Medical dominance in a changing world: the UK case

Allsop, Judith

doi:10.5172/hesr.2006.15.5.444

Cited by 39 publications

(38 citation statements)

References 8 publications

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“…Willis (2006), however, notes various challenges to medical dominance of health systems, including: the rise of ''health'' as a consumer product sold in an open market and shaped by the choices of patients as consumers; the rise of a culture of litigation in which doctors are increasingly challenged on competence; and the changing roles of healthcare professionals other than doctors, including taking over some of the tasks that were once the domain of medicine. Allsop (2006) adds a further element -where the state has introduced various regulations that serve to reduce doctors' autonomy, ''the context in which doctors practise has undergone radical change'' (p. 444). These observations concerning dislocating challenges to medical dominance will be progressed in a later section.…”

Section: Medical Dominancementioning

confidence: 98%

The dislocation of medical dominance: making space for interprofessional care

Bleakley

2013

Journal of Interprofessional Care

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The historical transition of modern medicine from an autonomous profession to a team-based interprofessional practice can be described in terms of space rather than time, with "place" as the unit of analysis. Imagining modern medicine spatially was instigated by Foucault, who described medical dominance as a territorializing of both individual body spaces and public spaces--the former through the diagnostic medical gaze, the latter in a gaze of health surveillance. However, much has happened since Foucault's (1963) analysis. The diagnostic gaze has been dispersed to develop a collaborative gaze including patients and healthcare professionals; political interests have appropriated the public health gaze; and the medical profession is subject to democratic processes of accountability. Medicine has lost its territorial imperative as new "liquid" and "nomadic" work practices emerge, making space for interprofessional care. Such dislocation of medical dominance and its multiple relocations are poorly theorised. Deleuze and Guattari distinguish between "striated" and "smooth" spaces. Striated space is associated with hierarchies and boundaries, where smooth space includes boundary crossing and democratic collaboration. Smooth or liminal spaces in hospitals, such as corridors, can paradoxically act as catalysts for collaboration or assembly democracy, affording opportunities for improvised interprofessional encounters. Such encounters can act as an antidote to planned protocols or imperatives for interprofessional collaboration.

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Section: Medical Dominancementioning

confidence: 98%

The dislocation of medical dominance: making space for interprofessional care

Bleakley

2013

Journal of Interprofessional Care

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“…86-87) discovered when they sought to empirically demonstrate the class location of the professions -meant they could only assert the connection as a 'truth' through theoretical analysis, because at the empirical level, the task Critical Studies in Education 3 involved conflating occupational or professional groups of individuals with an abstract notion of class (Willis, 1983, p. 13). This difficulty in theorising the mechanisms through which social practices can be linked to the economy and its structures have continued, even with the recent focus on the process of de-professionalisation, where the professions lose the capacity for self-regulation and submit to external supervision from the state and corporate sector (Allsop, 2006;Navarro, 1988). A less problematic theoretical route might be to regard professionalism as an ongoing struggle between professional (or professionalising) occupations over jurisdictions (Coburn, 1994;Freidson, 1970).…”

Section: Introductionmentioning

confidence: 98%

Practices of conformity and resistance in the marketisation of the academy: Bourdieu, professionalism and academic capitalism

Collyer

2014

Critical Studies in Education

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The paper reports on an empirical study based on qualitative interviews with staff from four Australian universities. These universities are shown to be undergoing significant social change as processes of marketisation impact on the everyday practices of academic workers. The universities are analysed as sites of contestation between the new professional managers and the established academic profession over the control of the conditions of work, the production of expert knowledge and the worksite itself. The theory of academic capitalism is examined, and the relevance of Bourdieu's work for the analysis of a university sector in a context of marketisation is assessed. Bourdieu's interlinked concepts of capital, habitus and the field are employed to investigate the nature of the contestation, revealing a dynamic process in which academics innovatively respond to threats to reduce their autonomy, to increased levels of surveillance and other constraints on practice. In addition, the study illustrates the processes through which actors within the sector, through acts of both conformity and resistance, contribute collectively to the growth of academic capitalism in the neoliberal university.

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“…However, since most of this literature emanates in developed countries and deals with the dominant modes of healthcare delivery by doctors and nurses, it tends to focus on professional 'boundaries' and 'power' in this context (Coombs 2004;Allsop 2006;Bourgeault & Mulvale 2006;Cooper et al 2012) without taking into account alternative modes of healthcare delivery as discussed in this article -thus limiting their explanatory powers.…”

Section: Discussionmentioning

confidence: 94%

‘Re-Engineering the Workforce to Meet Service Needs’: Exploring ‘Task-Shifting’ in South Africa in the Context of Hiv/Aids and Antiretroviral Therapy

Gilbert

2013

South African Review of Sociology

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This article explores the major trends in the South African health workforce in the context of HIV/ AIDS and analyses their potential impact on the professional work and status of nurses and doctors. The Human Resources for Health Strategy for the Health Sector 2012/13-2016/17 document, in addition to a wide range of secondary material, is used to depict the shifts that have taken place in the SA health workforce as a response to the unmet health needs and demands emanating from HIV/AIDS. Such a response is particularly challenging in the context of limited-resource settings and inadequate public healthcare services. Therefore, there has been a need to come up with inventive ideas to mobilise all available resources to curtail the spread of the epidemic as well as to cope with the provision of ART to large numbers of people as quickly as possible. Adopting a critical-analytical approach, this article draws attention to three such ideas: task-shifting, the training of new midlevel workers, and the use of members from the community in a variety of roles as 'community health workers'. Although these ideas are not new, they acquire acute poignancy in the context of HIV/AIDS in South Africa today. They also provide an interesting case study through which to interrogate arguments advanced in the sociology of the professions about 'medical dominance', 'occupational monopoly', 'laymanisation' and the potential challenge to medical authority and power that may have occurred alongside shifts in professional boundaries.

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Medical dominance in a changing world: the UK case

Cited by 39 publications

References 8 publications

The dislocation of medical dominance: making space for interprofessional care

The dislocation of medical dominance: making space for interprofessional care

Practices of conformity and resistance in the marketisation of the academy: Bourdieu, professionalism and academic capitalism

‘Re-Engineering the Workforce to Meet Service Needs’: Exploring ‘Task-Shifting’ in South Africa in the Context of Hiv/Aids and Antiretroviral Therapy

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