The which will result in the professionals becoming isolated

The
Proletarianization thesis, a Marxist notion predicts that eventually the
medical sector will become part of the capitalist system and have no control
over production which will result in the professionals becoming isolated from
their work as they will have no input. The term was exchanged to the
corporation thesis because of the limitations the proletarianization thesis and
‘the word was considered threatening’ (McKinlay and Marceau 2002). As the bureaucratic
rules, procedures and authority grow professional autonomy is increasingly
undermined because they will no longer be in control of things. The Neo-Marxist
perspective explains that as medicine advances and becomes more corporate and
bureaucratic, physicians lost some of their professional rights for
self-regulation.  The government also affected
medical work by breaking it into sub-specialisms. For instance, because medicine
has become more reliant on new modern technologies, non-medical staff are able
to intervene in doctor patient relationship by advertising new techniques as
trends or new products, also staff can control these technologies without the
doctor being there. This makes patients seem like clients of organisations that
doctors work within rather than being the doctors’ own responsibility and
developing intimate relationships. Therefore, medicine as an occupation cannot
be professionally dominant. McKinlay and Marceau (2002) argued that the Marxist
theories suggest that the capitalist development causes the reduction of
professional rights like the right to set salary showed medicine was producing
capital for the state. The Proletarianization thesis was seen as a flawed
argument so it was revised because as the corporate world becomes more and more
influential medical doctors become reduced to employees meaning they would be deprived
of their access to means of production. It was a one-sided theory, so it was
adapted to the corporation thesis. The Corporation thesis is more suggestive as
the cause of the changes than proletarianization. However, it is problematic
because it is not useful in countries where health care is provided by the
state for example medical autonomy is changing in places that have their health
care funded by the state.

Other
health care occupations have been thought to challenge medical dominance. For example,
nurses have been developing their clinical skills and growing in order to allow
their roles to cover other medical responsibilities that are parallel to
doctors, such as being able to prescribe medicine. This is also a similar case
to physiotherapy or pharmacy. From personal experience patients are being
referred and encouraged to go to pharmacists first to be treated and diagnosed,
the experience is comparable to an appointment at a general practice. It
creates a gap in the doctor patient relationship as the doctor no longer
becomes an important contact but rather a last resort. Also, it makes medicine
more available to patients which undermines the need to have doctors when it
has become easy to approach a counter and purchase medication. According to the
proletarianization thesis this is an example of the health sector surrendering
to the capitalist movement to separate the medicine from their work as doctors
to make profit.

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However,
this does not necessarily mean professional dominance is under threat, it just
represents a working hierarchal structure to society and within the health care
system. Considering that doctors are the main authority figure it often
reported and the case that they are overworked and constantly busy it only
makes logical sense to delegate to relieve the pressure. Cooper et al (2011) indicated
in their study the confidence that patients have in doctors to oversee the
prescription process and have a pivotal role in ensuring the correct clinical
competence ‘supplementary prescribing involves the doctor in the initial
diagnosis’. It doesn’t threaten medical dominance if anything it enhances it
allows nurses and pharmacists have the confidence to refer back and ask
questions, ’empowered them to discuss medication with doctors and question them
about how they made prescribing decisions’ (Bradley et al 2007). Doctors still
remain as the primary figures to diagnose and the medical knowledge bearers.

