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系統識別號 U0026-0812200914303080
論文名稱(中文) 泛專科化?美容醫學醫師的興起與再專業化
論文名稱(英文) Pan-specialty Specialization?The Rise of the Cosmetic Physicians and Re-professionalization in Taiwan
校院名稱 成功大學
系所名稱(中) 公共衛生研究所
系所名稱(英) Graduate Institute of Public Health
學年度 96
學期 2
出版年 97
研究生(中文) 張惠雯
研究生(英文) Hui-wen Chang
學號 t8695402
學位類別 碩士
語文別 中文
論文頁數 106頁
口試委員 口試委員-邱大昕
指導教授-趙曉秋
口試委員-吳嘉苓
指導教授-許甘霖
中文關鍵字 泛專科分化  專業計畫  醫學美容  美容醫學  專科分化  專業化 
英文關鍵字 pan-specialty  medical aesthetics  specialization  professionalization  professional project  cosmetic medicine 
學科別分類
中文摘要 研究背景:過去專業理論將專業視為有相同利益的職業群體,透過專業計畫達到市場壟斷及集體向上流動,專業組織在過程中扮演了重要角色。然而,新興的醫美市場中,醫師涉入傳統來說知識含量不高、低度專業化的美容領域。由不同專科醫師提供醫學美容服務,且在醫美市場上六個相關的專業組織。再者,從美容醫學會發展的軌跡看來,不僅有相關教育訓練、頒發所屬證照(美容醫學會員證書),也創造附屬醫事人員(護理美容師),這些特徵使美容醫學趨近於「次專科」,是傳統專業社會學提供的醫療專業化圖像無法解釋的現象。本研究透過專業壁壘策略、專業組織及專業論述,分析美容醫學專科醫師專業計畫,探討其理論意涵。

研究目的:以台灣美容醫學專業發展為例,分析專業內及專業間的競合關係與策略行動,主要目的有兩個:(1)探討美容醫學內不同專科醫師、醫事人員,以及與美容專業人員之間的競合關係和策略行動。重新檢視醫師專業發展,和既有的醫療專業化理論對話。(2)檢視美容醫學醫師採用的專業論述及其理論意涵。

研究方法:主要來源有三種:(1)參與觀察法:實際走訪醫美醫療機構、研討會,並記錄之。(2)檔案法:以相關報章雜誌、官方網站及醫師平臺(優活網)等收集資料,進行分析。(3)深度訪談法:透過多方管道取得專科醫師名單,進行深度訪談。最後對三種方式收集的資料進行分析。

研究結果:(1)產業透過儀器租賃、合資或聘僱等形式,主導不同專科醫師間、及醫療專業與其他專業間的分工。本研究指出醫療專業組織提供的新功能是市場參進資格,作為產業與醫師專業間的平臺,媒介了產業提供的技能訓練及執業機會,使更多不同專科醫師得以進入醫美市場。(2)美容醫學醫師再專業化過程中採用的專業論述,不只風險或科學論述,同時也包含美感、商業、生活等非醫療的專業論述建立發展的正當性。(3)從美容醫學專業發展的軌跡來看,其動力並不是源於醫療體系本身的需求。美容醫學的專業技術與發展方向主要是由產業主導,並透過醫療專業組織的運作。(4)由於這種次專科發展,其專業技術的取得主要由產業提供,且相對於醫療專業而言技術門檻並不高,或可稱之為「泛專科化」。
英文摘要 Background:In the past, profession theory viewed profession as group of occupations that with same interests, and profession monopolizes market and upgrades itself collectively by professional project .In the process, professional association plays an important role. However, in the new cosmetic medicine market, physician are involved in cosmetic field, which was concerned less knowledge needed and lower professionalization in tradition. Physician from different specialties supply service of cosmetic medicine, and establish six correlative professional associations. Tracing back to the way CSCSM developed, there were not only have correlative educational training, licenses (cosmetic physician specialty license), but also created paramedical occupation (medical cosmetician). These characteristics show that cosmetic medicine is drifting toward a sub-specialty. This phenomenon is beyond the explanation addressed by medical specialization, that comes from traditional professional sociology.

