Doctoring Medical Governance-Medical Self-Regulation In Transition

‘[Medicine]…must be enthused with a spirit of openness, driven by the conviction that… decisions must be routinely open to inspection and evaluation, like the openness that pervades science and scholarship’. Freidson (1994: 196) This topic is concerned with the sociological study of the medical profession and the principle of medical self-regulation. This is the view […]

From Ancient Beginnings to the 1858 Medical Act Part 1

‘The primitive does not distinguish between medicine, magic and religion. To him they are one, a set of practices intended to protect him from evil forces.’ Sigerist (1951: 127) This topic and the next provide an historical overview of the development of the principle of medical self-regulation, as institutionalised in the United Kingdom in the […]

From Ancient Beginnings to the 1858 Medical Act Part 2

The Clinical Gaze and the Doctor-Patient Relationship Foucault (1989) recognised that ‘hands on’ clinical training existed inprotoclinics before the establishment of the clinic in 1790′s France. For example, Rutherford (1695 to 1779) was giving bedside clinical teaching to medical students in Edinburgh in 1748. What was different for Foucault was not that clinical teaching at […]

From Club Governance to Stakeholder Regulation Part 1

‘Until the General Medical Council is composed of hard-working representatives of the suffering pubic, with doctors who live by private practice rigidly excluded except as assessors, we shall still be decimated by the vested interest of the private side of the profession in disease.’ Shaw (1957 Preface to The Doctor’s Dilemma) In doing do it […]

From Club Governance to Stakeholder Regulation Part 2

New Public Management, Medical Audit and Evidence Based Medicine By the beginning of the 1990s, the GMC was under pressure to modernise itself. Yet, the principle of medical self-regulation had not been directly challenged. The same cannot be said for the principle of clinical autonomy in the NHS. As the previous section discussed, from the […]

From Club Governance to Stakeholder Regulation Part 3

The Kennedy Report For many, the potent image of children’s gravestones made out of flowers being laid outside of the GMCs headquarters in London by anguished parents was too much to bear. Frank Dobson, the then Secretary of State for Health, made it abundantly clear on the television programme Newsnight that he felt all three […]

The Sociological Analysis of the Principle of Medical Self-Regulation Part 1

Here the entwined nature of medical governance with the development of the modern state was first noted. As was that a key paradox surrounding recent challenges to the principle of medical self-regulation is that they have occurred at a time when the success of medical knowledge and technology to promote public health is greater than […]

The Sociological Analysis of the Principle of Medical Self-Regulation Part 2

The Exclusive Cognitive Identity of the Medical Club and the Clinical Mentality The work of authors such as Burrage, Larson and Freidson calls attention to the fact that a professions’ possession of a monopoly over the market for its services is not a neutral and straightforward consequence of its possession of esoteric expertise or a […]

The Sociological Analysis of the Principle of Medical Self-Regulation Part 3

Governmentality and the Revival of Liberalism Classical liberalism emerged in the seventeenth and eighteenth centuries, through the works of a variety of writers, such as Thomas Hobbes, John Stuart Mills, Adam Smith, Thomas Locke, Jeremy Bentham and Herbert Spencer. It is possible to identify at the centre of classical liberalism the underlying concept of ‘possessive […]

The Restratification Thesis and Challenges to Medical Autonomy in the UK Part 1

It achieves this through exploring how sociologists conceptualised social changes that were held to be challenging medical autonomy, in the form of clinical freedom ‘at the bedside’ and the principle of self-regulation, from the 1980s onwards. Challenging Medicine The restratification thesis first emerged in the mid 1980s, in response to the growing recognition within sociology […]