Patient choice and medicine in health care

The moves to greater patient choice within the UK, to the extent they have actually occurred, have begun to redefine the relations between the patient, professional and state. Rather than the doctors being the voice of the patients it is now the state administration's claim to have begun to provide patients with their own voice(s) and choices. Whereas traditionally the physician would claim to speak for the patient in order to demand more clinical resources now it is the management who demands, on behalf of patients, greater efficiency and effectiveness from the medical and health care staff. Cynically one might suggest that the policy is as much about disciplining the professionals as it is in providing real choice. The new public management (NPM) rhetoric has familiarized us to the notion of empowerment and the importation of consumerism and the ‘market’ to the public sector, a process that has begun to undermine our pre-existing assumptions of the autonomy of the professionalized elements of expert labour, including medicine, and the impact of NPM has meant their growing ‘responsibilization’ (Hanlon 1998 Hanlon, G. 1998. Professionalism as Enterprise: Service Class Politics and the Redefinition of Professionalism. Sociology, 32(1): 43–63. [Crossref] , [Google Scholar]; Fournier 1999 Fournier, V. 1999. The Appeal of ‘Professionalism’ as a Disciplinary Mechanism. The Sociological Review, 47(2): 280–307. [Crossref], [Web of Science ®] , [Google Scholar], 2000). At least, that is a possibility.