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Donkin on Work - Professions

April 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 professionalism?

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 professional knowledge.

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 the public.

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.

*Exploring Professional Values for the 21st Century

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