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Regulating doctors and the custody of virtue

Prof Mary Dixon-Woods
University of Leicester

Date: 20 January 2009
Time: 1:00pm - 2:30pm
: CARR Seminar Room, H615


Until recently, doctors have been regulated primarily through professional norms operating both as standards of practice and as a constraint on action, with the law acting as a background threat. This approach was backed by a state "bargain" where the profession was granted a near-monopoly over the provision of its services, in return for its providing rules of conduct and associated regulatory procedures and processes. Traditionally, virtually unfettered professional discretion has been accorded to the clinician, based on the premise that only qualified members of the profession are capable of setting the appropriate standards, and detecting and assessing defaults from those standards. This approach can be understood to rely heavily for its effectiveness on individuals internalising and cooperating with the collective norms of the professional group by aligning their individual conduct with the profession's standards. Beginning with the work of Eliot Friedson, sociologists have often been highly sceptical of the claims both of virtue and expertise that secure occupational monopoly and immunity from external scrutiny. The professional dominance critique is especially critical of the traditional self-regulatory model, arguing that professional interests will tend to be privileged over others. This unsympathetic analysis of the medical profession's ability to deliver on its responsibilities appears to have had considerable purchase during a series of crises involving doctors in the UK (and some other countries) in recent years. The crises have been interpreted, in official inquiries and elsewhere, as demonstrating that the existing scheme of professional self-regulation was a vehicle through which the medical profession sought to safeguard its elite status, rather than promoting the safety and well-being of patients. These criticisms have been mobilised as part of a programme of regulatory reform that destabilises self-regulatory claims both at a corporate level (through reform of the General Medical Council) and at an individual level (through increasing intervention in the mandate of individual practitioners). Such criticisms, combined with institutional pressures towards risk management, have further legitimated the introduction of a range of measures aimed at controlling, directing, and surveillance the practices and conduct of doctors. In this paper, I explore some of the implications of these efforts at regulating doctors for the custody of virtue, arguing that there are grounds for caution about where and to whom custody is granted.

About the speaker
Mary Dixon-Woods is Professor of Medical Sociology at the University of Leicester, where she leads the Social Science Research Group at the Department of Health Sciences. Educated at Dublin City University, Trinity College Dublin, and Oxford University, she is currently a Fellow in medical regulation under the ESRC's Public Services Programme. She has particular interests in sociological approaches to quality and safety in healthcare, regulation of health professionals, bioethics, and childhood illness. She has also been involved in the development of methods for inclusion of qualitative research in evidence syntheses.