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Disciplining the Medical Profession?
Implications of patient choice for medical dominance
Mike Dent
Division of Health and Social Care, Staffordshire University, United Kingdom
Abstract
This paper deals with the dynamics of medical dominance and patient choice, primarily within the Britain, with reference to a range of other European countries too (including Germany, France and Greece) for comparative purposes.
It will draw upon two concepts in particular: 'responsibilisation' and 'proto-professionalism', the first undermining medical dominance the latter reinforcing it. The ongoing influence of a neo-liberal and managerialist agenda has eroded the certainties of the welfare state and the assumptions underpinning the dominant role of the medical profession, which has been subjected to increasing external state regulation and control (Dent 2003a).
These reforms, which are associated with New Public Management, have been aimed at bringing the cost and quality of health care more effectively under the control of the state. This has involved redefining the compact or contract between the medical profession, public and the state. In this project greater emphasis is being formally given to the wishes of patients. Rather than the physician claiming to be the patient's voice it is now the state administration's assertion to have provided the patient with their own voice(s) - and choices.
Keywords
patient choice, responsibilisation, proto-professionalism, medical profession, new public management, sociology
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