Sub at, 1991-2 ,pg. 16-22, Ileti!?im Yayrnlan.
- Terzioglu AsIan, "Galatasaray'daki Mekteb-iTIbbiye-i Adliye-i Sahane'ye
Dair Simdiye Kadar Bilinmeyen Almanca Kaynaklar" (The Sources in
German, which have not been discovered until now about the Imperial
School of Medicine at Galatasaray), , Tarih ve Toplmn, v: 100, Nisan, 1992 ,
pg. 17-26, Ileti!?im YayInlarl.
199
- Terzioglu, AsIan, "Dr. N ouridjan ve Onun Mekteb-i Tlbbiye-i $ahanede
Verdigi Tlbbi Deontoloji Giri~ Dersi", (Dr. Nouridjan and his Course on the
Introduction to the Medical Ethics), Tarih ve Tophnn, v: 111, Mart 1993, pg.
22-27, Ileti~im Yaymlan.
- Topuzlu, Cemil, 1945, Canh Tarihler,. (Living Histories), Tfirkiye
YaYlnevi, Istanbul.
- Tunc;ay, Mete & ozen, Haldun, "1933 DarUlftinun Tasfiyesi veya Bir TekParti
Politikaclslnln onlenemez Yiikseli~i ve Dii~ii~ii" (The 1933
Reorganization of Dariilfunun or an Unpreventable Rise and Fall of a
Single-party Politician), Tarih ve Toplum,v:l0, Ekim 1984, pg. 6-21,Ileti~im
YaYlnlarl.
- Turner, 1987, Medical Power and Social Knowledge., Sage Publications,
London.
- Turner, Bryan S., 1996, The Body- and Society-=--Explorations in Social
/
TheoIY-, Second edition, Sage Publications.
- Unat, Ekrem Kadri, 1989, Istanbul imiversitesi TIp FakUltelerinde 50 YI!
Hizmet,. (50 years of Service in the Faculties of Medicine, Istanbul
University), Istanbul universitesi Fen Fakiiltesi Doner Sermaye I~letmesi
Baslm Atolyesi, Istanbul.
200
- Unat, Ekrem Kadri& SamastI, Mustafa, 1990, Mekteb-i Tlbbiy-e-i MillkiYJ:!
{Sivil TIP Mektebi) 1867-1909,_Istanbul universitesi, Cerrahpa~a TIP
Fakiiltesi Yaymlan, Istanbul.
- UzuUf;ar~IlI, Ismail Hakkl, 1988, Osmanh Devletinin Saray Te~kilatl, The
Organization of Palace in the Ottoman State, Tiirk Tarih Kurumu
Baslmevi, Ankara.
- Woodham- Smith, Cecil, 1952, Sonsuz Fedakarhk (Lady-in-Chief: The
Story of Florence Nightingale), translation: S. Huri, Mohrbooks A. G.,
American Bord Publication, Istanbul.
- YlldrrIm, Nuran& ulman Ye$im I~ll, "Zoeros Pa~a ve Deontoloji", Tarih
ve Toplum, v:127, Temmuz 1994, pg: 29-34, Ileti~im Yaymlan.
- Istanbul Ansiklopedisi, (I.A.), 1993, Ttirkiye Ekonomik ve Toplmnsal
Tarih Vakfl &Killtiir BakanhgI.
- Geli~im Ansiklopedisi, (G. A.) 1986, v:6, Geli~im YaYlnlan.
- Tanzimattan Cumhuriyete Ttirkiye Ansiklopedisi, 1985, v:1, Bilim: TIP ve
Saghk, (Science: Medicine and Health), Ileti~im Yaymlarl.
-1923-1973, Ilk Elli Yllda Saghk Hizmetleri, ( 1923-1973,The Health Services
in the first Fifty Years), 1973, Saghk BakanhgI, (Ministry of Health),
Ankara.
201
- T.C. Devlet Planlama Te~kilatl, (DPT), Sag-hk SektorU Master Plan Etudtt,
Meycut Dururo Rap..gm, 1989, DPT Yaymlan, Ankara.
- TUrk Hekiminin DiilliL~, YannI,. ( The Yesterday, Today and
Tomorrow of the Turkish Doctor), (TTB) 1965, Ttirk Tabipler Birligi Merkez
Konseyi Ne~riyat1, Ya~ar Matbaasl, Istanbul.
- Talks by Orhan ArlOg-lu and Halit Ziya Konuralp and YtldlZ Ttimerdem in
the conference organized by Capa Faculty of Medicine &Turkish Chamber
of Medicine (TTB), "73. Ylhnda Cumhuriyetin Sag-11k Hizmetlerine
getirdikleri" (The Contributions to the Health Sector by the Republic in its
73th year), 29 October, 1996, Capa University, Istanbul.
