Jeffries Vincent (Editor). Handbook Of Public Sociology

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312 Chapter 17

AN EXPERT?

But I was already an “expert” board member in the eyes of those whom I

was observing. Even though I told board members over and over that I was

working as a researcher, they treated me as a well-informed member who

had seen how several boards operated. They asked for help and I found

myself talking too much at times. I could not tell others I might have

acted differently or asked other questions. On occasion I became frustrated

with public members who did not take an independent stance on an issue

when I thought I would have. I believed I had a reasonable idea from my

experiences as a board member what public members could and could not

ask. I fought the desire to jump into arguments. When the board members

asked my opinion on issues, I generally tried to avoid answering, but I

also sometimes had strong opinions about the issue. But as a researcher

and outsider, I could talk to staff about how they worked to control board

activities behind the scenes and I noticed more about how staff produced

meetings. They talked to me about the qualities of effective and ineffective

board members and about problems with local medical societies and doc-

tors. I was better able to see how boards and medical societies interacted

and some problems with the ways physicians impaired by alcohol or drugs

were handled. These conversations and observations provided me with a

clearer perception of physician and staff perspectives and insight into how

the medical world permeated board work.

THE FEEDBACK LOOP

As a professional sociologist, when examining my data, I began to focus

on differences in the ways members used medical, legal, and public inter-

est discourses and practices in their disciplinary processes, the activity that

takes the majority of time. Each board organizes the process differently but

some frame what happens more in terms of medicine and others in terms

of law. Even though all boards broadly framed disciplinary processes in

terms of due process, how boards developed disciplinary processes and

used law in practice varied considerably. All boards used law to outline

their procedures, but the extent to which legal discourse and practices were

used to frame cases in practice varied and some remained framed in the way

doctors talked about patients and dealt with problematic cases in hospitals

and training. This sociological insight was helpful in my work as a public

sociologist.

On a recent disciplinary case for which I chaired the hearing panel—a

long (ten days) and very complicated (it involved complex medical issues

and judgment and many patients) case—one of the two physicians on the

Public Membership on Medical Licensing Boards 313

panel tried to bully me and take over the role of chair. What he did not

understand was that we were following legal practices and we could not

reframe the entire case and procedures because he thought differently and

had made up his mind how we should organize the case. First, he did not

want to hear the respondent’s side, as he knew the result he wanted and

thought the case was taking too long. He did not see that the doctor against

whom the board brought charges had the right to the best possible defense.

I explained to him about legal procedures and how his authority as a doctor

only mattered to ask good questions and decide the substance, as it was a

legal process. I was not totally successful, as he then wanted to vote on the

outcome before the lawyers submitted briefs. When we were to discuss the

facts of the case, he said he wasn’t an expert in the area and so could not

help even though we had heard two experts, one on each side of the case

and had been reminded many times not to use our own expertise in decid-

ing cases, only to ask questions of the witnesses to improve the record. I

explained the difference between medical and legal authority and how he

had medical authority, which he used in his practice, but could not use

it at a hearing except to ask questions and assess the facts. The job of the

panel was to establish the facts—using the testimony we had, and decide

the conclusions of law and a sanction. Here my sociological analysis of my

data helped me think about how to understand our practices and to explain

to someone who thought as a doctor. He appeared unconcerned with legal

processes.

On other occasions at meetings, I use my observations to help other

public members develop their roles as public members and I provide them

with some of the history and analysis of public participation. My data and

analysis helps them to understand what their role might be and questions

they can ask.

