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| title | chunk | source | category | tags | date_saved | instance |
|---|---|---|---|---|---|---|
| Professionalization | 2/5 | https://en.wikipedia.org/wiki/Professionalization | reference | science, encyclopedia | 2026-05-05T13:50:56.331947+00:00 | kb-cron |
== Physicians == Physicians are a profession that became autonomous or self-regulating. Physicians started as a division of labor in health care. The social status of physicians made them feel like they merit deference. Physicians' authority was based on persuasion. Autonomy and independence of the organization of physicians caused a division of labor that is professionally dominated. Licensing caused monopolies on rights. Eliot Friedson had commented that the profession had "the authority to direct and evaluate the work of others without in turn being subject to formal direction and evaluation by them”. Doctors retained their dominance because hospitals were administered rather than managed. The medical field enjoyed more power than some other profession, for example engineering. In the United States physicians from other countries could not practice unless they satisfied US regulation requirements. To ensure social order and establish British institutions, Ontario established medicine as a self-regulating profession in the late 1860s. In many US states however, medicine remained unregulated until several decades later. A publication in the 1840 British Medical Journal revealed an increase in professional consciousness from medical practitioners in England. Physicians in the 19th century came to have the features of modern professions. A major one was autonomy. This was further emphasized with the establishment of a controlling body of the profession. Competition and overcrowding (two or three decades after 1930) also put pressure on governments to establish a system of registration and requirements for those who wished to practice. This led to the Medical Act 1840. In fact, this council consisted mostly of doctors. Therefore, they were in control of regulating their own profession. The act required their members to oversee medical education, keep track of the numbers of qualified practitioners, and regulate it for the government. It gave the qualified more power and set limitations on the unqualified. The exclusion from government service of the unqualified practitioners was the most influential policy. Along with the act, the qualified practitioners came to be known as the “officially recognized” healers, and as such had a competitive advantage in the job market. To reduce competition, the Medical Act 1858 also raised the standards for qualifications. A modern code of medical ethics was also implemented in the 19th century. Again, this proves the high degree of power that the profession had. As a result, many medical practitioners came to experience ethical problems. Unlike today, it was more the concern of the behavior of doctors towards each other, than towards their patients. It is suggested to be due by the changes of the medical world in the first half of the 19th century. Unlike the pre-industrial age, distinctions between say surgeons and physicians were greatly reduced, to replace a division of mostly consultants and general practitioners. This new division caused disorder in establishing the roles of different types of practitioners and their status. It led to more competition as their various field of expertise was not made clear and thus resulted in accusations of unprofessional conduct among each other to protect their own interests. Issues, around management of medical practitioners and their practice stemming from this change, had to be attended to. In the second half of the 19th century, ethics were more severely monitored and disciplinary action against violators was put in effect. This was allowed as by the Medical Act 1858. Even the allowance to remove from practice any practitioner violating the code of ethics put in place. A more elaborated code of professional ethics emerged. A practitioner had no other choice but to adhere to minimum standards if he wanted to keep his job and keep practicing. The 19th-century education to become a physician encountered some changes from the 18th century. The 18th century was an apprenticeship program. The apprentice and master worked together and so the level of training received varied from person to person varied. In the 19th century, hospital medical schools and universities gained popularity for teaching. Apprenticeships were reducing rapidly. Training became more standardized. It was standardized more all over the world too because medical students that attended these schools came from all over the world. With this came a sense of professional identity and community made possible this modern profession seen today. With the professionalization of medicine came the emergence of the movement of physical diagnoses of physicians' patients in the 19th century. It was believed to help treat patients better. Before the emergence of this movement, physicians based their diagnoses on the interpretation of their patients’ symptoms. Physical diagnoses became part of the modern professional practice of medicine. It was one of the major accomplishments of Parisian hospitals and with the rise of Parisian pathological-anatomy, it became a very important clinical practice. Disease was believed to be an anatomical lesion inside the body. Physical examination was necessary to properly qualify them. This new approach caused the problem of the growing diagnostic competence but smaller treatment capacities. As well, this caused a pressure on the physician to find and classify the illness but also to treat and cure the disease. Skepticism grew in the profession as fellow physicians watched each other for proper treatment of patients. The invention of the stethoscope in 1816 made auscultation and percussion regularly employed to help in the physical diagnosis process. Diagnose and treatment now had to be based on science. The rise of hospitals facilitated physical diagnoses. That being said, patients were often reluctant to undergo physical diagnosis, especially with the rise of new medical instruments being used. In fact, manuals were written to help physicians gain knowledge on proper “patient etiquette” and gain their consent to perform certain procedures. Society had a hard time accepting the procedures required for the routine physical examination and its necessity. It was more interested in the cure and treatment effectiveness of the diagnosis. The industrialization in the late 19th century resulted in a demand for physicians. In Canada, the industrializing towns and cities of the Maritimes gave plenty of opportunities for their physicians to show their skills as emerging professionals. For example, medical doctors were needed to inspect tenement housing, and sanitary conditions of factories and schools. Doctors were needed to promote public and personal hygiene to reduce disease transmission. Medical failures often hampered the reputation of these physicians which made their status as professionals harder to implement and make the general population accept them as this. Not to mention over-crowding eventually became a problem. the profession called on the government for help especially in the last quarter of the 19th century. Restriction on who could get in medical schools, and higher demands on their education were put in place. As well, greater attentions to their professional ethics were among the strategies employed to distinguish themselves as high status professionals. Physicians also pressured the government for better attention to the health of its citizens. For example, the recollection of data of the births and deaths which it had stopped doing in the Maritimes in 1877. Provincial medical boards, allowance of registration for practice across all provinces, better schools, protection against the unlicensed physicians and unskilled persons, were some other actions taken.