- Talks and interviews with doctors: Bulent Genr,; (1997), Irfan Gokr,;ay
(1996), Yusuf Sahip (1996), Gulr,;in Ttirker (1997), Ekrem Kadri Unat (1996)
and Aysun Uslu (1997).
- Class talk by Irfan GOkr,;ay / in Spring 1998 in the SOC 490, Sociology of
Health, Instructor: Belgin Tekc;e.
202
APPENDIX
A Brief Description of Informants
1) Dr. Merle
Born in 1967 in Bulgaria
Comes from a family with a low socio-economic status and who migrated
from Bulgaria when she was a child
Went to the Faculty of Medicine at Cerrahpru}a
Specialized in pediatrics at the Faculty of Medicine at Capa
Could not make an academic career there despite her wish
Currently works in a small hospital directed by an Islamic Foundation
2) Dr. Sakin
Born in 1963. Born and raised in Denizli
Comes from a family with a middle socio-economic status
Her father and her brother in-law are pharmacists in Denizli
Went to Faculty of Medicine at Ege University in Izmir
Went to -obligatory duty in Giresun
Specialized in gynaecology at Haseki Hospital where she works now at parttime
basis
Currently plans to work in a private hospital
3) Dr. TtirkC8Jl
Born in 1945 in Istanbul
Comes from a well-off family
Went to the Faculty of Medicine at ~apa
Specialized in opthalmology
Took active roles in the political movements in the universities in 1970·s
Currently have a private clinic and professor at ~apa
4) Dr. Saml
Born in 1965 in Ankara
Comes from a well-off family
Went to the Austrian High School (Private high school) in Istanbul
Went to Faculty of Medicine at Cerrahpa~a
Specialized in gynaecology at Kartal State Hospital
Currently works in the AClbadem Hospital (Private)
5) Dr. Yru;
Born in 1960 in Istanbul
Comes from a family with a low socio-economic status
Went to Faculty of Medicine at Cerrahp~a
Highly interested in music ~d cinema besides medicine
Specialized in orthopedics at Istinye State Hospital where he currently
works
Plans to open a private clinic soon
6) Dr. Caglar
Born in 1961 in Ankara
Raised and went to the medical school in different cotmtries such as India
and Pakistan because of his father who was ambassador
Comes from a well-off family
Went to Faculty of Medicine at Ankara University
Went to obligatory duty to Karaman
Specialized as a family doctor in kartal State Hospital where he currently
works
Appendix 2: Excerpts from the Original Interviews
1) Orada tabU herkes ... gerr;ekten boyle ser;ilmif? insanlar ... ondan sonra
hir;bir donem krrlk falan olmazdl yani boyle if?te~,ee Avusturya Lisesi ir;in
ba~anh sayllabilecek bir ortalamam vardl... Bende klasik kolej burnu
biiytikltigii falan vardl, yaa onlar r;ah~sln benr;ahf?madan da iyi notlar
ahnm falan.
2) MUmktin oldugu kadar, r;ah~kan ogrencilerde 0 psikoloji oluyor, i~te en
ytiksegi 01 sun, ne olursa olsun da onu kazanaYlm... Gene I olarak tabii
doktorluk toplumda saygln bir meslek. Her anne baba ister r;ocugunun
doktor olmasml.
3) Bizim donemde hep boyle ba~arlh r;ocuklar tlbba giriyordu.. oyleydi 0
zaman, 83 donemi... TIP faktiltesine ginnek r;ok biiyUk bir~eydi.
4) TIP herf?eyden farkh gortintiyordu bana ... N e bileyim, baZI bir~eyler
o kursun, biraz ilgilenirsin, i~letmedir f?udur budur. Ama bir herkes bir
tlbbl okuyup, doktor olamaz, tlbbl anlayamaz gibi geliyordu ... Kullamlan
terminoloji hOf?uma gidiyordu, rer;eteler .. Hir; boyle inanarrnyordum, c;ok
btiytik if?ti bana gore, yahuo ilac;lar nasll aklllarmda tutuyorlar, nasll tam
koyuyor bu adam bunu nasIl anladl .. hani f?unun f?USU var ve ilac; veriyor
adam iyilef?iyor. Aa diyorum ne kadar gUzel birf?ey (HIm).' Cok bana
inanIlmaz geliyordu ar;lkcasl doktorluk (Gulme). Cok da ula~llmaz
geliyordu. Ama dedim bu i~i ben r;allf?lrlffi, yaparlffi, diye inat ettik.
