Over up in medical structures. Scepticism in society towards

time there have been many discussions and debates concerning whether medical
power and professional dominance is under threat. ‘Medical autonomy is the
publicly accepted control that medical professions exercises over the terms and
conditions of its work. Medical dominance is a relative concept, indicating the
authority that the medical profession can exercise over other occupations
within the health care division of labour, patients or society.’ (Gabe and Monaghan, 2013) If there is a decline
of professional autonomy or dominance in the medical profession it can take a
range of different forms. One aspect will be a change in doctor patient
relationships, other aspects will include medical professions becoming less
autonomous as they will become more controlled from the side of the state, on
the basis of what they actually do and what they have input in, and patients
can then complain to figures higher up in medical structures. Scepticism in
society towards the health care system can also compromise the trust of
patients in physicians thus leading many patients to rely on the internet or seek
alternative medicine. There have been several shifts that explain the reason
for the transformations suggesting a decline in medical power and professional
dominance in contemporary society. However, I think medical power and
professional dominance are both under threat to a certain extent. This essay
will explore whether we are on the professional verge of a decline in the
professional power.Over the last
few decades of the twentieth century there have been several trends and
transformations in health care. Due to the transformation from modernity to
postmodernity dominant institutions in society that used to keep the balance,
have less influence. It has led to people having more freedom in the choices
they make regarding their culture and identity. Post modernisation has led to new
arrangements of social structures by introducing a state of flux within social
relations. Klein (2010) stated that the NHS is in a ‘permanent state of flux’,
the structures and positions in the system are fluid therefore the pace of change is so fast,
that it is hard to keep up with all the different things happening.  These transformations have been translated onto
the NHS which can make their service unsustainable. In order for the health
service to cope with the structural changes it has to make a profit off their
service whilst also creating social unity, but this is problematic as all their
resources are used up whilst not being able to accumulate profit.

The rise of
the new managerialism in the health care system mirrors the bureaucratic state
as it involves the government intervening to ensure development, it disperses
the medical power from the physicians in the centre of the system to managers
on the outside. Hence, resulting in a rising shift of involvement from third
parties who impact the health care system through their funds and organisation.
‘in the UK, the major reforms to the NHS that have been introduced since the
1980s – including the introduction of a more market- driven ethos and structure
have been seen by many as constituting an attack on producer dominance and
professional exemption from external scrutiny. In the USA, the expansion of
for-profit health care corporations, the move to managed care and associated
new financial management of medical practice’ (Gabe and Monaghan, 2013). The
new management has adopted the style of the private care system, so the service
provided to patients depends on how much money is spent, this further
demonstrates the effects of consumerism on the health care system. Those who do
not have the money to pay for private health care may not get the best
treatment or may not be able to afford the services which will lead them to
seek alternative medicine.Organisational
flux is a regular affair in the health care system as the trends and
transformations shape their policies. There has been a shift in health care
from focusing on disease to the main concern being and maintaining a healthy
lifestyle. ‘From the mid-1970’s, health policy documents began to emphasize the
need to promote good health rather than treat illness and disease’ (Nettleton,
2013). Another shift has been the health and medical care going from the
confines of a hospital to being dispersed through the community. The changes
from traditional to unconventional health care has driven patients to adapt
from the primacy of biomedicine to a plethora of health options. The choice of
alternatives has blurred the lines between medical knowledge experts and the
consumers. This may cause a decrease in professional dominance because they no
longer have influence on how patients are treated and what issues they bring to
the hospitals.

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There are
several explanations of why these transformations have taken place and can be
considered as underlying reasons to the demise of professional authority in
medicine. The theories predict how physicians control over the content of their
profession. The de-professionalization thesis focuses on the change in dynamic
between professionals and clients due to patients’ uncertainty of how effective
modern medicine is which have led to patients becoming sceptical. It is an
influential criticism of the developments in health care, it contemplates the
shift in policy from its values of inclusion and citizenship to focusing on
controlling public expenditure (Clark, 2005). ‘sustainability
and transformation plans (STPs) which propose ward closures, cuts in bed
numbers and changes to A and GP care in 44 areas…needs to find
£22bn in efficiency savings by 2020-21…A draft plan circulating among NHS
managers in West Yorkshire reveals proposals’ (BBC News, 2018), doctors do not
have a say in where the savings are made it is down to the managers and trusts
who work for the government. The cuts have led to protests from
patients and welfare workers who are feeling the pressures of the detrimental
savings. It also makes the private sector take responsibility from the public
sector such as formal services doing less and private individuals or families
doing more. The thesis also states a difference in the roles of the professionals;
they have less opportunity to be autonomous, so they may go against their
professional opinion for what may be best for their patients and they have less
will when it comes to treating patients (Clark, 2005). This reflects the
physicians experiencing de-professionalization because they can no longer give
their patients the best service in their opinion due to not having the access they
need to resources, in this case they lose their medical power as they become tools
of the state. Ritzer and Walczak (1988) stated ‘Their power, status, and continuing
control over a centrally important area of human existence lead us to believe
that they will not tumble far down the professional continuum’.