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This article notes the tendency in the sociological literature to frame studies of medical professionals in terms of a series of binaries (e.g. control/resistance, powerful/powerless professionals, medicine/management). It suggests that moving away from this approach to acknowledge a more nuanced perspective would be helpful. The article draws on recent empirical studies to support this view.Keywords: Doctor satisfaction, sociology, control, resistance

English
Over recent decades, UK government attitudes towards the pharmaceutical industry have been ambivalent, reflecting the conflicting aims of controlling drug expenditure and maintaining a strong pharmaceutical industry. Policy can best be characterised as a careful balancing act, with indirect regulation leaving drug producers free to set prices. However, recent policy developments suggest a shift towards a more directly interventionist approach to drug pricing and reimbursement. This paper outlines the political dimensions of drug rationing in the context of recent reforms and assesses the prospects of New Labour's high-risk strategy for its relationship with prescribers, pharmaceutical companies and the electorate.

Over recent decades, UK government attitudes toward the pharmaceutical industry have been ambivalent, reflecting the conflicting aims of controlling drug expenditure & maintaining a strong pharmaceutical industry. Policy can best be characterized as a careful balancing act, with indirect regulation leaving drug producers free to set prices. However, recent policy developments suggest a shift toward a more directly interventionist approach to drug pricing & reimbursement. This paper outlines the political dimensions of drug rationing in the context of recent reforms & assesses the prospects of New Labour's high-risk strategy for its relationship with prescribers, pharmaceutical companies, & the electorate. 39 References. Adapted from the source document.

`This is an excellent textbook for which there is currently a niche in the market. The chapters on rationing, professionalism, politics of clinical knowledge and the politics of democracy and participation are particularly strong and will be invaluable to students of health policy, health studies and health service research' - Professor Michael Calnan, University of Bristol. Written by leading academics in their field this book provides a clear and considered overview of the politics of health care in Britain. Bringing together a wide range of material on both past events and recent developmen

English
This article analyses data from a participant observation study of decision making in local National Health Service institutions, focusing on the construction of local clinical guidelines. We found that guideline construction departed significantly from the 'bureaucratic-scientific' model. Although clinical guidelines are often seen as constraining the practice of medicine, our study suggests that there is nothing intrinsically corrosive of professional autonomy about guidelines. It is not likely to be guidelines per se which diminish physician autonomy but rather the manner in which they are implemented. Participation in the guidelines process functioned primarily as a device by which actors hoped to pursue their existing opinions, either through imposing them on others, or by creating a framework of legitimation for themselves.

This article analyses data from a participant observation study of decision making in local National Health Service institutions, focusing on the construction of local clinical guidelines. We found that guideline construction departed significantly from the "bureaucratic-scientific" model. Although clinical guidelines are often seen as constraining the practice of medicine, our study suggests that there is nothing intrinsically corrosive of professional autonomy about guidelines. It is not likely to be guidelines per se which diminish physician autonomy but rather the manner in which they are implemented. Participation in the guidelines process functioned primarily as a device by which actors hoped to pursue their existing opinions, either through imposing them on others, or by creating a framework of legitimation for themselves. (Original abstract)

This paper argues that the means by which the profession of medicine has to legitimise itself in the context of state‐provided health services is changing in a way that may be summarised in Weberian terms as a shift from substantive to formal rationality. The traditional model for such legitimations, evident in the UK over the last 50 years, relied heavily on professional interpretation of emergent patient needs, on professional pragmatism as a means of coping with resource limitations, on unsystematic empiricism and self‐critical reflections as sources of clinical knowledge, on professional self‐regulation, and on an empirical legal test of professional negligence. This seems to be in the process of being replaced by a neo‐bureaucratic model that relies on formalised assessments of patient need, explicit micro‐economic analysis, cumulative "scientific" evidence implemented through bureaucratic rules, increasingly external regulation, and possible shift to normative legal tests of professional negligence.

Despite the increasing deployment of formalized boundary spanning roles and practices, the mechanisms and dynamics of their legitimation remain under-explored. Using the Bourdieusian lens, we theorize legitimation of boundary spanning as accumulation, mobilization and conversion of several forms of capital unfolding in a configuration of intersecting fields. Drawing on a qualitative longitudinal case study of a collaborative partnership between a university and healthcare organizations, we describe changes in the structure, sources and mutual convertibility of capital assets over time. We also analyse the implications of this evolution for the relationships between the intersecting fields and the social trajectory of boundary spanners. We argue that legitimation of boundary spanning roles and practices is a highly transformative, collective and political process that increases the capital endowments and authority of individual boundary spanning agents but may lead to the erosion of the very same roles and practices that were being legitimized.