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 code of conduct which appears to regulate member’s behaviour so their actions place clients’ interests first and foremost. The neo-Weberian ‘social closure’ model of professionalization became increasingly popular amongst sociologists as it focused upon the role of professional self-interest, instead of alleged altruistic tendencies, in the initial formation and subsequent development of professions such as medicine.As reflected in the early work of Freidson (1970). While the sociologist and GMC lay member Margaret Stacey (1992) used insights of Larson and Freidson to show that medical control of the GMC had led to a similar tension between medicine’s concern with maintaining its professional privileges and the GMC’s role in protecting the public interest.
The neo-Weberian perspective places a heavy emphasis upon undertaking an historical analysis of the development of modern medicine and the regulation of medical training and work.This has led to a particular form of reasoning, known as ‘the clinical mentality’ being placed at the centre of the occupational structure and culture of the modern medical profession. Following Larson (1977: 17) it can be argued that medicine has long possessed an ‘exclusive cognitive identity’. As noted earlier, the development of an exclusive ‘members only’ occupational identity, based upon the esoteric cognitive expertise shared by group members, formed a key part of the process by which the fledging medical profession initially sought to convert its increasingly scientific credentials into social and economic rewards during the nineteenth century.
Sociological accounts of medical knowledge, work and training highlight how doctors collectively and individually possess a ‘cognitive exclusiveness’ towards outsiders, given the specialist nature of medical work and the lengthy period of time it takes to train a new member of the medical club. These also reveal that a key characteristic of the culture of the medical club is a mutual respect amongst group members for each other’s clinical experience and expertise. This is reinforced by the hierarchical nature of the career structure of the medical profession in general and the organisation of local medical teams in particular. This leads to the general refusal, on behalf of juniors, to criticise publicly seniors in all but the most extreme cases, particularly if they want to work their way up the career ladder (Seabrook 2004).
Sociological studies of medical training and work have repeatedly highlighted that the development of ‘clinical acumen’ by trainees must be accomplished through the application of a characteristic mode of reasoning that is bound up with this feeling of exclusiveness, namely ‘the clinical mentality’. This often transcends and takes precedence over the more formal scientific basis of medical expertise that is frequently presumed to lie at the basis of medical power. In his now classic elucidation of the clinical mentality Freidson (1970) notes that an individual doctor’s knowledge and expertise is personally acquired through direct first-hand experience over the course of her professional career. Freidson (1970: 170) holds that at the basis of the clinical mentality lies a ‘kind of ontological and epistemological individualism’. He argues that the nature of her work makes the medical practitioner a pragmatist. She is driven to draw upon her experience of previous similar concrete clinical cases when making her professional judgments, instead of utilising more formal resources such as clinical protocols or statistical evidence. Freidson holds that this pragmatism comes about from a doctor’s need to take action and make clinical decisions in complex practice situations so she can make a positive difference (or at least do no further harm) to the lives of the patients she is professionally responsible for. Indeed, Freidson (1970: 170) says that: ‘In having to rely so heavily upon his personal, clinical experience with concrete, individual cases. the practitioner comes essentially to rely on the authority of his own sense, independently of the general authority of tradition or science. After all, he can only act on the basis of what he himself experiences, and if his own activity seems to get results, or at least no untoward results, he is resistant to changing it on the basis of statistical or abstract consideration. He is likely to need to see or feel the case himself’.
Freidson (1970) is not alone in making the point that the expertise of the medical profession is made up of formal-determinate and tacit-indeterminate dimensions (i.e. Allsop and Mulcahy 1996, Stacey 1992 2000) as well as holding that it is the latter, rather than the former, that is often ultimately used by doctors to justify clinical decisions (i.e. Armstrong, 2002). Bosk (1979: 91-94) in his discussion of the management of surgical errors argues that doctors possess two distinct ‘warrants for action’: ‘the academic’ and ‘the personal’. He describes how a doctor’s personal ‘clinical acumen’ or ‘clinical expertise’ is often used to ‘trump’ academic knowledge.
