ABSTRACT
Just as patients don’t coincide with their illness roles, professionals don’t coincide with their professional roles but relate to them. This chapter shows that this relationship is much more intrinsically normative than instrumentalist and merely functionalist views on professionalism tend to concede. Professionalism is more than a collection of skills and techniques. Professionals identify with roles that are determined by commitment to a greater good, i.e., serving society by healing, caring, and comforting the sick.
The chapter analyzes the history of the sociological concept of professionalism. Early phases were marked by Weberian ideas about division of labor, increasing specialization, and the establishment of the social contract between society and the medical profession. Later, in the sixties and seventies, professionalism suffered from distrust and loss of status and legitimacy. The recent past (nineties and later) is characterized by gradual reemergence of more pragmatic versions of professionalism.
Important elements of the old functionalist approach have remained in the current, more pragmatic views, however. The modern professional has become a bearer of functions, which derive their meaning from the rational framework of which they form a part. This framework obeys to the logic of the market and is increasingly determined by a bureaucracy that aims at control in terms of safety, access, efficiency, and efficacy.
The irony of recent developments is that the very logic behind the triad of functionalism, managerialism, and consumerism, which was meant to restore trust, has led to an erosion of trust, both between doctors and their patients, and between the medical profession and society. Normativity, value sensitivity, and responsibility still represent a forgotten dimension in the renewed negotiations about the social contract between medicine and society.
