HaDSoc Session 10

Question 1

What is a profession?

Answer 1

Type of occupation able to make distinctive claims about its work practices and status

Question 2

What does a profession often require of its members?

Answer 2

Registration

Question 3

What is professionalisation?

Answer 3

Social and historical process of an occupation becoming a profession

Question 4

What are the three main points involved in professionalisation?

Answer 4

Assert exclusive claim over body of knowledge/expertise; establish control over market and exclude competitors; establish control over professional work practice

Question 5

Why does a profession exert control over its own professional work practice?

Answer 5

External bodies lack expertise to guide practice

Question 6

What was the elite status of Dr’s based on historically?

Answer 6

Social background

Question 7

What was the result of the 1858 Medical Act?

Answer 7

Gave GMC power over registration with controlled entry and removal of individuals from the medical register

Question 8

What does doctrine of clinical autonomy state?

Answer 8

Only Dr’s have enough expertise to monitor and control the work of other Dr’s

Question 9

Why was professional self regulation thought to be OK historically?

Answer 9

Assumed alignment of professional and public best interests

Question 10

What did the 1858 Medical Act assume of admitted individuals?

Answer 10

Of good character and competence, socialisation and peer-norming would be sufficient regulation

Question 11

What is socialisation?

Answer 11

Process by which professionals learn attitudes and behaviours necessary for a professional role during training and education

Question 12

What does socialisation include?

Answer 12

Learning to internalise, cooperation with collective norms, alignment of conduct with standards of the profession

Question 13

What is socialisation similar to?

Answer 13

Process through which children develop socially through interaction with others

Question 14

What is the formal curriculum?

Answer 14

Knowledge tested/examined

Question 15

What is the informal curriculum?

Answer 15

Attitudes/beliefs that are noted but not formally examined

Question 16

Give some critique of the professions.

Answer 16

Professions are protected monopolies; claims of virtue are self-serving and strategic; professions seek to optimise own interests not clients; self-regulation leads to self-deceiving vision of objectivity and reliability of professional knowledge and virtue of members

Question 17

What were the systemic problems identified by investigations such as the Bristol Inquiry, Harold Shipman and Bradbury?

Answer 17

Informed staff found it difficult to act; pts concerns were greeted with disbelief or discredited; whistleblowers were not believed; NHS disciplinary procedures cumbersome, costly and inhibiting

Question 18

What are the problems with self regulation of the medical profession?

Answer 18

Dr’s discouraged from raising concerns about each other; etiquette rule forbids close monitoring; shared sense of personal vulnerability; high costs associated with sanctions; problems with evidence and support; credibility gap; social norms are powerful but not enough; lack of clarity about responsibility and authority

Question 19

Why was the authority for management, setting standards, monitoring practice and conduct real at outside of the medical profession?

Answer 19

Scandals and failure of GMC to develop a satisfactory system of reform

Question 20

What are the results of moving regulation outside of the medical profession?

Answer 20

GMC has parity of lay and professional members that are appointed independently; Council overseen by PSAHSC; civil standard of proof used; sweeping reform of processes

Question 21

What is the purpose of revalidation every 5 years based in Good Medical Practice?

Answer 21

Assure pts; maintain, improve and support practice; identify concerns early; encourage pt feedback; drive local clinical governance

Question 22

What is a criticism of the sweeping reform of processes as a result of the end of self regulation of the medical profession?

Answer 22

Large administrative overhead

Question 23

What can lead to a FTp hearing?

Answer 23

Misconduct; poor performance; criminal conviction/caution in UK; ill health; determination by regulatory body

Question 24

What are the possible outcomes of an FTP hearing?

Answer 24

Agreed undertaking with Dr; conditions on regulation; suspension; removal from register

Question 25

Who decides the outcome of an FTP hearing using clear criteria?

Answer 25

Medical Practitioners Tribunal Services

Question 26

What is a responsible officer?

Answer 26

Formally appointed Dr responsible for local performance and conduct issues with a duty to share information where needed to protect pts/public

Question 27

What has led to concerns of loss of clinical autonomy in the medical profession?

Answer 27

Rise in managerialism from administration to facilitate work of professionals to management to control their work

Question 28

What impacts has increasing managerialism had leading to concerns of loss of clinical autonomy?

Answer 28

Proliferation of guidelines, pay for performance, league tables, reputational sanctions

Question 29

What are the three logics of professions?

Answer 29

Bureaucracy, markets and professionalism

Question 30

What are the negative results of bureaucracy in the medical profession?

Answer 30

Displacement of professional goals and ethos with organisational ones; undermine clinicians role as pt advocate; reduced professional discretion

Question 31

What is the markets logic of the medical profession?

Answer 31

Better performers will naturally rise to the top if clients are given the choice

Question 32

What happens if bureaucracy and markets dominate in the medical profession?

Answer 32

Quality suffers due to loss of independence of judgement and freedom of action but they replace the former ‘club like’ culture of individual professionalism with a collective professionalism

Question 33

What is collective professionalism?

Answer 33

Responsibility of profession as a whole to do good

Question 34

Why is a new model of professionalism being looked for?

Answer 34

Distrust fuelled regulation is wasteful, corrosive and causes anxiety by creating a system seen as unfair and burdensome