The veneration by members of the medical fraternity of the autonomy of the individual practitioner and the existence of clinical judgment and expertise, accounts for the presence of variation in clinical diagnosis and treatment, as well as the fact that medical practitioners can be collectively and individually resistant to innovation and change. However, it also leads to a shared belief amongst medical club members that they can legitimately exclude outsiders from judging members of the club. For there is a mutual recognition between club members that the inherent uncertainty at the basis of their expertise means that it is a case of ‘there but for the grace of god go I’ when medical errors occur. They therefore collectively ‘close ranks’ to ensure club members are protected. The highly personal but mutually shared nature of the clinical mentality, alongside the inherently insular nature of medicine’s ‘members only’ regulatory club, leads to a natural reluctance on behalf of individual members to report any concerns they may have about other club member’s competence. Not least of all because club members fear of being ostracised by their peers and their careers consequently blighted. Furthermore, this situation has led to tendency within medical training for ‘teaching by humiliation’, particularly when trainees make common clinical errors (Sinclair 1995). A growing body of sociological literature reporting medical students’ experiences of being bullied, shouted at and publicly humiliated (Silver and Glicken 1990, Schuchert 1998, Seabrook 2004). This is in spite of the fact that medicine’s elite institutions have recognised that they must promote an occupational culture that is more open and accountable and encourages individual practitioners to learn from their mistakes (Catto 2006 2007). For medicine’s ‘new professionalism’ requires doctors report medical errors, whether or not they are made by themselves or their peers, and actively admit to mistakes and learn from them (Irvine 1997 2003 2006).
The Dominance of the ‘Social Closure’ Model
Given the previous discussion, it is not surprising to learn then that the neo-Weberian viewpoint has dominated the sociological study of professional regulation in the UK for the last four decades. In addition to the important insights its offers into the nature of the ‘clinical mentality’ and the fundamentally exclusory nature of ‘club governance’, it encapsulates the socio-legal and political realities of the regulatory context with regards to the professions in general and medicine in particular (Stacey 1992, Moran and Wood 1993, Johnson Larkin and Saks 1995, Allsop and Saks 2002, Davies 2004, Allsop 2006, Slater 2000 2003 2007). The interrelated concepts of ‘professional project’, ‘occupational monopoly’ and ‘social closure’ reflect the reality of ‘state licensure’, as achieved by professions such as medicine, in the Anglo-American context (McDonald 1995, Elston 2004). Additionally, although the exact process by which an occupation becomes a profession (i.e. professionalization) differs between nations and occupations, the general form of state licensing of professional groups in the Anglo-American context has historically been based upon ‘the model of the medical profession of the nineteenth century.In this respect, all the health professions are licensed by statute, and the terms of the licence may be modified by parliament’ (Allsop and Saks 2002: 7). Furthermore, it can be argued that the neo-Weberian viewpoint will continue to encapsulate the medical regulatory context for the foreseeable future. For whatever the outcomes of the current White Paper may be, medical control of the GMC will remain in some form, and medical elites such as the Royal Colleges will continue to take the lead in controlling entry onto and exit from the register of approved medical practitioners.
However, the neo-Weberian perspective is not beyond criticism. It can be accused of being as one sided as early Functionalist accounts when they uncritically accepted the altruistic claims made by occupational groups such as medicine. For the neo-Weberian viewpoint does highlight how professions sought to obtain, protect and promote their self-interest over the interest of their clients. Nevertheless, it can be argued that it does so by neglecting that the day-to-day activities of a large number of health care practitioners demonstrate that they possess a strong personal commitment to their work. Indeed, they often place their personal needs second to their professional commitments in order to ensure that patients receive the best quality of care possible. It could equally be argued, however, that the value of the neo-Weberian analysis lies in the fact that it reinforces the need for the general public and state to recognise that doctors need to be able to exercise discretion in their work, and indeed can by and large be trusted to place their clients interests before their own. While at the same time reinforcing to doctors that the possession of a distinctive mixture of cognitive and altruistic characteristics, does not in itself justify the extent to which they have traditionally been left alone to manage their own affairs.
