From fear to fraternity: a socio-legal analysis of doctors' responses to being called to account by patients

Mulcahy, Linda (2000) From fear to fraternity: a socio-legal analysis of doctors' responses to being called to account by patients. Doctoral thesis, University of North London.


This thesis considers how senior hospital doctors respond to challenges to their autonomy contained in complaints. It focuses on how doctors talk about, explain, circumvent and resist these threats. The aims were twofold. First, to contribute to the development of socio-legal theories of disputes. In particular, the study aimed to enhance understanding of reactions to voiced grievances which tend to be under-theorised. A second aim was to examine how a powerful elite, such as the medical profession, responds to attempts by the legislature to regulate their responses to complaints. The thesis raises issues of how and whether regulation of medical work can be achieved and the success of law as a medium through which to facilitate regulation. It considers the ways in which the impact of law is mediated by competing normative frameworks, such as those developed by the medical profession.

Exploration of these themes has been informed by an qualitative and quantitative empirical studies of how hospital consultants respond to complaints. A theoretical framework was developed using a grounded theory which was used to code three main datasets; interviews with 35 consultants, interviews with 25 managers and postal questionnaires from 443 consultants. The theoretical perspective adopted drew on and contributed to attribution theory, socio-legal theories of regulation, theories about doctor-patient interactions and work on the sociology of the profession.

It is concluded that complaints have a significant impact on the emotional well-being of consultants and are likely to lead to changes in the way in which they provide medical care in the future. Complaints cause consultants to question their abilities and, in their attempts to come to terms with the criticisms made of them, they rely heavily on medical networks for support, to the virtual exclusion of other networks. The medical fraternity has a large part to play in the re-negotiation and construction of doctors' damaged identities in line with the needs of the group.

As well as representing a challenge to the individual, complaints are viewed as a symbolic challenge to the medical group. There are two main reasons for this. Firstly, the very act of making a complaint implies that the complainant has the competence and knowledge to challenge expert medical work. Secondly, the making of a complaint provides the trigger for managerial interferences in the doctor-patient relationship. An understanding of these broader threats to the profession go some way to explaining why elite medical groups have worked so hard to resist regulation of their work.

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