The
rise of consumerism also influences medical power, there have been broader
shifts in the climate of medicine and the emergence of the more consumerist
context. The choice of patients is now prioritised in health care which gives
them the chance to choose between different doctors and diffdifferent
medical approaches. Complementary and alternative medicine today views the body
holistically and suggests that illness is caused by our psychological state,
spiritual and social environment being disrupted. The new medical movement to
focus on living a healthy lifestyle means patients will often to choose to go
for alternative medicine as it allows them focus on restoring balance and
repairing their body rather than focusing on an illness and dealing with
symptoms. This is especially true for patients who may have a chronic illness
but do not want to spend their lives managing or concentrating on its effects
as it viewed as the medical practice’s inadequacy to treat them. Thus, leading
to patients taking matters into their hands and seeking an additional helping
hand, this shows how willing patients are to challenge the medical expertise
which provides them with more hope. This can once again destabilise medical
power because if they alternative medicine is able to benefit patients who had
been turned away by physicians it creates a public scepticism towards the
efficacy of the health system. ‘CAM and biomedicine are in an economic
political and cultural struggle by the medical profession attempt to maintain a
monopoly’ (Saks 2003). The struggle can cause a shift from biomedicine
dominating the health system to equally sharing with complementary and
alternative medicine due to the increased interest by patients. ‘2002, about 62% of U.S. adults used
some form of CAM in the past 12 months’, Barnes et al 2004 argue that the
results found in their study related to patients confirming results from CAM
are surprising as there is a lack of evidence to support the efficacy and
safety of these therapies. However, the effects of it could be due to many
reasons such as individual differences or the placebo effect which suggests
treatment will work as long as the patient believes it will work.The internet
has become a form of empowerment for patients due to the bureaucratic
regulation on the system it has allowed expert knowledge to become more
accessible to everyday civilians. Reducing the knowledge gap between the professionals
and patients presents a challenge to the medical power as they no longer view
the professionals as a more knowledgeable other. They feel as though all the
answers they need can be found on the internet. A majority of people go to the
internet first when they experience some symptoms, sometimes this can be the
answer for example when they conduct their search on websites or forums
accredited by professionals or run by them. If this was the case, there would
be no issues but many of these sources on the internet are controlled by lay
people and the information is not completely credible. This then causes
patients to believe their condition is either more serious or less serious than
it is, the doctor will tell them the opposite of what they think, resulting in
tensions to grow. This is also an impact of changing lay perceptions and knowledge,
as the patients increased use of a broad
variety of secondary sources on the internet, promoted by health care
institutions has led to more critical patients who are better informed to make
better informed decisions. This will put the professional dominance under
threat as patients can view themselves coping with out doctors because the
internet can diagnose and provide treatment instructions.

An
additional challenge to medical power is due to a loss in trust from patients
in the health care system and in the professionals that work for the system. Associated
with the rise in consumerism, patients are encouraged to become complaisant in
trusting medical expertise, this explains patients moving away from
institutions such as the NHS to private health care because they assume paying
for a product or service and the reputation will ensure higher quality care. Moreover,
the decline in trust has also been caused by numerous malpractice allegations, Dixon-Woods,
Yeung and Bosk reported in 2011 the role of medical scandals ending
self-regulation. Scandals involving bad doctors were nothing new, they were all
similar in content, for example patients being murdered by doctors, or being
sexually abused. Some offences by the doctors were not even reported due to the
high status of the doctors and patients being afraid of backlash from society.
Therefore, trust has to be re-built, because these cases have caused trust in
the medical sector to be shattered, especially in a time of a social media peak
doctors cannot afford further transgressions as it will reach masses of people
all over the world.  A scandal in one
country will be enough to affect trust of the health care system in other
countries. On the other hand, Calnan and Rowe (2008) conducted a study and
found that there is a lack of evidence to indicate a decline in trust toward
health care professionals. They reported that studies from the UK and USA show
trust is still high for doctors but vary depending on the type of illness, how
big the risk is on the patient and their previous experience with health care.
They concluded that trust in health care as a whole is lower than in doctors
individually.

Is
medical power and professional dominance currently under threat?  I’ve concluded from the literature and various
texts that the health care system has surpassed the biggest impact of all the
trends and transformations that may cause a threat. Although many changes are constantly
happening, it is only under threat to a certain extent. Society will remain reliant
on the healthcare based on the knowledge that the treatment used by the health
care has been empirically test and can objectively prove their treatments have a
positive effect on diseases. Even though the health care system has become more
regulated it ensures welfare workers are professional in all they do and limits
the possibilities of scandals occurring. As long as physicians continue to
rebuild trust with patients and maintain relationships patients will seek less
alternative methods to curing their illnesses. On the other hand, doctors may need
to accept that they are no longer the primary drivers due to the rise in
consumerism, new biotechnology and third parties’ involvement.

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