5) HastaYI r;ok ozenerek, BEZENEREK, artlk boyle goztine baklyorsunuz.
Hocaclm degerlendiriyor, ark.ada~larln seni degerlendiriyor (Gii:1me). Ne
bileyim, hoca'soru sordugu zaman cevap vermek lazlm ... Stres baf?hyor
yava~ yava~. Hem zevkli hem de mahr;up olmama slklntlsl. Klinikte, hep
insanlarla k~l k~lyasID1Z. Hocanlz size sora sorucak, bilemiyeceksiniz
(-ses yfikseltme-) arkada~lannlZln yanlnda r;ok aYlp (Gftlme). Hem
hastanln yamnda mahr,;;up olucakslnlz, hep 0 slkmtl da var ... Hem kitap
okumaruz lazlm, sftrekli bir~ey okumanlz lazIm, bir ~ekilde bilmen lazlm,
bi~eyler bilmen lazim. Panik ba~hyor tabii, fIrr;a yemiyeceksin ... Hoca
..
kovar, vizitten atar, terket, vizitten terket, t;lk t;1k, dokunma, hastaya
dokunma der.
6) Oyun gibiydi ya, yani aslmda ilk once r;ok midemiz bulanarak 0
salonlan, 0 cesetleri, hit; ceset gOnnemi~tik daha once. GOrfir garmez boyle
ee ne olucak diye korkudan korktuk, yani arkad~larlmIZa aYlP olur mu
acaba, yani korkup baYIhrmIYIm diye 0 korku paranoyasmdan daha r;ok
korktum yani. .. Korkmamaya r;ah~lp onu, 0 projeksiyonumu mutlu
mizar,;;la gosterdim, aaa bu olftymft~ diyip kolunu kaldIrdlm biraktim .
... Eldiven bile giymeden biraktlm. Aslmda ir,;;im ti triyordu... Ama daha
sonra 0 i~e yansIdl, bir Yll 0 sene okulu biraktlm zaten, bir Yll okula
gitmedim 0 Yll.
7) Bir parmagIn bile kompleksligini gordftm. Otonom sinir sistemini
okurken hayretler it;inde kahyordum... Aman Allahlm ne kadar mftthi~,
ne kadar mftthi~ diyip ... ozellikle dinsel yargIlamalara falan ger;iyorsun
daha r;ok yani oyle. Her tlP og-rencisi herhalde fizyoloji okurken, patoloji,
fizyoloji, anatomi okurken, boyle biraz Tanrl Yl sorgular herhalde, varol~u
sorgular ... Bir parmagIn binlerce bilgisayardan r;ok daha kompleks bir
yapisl var... ve bir hormonlar sistemini d~ftndftgi.in zaman inanIlmaz,
ir,;;inden' r,;;lkanllyorsun, nasll dengeliyorlar birbirlerinin, nasil 0 artlyor 0
azahyor ... 0 nasll beyinde kontrol altlna almlyor filan 0 inamlmaz bi~ey.
Inanllmaz bir~ey. InanamaYlnca da ya Allah var galiba falan diyorsun
(Gulme).
8) Bir insanm yani sadece sermayesi beyin olarak, her ~art altInda ne
~ekilde ya~anuru kazanabilecegi. Birincisi bu, ikincisi peki yani bagl1l1SIZ
olai'ak ne i~ yapabilecegi ... mono ton olmayan ne i~ yapabilecegi, oyle veya
boyle saygJ. duyabilecegi insanlarm, ne i~ yapilabilecegi. Sonu~ta ee ya olay
~eydi ya takIm oyunu oynayacaktl1l1 ya bireysel bir spar yaplcaktl1l1 ... ya i~te
bir futbol takImmm kalecisi. .. gibi bir~ey se~icektim , ya da tenis~i gibi tek
ba~ma yapabilecegim bir ~ey olacaktI. Tabii tabm ruhunda biraz da
ba~kaiarmin hataianni ortmek zorundasIn, veya i~te ani arm yaptigi
~eylerin sorumlulugunu tistlenmek zonmdasin ve i~te onlarm kotti oImasl
sonu~ta senin b~ariru da etkiler diye d~tintiyortnn.