My analysis of the development of impaired physicians programs helped

my argument for a new look at the guidelines for dealing with impaired

physicians. In the mid-1990s the federation committee developed guide-

lines for boards to handle cases of physicians’ chemical dependencies and

mental illness but we had not included what the boards’ relationships

should be with the impaired physicians committees (often run by medical

societies). Later in my professional analysis, I saw the impaired physicians

programs as hiding some of the problem physicians from the regulatory

boards. These committees were started when boards were shifting from

licensure to discipline and many of those disciplined had drug and alco-

hol problems. At the same time boards were adding public members and

the state actors were becoming more active. It was a way for the medical

profession to take control of “sick” physicians (broadly defined) and keep

them out of the public eye and the boards’ reach. I argued with the federa-

tion that they should reopen the issue and give boards more control over

314 Chapter 17

the impaired physicians in the programs that use the discourse of reha-

bilitation, not public protection. It seems like they will go along. From the

public protection perspective, impaired physicians programs are likely to

err by allowing a relapsing physician to continue to practice as part of the

rehabilitation process.

WRITING AS A PROFESSIONAL AND PUBLIC SOCIOLOGIST

Although some may argue that writing from the perspective of organic pub-

lic sociology is similar to an exposé, a complete insider’s view, or a political

tract, it need not be. Excellent, insider books by physicians such as Atul

Gawande’s Complications, Jerome Groopman’s How Doctors Think, and Pau-

line Chen’s Final Exam deal very effectively with issues such as the failure of

medical school and training to teach about dying, the problems of learning

on real bodies, and how the sometimes unreflective way doctors proceed

leads them to making serious errors. James Stewart, a journalist, published

Blind Eye, a detailed and measured exposé of the case of Dr. Swango, who

killed many patients while the medical profession could have taken action

to keep him out of medicine on any number of occasions, but did not. As

a public sociologist, issues of community interest must be brought into

the open to inform public deliberations about boards. Medical licensing

boards are organizations dominated by the members of a profession with

a stake in self-governing, and although boards and their members now

typically articulate the mission of the boards as protecting the public and

disciplinary actions have increased, this rhetoric sometimes obscures issues

still affecting citizens as patients. But the question and analysis can and

should remain sociological and critical. How have boards become more

public institutions and do some of them become and should they become

more public?

Combining public and professional sociology provides a more multi-

faceted story. Is the data convincing? The perspective that one can have a

view from nowhere or one has a view from everywhere doesn’t work. We

are all multiply situated with multiple identities that others or we activate in

any one situation. Although in theory it may be reasonably easy to separate

all these identities, it is not possible in the world when we interact with real

people, doing and feeling real things. The fullest objectivity we can hope

to get is to be found on the intersection of conflicting accounts available

to us as researchers and public sociologists. I am committed to protecting

the public as a board member and that gives me a particular perspective on

the board activities. Although my participation may lead me to be overly

positive about the ability of public members to increase board account-

ability, protecting the public is the general mission and, if public members

Public Membership on Medical Licensing Boards 315

are being co-opted and the boards remain captive of the profession, then

the public may not be sufficiently protected. Moreover, the observations of

other boards and their members may help to balance any tendency to over-

estimate the independence and importance of public members. My role as

a public member and sociologist is the same—to protect the public. The

two vantage points permit and encourage balance in the analysis.

As a research sociologist I want to better understand how publics are created

and different publics use the state in the regulation of experts in a democracy.

In that sense my writing is theoretical and empirical. As a public sociologist

my writing requires that I communicate with the public to increase dialogue

and provide additional insights for change, for example, specify the condi-

tions under which public members have a greater voice that may promote

policy changes. In 2001 Freidson, a critic of the medical profession, argued

that professionalism worked better than markets or bureaucracies to organize

expert labor. As a critical sociologist I need to modify this position. The social

world created by experts cannot remain as isolated from the rest of the social

world as medicine accomplished in the twentieth century if the public is to

contribute to creating a better system of protecting itself.

Here I argued that an ethnographic project provides one methodology

for the four sociologies to exist within one project. Doing one’s “civic re-

sponsibility” provides a slightly different spin on what “public sociologists”

might do and includes working within organizations that are only partly

in the civil sphere. Effectively participating in a state/private organization

often means a public sociologist must tread carefully and persuade others

of needed change. This approach might allay some of the fears of some op-

ponents of public sociology. Often small steps for change and sensitivity

to what the “public interest” is are essential. Doing professional research in

order to expand understanding enables broader change than participation

alone and maintains sociological interest in the project.

