The Medical Profession

Question 1

LO1: desc professionalisation of medicine.

Answer 1

• profession= type occup able to make claims about work pracs and status. HC us refs to those req regist.
  Professionalisation= soc and hx proc that res in occup becoming profession.
• HCPs-
  Us regist occupat. Mems committ to org professional community, strong profess ID. Specif tasks and roles in orgs.
• professionalisat invs 3 elems-
  Assert exclus claim over bod of knowl/expertise.
  Est contr over market and exclud comp.
  est contr over profess work prac.
  -hx-
  RCP 1500s based on soc backg.
  Drs as elite grp- only wealthy pts. Apoth and barbers rest. Healing domestically. Norm wom acted as midwives.
  C19 men only physicians. Other healers.
  1858 medical act- GMC pow over regist. Inspected medic schools. Init self regulatory ie socialisat and peer norming.

Question 2

LO2: desc ev and theory about socialisat of drs into medical profession.

Answer 2

-socialisat= proc by which professionals learn dur educ and training, the attits and behavs necess to assume their profess role.
Indivs learn to coop with collec norms of grp and align conduct with professions stands.
- in medicine-
Occs via formal and informal interac. Medic educ for facts, skills and tech compet. Also dev partic types of orients to pts, colleagues, and repro or chall partic norms.

Question 3

LO3: assess ciritcally diff apprs to regul of drs.

Answer 3

• lev of skill and knowl means only drs can eval or regul.
  HCPs are responsib and should be trusted.
  Profess should be trusted to act if someone not compet or ethical.
• critique of the professions-
  Are protected monopolies. Claims of virtue and self serving are strategic. Seek to optim own ints.
• critic of self regul model-
  Self deceiving vis of objectivity and reliabil of its knowl and the virtues of its own mems. Auton has led to insularity and arrog about its mission.
• eg bristol heart babies. Club cult, resis to ext scrutiny, critic or contr.
  Shipman over 200 murders. Prev convics for obt drugs illeg but GMC no furth action.
  Jeet bains filmed intim examins.
• systemic probs- other staff fnd diffic to act. Pts and whistleblowers not believed. NHS discip proceds costly and inhibiting.
• rules on profess propriety-
  Drs discour from raising concerns about each other. Etiquette forbid close monit. Shared personal vuln. High costs of sanction. Probs with qual of ev and no supportive proc. Credibility gap.
• mostly informal controls- soc norms pow corrective force. GMC, NHS managem, gov, unclear admin sys to blame.
• concerns about self regul-
  Fail auth figs in NHS/ reguls to detec signs of unacc or incompet profess behav and to take effec timely action to protec pts.
• 2000s move away from self regul. Auth for sett stand, monit and managem reloc from inside th profession.
  Gov resp- white paper 07.
  GMC now parity of lay and profess mems. Indep appointed. Overseen by profess stands auth.
  Fitness to prac concerns ref to medic practitioners tribunal services.
• Revalid ev 5yr.
  Aims of revalid- assure pt, impr prac, supp drs in keep up to date, early ID concerns, encour pt feedb, impr clinic govat loc lev and pt care stabds.
  Royal colls set content and stands for each speciality. Drs prov ev fit to contin prac. Responsib officer ass ev.
• revalid invs-
  Loc eval by annual appraisals. Portfolio supp info. Pos recomm from responsib officer.
  Ev req- contin profess dev, qual impr activ, sig events, feedb, review compliants.
  Responsib officers- dr deals with loc conduct iss with GMC. Duty to share info.
  Jnr dr revalid- annual review compet using record of in training ass.

Question 4

LO4: critic eval ev and theory on challs to medical profession.

Answer 4

-rise of managerialism-
Consultants, job descrips, gov policy, comply guidelines.
-threats to clinic auton-
Guideline prolif, monit, pay for perf, league tables, reputational sanctions, Elec record contr and surv.
- threats to professionalism-
Dimin profess discretion. Ext accountabil conseqs. Large admin overhead. Undermin clinician role as pt advocate. Displ profess goals and ethos for organisat ones.
- THREE LOGICS:
Bureaucracy- contr by managem.
Markets
Professonalism.
- freidson critique-
Service qual suffers if logics domin. Drs need indep moral voice so req indep of judgem and freedom of action.
But repls former indiv professionalism with collective- whole profess act as force for good.
- new professionalism and regul-
Distrust fueled regul wasteful and corrosive. Drs anxious about unfair and burdensome sys. Still searching for better mods.