Science, consumerism and bureaucracy: New legitimations of medical professionalism Available to Purchase

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.