Doctoring Medical Governance-Medical Self-Regulation In Transition

The Restratification Thesis and Challenges to Medical Autonomy in the UK Part 2

Support for the Restratification Thesis in the UK context Taking up this point Elston (1991) argued following Freidson (1994) that medicine in the UK was undergoing a process of restratification. She noted that the fact it was already embedded within the managerial and bureaucratic structures of the NHS facilitated this process. She agreed that managerial […]

Performance Appraisal Inside the Medical Club Part 1

The previous topic concluded by arguing for the need to investigate the implementation of portfolio based performance appraisal within the medical profession.Revalidation was an unknown quantity when the research started, so the decision was made to focus upon exploring the introduction of appraisal within medicine through discussing with doctors their experience of annual appraisal as […]

Performance Appraisal Inside the Medical Club Part 2

Portfolio Based Performance Appraisal and Medicines New Professionalism ‘(Governance is) a form of activity aiming to shape, guide or affect the conduct of some person or persons’. Gordon (1991:2). Portfolios can be said to act as one of medicines key new ‘visible markers’ of trust within the contemporary governing context (Allsop 2006, Kuhlmann 2006b).It modernises […]

Performance Appraisal Inside the Medical Club Part 3

Appraisal and the Elitist Nature of the Medical Club It also shows how there is a propensity for doctors to hide such attitudes behind the ‘service ideal’ of their professionalism (i.e. that it is in the best interests of patients that they be left alone to manage their own affairs) (Gladstone 2000). Critical social commentators […]

Performance Appraisal Inside the Medical Club Part 4

The Appraisal Ritual within the Medical Club: ‘Bureaucratic Accountability’ and ‘Paperwork Compliance’ Appraisal requires doctors document their decisions and the reasons for them in a manner that is open to collegiate surveillance and correction (Harrison and Dowswell 2002). Interviewees admitted that portfolio appraisal leaves a ‘paper trail’. In doing so, it places them under greater […]

Performance Appraisal Inside the Medical Club Part 5

Supporting ‘Paperwork Compliance’: The Ideological Factor Although of clear importance, it may well be that the ‘ideological’ factor is most important in comparison to the structural one. For the ‘structural factor’ reinforces the ‘ritual quality’ of doctors ‘bureaucratic accountability’ to medical elites. In doing so, it contributes to the adoption of ‘paperwork compliance’ by ‘rank […]

The Governance of Doctors Under Neo-Liberal Mentalities of Rule

It therefore represents the first attempt to analyse doctors educational autonomy in the context of contemporary sociological debate concerning ‘the decline and fall’ of medical autonomy and the future of the principle of professional self-regulation. The research findings provide direct empirical evidence to support the central argument of the ‘restratification thesis’. Namely that medical elites […]