Sociological analysis demonstrates how referral networks structure medical practice, indicating that doctor autonomy shifts between client demands and colleague oversight.
The interaction among colleague, practitioner, and patient is analyzed as a function of variable location in two sometimes conflicting systems-the lay referral system, which consists in a variable lay culture and a network of personal influence along which the patient travels on his way to the physician, and the professional referral system of medical culture and institutions. Two analytically extreme types of practice are distinguished on the basis of their location in each of these systems. Independent practice is located in the lay referral system and is primarily subject to client controls. Dependent practice is located well within the professional referral system and is primarily subject to colleague controls.
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Eliot Freidson (1960) studied this question.
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