¶ … 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...
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