NOTES

1. According to one of Shaw’s biographers, Holroyd (1989), he had frequent

conversations with a physician in preparation for writing his play A Doctor’s Di-

lemma.

2. Freedom of Information Acts in the last 15 years generally affected some of

the ways boards did their business and also required that they provide more infor-

mation to the public. Each state made its own decisions and affected the boards in

many different ways. What is public in some states is not in others.

3. In 1976 Common Cause pushed for Colorado legislation to start evaluating

regulatory boards and whether they were necessary. Over 30 states passed similar

legislation and it focuses attention on board activities and frequently leads to

changes in the Medical Practice Acts.

316 Chapter 17

4. American pragmatists such as Dewey and Mead both played active public

roles, writing editorials and working for social change (Shalin 1988) as did many of

the early Chicago sociologists who Mattson (2007) argues were important activists

but were not as good sociologists as they might have been.

5. FLEX, the Federation Licensing Exam, was a national exam used mainly by

foreign trained physicians and accepted by all states after 1976. Most U.S. trained

doctors took and take the USMLE (United States Medical Licensing Exam).

6. I was later appointed to the editorial board of the federation journal to help

change the journal to include research and policy articles rather than speeches.

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319

Michael Burawoy’s impassioned (2005a, 2005b, 2007) calls for “public

sociology” provoke strong reactions. Published responses suggest that vari-

ous sociologists have been enthralled, embarrassed, redeemed, outraged,

invigorated, or discouraged by Burawoy’s descriptions of sociology and his

vision for its future (e.g., see Burawoy et al. 2004; Clawson et al. 2007). We

add to this debate by describing some of the difficulties of doing the kind of

public sociology that Burawoy envisages. Our discussion focuses on collab-

orative research on the Darfur genocide led by the second author of this ar-

ticle, Hagan (see Hagan and Palloni 2006; Hagan and Rymond-Richmond

2009; Hagan, Rymond-Richmond, and Parker 2005; Hagan, Schoenfeld,

and Palloni 2006). Our orientation follows previous comments by soci-

ologists Judith Stacey (2004) and Diane Vaughan (2006). Using their own

research as case studies, they chart some of the provocative pathways of

public sociology. Stacey reflects on the complications and disappointments

that occurred when she spoke with various publics about her research on

gay parenting, while Vaughan’s account of working with NASA on the Co-

lumbia accident suggests a more positive venture into public sociology.

In the pages that follow we briefly summarize Burawoy’s position. We

then describe the situation in Darfur, the debate about the number of

people who have been killed there, and Hagan and colleagues’ research on

this issue. Although we are longtime collaborators in the terrain of public

sociology (McCarthy and Hagan 1992; Hagan and McCarthy 1997), we

experiment with new roles in this chapter: Hagan is the key informant and

McCarthy the interviewer. In this discussion we focus mostly on the debate

about the number of people killed in Darfur; limitations of space require

319

Counting the Deaths in Darfur:

Pitfalls on the Pathway to

a Public Sociology

Bill McCarthy and John Hagan

320 Chapter 18

that we set aside the important issue of whether the killings constitute

genocide (see Hagan and Rymond-Richmond 2009; Prunier 2005).

Our analysis of Hagan and colleagues’ experiences highlight four prob-

lems insufficiently addressed by Burawoy’s calls for and comments on

public sociology. First, Burawoy assumes that public sociology will help

bring consensus on moral issues. Second, he presumes that there will also

be a consensus among scholars who enter the public arena. Third, although

Burawoy recognizes the power of the state, he suggests that the combina-

tion of sociological voices with those of various publics will have a substan-

tial affect on state actions. And fourth, although Burawoy acknowledges

that the media have their own interests, he presumes that they will, for the

most part, assist public sociologists in disseminating their contributions.