The Feminist Critique
By the end of the 1970s, there was a growing Feminist critique of how the professions sustained gender inequalities in society. A ‘gender blindness’ existed in the neo-Weberian view of the professions. For example, Spencer and Podmore (1986) argued that sociological accounts of the legal profession ignored that female solicitors were marginalised by their male colleagues, and discussed how this was related to broader social expectations regarding appropriate male and female roles and relationships. Their empirical research found that discrimination against women within the legal profession occurred primarily because the confrontational nature of court hearings meant law was held to be a masculine, aggressive, occupation. Female solicitors were defined by their male colleagues as ‘the other’ through engaging in gender laden discourses that variously categorised them as ‘sex objects’, ‘different beings’ ‘over emotional’ or ‘basically not tough enough’. This situation enabled the allocation of female solicitors into what were seen as gender appropriate careers, such as family law, and actively excluded them from elite occupational positions within the profession. At the time of Spencer and Podmore’s study in the mid 1980s, only 2% of judges were women while they were no women law lords. This was preventing them from becoming a part of the legal professions self-regulatory elite (Dingwall and Lewis 1983). As noted earlier a similar situation was found by Stacey (1992) in her study of the GMC. The first female member of the GMC was not elected until the 1950s. That is nearly one hundred years after the foundation of the GMC in 1858. There were only three female members of the GMC throughout the 1970s and early 1980s (two of whom were non-medical, including Stacey herself). While there was an over-representation of female doctors in what were seen within the profession as being ‘female friendly’ specialties, such as general practice. As in the case of the legal profession, ‘female friendly’ specialties were not conducive to obtaining access to the higher echelons of the professions elite training and regulatory institutions.
Feminism is a not a unitary social theory. It incorporates authors operating from Liberal, Radical, neo-Marxist, Black and Postmodern viewpoints, to name a few (Anthias and Yuval-Davies 1993). The concept of patriarchy has traditionally been at the centre of feminist viewpoints, with its claim that there is an all-pervasive ‘male gaze’, which directly oppresses women and possesses institutionalised power within the apparatus of the state. This has been criticised by feminists and postmodern thinkers who hold an anti-essentialist view of the self, and so reject the idea that there is a universal female subject or a common ‘feminine’ experience and identity (Barrett and Phillips 1992). Authors working in the field of ‘men’s studies’ extend these views further and use the notion of ‘hegemonic masculinity’ to explore the oppressive features of the rational, domineering, aggressive and exploitative white Anglo-Saxon Protestant male (Connell 1995).
Throughout the 1970s and 1980s a growing number of authors interested in the social role of medicine and working from a Feminist perspective, focused upon the fact that the history of modern medicine and its treatment of women was tied up with a broader narrative of subordination of ‘the female’ to ‘the male’ (Butler 1993). Women were socially constructed as ‘the other’ and assigned normative social roles belonging to the private sphere. For example, studies by Barker-Penfield (1979) and Holmes (1980) traced the historical development of the medical discipline of obstetrics and gynaecology. They highlighted how this was tied up with a socio-economic need to manage the female body to locate its biological destiny within the social roles of mother and housewife.Pfeffer’s work discusses how a women’s experience of her body is mediated through medical categories and conditions that possess fundamentally negative gender images, as ‘infantile’ uterus, ‘failed’ labour, placental ‘insufficiency’, ‘irregular’ menstrual cycles and hormonal ‘imbalances’.
Underlying the critique of the Feminist perspective was the belief that the structure of medical knowledge was in many ways sexist and patriarchal due to medicines close relationship to science (Fox-Keller 1985). The Feminist perspective holds that the rationality of ‘the Enlightenment’, which spawned modern scientific thought, was inherently masculine (Butler 1993). Women were perceived as ‘the other’ and held to be illogical or irrational. Women were fundamentally flawed and emotional creatures inextricably bound to their reproductive role (Ehrenreich and English 1979). As Fox-Keller (1985: 78) maintains, the Feminist perspective held that ‘in characterising scientific and objective thought as masculine, the very activity by which the knower can acquire knowledge is genderised’. Ehrenreich and English (1979) documented how women were socially defined by society as fragile creatures that were prone to hysteria. The development of scientific medicine over the course of the nineteenth century allowed the source of this problem to be increasingly located within the female reproductive system. This explanation was seen as socially acceptable as it precluded men from the possibility of becoming ‘hysterics’. To this day female patients more than male patients are likely to be viewed as ‘unhappy’, ‘depressive’ and ‘anxious’ by general practitioners and psychiatrists. Furthermore, they are more likely to receive pharmacological treatments such as Valium and Prozac and Seratoxat (Prior 1999).
