2003 - Reforming the professions
When I mentioned that I had
a "dead toe" on my last visit to the
local surgery, not only did the locum appear uninterested
but she gave me a prescription for an infection
I did not have.
Now when you take your toe to the doctor, you
expect a flicker of reaction at the very least.
Why did she not refer me to a toe specialist?
Where, in other words, was her
I carried this mildly irritating
concern to a round table discussion last week
to launch three new papers on the professions
prepared for the Royal Society for the Encouragement
of Arts, Manufactures and Commerce (RSA).*
But any desire to mention my
misfortune wilted under the invective of Harold
Perkin, the social historian and author of The
Rise of Professional Society. Launching his paper,
he catalogued a whole list of professional inadequacies
to support a conviction first voiced 100 years
ago by George Bernard Shaw, that professions were
"a conspiracy against the laity".
As a lesson in the art of offending
just about everyone, it took some beating.
Among his targets were doctors
who maltreat patients with unnotified hysterectomies
or who store babies' body parts; psychiatrists
who systematically molest patients; lawyers who
overcharge clients; dentists who charge six times
the National Health Service rate for routine procedures;
engineers who build wobbly bridges; journalists
who harass and invent stories about celebrities
and victims of crime; and business executives
who steal from shareholders by insider trading
and golden handshakes.
All, he said, had given the professions
a bad name and had undermined the trust on which
their status and reputation depended.
Every profession would have bad
apples, he conceded. But professional bodies had
done too little to expose malpractice within their
own ranks. Professional bodies such as the General
Medical Council, the Law Society and the Press
Complaints Commission, which practise self-regulation
in the UK, he said, were often behaving as "defence
organisations for their members rather than guardians
of their clients and the public".
The self-regulatory role of the
professions , which Prof Perkin suggested was
scarce outside the English-speaking world, is
central, he believes, to the need for reforming
professional organisations to restore public confidence
in their ability to maintain standards.
It would be tempting to conclude
from these remarks that Prof Perkin is an enemy
of the professions . On the contrary, he is convinced
that professionalism is the defining quality of
our post-industrial society. But he worries that
there are too few restraints and sanctions against
abuses of professional privilege and too many
restrictive practices, resulting in a decline
of public trust.
The upshot is that the professions
are under threat from the free market, "where
any charlatan can pretend to expertise and charge
whatever fee or salary the market will bear".
The RSA investigation, then,
is timely - because these days there are large
numbers of career disciplines embarking on the
well-trodden path to professional status. The
professional and membership bodies of personnel
management, general management and board directorship
in the UK are all either creating, or investigating
the possibility of creating, chartered practitioners.
At the same time, old and new
professions are under pressure to develop programmes
of continuing professional development. In some
cases these are compulsory additions to earlier
qualifications, considered necessary for professionals
to keep up to date with advances and procedures.
It is right that professional
bodies should take an interest in promoting strong
professional credentials among their members.
A danger arises, however, when these bodies succeed
in creating a "closed shop", barring
able outsiders from practising the same skills.
Professional barriers may well keep out the quacks
but they also ignore the experienced amateur.
At the same time they tend to promote traditional
practices, alienating alternative or innovative
practices that may have much to contribute to
Much of the discussion at last
week's gathering sought to isolate the concept
of aligning professions with their historically
central role of serving the public. Should the
professions , for example, be the arbiters of
public interest? Professional ethics, suggested
one contributor, might, in some circumstances,
require professionals to conceal knowledge from
This is a difficult subject.
How should a body of educated opinion be weighed
against the desire for democratic and public debate?
Is it reasonable, on the grounds of professional
judgment for example, to introduce genetic modification
of food without engaging public opinion? It would
be quite possible in these circumstances for professionals
to find themselves taking a promotional stance
in the face of widespread public opposition. In
the absence of a higher authority, who is to say
that professional opinion may be wrong?
There are numerous examples of
professionals who have made mistakes or who have
adopted a particular stance, then changed it in
the face of conflicting evidence introduced at
a later date. Professions should never be credited
as the fount of all knowledge in their specialism.
But they should be respected and trusted authorities
that command broad respect in the wider society
and they should retain a sense of public service.
One other important matter likely
to be raised as the project continues is the relationship
between professional practice and profit. The
conflict of interest in accountancy firms that
acted as both auditor and consultant in companies
such as Enron and WorldCom has raised questions
about the ethical bases of professional codes.
At the same time it must be acknowledged that
some of the most capable of professionals are
attracted to entrepreneurial ventures.
Prof Perkin has his own opinion:
"In the end the market is the enemy of the
professions . You can judge a loaf of bread by
its taste or a car by its performance. But you
cannot judge a surgeon except by his qualification,
a lawyer except by her membership of the Bar,
or an engineer by his certified training. Some
trusted body must guarantee their expected performance."
I wish there were a department
for the protection of toes. But that might be
asking too much.
Values for the 21st Century www.theRSA.org.uk