As goes one..............

So go the rest

Here we show some thoughts about the shift in power from doctors to government.

The waning of professional power is portrayed as being in the interests of patient autonomy.

But its replacement by corporate power within a market economy may compromise patient

autonomy even more destructively.

It is the interests of corporate profit that underpin the diminishing of both patients and doctors to replaceable units.

One of health need and the other of healthcare provision. 

These trends are generating huge and increasing commercial profits and are shifting attention and investment within health care from the sick to the well, 

From the old to the young and displacing care mediated by touch with a system driven by paper and computers.

These trends operate in the interests of politicians because a system in which the agents are interchangeable is much easier to organise and to control 

And it also minimises the possibilities of physicians and patients forming political alliances with the potential to draw public attention to the deficiencies and failure of government. 

The trends operate in the interests of global capital because markets are maximised wherever consumers and employees can be standardised.

Yet, the exercise of power always breeds resistance. 

As Eliot Friedson puts it, “substituting [bureaucratic] arrangements for trust results actually in a Hobbesian situation, in which any rational individual would be motivated to develop clever ways to evade them to lead to manipulation of the system to the detriment of policy intentions.”

I think we see these processes in action across the public services.

On top of all this, also as part of the culture of control, we have powerful new strands of rhetoric about risk and safety.

The one to be minimised, the other maximised.

Aims which are now assumed to trump other equally valid aspirations such as allowing

children to explore, to play freely and to learn from their own experience.

The rhetoric of risk trades on a politics of responsibility, which transmutes into an increasingly oppressive social obligation. 

We are encouraged to be afraid or ashamed of what we eat and drink and breathe and to avoid a whole panoply of different risks and to lead ever more regulated lives devoid of fun and thrills.

The Royal College of Psychiatrists tried to stem the tide in a 2002 report: 

“Strict adherence to guidelines, for fear of risk,should not be allowed to stifle responsible, innovative practice or the patient’s choice of alternative based on population data to individuals and the increasingly heavy hand of bureaucratic surveillance seems likely to impede

sensitivity, flexibility and innovation in the delivery of care. 

The standardisation of professionals is welcomed as a way of eliminating the worst of practice, but it may also eliminate the best. 

Is this a beneficial exchange?

Dr Iona Heath