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SOCIAL AND COMMUNITY PERSPECTIVES

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SOCIAL AND COMMUNITY PERSPECTIVES Medicine as a profession 6th May 2003 – PowerPoint PPT presentation

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Title: SOCIAL AND COMMUNITY PERSPECTIVES


1
SOCIAL AND COMMUNITY PERSPECTIVES
  • Medicine as a profession 6th May 2003

2
Aims
  • To explain what is meant by the terms
    professional, socialisation and
    professionalisation
  • To contrast the different approaches to
    consultation used by orthodox and non
    conventional practitioners
  • To illustrate an awareness of the ways in which
    the medical profession has developed

3
Introduction
  • Why do we need to consider medicine as a
    profession?
  • Drs differ from other groups of health service in
    terms of professional status
  • Along with lawyers regarded as foremost profession

4
Historical context
  • Royal College of Physicians founded 1518.
  • You needed
  • an Oxford or Cambridge degree
  • to be an Anglican.
  • Not very scientific
  • e.g by 1790 oral exam in Latin was still the main
    entry requirement
  • Elite status ? not based on scientific knowledge,
    but on social background of doctors.

5
Doctors as an elite group
  • Physicians only catered for the wealthy.
  • Apothecaries and barber surgeons treated the
    rest.
  • Most healing took place domestically.
  • Women cared for others in childbirth and knew how
    to make potions and lotions.

6
Modern clinical medicine
  • Began turn 18th/ early 19th Century.
  • Associated with the emergence of hospitals in
    England.
  • 19th Century medicine was very competitive.
  • Few effective cures at this stage.
  • Very dependent on wealthy clients and the quality
    of bedside manner.

7
Modern clinical medicine
  • Much rivalry and competition in early part of
    19th century.
  • Ill-feeling towards each other among
    healers/doctors.
  • Same situation prevailed in America.
  • No unity or collective authority

8
Attitudes towards medical profession in early-mid
19th century
  • Qualification of physician restricted to
    gentlemen.
  • But there were other healers - e.g. teeth
    pullers, bone-setters, itinerant healers etc.
  • Occupation of healing was often seen as a
    rattlebag of quacks and rogues.
  • Queen Victoria - did not recognise army surgeons
    as officers and gentlemen.

9
Changing times
  • Changes in culture, society, science and
    technology in mid-19th Century.
  • Capture of a body of scientific knowledge.
  • anaesthetics
  • discovery of tubercle bacillus
  • introduction of forceps
  • Struggle for cultural authority and social
    mobility.
  • Begin to see professionalisation of medicine

10
The professionalisation of medicine
  • Increasing specialisation increasing
    interdependence.
  • 1858 Medical Act - gave the GMC power over
    registration of doctors.
  • Led to a monopoly on supply of medical services.
  • Control over medical education by the medical
    profession.
  • Restriction of entry led to raising of standards.

11
Late 19th/early 20th century
  • Industrialisation - led to dependency on
    strangers ? change in relationship between
    doctors and pts
  • BMA and AMA - medical profession could present a
    solid and united front with a code of ethics.
  • Claim to be above commercialism.

12
Early 20th century
  • Growth of medical authority continued to expand
  • Helped by
  • development of medical science.
  • role as gatekeepers to medicines and sickness
    certificates.
  • Doctors became better paid.
  • Major change WWI - swept away old elite systems
    and gave new acceptability to the professions.

13
Why and how did profession of medicine develop?
  • Two approaches
  • Functionalist
  • Conflict

14
Functionalist approach
  • Associated with authors such as Talcott Parsons
  • Profession ? accorded high status and given
    greater financial rewards than other occupational
    groups.
  • Profession of medicine developed because of
    societys desire to control illness
  • Need group with access to technical knowledge
    used in interest of community functional for
    system

15
Functionalist approach
  • Technical knowledge power and status (although
    all illnesses not controlled)
  • Drs status legitimised because
  • Practise on the grounds of technical competence
  • Institutionalised expectations of doing
    everything possible for good of whole community

16
Conflict theory
  • Reject idea that medical profession emerged
    naturally
  • Profession developed out of specific historical
    process which involved a power conflict among a
    number of different interest groups.
  • Medicine not evolve naturally, but as a result of
    political struggle between groups intent on
    achieving higher status

17
Conflict theory
  • Conflict theorists want to explain why medicine
    was successfully in attaining professional power
    compared to other competing groups
  • Freidson (1970) sees profession as a structural
    position which has to be attained and maintained
  • Freidson identified certain profession
    characteristics

18
Conflict theory
  • A profession has
  • Specialised Knowledge
  • Careful management of knowledge
  • Monopoly
  • Control of numbers, selection and training of
    entrants
  • Autonomy
  • Clinical autonomy doctors are responsible only
    to their patients for diagnosis and treatment,
    and only peers can comment on clinical
    judgements.
  • Code of ethics

19
Importance of the role of the General Medical
Council
  • Medical profession regulates itself through the
    GMC.
  • controls entry to medical register and can remove
    practitioners from it.
  • approves and inspects medical schools.
  • Based firmly on principle of self-regulation.
  • Self-regulation itself is based on doctrine of
    clinical autonomy.
  • Now includes lay members.

20
Medical education
  • Medical education crucial in turning lay person
    into professional
  • Becoming a doctor not just about learning facts,
    but also certain values and attitudes (Tomorrows
    doctors)
  • More than accumulating knowledge about developing
    appropriate attitudes to patients, colleagues,
    fellow worker

21
Medical education
  • This process known as socialisation
  • process by which culture/values of a particular
    society (or group within it) are transmitted to
    new incumbents as they learn to conform with
    demands and expectations of the society/group

22
Medical education
  • Medical education involves
  • Lengthy training controlled by profession
  • Recruitment and selection
  • First stage of socialisation from lay to
    professional selection
  • Appropriate attitudes and behaviour

23
Medical education
  • Formal/Informal curriculum
  • Formal knowledge/tested through exams
  • Informal attitudes beliefs/ performance noted
    not formally examined
  • May ? students concentrating on getting by
    losing former idealism
  • Socialisation and education takes place in
    different arenas
  • Front stage/back stage

24
Source Sinclair S (1997) Making Doctors An
Institutional Apprenticeship Oxford, Berg
Official Unofficial OFFSTAGE
Front Stage Manifest curriculum Lecture.Ward Rounds/ Exams Games Field (rugby/ football) Theatrical performances Lay World
Back Stage Hidden curriculum Libraries, Hospital wards Preparation for unofficial front stage activities Students bar Lay World
25
Summary
  • Medicines position of authority and status
    evolved over time
  • Different ways of viewing professions position
    functionalist/conflict
  • Role of medical education

26
Questions
  • Freidson (1970) identified a profession as having
    certain characteristics. List these and explain
    what is meant by each
  • In order to become a medical practitioner new
    entrants must acquire certain skills, knowledge
    and attitudes. What role does medical education
    play in this process?
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