The limitations the proletarianization thesis and ‘the

TheProletarianization thesis, a Marxist notion predicts that eventually themedical sector will become part of the capitalist system and have no controlover production which will result in the professionals becoming isolated fromtheir work as they will have no input. The term was exchanged to thecorporation thesis because of the limitations the proletarianization thesis and’the word was considered threatening’ (McKinlay and Marceau 2002).

As the bureaucraticrules, procedures and authority grow professional autonomy is increasinglyundermined because they will no longer be in control of things. The Neo-Marxistperspective explains that as medicine advances and becomes more corporate andbureaucratic, physicians lost some of their professional rights forself-regulation.  The government also affectedmedical work by breaking it into sub-specialisms. For instance, because medicinehas become more reliant on new modern technologies, non-medical staff are ableto intervene in doctor patient relationship by advertising new techniques astrends or new products, also staff can control these technologies without thedoctor being there. This makes patients seem like clients of organisations thatdoctors work within rather than being the doctors’ own responsibility anddeveloping intimate relationships. Therefore, medicine as an occupation cannotbe professionally dominant. McKinlay and Marceau (2002) argued that the Marxisttheories suggest that the capitalist development causes the reduction ofprofessional rights like the right to set salary showed medicine was producingcapital for the state. The Proletarianization thesis was seen as a flawedargument so it was revised because as the corporate world becomes more and moreinfluential medical doctors become reduced to employees meaning they would be deprivedof their access to means of production.

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It was a one-sided theory, so it wasadapted to the corporation thesis. The Corporation thesis is more suggestive asthe cause of the changes than proletarianization. However, it is problematicbecause it is not useful in countries where health care is provided by thestate for example medical autonomy is changing in places that have their healthcare funded by the state. Otherhealth care occupations have been thought to challenge medical dominance. For example,nurses have been developing their clinical skills and growing in order to allowtheir roles to cover other medical responsibilities that are parallel todoctors, such as being able to prescribe medicine. This is also a similar caseto physiotherapy or pharmacy. From personal experience patients are beingreferred and encouraged to go to pharmacists first to be treated and diagnosed,the experience is comparable to an appointment at a general practice.

Itcreates a gap in the doctor patient relationship as the doctor no longerbecomes an important contact but rather a last resort. Also, it makes medicinemore available to patients which undermines the need to have doctors when ithas become easy to approach a counter and purchase medication. According to theproletarianization thesis this is an example of the health sector surrenderingto the capitalist movement to separate the medicine from their work as doctorsto make profit.

However,this does not necessarily mean professional dominance is under threat, it justrepresents a working hierarchal structure to society and within the health caresystem. Considering that doctors are the main authority figure it oftenreported and the case that they are overworked and constantly busy it onlymakes logical sense to delegate to relieve the pressure. Cooper et al (2011) indicatedin their study the confidence that patients have in doctors to oversee theprescription process and have a pivotal role in ensuring the correct clinicalcompetence ‘supplementary prescribing involves the doctor in the initialdiagnosis’. It doesn’t threaten medical dominance if anything it enhances itallows nurses and pharmacists have the confidence to refer back and askquestions, ’empowered them to discuss medication with doctors and question themabout how they made prescribing decisions’ (Bradley et al 2007).

Doctors stillremain as the primary figures to diagnose and the medical knowledge bearers.Therise of consumerism also influences medical power, there have been broadershifts in the climate of medicine and the emergence of the more consumeristcontext. The choice of patients is now prioritised in health care which givesthem the chance to choose between different doctors and diffdifferentmedical approaches.

Complementary and alternative medicine today views the bodyholistically and suggests that illness is caused by our psychological state,spiritual and social environment being disrupted. The new medical movement tofocus on living a healthy lifestyle means patients will often to choose to gofor alternative medicine as it allows them focus on restoring balance andrepairing their body rather than focusing on an illness and dealing withsymptoms. This is especially true for patients who may have a chronic illnessbut do not want to spend their lives managing or concentrating on its effectsas it viewed as the medical practice’s inadequacy to treat them.

