HaDSoc Session 10 Flashcards
What is a profession?
Type of occupation able to make distinctive claims about its work practices and status
What does a profession often require of its members?
Registration
What is professionalisation?
Social and historical process of an occupation becoming a profession
What are the three main points involved in professionalisation?
Assert exclusive claim over body of knowledge/expertise; establish control over market and exclude competitors; establish control over professional work practice
Why does a profession exert control over its own professional work practice?
External bodies lack expertise to guide practice
What was the elite status of Dr’s based on historically?
Social background
What was the result of the 1858 Medical Act?
Gave GMC power over registration with controlled entry and removal of individuals from the medical register
What does doctrine of clinical autonomy state?
Only Dr’s have enough expertise to monitor and control the work of other Dr’s
Why was professional self regulation thought to be OK historically?
Assumed alignment of professional and public best interests
What did the 1858 Medical Act assume of admitted individuals?
Of good character and competence, socialisation and peer-norming would be sufficient regulation
What is socialisation?
Process by which professionals learn attitudes and behaviours necessary for a professional role during training and education
What does socialisation include?
Learning to internalise, cooperation with collective norms, alignment of conduct with standards of the profession
What is socialisation similar to?
Process through which children develop socially through interaction with others
What is the formal curriculum?
Knowledge tested/examined
What is the informal curriculum?
Attitudes/beliefs that are noted but not formally examined
Give some critique of the professions.
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
What were the systemic problems identified by investigations such as the Bristol Inquiry, Harold Shipman and Bradbury?
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
What are the problems with self regulation of the medical profession?
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
Why was the authority for management, setting standards, monitoring practice and conduct real at outside of the medical profession?
Scandals and failure of GMC to develop a satisfactory system of reform
What are the results of moving regulation outside of the medical profession?
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
What is the purpose of revalidation every 5 years based in Good Medical Practice?
Assure pts; maintain, improve and support practice; identify concerns early; encourage pt feedback; drive local clinical governance
What is a criticism of the sweeping reform of processes as a result of the end of self regulation of the medical profession?
Large administrative overhead
What can lead to a FTp hearing?
Misconduct; poor performance; criminal conviction/caution in UK; ill health; determination by regulatory body
What are the possible outcomes of an FTP hearing?
Agreed undertaking with Dr; conditions on regulation; suspension; removal from register
Who decides the outcome of an FTP hearing using clear criteria?
Medical Practitioners Tribunal Services
What is a responsible officer?
Formally appointed Dr responsible for local performance and conduct issues with a duty to share information where needed to protect pts/public
What has led to concerns of loss of clinical autonomy in the medical profession?
Rise in managerialism from administration to facilitate work of professionals to management to control their work
What impacts has increasing managerialism had leading to concerns of loss of clinical autonomy?
Proliferation of guidelines, pay for performance, league tables, reputational sanctions
What are the three logics of professions?
Bureaucracy, markets and professionalism
What are the negative results of bureaucracy in the medical profession?
Displacement of professional goals and ethos with organisational ones; undermine clinicians role as pt advocate; reduced professional discretion
What is the markets logic of the medical profession?
Better performers will naturally rise to the top if clients are given the choice
What happens if bureaucracy and markets dominate in the medical profession?
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
What is collective professionalism?
Responsibility of profession as a whole to do good
Why is a new model of professionalism being looked for?
Distrust fuelled regulation is wasteful, corrosive and causes anxiety by creating a system seen as unfair and burdensome
