Challenging Medicine: the case of podiatric surgery

Abstract

This paper examines the establishment of National Health Service (NHS) podiatric surgery as a challenge to the dominance of medicine and its control over the provision of foot surgical services. The practice of surgery by non-medically qualified podiatrists and its integration within mainstream NHS service provision is evaluated as possible evidence of the diminishing authority of medicine in determining the scope and boundaries of paramedical practice and in successfully resisting encroachment from other ‘health professions’. The centrality of medical power in the organisation of healthcare has characterised much of the existing sociological literature on the health professions, most evident within the professional dominance perspective (Freidson 1970a, 1970b). This approach, and its variants, particularly highlight the autonomous control of medicine over its knowledge base, clients and clinical activities, in addition to its hegemonic position in relation a range of subordinate healthcare occupations (Freidson 1970a, 1970b; Johnson 1972; Larkin 1983, 1988, 1993, 1995; Wolinsky 1993).