Thus, leadingto patients taking matters into their hands and seeking an additional helpinghand, this shows how willing patients are to challenge the medical expertisewhich provides them with more hope. This can once again destabilise medicalpower because if they alternative medicine is able to benefit patients who hadbeen turned away by physicians it creates a public scepticism towards theefficacy of the health system. ‘CAM and biomedicine are in an economicpolitical and cultural struggle by the medical profession attempt to maintain amonopoly’ (Saks 2003).

The struggle can cause a shift from biomedicinedominating the health system to equally sharing with complementary andalternative medicine due to the increased interest by patients. ‘2002, about 62% of U.S. adults usedsome form of CAM in the past 12 months’, Barnes et al 2004 argue that theresults found in their study related to patients confirming results from CAMare surprising as there is a lack of evidence to support the efficacy andsafety of these therapies.

However, the effects of it could be due to manyreasons such as individual differences or the placebo effect which suggeststreatment will work as long as the patient believes it will work.The internethas become a form of empowerment for patients due to the bureaucraticregulation on the system it has allowed expert knowledge to become moreaccessible to everyday civilians. Reducing the knowledge gap between the professionalsand patients presents a challenge to the medical power as they no longer viewthe professionals as a more knowledgeable other. They feel as though all theanswers they need can be found on the internet. A majority of people go to theinternet first when they experience some symptoms, sometimes this can be theanswer for example when they conduct their search on websites or forumsaccredited by professionals or run by them.

If this was the case, there wouldbe no issues but many of these sources on the internet are controlled by laypeople and the information is not completely credible. This then causespatients to believe their condition is either more serious or less serious thanit is, the doctor will tell them the opposite of what they think, resulting intensions to grow. This is also an impact of changing lay perceptions and knowledge,as the patients increased use of a broadvariety of secondary sources on the internet, promoted by health careinstitutions has led to more critical patients who are better informed to makebetter informed decisions. This will put the professional dominance underthreat as patients can view themselves coping with out doctors because theinternet can diagnose and provide treatment instructions.

Anadditional challenge to medical power is due to a loss in trust from patientsin the health care system and in the professionals that work for the system. Associatedwith the rise in consumerism, patients are encouraged to become complaisant intrusting medical expertise, this explains patients moving away frominstitutions such as the NHS to private health care because they assume payingfor 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 endingself-regulation. Scandals involving bad doctors were nothing new, they were allsimilar in content, for example patients being murdered by doctors, or beingsexually abused. Some offences by the doctors were not even reported due to thehigh 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 inthe medical sector to be shattered, especially in a time of a social media peakdoctors cannot afford further transgressions as it will reach masses of peopleall over the world.

 A scandal in onecountry will be enough to affect trust of the health care system in othercountries. On the other hand, Calnan and Rowe (2008) conducted a study andfound that there is a lack of evidence to indicate a decline in trust towardhealth care professionals. They reported that studies from the UK and USA showtrust is still high for doctors but vary depending on the type of illness, howbig 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 doctorsindividually.Ismedical power and professional dominance currently under threat?  I’ve concluded from the literature and varioustexts that the health care system has surpassed the biggest impact of all thetrends and transformations that may cause a threat.

Although many changes are constantlyhappening, it is only under threat to a certain extent. Society will remain relianton the healthcare based on the knowledge that the treatment used by the healthcare has been empirically test and can objectively prove their treatments have apositive effect on diseases. Even though the health care system has become moreregulated it ensures welfare workers are professional in all they do and limitsthe possibilities of scandals occurring. As long as physicians continue torebuild trust with patients and maintain relationships patients will seek lessalternative methods to curing their illnesses.

On the other hand, doctors may needto accept that they are no longer the primary drivers due to the rise inconsumerism, new biotechnology and third parties’ involvement.


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