Professional Self-governance Research Articles

Sick Doctors: The Social Construction of Professional Deviance

It has only been in the past decade that organized medicine has open acknowledged the extent to which drug addiction, alcoholism, and psychiatric disorders among doctors affect professional performance. The conceptualization of substandard performance as a medical rather than a legal, moral, or educational problem has led to the development of programs and policies that integrate medical rehabilitation with professional peer review. This paper identifies the assumptions underlying the concept of physician impairment, outlines the characteristics of impaired physician programs and policies, links organized concern for sick doctors to social, legal, and political pressures for professional accountability, documents the emergence and diffusion of the concept of impairment and identifies its early and active supporters, and explains the rapid acceptance of medical control of problem doctors in terms of its compatibility with professional values and interests. This analysis highlights the importance of examining the social and cultural components of professional self-governance.

Hard Cases Make Bad Law

Medicine is largely self-governed. This is so because the public, the citizens of the state, have permitted it. Professional self-government does not result from natural or constitutional right. It is a privilege. Society believes it lacks the knowledge and expertise needed to review the quality of professional service or to evaluate professional judgments. But beliefs can and do change. The public can be stampeded into believing (1) its rights are being impinged upon (2) medicine isn't policing its own ranks (3) the privilege of self-government should be restricted or curtailed, or (4) the public should participate with the profession in administering self-government. Medical societies appear to have been reluctant to tackle tough problems relating to questionable actions by their members. It is amazing how many excuses can be found for not conducting an investigation or for not taking action. One common excuse is that if the medical society becomes involved