Objectives:Taking the development of cosmetic physician in Taiwan for example, to analyze co- competition and strategy-act among inter-profession and intra-profession.
The main purpose is to discuss the co- competition and strategy-act among cosmetic physician specialty , paramedical medical, and cosmetician. Herewith the discussion, to review the development of medical profession, and reply the medical profession theory.

Material and Method:There are three kind of main sources:(1) Participant observation: Visiting the cosmetic medicine institution and conference.(2) Documentary method :Collecting data from correlative newspapers and magazines, authoritative website, and platform among doctors.(3) In-depth interview : The list about cosmetic physician who practices cosmetic medicine was introduced by multiple channel .And analyze the data finally.

Conclusion:(1) By medical instruments renting, capital collecting, hiring, the correlative industries dominate the division of labour not only among doctors of different specialties, but also medical profession and other professions . This thesis indicated that the new function of medical professional associations is providing doctors for qualification to enter market . As a platforms between industries and doctors, these associations provide skill training and working opportunities from industries. making the medical aesthetics market accessible to more kinds of specialty doctors. (2) The process of re-professionalization of cosmetic physicians adopt expertise discourse that not only including risk and scientific discourse but also aesthetic, commerce, and life-style. For the development of cosmetic medicine, these non-medical discourses establish its legitimacy. (3) Tracing back to the way CSCSM developed, its driving force did not come from the demand of the medicine system itself. The professional skill and orientation of development of cosmetic medicine was leaded by industry, and worked by medical professional association. (4) Because the professional skill was afforded by industry in such kind development of sub-specialty, and relatively speaking, its technical threshold is not high to medical profession, so maybe it can be call 「pan-specialty」.
論文目次 前 言 1
第一章 專業化與專業計畫 5
第一節 專業化與專科分化 5
(一)專業化 5
(二)專科分化 7
第二節 專業計畫 8
(一)社會壁壘策略 8
(二)專業組織 10
(三)專業論述 11
小結 13
第二章分析架構與研究方法 14
第一節 研究問題與分析架構 14
第二節 研究方法 17
(一)檔案分析法 17
(二)參與觀察法 18
(三)深度訪談法 19
第三章 醫學美容與美容醫學 21
第一節 醫美市場與醫美產業 21
(一)醫美市場 21
(二)醫美產業 30
第二節 美容醫學醫師的興起與美容醫學 33
(一)美容醫學興起的背景 33
(二)美容醫學專科 37
小結 42
第四章社會壁壘與專業組織 43
第一節 專業內與專業間的關係 43
(一)專業內的聯合 43
(二)專業間的關係 46
第二節 專業組織的角色與功能 52
(一)專業與醫學會的關係 53
(二)產業與醫學會的關係 55
小結 58
第五章 專業論述 60
第一節 科學化論述與美容的醫療化 61
(一)美容風險與美容健康 61
(二)醫療技術作為美容問題的解決方案 64
第二節 非科學化論述與美容的去醫療化 71
(一)醫學美容作為美感創造工程 71
(二)醫病關係的重塑 75
(三)醫療空間的社會重組 82
小結 87
第六章 結論 88
第一節 泛專科化? 88
第二節 政策意涵 90
第三節 研究限制與未來方向 91
參考文獻 94
參考文獻 參考文獻
英文部分
Abbott, Andrew,1988, The system of Professions. Chicago: The University of Chicago Press.
Amark, Klas,1990, "Open Cartels and Social Closures:Professional Strategies in Sweden,1860-1950." Pp. 94-115 in Professions in Theory and History:Rethinking the Study of the Professions, edited by Michael Burrage and Rolf Torstendahl. London: Sage.
Cant, Sarah L., and Ursula Sharma, 1996, "Professionalization of Complementary Medicine in the United Kingdom." Complementary Therapies in Medicine 4:157-162.
Carpiano, Richard M, 2001, "Passive Medicalization:The Case of Viagra and Erectile Dysfunction." Sociological Symposium 21:441-50.
