Challenging Medicine by Jonathon Gabe

By Jonathon Gabe

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They could seek to maintain it While on the face of it developments in management and health policy can be seen to pose a major threat to medical dominance as it has traditionally been configured, the preceding analysis has sought to challenge this view by arguing that (a) the medical profession continues to enjoy high social standing, and (b) doctors may be resorting to countervailing sources of power to shape the new managerial developments to their agenda and definition of medical care. There are signs that this is already happening.

In short, doctors should get involved in management not to hasten or collude in the erosion of their freedom and the privileges it brings to dictate what kind of medicine is practised but to ensure that the erosion is resisted. MEDICINE AND MANAGEMENT: A POSSIBLE SCENARIO As the above sections have suggested, all the indications are that the involvement of doctors in management will continue to grow in keeping with the mounting pressures on governments to contain costs, to hold doctors more accountable for what they do, to investigate the causes of clinical variation and to propose solutions to them, to address issues of efficacy in respect of medical interventions to ensure that only cost-effective ones and those of proven value get adopted, and to give closer attention to the whole issue of health outcomes and the impact of health care and medicine on these.

Drucker, P. (1990) The New Realities,London: Mandarin. G. (1990) ‘The day in the night-time: medical practice variations and health policy’, in Mooney, G. S. (eds) The Challenge ofMedical Practice Variations,Basingstoke: Macmillan. Fitzgerald, L. (1991) ‘Made to measure’, Health Service Journal,31 October: 24–5. Flynn, R. (1992) Structures of Control in Health Management,London: Routledge. Freidson, E. (1990) ‘The centrality of professionalism to health care’, JurimetricsJournal of Law, Science and Technology,30:431–45.

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