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Over the last few decades of the twentieth century there have been several trends and transformations in health care. Due to the transformation from modernity to postmodernity dominant institutions in society that used to keep the balance, have less influence. It has led to people having more freedom in the choices they make regarding their culture and identity. Post modernisation has led to new arrangements of social structures by introducing a state of flux within social relations. Klein (2010) stated that the NHS is in a ‘permanent state of flux’, the structures and positions in the system are fluid therefore the pace of change is so fast, that it is hard to keep up with all the different things happening.  These transformations have  had an effect on the NHS which can make their service unsustainable. In order for the health service to cope with the structural changes it has to make a profit off their service whilst also creating social unity, but this is problematic as all their resources are used up whilst not being able to accumulate profit.The rise of the new managerialism in the health care system mirrors the bureaucratic state as it involves the government intervening to ensure development, it disperses the medical power from the physicians in the centre of the system to managers on the outside. Hence, resulting in a rising shift of involvement from third parties who impact the health care system through their funds and organisation.  The new management has adopted the style of the private care system, so the service provided to patients depends on how much money is spent, this further demonstrates the effects of consumerism on the health care system. Those who do not have the money to pay for private health care may not get the best treatment or may not be able to afford the services which will lead them to seek alternative medicine.Organisational flux is a regular affair in the health care system as the trends and transformations shape their policies. There has been a shift in health care from focusing on disease to the main concern being and maintaining a healthy lifestyle.  Another shift has been the health and medical care going from the confines of a hospital to being dispersed through the community. The changes from traditional to unconventional health care has driven patients to adapt from the primacy of biomedicine to a plethora of health options. The choice of alternatives has blurred the lines between medical knowledge experts and the consumers. This may cause a decrease in professional dominance because they no longer have influence on how patients are treated and what issues they bring to the hospitals.There are several explanations of why these transformations have taken place and can be considered as underlying reasons to the demise of professional authority in medicine. The theories predict how physicians control over the content of their profession. The de-professionalization thesis focuses on the change in dynamic between professionals and clients due to patients’ uncertainty of how effective modern medicine is which have led to patients becoming sceptical. It is an influential criticism of the developments in health care, it contemplates the shift in policy from its values of inclusion and citizenship to focusing on controlling public expenditure (Clark, 2005). doctors do not have a say in where the savings are made it is down to the managers and trusts who work for the government. The cuts have led to protests from patients and welfare workers who are feeling the pressures of the detrimental savings. It also makes the private sector take responsibility from the public sector such as formal services doing less and private individuals or families doing more. The thesis also states a difference in the roles of the professionals; they have less opportunity to be autonomous, so they may go against their professional opinion for what may be best for their patients and they have less will when it comes to treating patients (Clark, 2005). This reflects the physicians experiencing de-professionalization because they can no longer give their patients the best service in their opinion due to not having the access they need to resources, in this case they lose their medical power as they become tools of the state. Ritzer and Walczak (1988) stated The Proletarianization thesis, a Marxist notion predicts that eventually the medical sector will become part of the capitalist system and have no control over production which will result in the professionals becoming isolated from their work as they will have no input. The term was exchanged to the corporation thesis because of the limitations the proletarianization thesis. As the rules, procedures and authority are increasingly controlled the professional autonomy is undermined as they will no longer be in control of things. The Neo-Marxist perspective explains that as medicine advances and becomes more corporate, physicians lost some of their professional rights to regulate their service without the government intervening.  The government also affected medical work by breaking it into specialist sub sections. For instance, because medicine’s increased use of new modern technologies, allows staff who are not medically trained to be able interfere in the relationship doctor and patient by advertising new techniques as trends or new products, also these staff can also control these technologies without the doctor being there. This makes patients seem like clients of the NHS or trusts that manage the doctors rather than being the doctors’ own responsibility and being able to develop intimate relationships. Therefore, physicians cannot be seen as professionally dominant due to them working for the organisations and not being self-employed. McKinlay and Marceau (2002) argued that the Marxist theories suggest that the capitalist development causes the reduction of professional rights like the right to set salary showed medicine was producing capital for the state. The Proletarianization thesis was seen as a flawed argument so it was revised because as the corporate world becomes more and more influential medical doctors become reduced to employees meaning they would be deprived of their access to means of production. It was a one-sided theory, so it was adapted to the corporation thesis. The Corporation thesis indicates the nature of the changes more than proletarianization. However, it is problematic because it is not useful in countries where health care is provided by the state for example medical autonomy is changing in places that have their health care funded by the state. Other health care occupations have been thought to challenge medical dominance. For