The critique of the Feminist perspective of medical knowledge and practice extended into the very organisation of the medical profession. Witz (1992) argued in line with the neo-Weberian thesis that the medical profession obtained its market monopoly in the United Kingdom through using its educational credentials as a ‘bargaining chip’ from which to negotiate with state control over its regulatory arrangements. She also held that medicine’s achievement of ‘social closure’ in the nineteenth century succeeded because the strategy of closing off medical training and practice to all but an elite few was in line with boarder social norms of the time. Medicine actively sought to keep women in the private not public sphere. It excluded women and to a lesser extent working class men from practicing medicine due to its historically close association with the gentry. She argues that medicine’s elite institutions used, firstly, ‘exclusionary strategies’ to deny women entry into medical school and so the medical register, and secondly, ‘demarcatory strategies’ where medical control was firmly established over other health care occupations dominated by women, such as nursing and midwifery. As topic earlier discussed, medicine’s professionalization process was certainly dominated by men and involved the appropriation of healing and caring domains that had traditionally belonged to women. Far from being a neutral science medicine reflected the patriarchal and class based nature of society at the time.
By the mid 1980s the work of Feminist authors such as Ann Oakley (1984) had made a significant contribution to the growing recognition that the practice of modern medicine was largely socially and culturally bounded. Authors working within neo-Weberian and Feminist positions shared a common view of medical practice, which was diametrically opposed to medicine’s self-image as scientific, value-free and morally neutral (Elston 2004). However, despite of the important contribution of the Feminist perspective, the neo-Weberian continued to dominate sociological analysis of professionalism and the principle of professional self-regulation in the Anglo-American literature. The Feminist perspective tended to be held by sociologists concerned with the sociological analysis of the professions to supplement and expand the neo-Weberian perspective, not necessarily replace it (Lupton 1994). The was because there was an ongoing debate within sociology about the extent to which the clinical gaze of modern medicine was a social construct and therefore could be seen as inherently ‘gendered’ (Williams and Calman 1996). Some commentators held the view that although a human undertaking, and therefore open to a range of intervening socio-economic and cultural factors, medical science does reflect a reality that exists ‘out there’ independently of the observer (Kelly and Field 1994). Modern medical expertise and technology consequently was seen to exist beyond the particular circumstances surrounding their creation and application. Both Elston (1991) and Ahmed and Harrison (2000) note that medical judgments are likely to be seen as valid and true because modern medicine possesses a considerable amount of ‘cultural authority’ over definitions of reality. This is due to the predictive power of the randomised clinical trial. However, other social commentators held that it is impossible to trust the objectivity and neutrality of the seeing-knowing subject whose gaze extracts knowledge from the world, whether they are a scientist, a doctor or a philosopher (Hoy 1986). The growing ‘social constructionist’ influence of postmodernism in sociology gave weight to the view that human knowledge of the world is limited by language. Indeed, this asserts that it is impossible to apprehend reality outside of the arbitrary linguistic conventions and metaphoric imperatives belonging to the ‘language games’ used to describe it (Drolet 2004). Most sociologists, like Turner (1995) for example, held onto the middle ground within this debate. He argued that some aspects of modern medical knowledge and expertise, such as for example the diagnosis and treatment of Hyperactivity in children, are more clearly socially constructed than others, such as for example cirrhosis of the liver, as these possess a structural and biochemical origin within the human body.
Adopting a somewhat pragmatic position in this manner has meant that to this day it is possible to detect, as Riska (2001) discusses, three possible stances towards the question of whether or not medical knowledge and work are too gendered. First is the view that medicine is a gender-neutral activity and the creation and application of medical knowledge and expertise is a value-free affair. As Riska notes, this viewpoint is not so much held by feminist authors themselves but by members of the public as well as many doctors themselves. Second is the view that medicine is an inherently masculine activity, which promotes a negative view of women and the female body. It relegates women to the private sphere and the role of mother and wife due to their reproductive role and biological difference to the ‘alpha male’. Riska notes that the third position operates somewhere in the middle of these two extremes. This view holds that the creation and application of modern scientific medical knowledge does appear to mirror the nature of the world in which human beings live. Furthermore, it does enable them to access and actively manipulate the biological realties of their existence. This position also asserts the practice of medicine is nevertheless an inherently social activity; it reflects the broader cultural values of the society within which it operates. Therefore, medicine possesses gendered processes and practices. Riska (2001) provides cross-national evidence to show that although more women today than ever before are pursing medicine as a career, a ‘glass ceiling’ still operates inside the medical club that stops female doctors accessing certain prestigious surgical sub-fields.
