Analysis of a human service from inception to current day

Introduction

This essay discusses the growth of the profession of doctors. The essay discusses how doctors first came to be involved in the profession of health care and how the profession has evolved over time. The essay also discusses the professional ethics and legal responsibilities related to the profession.

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Doctors: History and development of profession, duties, responsibilities

The early history of medicine is considered to date back to Neanderthals, who are believed to have been involved in medical practices of some kind (Spitkins & al, 2018). Early history of medicine is also linked to herbalism, which saw early humans using herbs found in forests and nature to cure medical ailments (Spitkins & al, 2018). Most early civilizations have involved some practice of medicine, although India is considered to be the first ancient civilization where major developments in the field of medicine were made. In ancient India, early forms of surgical treatments and prognosis were done (Wujastyk, 2003). Medical ethics, an important aspect of professional ethics for doctors were also first engaged in ancient Indian literature (Wujastyk, 2003). It may be mentioned that the Islamic world has also contributed significantly to the growth of medical profession in the Middle Ages as it is in this time that several crucial discoveries were made in the field of medicine which became relevant to the modernization of the profession; for instance the idea of germs developed in the Islamic world which led to the development of modern hospitals and separation of patients with certain diseases (Elgood, 2010). Over time, other civilizations also developed medical practices and eventually European nations also developed these. In Europe, including in England, significant development of medicine happened in the post enlightenment period.

In the 19th century, doctors shifted towards specialism, and the 21st century has seen the development of different fields of specialism within the field of medicine (Ackerknecht & Haushofer, 2016). The 20th and 21st centuries have seen a significant growth of medicine sciences because of the development of large populous cities, which being the home to large populations, furnished larger number of patients, afflicted with a variety of diseases (Ackerknecht & Haushofer, 2016). This led to the growth of general medicine, especially in the context of specialist medicines, which were developed to respond to the variety and complexity of disease incidence in large cities like London (Ackerknecht & Haushofer, 2016).

In the last five decades, specialist medicine has grown significantly (Ackerknecht & Haushofer, 2016, p. 155). Earlier specialism was related to specific fields within medicine, including surgery, obstetrics, and gynaecology; however, in the last five decades, specialist medicine concerning specific kinds of diseases has evolved. This has led to doctors becoming specialists in the fields of specific diseases or even specific conditions within those diseases (Ackerknecht & Haushofer, 2016, p. 155). The development of the medical field in general, and medical engineering has led to inventions of variety of new instruments or ‘scopes’, which has helped in the development of specialised doctors because these instruments require special training for use, leading to the development of new age professionals who are adept at using these new instruments and technologies (Ackerknecht & Haushofer, 2016).

Another important change in the medical profession is the division between general medicine and psychiatry. Psychology was recognised as a separate discipline in 1694; this is when Steven Blankaart defined psychology as the discipline " which treats of the Soul” (Blankaart, 2009, p. 13). Thus, psychology came to be identified as being distinguished from anatomy, leading to the division between general medicine, which is the treatment of the body, and the development of psychiatry. In the 19th century, psychiatry developed as a specialist area (Ackerknecht & Haushofer, 2016). By early 20th century, psychology became more specialism oriented with a focus on behaviour (Watson, 1913). Today, psychiatry is considered to be the youngest of the disciples of medicine (Ackerknecht & Haushofer, 2016, p. 163).

The medical profession has also come to become a part of the public health initiative and the post war England saw the establishment of the National Health Service (NHS) as a public health initiative. To a great extent, the public health initiative was driven by the social reform movements and by the developments in the field of medicine and biology (Koplan, et al., 2009). The social reform movement focused on social justice, which also emphasised on the provision of health equity in the society; the development of medicine and biology related to the causation and management of disease (Koplan, et al., 2009). These two forces converged together around the early 20th century to create a strong movement for the provision of public health care services, which also led to the change of the medical profession, which was no longer a private occupation only but became a part of the public health initiative through the establishment of the NHS (Koplan, et al., 2009).

