Reflections on contemporary medical professionalism; an exploration of medical practice as refracted in doctors’ narratives

Spooner, Sharon (2013) Reflections on contemporary medical professionalism; an exploration of medical practice as refracted in doctors’ narratives. Doctor of Philosophy thesis, University of Liverpool.

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Abstract

Background During a period of continuing changes in society and increasing availability of medical information, publication of patients’ views on experiences of health and illness have gained greater prominence. By contrast, studies of medical perspectives have tended to concentrate on reported discontent and implications for workforce planning while leaving broader insights and concerns under-investigated. Since the applied skills of highly trained and publicly funded clinicians are vital for safe and effective delivery of the nation’s health care, it seemed important to explore new ways to consider components of medical professionalism and to set these in current NHS contexts. Rationale and fieldwork Focussing attention on the individual perspectives of NHS doctors in order to hear and understand their experiences of work was central to development of this thesis. An interpretive epistemological approach to biographical narratives as told by a group of 12 doctors drawing on 25 years of NHS experience included use of Situational Analysis Mapping to support detailed analysis of their richly informative, first-hand accounts. As knowledgeable and reflective informants with stories from diverse clinical specialties and differing personal viewpoints, their narratives produced a range of views and observations shaped by their lived experiences as clinicians. Poetic representation of sociologically-informative narrative extracts provided an effective vehicle for engaging mixed audiences and has evoked emotionally resonant reactions from doctors. Findings Strong connections between individuals’ core principles and enacted responses were evident; doctors identified preferred working practices which they believed supportive of delivery of high quality health care. Key aspects of professionalism, including professional autonomy, self-regulation and application of clinical knowledge, were challenged by progressive introduction of new working processes and regulatory mechanisms. Increased recording of clinical and administrative data for performance monitoring and achievement of targets produced reactive strategies in individuals and teams while challenging their sense of professional position or developed medical identity. Poorly performing colleagues and difficult team interactions caused much disruption while blurred ethical boundaries exposed contestable decision-making and demonstrated the limited effectiveness of external regulatory monitoring. Conclusions This research indicates that contemporary NHS doctors may experience conflict between what is expected in managed medical practice and their interpretation of best professional performance. Better understanding of these fundamental relationships could constructively contribute to reconsideration of contemporary medical professionalism and assist with progressive workforce preparation for an effective future NHS.

Item Type:	Thesis (Doctor of Philosophy)
Additional Information:	Date: 2013-12 (completed)
Uncontrolled Keywords:	Biographical narratives, Situational Analysis Mapping, Medical identity, Neo-professionals, Contemporary medical professionalism
Subjects:	?? HM ?? ?? R1 ??
Divisions:	Faculty of Humanities and Social Sciences > School of Law and Social Justice
Depositing User:	Symplectic Admin
Date Deposited:	13 Aug 2014 10:10
Last Modified:	16 Dec 2022 04:42
DOI:	10.17638/00018175
Supervisors:	Robinson, Jude ORCID: 0000-0001-5491-4893 Byrne, Paula
URI:	https://livrepository.liverpool.ac.uk/id/eprint/18175