There are two key interrelated reasons why sociological analysis of professionalism has continued to be dominated by the neo-Weberian viewpoint. First, the neo-Weberian viewpoint by and large reflects that nature of the regulatory context in the United Kingdom in regards to health and social care professions in general and the medical profession in particular (Stacey 1992, Moran and Wood 1993, Johnson Larkin and Saks 1995, Allsop and Saks 2002, Davies 2004, Allsop 2006, Slater 2007). Indeed, although the GMC is under threat in its current format, it will continue to exist. Furthermore, medical control over admission onto and exit from a state approved register of practitioners will undoubtedly continue (Bruce 2007, GMC 2008). It is precisely because of this fact that feminist authors working within the UK context, such as Elston (1991, 1997, 2004), Stacey (1992, 2000) and Witz (1992), used the framework provided by neo-Weberian viewpoint when analysing how medicine as a profession is regulated.
Second, the growing Feminist critique of medicine remained focused upon forms of medical knowledge and technology that were experienced mainly by women, such as reproductive technology (Lupton 1994, Elston 1997). Although this focus was justifiable, it nevertheless limited the ability of the Feminist perspective to contribute to broader sociological debates regarding the regulatory arrangements concerning occupational groups categorised as professions. Because its research focus was ‘gender exclusive’, the contribution of the Feminist perspective lies within the broader field of the sociology of health and illness and not within the sociological study analyse of professional self-regulation (Nettleton 1995, Coburn and Willis 2000). Particularly as this is restricted to the analysis of occupational groups which claim to possess not just esoteric specialist knowledge but also an ethical code of conduct that requires they place their clients’ interests before their own (McDonald 1995). This code of conduct is used to obtain not only social and economic rewards but also exclusive occupational control over members training, practice and discipline (Freidson 1970 1994 2001). This includes traditionally female dominated occupations such as nursing (Stacey 1988). The history of the professionalization of nursing in the UK shows how broader social norms alongside the restrictive actions of a male dominated medical profession initially blocked nurse’s claim to professional status. That is until a mixture of NHS service needs and continued political activism on behalf of nurses throughout the 1950s and 1960s eventually lead the establishment of a General Nursing Council in 1979 (Riska and Wegar 1993). Yet historical narrative shows that throughout this time nursing sought proactively to exclude third party evaluation of practitioners’ activities as a key part of its quest for professional status. Indeed, like the medical profession before it, nursing eventually acquired a legal statute through parliament that enshrined in law its right to possess exclusive occupational control over a register of member’s entry into and exit from the nursing profession, as well as the standards governing members training, practice and discipline (Davies and Beach 2000). Furthermore, similar to other occupations categorised as professions (e.g. medicine, law, psychiatry and social work) nursing’s self-regulatory body has in the last two decades been accused of being elitist, inherently inward looking and ‘protectionist’, as a result of high profile malpractice cases in the media. This has led to calls for greater lay involvement in nurse regulation and a more open and multi-disciplinary approach towards nurse training and discipline.
Medicine and the State: The Invasion of Capital into the House of Medicine
Despite its dominance in the sociological study of professional regulation, the neo-Weberian perspective was criticised by authors operating from a neo-Marxist viewpoint for failing to account for the entwined nature of the development of the modern state and professions such as medicine, as was touched upon earlier when discussing ‘club governance’ (Moran 1999 2004). Indeed, although his Profession of Medicine was (and still is) regarded as a sociological classic, Freidson was criticised by neo-Marxist commentators for ignoring the political economy and under theorising the relationship between medical and state power. As Larson (1977: xiv) notes, Freidson’s work does tend to assume that the professions are ‘independent from or at least neutral vis-a-vis the class structure^. In contrast, the neo-Marxist perspective of the professions argued that medical dominance in the health care division of labour played a central role in the surveillance and reproduction of working class labour on behalf of capital (Johnson 1977). As Johnson (1977: 106) notes: ‘the professionalism of medicine – those institutions sustaining its autonomy – is directly related to its monopolization of ‘official’ definitions of illness and health. The doctor’s certificate defines and legitimates the withdrawal of labour. Credentialism, involving monopolistic practices and occupational closure, fulfils ideological functions in relation to capital and reflects the extent to which medicine in its role of surveillance and the reproduction of labour power is able to draw upon powerful ideological symbols’.
