Challenging Medical Dominance in Australia

Sociology — Medical Dominance on the Profession of Nursing and How is the Profession of Nursing Challenging Medical Dominance in Australia

In the context of medical practice, the contemporary medical society is representing a change in the increasing issues of domination between medical professions. The focus of each practice’s attention is on exploring its goals in providing integral contributions and impact to the framework of health care services. Each dimension of medical interest, specifically the doctors and nurses, are developing their respective paradigm and uniqueness to establish skills and authority in the field of health service.

This paper aims to do an informative research on medical dominance over the profession of nursing in Australia. As the industry of medicine progresses, the issue of domination among medical doctors and nurses in health care institutions are associated with competencies and authority over the other. The power and privileges of the profession is an aspect covered in the issue of medical dominance.

At the core of medical dominance are the advantages brought by nursing to medical doctors. This paper aims to present information from articles and research on medical dominance in nursing, as well as the advantages and disadvantages it brings. In contrast, the challenges brought by nursing to medical dominance will also be discussed in this paper. In the term medical dominance, “medical” in this paper particularly refers to doctors.

The issue of medical dominance in nursing generally suggests the question “What sets apart between doctors and nurses?” Along the process of providing information in our research, this paper aims to answer this question.

Medical Dominance on the Profession of Nursing

In his Professionalism and Health Care, Faraizi indicates the dominance of doctors over the nursing profession in the hierarchy of medicine.

As medicine has progressed as an industry, it has increasingly been subjected to professionalism. Doctors stand on top of the professional hierarchy in medicine.

… though other health care workers, nurses for example, are now attempting to gain professional recognition, professional status largely remains with doctors.

This reflects that while doctors and other types of health care profession both function for the purpose of providing health care services, Faraizi suggests that the term “medical professionals” is generally associated to doctors, and that other form of health care profession is still of “semi-professional” status. One element suggested to be the cause of doctors’ dominance in the professional field of medicine is “the degree of specialized knowledge they have and the ultimate degree of power and control that can be exercised through the application of this knowledge.” (Faraizi, Professionalism and Health Care).

In Australia, medical dominance is one of the factors that limit the best performance of nurses in their profession. It limits and bounds the context of nurses’ role in decision making and other aspects of their job. Because of dominance of medical professions, there is no broader context in the roles nurses portray in health service. Medical dominance serves as a boundary of clinical knowledge and expertise of the specialist doctors from the nurses.

The notion of medical dominance in Australia emerged from the professionalism delivered and demonstrated by doctors. This assumption does not only cause major consequences to the nursing profession, but to other health occupations as well. The literature The Consequences of Medical Dominance for Patients suggests that

The professionalism of doctors has consolidated the dominance of medicine over all other health occupations in Australia and in other advanced societies where health care is a commodity. This has not only served to improve doctors’ overall wealth and status but has also limited fairly much the opportunities afforded to other health occupations and medical approaches to gain legitimacy.

Michel Foucault defined medical dominance, in its historical context, that, it transformed from the exercise of power from which its acknowledgement as the only “professional” form of medical status originated. Hence, there is a medical dominance where there is a superior exercise of medical profession, such as in decision-making, and overpowers other health professions.

The division of labour in health service provides apparent proof of medical dominance in nursing, not just in Australia but also in many countries. Willis suggests the societal context of the division of labour in Australia, specifically within the capitalist structure (Andrews & Hale, 2000). He argues that the sovereignty of medical profession over the other members of health care service, such as the nurses, is achieved because of state patronage. This thereby, makes way for medical professions’ success as the dominating body of medicine.

The hierarchy in health professions, in which medical dominance over the profession of nursing has been the contemporary division of medicine nowadays, has posed privileged positions and distinction for medical profession. The “semi-professional” class, such as the nurses, is stereotyped as the dominated health care profession.

How is the Profession of Nursing Challenging Medical Dominance in Australia

The profession of nursing in Australia is aiming to extend its image and role in the field of health service. Nurses contend medical dominance and demonstrate continuing preparedness in accommodating and playing advanced roles in health service. The literature Rural Nurses: Knowledge and Skills Required indicates a deduction of Hegney, in her study of the function and role of rural nurses in Australia, on the challenge and threat brought by nursing to medical practitioners. The literature states

Hegney deduces that medicine is threatened by the emergence of advanced practice nurses who seek independence through legitimisation of the role as Nurse Practitioners. Further, she argues that nurses have not acquiescenced to medicine’s continued attempts to maintain control over nursing practice.