Cervero, R. M. ,1988, Effective Continuing Education for Professionals. San Francisco: Jossey-Bass.
Charles-Jones, H, Latimer. J, and Mary. C, 2003, "Transforming General Practice:the Redisttribution of Medical Work in primary care." Sociology of Health and Illness 25:71-92.
Clarke, Adele E., Janet K. Shim, Larura Mamo, Jennifer Ruth Fosket, and Jennifer R. Fishman, 2003, "Biomedicalization:Technoscientific Transformations of Health, Illness, and U.S. Biomedicine." American Sociological Review 68:161-94.
Collins, Randall,1990, "Market Closure and the Conflict Theory of the Professions." in Professions in Theory and History: Rethinking the Study of the Professions, edited by Michael Burrage and Rolf Torstendahl. London: Sage.
Collins,Randall,1979,The Credential Society: an Historical Sociology of Educaton and Stratification .
Conrad, Peter, 2004, "Medicalization,Markets and Consumers." Journal of Health and Social Behavior 45(Extra Issue):158-176.
—, 2005, "The Shifting Engines of Medicalization." Journal of Health and Social Behavior 46:3-14.
—, 2007, The Medicalization of Society : on the Transformation of Human Conditions into Treatable Disorders. Baltimore: Johns Hopkins University Press.
Conrad, Peter, and J.W. Shneider, 1980, "Looking at Levels of Medicalization: a Comment on Strong's Critique of the Thesis of Medical Imperalism." Social Science & Medicine 14A:75-79.
Coyle, Susan L, 2002, "Physician-Industry Pelations. Part 2:Organizaional Issues." Annals of internal medicine 136:403-406.
D. B.Sarwer, M. J. Wadden, T. A.&Whitaker, and L.A, 1998, "Psychological Investigations of Cosmetic Surgery Patients: A look Vack and a Lood Ahead." Plastic and Reconstructive Surgery 101:1136-1142.
DeVries, Raymond G.,1993, "A Cross-National View of the Status of Midwives." Pp. 131-146 in Gender, Work and Medicine:Women and the Medical Division of Labour edited by Elianne Riska and Katarina Wegar. London: Sage.
Elizinga, Aant, 1990, "The Knowledge Aspect of Professionalization:the Case of Science-Based Nursing Education in Sweden" p.151-174 " Pp. 151-173 in The Formation of Professions:Knowledge,State and Strategy, edited by Rolf Torstendaho and Micaael Burrage. London: Sage.
Freidson, Eliot, 1970, Profession of Medicine. Chicago: University of Chicago Press.
—. 1983. "The reorganization of the professions by regulation." Law and Human Behavior 7:279-290.
—. 1994. Professionalism Reborn: Theory,Prophecy, and Policy. Chicago: The University of Chicago Press.
Goode, William J, 1960, "Encroachment,Charlatanism,and the Emerging Profession:Psychology,Medicine, and Sociology". American Journal of Sociology 25:902-914.
Greenwood, E, 1957, "The Attributes of a Profession." Social work 2:44-55.
Gritzer, G, and A Arluke, 1985, The Making of Rehabilitation: a Political Economy of Medical Specialization,1890-1980. Berkeley: University of California Press.
Gross, Revital, Hava Tabenkin, and Shuli Brammli-Greenberg, 2000, "Who needs a gatekeeper? Patients' Views of the Role of the Primary Care Physician." Fam. Pract. 17:222-229.
Halpern, Sydney A, 1990. "Medicalization as Professional Process: Postwar Trends in Pediatrics." Journal of Health and Social Behavior 31:28-42.
—, 1992, "Dynamics of Professional Control: Internal Coalitions and Crossprofessional Boundaries." The American Journal of Sociology 97:994-1021.
Hanlon, Gerard, 1997, "A Profession in Transition?: Lawyers, the Market and Significant Others." The Modern Law Review 60:798-822.
Hirschkorn, Kristine A, 2006, "Exclusive versus Everyday Forms of Professional Knowledge: Legitimacy Claims in Conventional and Alternative Medicine." Sociology of Health & Illness 28:533-557.