The history of medical profession was impacted by the establishment of the NHS because a welfare principle was applied to provide medical services to people in England and Wales, irrespective of the financial situation of the patients. Prior to the establishment of the NHS was established in 1946, health care services were available to the rich and affluent or those who were successful in getting free treatment through teaching hospitals or charity (Greener, 2009 ). NHS was established on the principles that comprehensive and free medical services should be provided to the patients who need it (Greener, 2009 ). As per the seminal report prepared by Lord Beveridge, disease was one of the ‘five giant’ problems in the post war England, to encounter which free medical services were to be provided free under the NHS (Greener, 2009 ). There was opposition from voluntary hospitals, and some doctors who were opposed to the idea of removal of all economic barriers to health care (Webster, 2002). However, the NHS was established and the doctors who work within the NHS are bound by the contractual obligations that are enforced under their employment with the NHS.

From the time of its inception, many significant changes have come into practice, particularly with regard to the professional ethics of the doctors. These professional ethics are to be followed by the doctors in their field in order to ensure that the rights and interests of the patients are safeguarded. The principle of respect for autonomy emphasises on the rights of patients to freedom and choice (Beauchamp, 2007). Where patients have the critical metal faculties, such as, understanding, knowledge, awareness, and voluntary decision making capacity, the doctor must seek consent from the patients (Beauchamp, 2007). The principle of nonmaleficence is aligned to the Hippocratic Oath, and is based on the principle primum non nocere or “Above all, do no harm”; this is the most important principle in the history of code of health care (Beauchamp, 2007, p. 4). The ethical principle of justice relates to notions of fairness and equitable treatment (Beauchamp, 2007). Finally, the principle of beneficence is related to kindness, mercy, and charity as per which doctors should “further their important and legitimate interests, often by preventing or removing possible harms” (Beauchamp, 2007, p. 5). These are the important ethical standards that are to be followed by all doctors at all times.

Over a period of time, the medical profession has also come to be subjected to the domain of the law of crimes and tort. The law of crimes is applicable to doctors if in their professional capacity they give a treatment to the patient without the informed consent of the patient; in this context doctors can be held for assault or battery against the patient. The legal authority in this regard is the Malette case in which the doctor was held liable for battery on the patient for giving blood transfusion to the patient even when the doctor aware of the patient’s religious beliefs against the blood transfusion (Malette v Shulman [1991] 2 Med LR 162., 1991). In such cases, the battery can be treated as a tort as well, making the doctor liable to pay damages to the patient for the intentional tort. The doctor’s duty to take informed consent from the patient is a part of the professional ethics of the medical profession (Selinger, 2009). Medical negligence has come to be developed as a major part of tort law (Selinger, 2009).

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Conclusion

To conclude, the medical profession has developed over a long period of time. Modern doctors are highly specialized unlike earlier doctors who practiced medicine in more general formats. The fields of general medicine and psychiatry came to be separated. Medical ethics and professional ethics create standards to be followed by doctors. Laws are also applied to doctors, including criminal and tort laws. Medical profession has also been subjected to forces of social reform due to which NHS was established in the UK to provide free medical services to people.

References

Bibliography

Ackerknecht, E. H. & Haushofer, L., 2016. A Short History of Medicine. JHU Press.

Beauchamp, T. L., 2007. The ‘four principles’ approach to health care ethics. In: Principles of health care ethics. New York: Wiley and Sons, pp. 3-10.

Blankaart, S., 2009. Psychology. In: A Dictionary of Psychology. Oxford: Oxford University Press , p. 13.

Elgood, C., 2010. A Medical History of Persia and The Eastern Caliphate. London : Cambridge.

Greener, I., 2009 . Healthcare in the UK Understanding Continuity and Change. Bristol: Policy Press .

Koplan, J. P. et al., 2009. Towards a common definition of global health. The Lancet , 373(9679), pp. 1993-1995.

Malette v Shulman [1991] 2 Med LR 162. (1991).

Selinger, C. P., 2009. The right to consent: Is it absolute? The right to consent: Is it absolute?. BJMP , 2(2), pp. 50-54.

Spitkins, P. & al, e., 2018. Calculated or caring? Neanderthal healthcare in social context. World Anthropology, 50(3), p. 384–403.

Watson, J. B., 1913. Psychology as the Behaviorist Views It. Psychological Review, 20(2), p. 158–177.

Webster, C., 2002. The National Health Service: a political history. Oxford: Oxford University Press.

Wujastyk, D., 2003. The Roots of Ayurveda. London:Penguin .

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