example, nurses have been developing their clinical skills and growing in order to allow their roles to cover other medical responsibilities that are parallel to doctors, such as being able to prescribe medicine. This is also a similar case to physiotherapy or pharmacy. From personal experience patients are being referred and encouraged to go to pharmacists first to be treated and diagnosed, the experience is comparable to an appointment at a general practice. It creates a gap in the doctor patient relationship as the doctor no longer becomes an important contact but rather a last resort. Also, it makes medicine more available to patients which undermines the need to have doctors when it has become easy to approach a counter and purchase medication. According to the proletarianization thesis this is an example of the health sector surrendering to the capitalist movement to separate the medicine from their work as doctors to make profit.However, this does not necessarily mean professional dominance is under threat, it just represents a working hierarchal structure to society and within the health care system. Considering that doctors are the main authority figure it often reported and the case that they are overworked and constantly busy it only makes logical sense to delegate to relieve the pressure. Cooper et al (2011) indicated in their study the confidence that patients have in doctors to oversee the prescription process and have a pivotal role in ensuring the correct clinical competence ‘supplementary prescribing involves the doctor in the initial diagnosis’. It doesn’t threaten medical dominance if anything it enhances it allows nurses and pharmacists have the confidence to refer back and ask questions, Doctors still remain as the primary figures to diagnose and the medical knowledge bearers.The rise of consumerism also influences medical power, there have been broader shifts in the climate of medicine and the emergence of the more consumerist context. The choice of patients is now prioritised in health care which gives them the chance to choose between different doctors and different medical approaches. Complementary and alternative medicine today views the body holistically and suggests that illness is caused by our psychological state, spiritual and social environment being disrupted. The new medical movement to focus on living a healthy lifestyle means patients will often to choose to go for alternative medicine as it allows them focus on restoring balance and repairing their body rather than focusing on an illness and dealing with symptoms. This is especially true for patients who may have a chronic illness but do not want to spend their lives managing or concentrating on its effects as it viewed as the medical practice’s inadequacy to treat them. Thus, leading to patients taking matters into their hands and seeking an additional helping hand, this shows how willing patients are to challenge the medical expertise which provides them with more hope. This can once again destabilise medical power because if they alternative medicine is able to benefit patients who had been turned away by physicians it creates a public scepticism towards the efficacy of the health system. The struggle can cause a shift from biomedicine dominating the health system to equally sharing with complementary and alternative medicine due to the increased interest by patients.  Barnes et al 2004 argue that the results they found in their study associated to patients confirming results from CAM are surprising as there is a lack of evidence to support the efficacy and safety of these therapies. However, the effects of it could be due to many reasons such as individual differences or the placebo effect which suggests treatment will work as long as the patient believes it will work.The internet has become a form of empowerment for patients due to the bureaucratic regulation on the system it has allowed expert knowledge to become more accessible to everyday civilians. Reducing the knowledge gap between the professionals and patients presents a challenge to the medical power as they no longer view the professionals as a more knowledgeable other. They feel as though all the answers they need can be found on the internet. A majority of people go to the internet first when they experience some symptoms, sometimes this can be the answer for example when they conduct their search on websites or forums accredited by professionals or run by them. If this was the case, there would be no issues but many of these sources on the internet are controlled by lay people and the information is not completely credible. This then causes patients to believe their condition is either more serious or less serious than it is, the doctor will tell them the opposite of what they think, resulting in tensions to grow. This is also an impact of changing lay perceptions and knowledge, as the patients increased use of a broad variety of secondary sources on the internet, promoted by health care institutions has led to more critical patients who are better informed to make better informed decisions. This will put the professional dominance under threat as patients can view themselves coping with out doctors because the internet can diagnose and provide treatment instructions.An additional challenge to medical power is due to a loss in trust from patients in the health care system and in the professionals that work for the system. Associated with the rise in consumerism, patients are encouraged to become complaisant in trusting medical expertise, this explains patients moving away from institutions such as the NHS to private health care because they assume paying for 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 ending self-regulation. Scandals involving bad doctors were nothing new, they were all similar in content, for example patients being murdered by doctors, or being sexually abused. Some offences by the doctors were not even reported due to the high 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 in the medical sector to be shattered, especially in a time of a social media peak doctors cannot afford further transgressions as it will reach masses of people all over the world.  A scandal in one country will be enough to affect trust of the health care system in other countries. On the other hand, Calnan and Rowe (2008) conducted a study and found that there is a lack of evidence to indicate a decline in trust toward health care professionals. They reported that studies from the UK and USA show trust is still high for doctors but vary depending on the type of illness, how big 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 doctors individually.

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