9) Simdi boyle degi~kenlik yani istediginiz zaman, ya bir dala
yonelebileceginiz, istediginiz zaman be~ dala birden ve bunu zaman
~eysiyle, yani tibbi uyguladlgInlZ zaman, hasta baktlgmiz stirece
uyguiadigmiz bir~ey oldugundan degi~kenlik val', bundan daha gUzel
bi~ey olamaz diye d~tindtim... Bir de yeni bir dal, birileri b~eyler yapIp,
ortaya b~eyler ~lkartIp ee ondan sonra oyle bir ~er~eve i~erisinde, yani bir
"pioneer" denilen Amerika'da i~te onctiler gibi, oyle bir ~ey bana daha
uygun geliyor.
10) 0 donemde de Cronin'in romanlanru ~ok okuyorduk. Biraz degi~ik bir
gen~kIzdIm ben, bana tip daha bir cazip geldi, insanlara ~ok faydah
olaCagIml dti!1tinuyordum. Topluma faydah olacagIml, yani Turk
toplumunun geli!1mesi i~in, ee tIbbl se~erek daha faydah olaCagIml !1ey
yaplyordum. Cok idealist tim a zamanlar, !1imdi a kadar idealist degilim.
11) Bu ~ok aCI bir oltimdti bence ger~ekten... Mikroskopla bile
goriIlemeyecek !1eyler vardIr, bu da ondan doaYl oldu. Hekim hatasl
degildi. Ama ben ilk ba!1tan, yani yeni asistarumda, oyle mi falan diye
kontrol edilene kadar Oltimlerden alUm begendirn yani. Istifa etrneye
kalktnn. Bu i~in bana gore olrnarugull dti!?tlndtun.
12) Capa'da kalrna irnkarurn yoktu .. .Iddiah bir!?ey degildirn. ogrencilikteki
ba~arnnl asistanhkta gasterdirn diyernern ge~ekten ... Yani gerek hocalara
k~l yaklnla!?rnak aC;lsmdan, yani kendirni gasteren bir tip degilirn zaten.
Hic;bir zaman onlar beni degerli bir asistan olarak gannemi!?lerdir. Ama
hep, slradan, vasat bir asistandlm i!?te, ne denilse yapan, sessiz bir
insandnn. halbuki kalrna kri terleri c;ok farkhydl tlniversi tede, bu yaptlgIn
i!?le alakah bir !?ey degil, bilgiyle de alakah degil. Simdi benim yarumda
c;ah~an doktor mesela c;ok c;ok bilgili, ben de okurdum, 0 c;ok daha fazla
okur. Eee, i~te bu uzmanhk slnavmda da birincilikle girrni!?ti, sUper bilgili
bir c;ocuk, onu da almadllar i!?te. Onlarm aradlgI kriterler degildi, i!?te
ara!?tlrma yapabilen, hastalara bakan degil...Cok politik, Ttirkiye'nin
btittin i~te !?ark kafasl diyorlar ya, aynen oyle. Aym c;izgi bizlerde de var.
Yani kendileri gibi olanlan sec;iyorlar. I!?te hatta bu fiziksel gartinti!? bile
olabiliyor ne yazlk ki... Fiziki iyi olan, i~te gosteri!?li 01 an, karizmatik
olanlar, sosyo-ekonomik dtizeyi iyi olanlar, kolej mezunu olanlanlar ... Biz
tahmin ediyorduk, ~u kahr, ~u kalmaz ... Gerc;ekten bilrniyorum onlar
nasll he~eyi biliyorlar ... Ha, kendilerine yakIn olan asistanlar var,her
donemde oluyor tabii, onlar da jurnalliyorlar da seni.
Chapter 3:
13) Ben r;ocuklugumda, annem beni hastahaneye gatiiriirken, ya a~n olucaz
belki sadece, ama tlmagImlzl dahi keserdi, kilodmnuzu degi.!?tirirdi.
Ylkanlrdlk, yani doktor ister belki olum, soYWltIrsunuz fHan. Mahr;up
olmayabm diye en gfizel bayramhk giysilerimizi giyer giderdik, yani boyle
bir r;ekingen, boyle bir saygIyla giderken ...
14) Doktor eve gelecegi zaman, i~te ev temizlenir, doktorun ticreti dahi
onceden bir zarfa yerlef?tirilirdi... Cahit Sami Gtirsoy'un gelif?i bizim ev
ic;;in boyle bir f?olen gibiydi, onu gider babam muaynehanesinden ahr
getirir, ee te~ekktirler edilir falan fHan. Simdi tabii boyle birf?eyler yok.
Doktorlar da ev hastasma falan girmeyi semiyorlar yani, pek gitmiyorlar
yani. Cok tarudlktl bilmem neydi, yakw gidiyor, ama pek gitmiyorlar yani,
vaktiyok.