McKinley is typical of the neo-Marxist viewpoint when he states, ‘the House of Medicine under capitalism will never contribute to improvements in health unless such improvements facilitate an acceptable level of profit’ (McKinley 1977: 462). According to neo-Marxists, there is no difference between the production of taken for granted capitalist commodities such as cars, fridges and clothes, and the practice of the surgical techniques of modern medicine; such as open-heart surgery (Navarro, 1976). Both involve the search for profit. Large corporations involved in the production of medical supplies, particularly pharmaceutical therapies, profit from individual experiences of illness and disease (Navarro 1986). Neo-Marxist commentators may agree with their neo-Weberian counterparts that medicine possessed substantial control over other health care occupations and patients. Nevertheless, they also held that medical work was increasingly coming under direct bureaucratic-managerial surveillance and control operating on behalf of capital (McKinley 1977).
The neo-Marxist sociologist Navarro (1976 1986) argued that medical autonomy is tied to the needs of capital. He held that it only emerged because the increasingly scientific foundations to medical expertise were congruent with the interests and needs of nineteenth century industrialists, who were using the apparently neutral concept of science to justify the introduction of new factory-based mass production methods. Navarro (1976: 31) argued that there had been an ‘invasion of the house of medicine by capital’ and consequently medical knowledge and technology could not be seen as separate from capitalism but rather was part of it. Medical knowledge was not overlain onto capital ideology but rather modern medicine under capitalism is capitalist medicine (Navarro 1980). Navarro views medicine’s essentially mechanistic view of the human body as being tied up with the capitalist mode of production. Neo-Marxists argue that medicine plays a key role in supporting the status quo in the capitalist system by reinforcing the idea that ‘lifestyle choices’ as well as ‘natural processes’ are responsible for personal and collective experiences of illness and disease. They hold that in adopting this approach medicine camouflages alternative social and economic factors relating to worker exploitation under the capitalist system (McKinley 1977). They follow Marx’s colleague, Fredrick Engels, who in his key text The Condition of the Working Class in England (1974) held that an individual’s personal experience of for example alcoholism, was an outcome of the impoverished life chances available to low paid workers living in the slums of industrialised cities. For Engels dependence on alcohol was a result of an attempt to ‘blot out’ the harsh reality of the working and living conditions present in nineteenth century society. It was not due to some inherent biological tendency towards addiction. Waitzkin’s (1989) work on how doctor-patient interaction reinforces class inequalities focuses upon this point. Waitzkin (1989: 223) argues that during the doctor-patient encounter ‘technical statements help direct patients’ responses to objectified symptoms, signs and treatment. This reification shifts attention away from the totality of social relations and the social issues that are often causes ofpersonal troubles’.
A key criticism of the neo-Marxist viewpoint is that similar to Functionalism it seeks to explain medicine’s position in society as stemming from the important social role it plays in maintaining the established social order. The main difference between the two perspectives is that neo-Marxists regarded this order as exploitative and ultimately offering no benefit to the individual worker. This is an overly simplistic viewpoint. In contrast, authors operating from the Foucauldian Governmentality perspective may like their neo-Marxist counterparts focus upon how health and social care professions such as medicine are deeply bound up with the process of governing populations. So much so that Governmentality authors such as Johnson (1995: 13) hold that, ‘the expert is not sheltered by the environing state, but shares in the autonomy of the state’. Yet the key difference between the respective neo-Marxist and Foucauldian perspectives is that while the neo-Marxist viewpoint sees this state of affairs as fundamentally repressive, by arguing it sustains class-based inequalities, in contrast a Foucauldian viewpoint considers its productive affects. It does this by focusing upon the role professional expertise plays in promoting and sustaining an individuals’ capacity for engaging in self-surveillance and self-regulation (i.e. through acting on advice provided by their local general practitioner and other public health experts regarding appropriate dietary and exercise regimes) (Peterson and Bunton 1997). For the Governmentality perspective sees this as being part of the ability of expertise to render ‘the complexities of modern social and economic life knowable, practicable and amenable to governing’ (Johnson 1995: 23). The topic will now turn to discussing the Governmentality perspective and its contribution to the sociological study of the professions and professional regulation.