Hughes, Everett, 1963, The Sociological Eye: Selected Papers. Chicago Aldine-Atherton.
Ishigooka, J., Iwao M., Suzuki M., Fukuyama Y., Murasaki M., and Miura S, 1998, "Demographic Features of Patients Seeking Cosmetic Surgery." Psychiatry and Clinical Neurosciences 52:283-287.
Johnson, Terence J, 1972, Professions and Power. London: Macmillan.
Kreckel, R, 1980, "Unequal Opportunities Structure and Labour Market Segmentation." Sociology 4:525-550.
Larkin, G.,1983, Occupational monopoly. London: Tavistock.
Larkin, G.,1978. "Medical Dominance and Control:Radiopraphers in the Division of Labour." Sociological Review 26:843-858.
Larson, Magali Sarfatti, 1977, The Rise of Professionalism: A Sociological Analysis. Berkeley: University of California Press.
Lupton, Deborah, 1997, "Doctors on the medical profession." Sociology of Health & Illness 19:480-497.
M. K.Goin, J. M. Goin, and & M. H. Gianini, 1977, "The Psychic Consequences of a Reduction Mammaplasty." Plastic and Reconstructive Surgery 59:530-534.
Macdonald, Keith M, 1995, The Sociology of the Professions. London: Sage.
Murphy, R, 1984, "The Structures of Closure:a Critique and a Development of the Theories of Weber, Collins and Parkin." British Journal of Sociology 35.
Napoleon, A, 1993, "The Presentation of Personalities in Plastic Surgery." Annals of Plastic Surgery 31:193-208.
Parkin, F. 1979. Marxism and Class Theory:Bourgeois Critique. London: Tavistock.
Parry, N, and J Parry, 1976, The Rise of the Medical Profession. London: Groom Helm.
Qingxing, Pen, Wang Xue, and Zhao Jiaye. 1995. "The rise of Prospects of Medical Aesthetics." Social Science & Medicine 41:1197-1201
Rosen, George, and Charles E. Rosenberg, 1983, The Structure of American Medical Practice,1875-1941. Philadepphia: University of Pennsylvania Press.
Rothman, Robert A, 1979, "Occupational Roles: Power and Negotiation in the Division of Labor." The Sociological Quarterly 20:495-515.
Sanders, Tom, and Stephen Harrison, 2008, "Professional Legitimacy Claims in tthe Multidisciplinary Workplace:the Case of Heart Failure Care." Sociology of Health & Illness 30:289-308.
Sarwer, David B ., and Canice E . Crerand, 2004, "Body Image and Cosmetic Medical Treatments." Body Image 1:99–111.
Selander, Staffan, 1990, "Associative Strategies in the Process of Professionalization: Professional Strategies and Scientification of Occupantions." in Professions in Theory and History: Rethinking the Study of the Professions, edited by Michael Burrage and Rolf Torstendahl. London: Sage.
Stevens, Rosemary, 1966, Medical Practice in Modern England:the Impact of Specialization and State Medicine. New Haven: Yale University Press.
—. 1971. American Medicine and the Public Interest. New Haven: Yale University Press.
Taylor, Geoffrey Stuart, and Malcolm Nicolson, 2007, "The Emergence of Orthodontics as a Specialty in Britain: the Role of the British Society for the Study of Orthodontics." Medical History:379-398.
Torstendahl, Rolf. 1990. "Introduction:Promotion and Strategies of Knowledge-Based Groups." Pp. 1-10 in The Formation of Professions:Knowedge,State and Strategy, edited by Rolf Torstendahl and Michael Burrage. London: SAGE.
Turner, Bryan S., and Colin Sampson. 1987. Medical Power and Social Knowledge London: Sage.
Weisz, George, 2003, "The Emergence of Medical Specialization in the Nineteenth Century." Bulletin of the history of medicine:536-575.
Witz, Anne. 1992. Professions and Patriarchy. London: Routledge.

