In the Public Interest

Medical Licensing and the Disciplinary Process

Ruth Horowitz

Publication Year: 2012

How do we know when physicians practice medicine safely? Can we trust doctors to discipline their own? What is a proper role of experts in a democracy? In the Public Interest raises these provocative questions, using medical licensing and discipline to advocate for a needed overhaul of how we decide public good in a society dominated by private interest groups. Throughout the twentieth century, American physicians built a powerful profession, but their drive toward professional autonomy has made outside observers increasingly concerned about physicians’ ability to separate their own interests from those of the general public. Ruth Horowitz traces the history of medical licensure and the mechanisms that democratic societies have developed to certify doctors to deliver critical services. Combining her skills as a public member of medical licensing boards and as an ethnographer, Horowitz illuminates the workings of the crucial public institutions charged with maintaining public safety. She demonstrates the complex agendas different actors bring to board deliberations, the variations in the board authority across the country, the unevenly distributed institutional resources available to board members, and the difficulties non-physician members face as they struggle to balance interests of the parties involved.In the Public Interest suggests new procedures, resource allocation, and educational initiatives to increase physician oversight. Horowitz makes the case for regulations modeled after deliberative democracy that promise to open debates to the general public and allow public members to take a more active part in the decision-making process that affects vital community interests.

Published by: Rutgers University Press

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Many people provided different kinds of support for this project. My fellow medical board members and their staff from across the country, the staff of the Federation of State Medical Boards, and my colleagues from the Citizen Advocacy Center taught me how to be a public member and what medical boards did. ...

Abbreviations

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pp. ix-x

Introduction. Medical Boards and the Public Interest

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pp. 1-9

We know from numerous surveys that most of us are satisfied with our personal doctors. And yet doubts occasionally surface as to whether a doctor did the right thing or put our interests first. How do we know our physicians are competent, ethically fit, and have our best interests at heart? ...

Chapter 1. Public Member, Researcher, and Public Sociologist: The Genesis of a Project

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pp. 10-31

My position as a board member evolved over time. I started as a citizen doing my civic duty, a member of society who happened to be a sociologist, invited to serve first on Board A, then Board B. With the passage of time, my role as a committed intellectual made itself felt, and I slowly became an organic ...

Chapter 2. How Licensure Became a Medical Institution

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pp. 32-56

Eliot Freidson argues that the handful of occupations deemed to be “professions” proper have credentialed practitioners given the exclusive right to provide designated services.¹ Other social scientists provide lists of characteristics of professions or stages distinguishing emerging professions. ...

Chapter 3. Public Participation: The Federal Bureaucracy Starts a Public Dialogue

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pp. 57-70

George Bernard Shaw saw the medical profession as self interested: “[Medical practice] is quite unregulated except by professional etiquette, which, as we have seen, has for its object, not the health of the patient or of the community at large, but the protection of the doctor’s livelihood and the concealment of his errors.”¹ ...

Chapter 4. The State, the Media, and the Shaping of Public Opinion

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pp. 71-97

Local medical societies often resisted changes, yielding only when media campaigns grew too hot and when boards found they had less to do since licensure issues were largely resolved by the use of national exams.¹ As George Bernard Shaw argued in the 1930s, “In the main, then, the doctor learns that if he gets ahead ...

Chapter 5. Rhetorics of Law, Medicine, and Public Interest Shape Board Work

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pp. 98-119

The language of public protection slowly crept into board work, but it is still often overwhelmed by the discourses of medicine and law in shaping deliberations. The language of “protecting the public” began to appear regularly in the Federation Bulletin in the 1970s and was heard increasingly at Federation meetings. ...

Chapter 6. Medical and Legal Discourses in Investigatory Committees

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pp. 120-149

By the end of the twentieth century board members took their disciplinary authority seriously, framing their goal as public protection. About 12 percent of cases largely concerned incompetence and negligence, but the majority focused on what Dr. Edmund Pellegrino considered character issues or what Charles Bosk ...

Chapter 7. Hearing and Sanction Deliberations: Transparency and Fact Construction Issues

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pp. 150-168

Most “disastrous duffers,” as described by George Bernard Shaw, settle their cases prior to hearings: “We may guess that the medical profession, like other professions, consists of a small percentage of highly gifted persons at one end, and a small percentage of altogether disastrous duffers at the other.”² ...

Chapter 8. Democratic Deliberation and the Public Interest

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pp. 169-190

For decades critics have wondered if letting professions police themselves was like allowing foxes to guard the chicken coop.¹ The licensure movement unfolded under the banner of ensuring quality of service and weeding out bad apples within the profession—a public-minded rationale, to be sure, yet as this book ...

Conclusion. An Exercise in Democratic Governance

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pp. 191-196

While bringing this project to a close, I did the paperwork required for my board reappointment. The process has grown more complicated in recent years, with extra forms and documents to produce. The change was made in the name of “good government,” but it reminds us how difficult achieving the intended outcome ...

Notes

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pp. 197-228

References

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pp. 229-246

Index

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pp. 249-261

E-ISBN-13: 9780813554280
E-ISBN-10: 0813554284
Print-ISBN-13: 9780813554273
Print-ISBN-10: 0813554276

Page Count: 272
Publication Year: 2012

Series Title: Critical Issues in Health and Medicine
Series Editor Byline: Rima D. Apple and Janet Golden