BURAWOY’S PUBLIC SOCIOLOGY

Burawoy’s (2005a) ideal type classification separates sociology into four

quadrants—professional, public, policy, and critical—for which the bor-

ders are often overlapping, rather than sharply demarcated, and in which

sociologists often work simultaneously. Our discussion concerns the first

two types of sociological practice. Professional sociology is the source of

orienting questions, conceptual frameworks, accumulated knowledge,

and methods that define the discipline. It is the quadrant in which most

academic sociologists invest most of their time. Nonetheless, public soci-

ology engages scholars beyond the academy in various dialogues about

fundamental values, and matters of political and moral concern (Burawoy

2004:1607). Burawoy envisions public sociology as the protector of civil

society; he claims it arises in reaction to modernity and can elude control

by states and markets.

Burawoy further divides public sociology into two approaches: tradi-

tional and organic (and perhaps further sub-types, see Burawoy 2005a,

2007; Patterson 2007). Sociologists working in the traditional mode

typically have orienting questions, conceptual frameworks, methods, audi-

ences, and publication aspirations that reflect a firm grounding in profes-

sional sociology. However, they also move beyond these groundings and

address publics outside of the academy. In the organic mode, sociologists

work more closely with a public or publics that are often actively involved

in the formulation of research questions, the choice of methodologies, and

the preparation and dissemination of findings.

Most of our own collaborative and individual research originate and are

directed toward professional sociology. However, as is often the case, some

of our work straddles the professional and public sociology divide. For

example, our research on homeless adolescents is animated by questions

320 Chapter 18

Counting the Deaths in Darfur 321

central to the concerns of sociological criminologists and our publications

are directed toward this audience (e.g., see Hagan and McCarthy 1997). Yet,

consistent with traditional public sociology, we also wrote abridged reports

for the various social service agencies that serve the homeless and that con-

tributed toward our studies; we also spoke with representatives from vari-

ous media outlets who responded to our academic publications.

Hagan’s research on the International Court of Justice and the atrocities

in the Balkans (2003) as well as his studies of Americans who resisted

the Vietnam War and immigrated to Canada (2001) also involved several

public sociology components. Most recently, his work included public

advocacy in Canada with Vietnam era war resisters who are calling for

refugee status for a new generation of military resisters to the Iraq war.

Notwithstanding these public elements, Hagan’s research was mostly

motivated by professional sociology and was addressed to an academic

audience.

In their current research on Darfur, Hagan and colleagues chose a

more visible and issue-oriented approach that answers Burawoy’s (2005a,

2005b:419) challenge to professional sociologists to break “out of the

bubble” and engage various publics. Although issues central to sociology,

criminology, and legal studies initially attracted Hagan and colleagues to

the crisis in Darfur, they decided to expand their focus and reach out to

broader publics.

THE CRISIS IN DARFUR

Sudan is the largest country in Africa, with a population estimated at about

40 million. According to the United Nations, Sudan is one of the least de-

veloped countries on the continent, ranking 139 on the UN’s Human De-

velopment Index (2005). The Sudanese government is dominated by Arab

military figures and politicians who receive support from neighboring Arab

states. Darfur is located in the western region of Sudan and includes three

states: North, West, and South Darfur. Over 80 tribes and ethnic groups live

there. Most of the African tribes are involved in subsistence farming, while

the nomadic Arabs are mostly cattle herders. Although there are important

differences between the cultivators and herdsmen, most are Islamic. In the

past, these groups often intermarried and resolved disputes in traditional

legal forums. However in recent years, water and land shortages, as well

as activities by the Sudanese government, have provoked increasing civil

conflict and human rights violations, often involving ethnic and tribal

disputes. The conflict in Darfur is also indirectly related to a longer-term

insurgency in the south of Sudan, where oil discoveries have fueled a ten-

year armed insurrection.