中文部分
王文科,1995,《教育研究法》。臺北:五南。
王增勇、陶蕃瀛,2006,<專業化=證照=專業自主?>。《應用心理研究》:201-224。
余雲楚、梁志遠、謝博齊、邱延亮,2004a.,<生業、職業、專業與志業--助人志業自主抗爭的社會學反思>。臺北:台灣行動研究學年會。.
—. 2004b,<社會工作專業化的夢魘--一個社會學的剖析>,臺北:台灣行動研究學年會。
吳嘉苓,2000,<醫療專業、性別與國家:台灣助產士興衰的社會學分析>。《台灣社會學研究》4:191-268。
吳嘉苓,2001,<空間、規訓與生產政治>。《台大社會學刊》29:1-58。
宋奉宜,2003,《公立醫院自費醫療服務之績效評估─以某醫學美容中心為例》。桃園:長庚大學醫務管理學研究所。.
李希敏,2005,《醫學美容市場發展趨勢與商機探討-儀器設備》。臺北:經濟部技術處。
沈怡君,2005,《對鏡:皮膚醫學美容病患身體意象及其相關影響因素》。臺北:臺北醫學大學醫學人文研究所碩士論文。
林信男,2005,《醫學美容消費決策影響因素之研究》。嘉義:國立嘉義大學管理學院碩士在職專班論文。.
林俞寬,2006,《探討影響醫學美容顧客行為意圖之重要因素---以大臺北地區皮膚科醫療院所為例》。臺北:大同大學事業經營學所碩士論文。
許甘霖,2008,<親密關係與「關係體型資格」:兩則減肥藥行銷活動的啟示>。論文發表於「身體治理工作坊」,臺北。2008年06月28日。
胡幼慧,1996,《質性研究:理論、方法及本土女性研究實例》。臺北:巨流。.
張苙雲,2004,《醫療與社會:醫療社會學的探索》。臺北:巨流。
畢恆達,1996,<已婚婦女的住宅空間體現>。本土心理學研究,6,300-352。
許章騰,2006,《臺北縣市醫學美容消費行為及市場區隔--以生活形態變數進行市場區隔》。臺北:銘傳大學管理學院高階經理碩士論文。.
楊玫瑩,2000,<台灣的社會工作專業化:「社工師法」的立法過程>.。《台灣的社會福利運動》。臺北:巨流。
劉惠琴,2006,<吹皺一池春水:對台灣諮商心理師證照化現象的觀察與省思>。 《應用心理研究》:37-58.
劉懿德,2007,《組織再造、學校衛生制度變遷,與專業精神再建:台灣校護運動的社會學分析》。台南:成功大學公共衛生研究所碩士論文。
鄭婉君,2005,《臉部整型美容的女性身體經驗.》。高雄:高雄醫學大學性別研究所碩士論文。
蘇子炘,2005,《醫學美容消費者體驗層級效果模式》。嘉義:國立中正大學企業管理研究所碩士論文。

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16. <女性怕更年期,情緒憂鬱不安定,唯恐丈夫對她失去興趣,亂找醫生美容和整形>《聯合報》,1978/05/08

參考網站
1. 台灣雷射皮膚中心: http://www.taiwanlaser.com/
2. 優活網:http://www.uho.com.tw/
3. 衛生署網站:http://www.doh.gov.tw/cht2006/index_populace.aspx
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  • 同意授權校外瀏覽/列印電子全文服務,於2008-08-21起公開。


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