True Are Claims That the Medical Profession Thesis

Excerpt from Thesis :

True Are Claims that the Medical Profession Exercises Undue Dominance Over Health Professionals and Patients?

The objective of this study is to answer the question of how true the claims are that the Medical Profession exercises undue dominance over health professionals and patients? Toward this end, this study will conduct a review of literature in this area of inquiry. ) According to the work of Willis, et al. (2008) the rationale that doctors use for the maintenance of autonomy and control over their working conditions is derived in part from "the importance our society attributes to the relationship between the doctor and their patient. This is referred to as the patient-practitioner relationships." (Willis, et al., 2008) Stated to be an important part of the role of the doctor is the "obligation to provide the best available evidence-based care for patients." (Willis, et al., 2008) This has been termed as 'personalized service'. (Alford, 1975: in Willis, et al., 2008) This means that the doctor does not favor one patient over another and maintains confidentially about the condition of the patient. These obligations provide doctors with a great deal of control over health care used in treating patients and without autonomy, this relationship would greatly suffer. The power afforded to doctors derives from their history of success in the late 19th and early 20th centuries, which established them firmly as the "dominant controllers of medical care" early before the development of scientific medicine. (Willis, 1983 in: Willis, et al., 2008) This authority is granted to them by the state and positions them effectively as the dominant profession stated to be referred to as "medical dominance." (Willis, et al., 2008)

I. Medical Dominance

Medical dominance is defined as "ideological dominance over developing occupations, power to influence resource allocation decisions, and organizational authority." (Ovretveit, 2008) Autonomy and dominance are concepts, which are reported to be related. There are reported to be types of professional autonomy, which can be distinguished as follows:

(1) Document different forms of independence acquired by an occupational group at different points in history;

(2) Identify important differences between occupations in terms of the different types of independence achieved;

(3) Explore varying patterns of occupational development (rather than view all occupations as following a single inevitable process of professionalization)

(4) Establish whether aspects of professional autonomy are related to aspects of medical dominance and whether aspects of medical dominance have declined; and (5) Examine forms of control over developing health occupations other than those exercised by the medical profession. (Ovretveit, 2008)

Professional autonomy exists at multiple levels including at the national and international levels. There is also a different from of professional autonomy, which exists "where the state grants members of an occupational group a legal monopoly over a sphere of work." (Ovretveit. 2008) There is however, a challenge to defining boundaries of work. As well, it is reported that the type of legal monopolies "is really the freedom of an occupational group to exclude others who are not qualified, in their interests of protecting the public." (Ovretveit, 2008) Stated as a form of autonomy that is related closely to the right of a profession is the regulation of its own schools of training and its curriculum for education. (Ovretveit, 2008, paraphrased) This is accomplished in the United Kingdom through a central council with a majority membership of the profession that accredits training centers, supervises exams, and issues certificates of competence for practice. (Ovretveit, 2008, paraphrased) Professional autonomy at the District Level is England is divided into 192 District Health Authorities. Professional autonomy at the District Level is in the form of self-management reported to be "the right of an occupational group to be managed by members of the same occupation." (Ovretveit, 2008) The manager is defined as "one who is accountable for his subordinates work in all aspects; who is able to assess the quality and effectiveness of his subordinates' work as it is done, and who has the authority to make any further prescriptions or re-assignments of work which he may judge to be necessary." (Ovretveit, 2008) Professional autonomy at the individual level is reported to be "incompatible with the nature of the work they do." (Ovretveit, 2008) The existence of a manager is held by some to be such that serves to harm the "formation of a confidential and trusting personalized relationship between the practitioner and patient." (Ovretveit, 2008) This type of autonomy is referred to as "practice autonomy." (Ovretveit, 2008) This is because the freedom from interference by a manager in clinical decision-making "extends to other areas of the professional's work." (Ovretveit, 2008)

II. Historical Development of Medical Dominance

The classic work of Jewson (1976) on the history of the development and production of medical knowledge is reported to define what Jewson termed "medical cosmologies." (Crinson, 2007) It is reported that these frameworks are used in describing the manner in which "historically, developments in science have been intimately linked with the particular social relations and dominant ideas that existed within the society at the time" -- or that of "the production of medical knowledge is rooted within social, rather than the popular notion of a progressive march of science towards ever greater knowledge of the functioning of the human body." (Crinson, 2007) Jewson's first identified cosmology is what he termed as "person-oriented." (Crinson, 2007) This is reported to exist before industrialization and the age of enlightenment and makes a requirement of the physician that he acknowledge the patient as "a holistic entity." (Crinson, 2007) Judgments of medicine were made "in terms of the personal attributes of the sick person, if they were not, then the physician would lose that person's business." (Crinson, 2007) The development of medicine that is hospital based in the late 18th and early 19th centuries is viewed as "being associated with the broader social changes occurring within…society at that time." (Crinson, 2007) Otherwise stated it was linked to the growth of capitalist forms of production, industrialization, town, and city growth and "the increasing dominance of scientific knowledge and explanation." (Crinson, 2007) Jewson describes this as "an object oriented cosmology" and to reflect a period in which "the doctor-patient balance of power begins to change." (Crinson, 2007) The medical elite at this time were no longer dependent upon the patronage of their patients and the "control of medical knowledge passed from the patient to the clinician." (Crinson, 2007) At this time, the hospitals became "training centers for the new profession of medicine and sites for scientific research." (Crinson, 2007) In the late 19th century, the third medical cosmology posited by Jewson began which Jewson labeled 'laboratory medicine" which is a time when the patients is the object of medical practice "moves out of the frame and disease become a 'physiochemical process'. This medical practice is reported to be characterized "by the emergence of what Foucault (1973) termed the new 'clinical gaze'" reported to be reflective of the shifting social relationship of the power between patients and their doctors. (Crinson, 2007, paraphrased) The work of Foucault is reported to conceptualize power "as the property not of any particular social group, or as something exercised through a structural instrument such as the state, rather "It is a relationship which was localized, dispersed, diffused and typically disguised through the social system, operating at a micro, local and covert level through sets of specific [discursive] practices." (Turner 1997, xii in: Crinson, 2007) Power therefore, is conceived as a 'strategy' or a "set of discursive practices that characterizes the working of modern social systems…" (Crinson, 2007) Foucault summed this up in his statement that "power is a machine that no one owns." (Crinson, 2007) Therefore, from the view of Foucault, government, in its traditional form "depend on systems of knowledge and truths that constitute the object of its activity and here the roles of experts and their expertise are central." (Crinson, 2007) In terms of medicine "power is embodied in and comes with the day-to-day rational-scientific practices associated with the work of doctors in the hospital or clinic, which Foucault (1973) termed the 'clinical gaze'. Such everyday practices contribute to the (social) construction and reproduction of what has been termed the 'biomedical discourse'." (Crinson, 2007) From the view of Foucault, the relationship that exists between knowledge and power is one that is "an inevitable and inextricable one: any extension of power involves an increase in knowledge. Specific forms of power require highly specific formations of knowledge. In this sense, institutions such as medicine (also the law and organized religions) exercise power not through overt coercion but through the moral authority over patients associated with being able to explain individual problems (such as an illness) and then provide solutions (i.e. treatment) for them." (Crinson, 2007) It is stated by Miller and Rose that medical experts serve as a mediator between the individuals and authorities and serve to shape conduct "…not through compulsion but through the power of truth, the potency of rationality and the alluring promises of effectivity."…

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