Further, nurses were indicated to pursue strategies in resisting medical dominance such as performing roles beyond their duties and legitimacy (Rural Nurses: Knowledge and Skills Required).

Another challenge posed by the nursing profession on medical dominance is the struggle of some nurses to involve themselves in the diverse arena of medical science. Some nurses take on the course of studying other medical fields. They try to learn in other areas of health service to enhance their skills in caring for patients and other medical management techniques. In New South Wales, for instance, the State Government allowed the provision of training to nurses for additional health care tasks such as conduction of diagnostic tests and management of patient conditions independently (Duffy, E.). The article Nursing in the Era of High Technology Medicine, from online ABC Australia, indicated the struggle of nurses in establishing a role acknowledged by people and not merely dominated by medical doctors.

Many nurses are trying to bridge these gaps by studying in other fields. A colleague of mine has a PhD in physiology, and many are studying in fields such as public health and epidemiology.

The evolving role of nursing in health care presents a challenge to the medical dominance in Australia. This includes effects on diverse aspects such as decision-making, job responsibilities, and remuneration. Particularly on roles and responsibilities of nurses and medical professions, Duffy indicated an issue stating that

Concerns about prescribing and ordering diagnostic imaging have been perceived as belonging exclusively within the boundaries of the medical profession.

The establishment of new roles of nurses in Australia is a current challenge to all health professionals to recognize the contributions and value nurses are capable of delivering to community health service.

Conclusion

Theoretical issues exploring medical dominance in Australia are mostly rooted from the capitalism of medicine. As what Willis argues, the dominance of medical doctors in the contemporary Australia was caused by the sponsorship and support, such as in research and practice, by the corporatist medicine. Thus, this provides much advantage to medical doctors compared to other health care professions. Even the Australian Medical Association (AMA) is largely composed of private medical doctors (Faraizi, A. Professionalism and Health Care).

What sets medical doctors apart from other health professions, such as nursing, is the degree of knowledge and skills they specialized. This provides them with a degree of power over nursing, ascending them into dominance. However, this aspect can no longer be considered as a boundary between specialist doctors and nurses. Nurses are now able to involve themselves in other fields of interest in health care, aiming to break the marginal lines of dominance between the roles of doctors and themselves. Although the roles each profession serves in health care may be different, through further achievements, the profession of nursing may eliminate medical dominance.

The profession of nursing is generally seen as job dependent on other medical professions such as the doctors. This is one of the reasons that cause medical dominance in Australia. The model of working under the management of medical professionals presents a lack of job autonomy for the nurses, hindering the opportunity of broadening the structure of their profession. Perhaps, through consideration and regulation of labour division for the health care professions, including the nurses and doctors, the issue of medical dominance in Australia, and in other nations, can be eliminated.

Bibliography

Andrews, I., Hale, A. (2000). The Division of Labour in Health Care Delivery.

Retrieved Sept 23, 2003, from Faculty of Health Sciences. The University of Sydney.

Web site: http://www2.fhs.usyd.edu.au/bach/1107/topic9.htm

Duffy, E. Evolving Role and Practice Issues: Nurse Practitioners in Australia.

Monash University School of Rural Health, 2-3.

Faraizi, A. Professionalism and Health Care.

Health and Medical Sociology.

Faraizi, A. Consequences of Medical Dominance for Patients.

Health and Medical Sociology.

Shields, L. Nursing in the Era of High Technology Medicine.

Retrieved Sept 24, 2003, from ABC Science.

Web site: http://www.abc.net.au/rn/science/ockham/stories/s273.htm

(2001). National Review of Nursing Education.

Retrieved Sept 25, 2003, from The New South Wales College of Nursing.

Web site: http://www.nursing.aust.edu.au/news/brief_14.html

(2001). Rural Nurses: Knowledge and Skills Required by to Meet the Challenges of a Changing Work Environment in the 21st Century: A Review of the Literature.

Retrieved Sept 25, 2003, from Commonwealth of Australia.

Web site: http://www.dest.gov.au/highered/nursing/pubs/rural_nurses/7.htm

Willis, E. (2003). Shifts and Counter-Shifts in Medical Autonomy: The Case of Salaried Medical Officers. Flinders University.

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