Review

Trust us, we’re doctors

States, regulation and the medical profession
Michael Moran & Bruce Wood
Open University Press, 1993

Comparative studies of health services make for dry reading, or so the stereotypes say. Who cares how health services are organised as long as they deliver the goods? Most of us subscribe to this view, at least in times of personal need, and Moran and Wood demonstrate exactly how the national peculiarities of European health services converge on the same end point - more or less equitable medical services, largely free at the time of need and almost invariably funded by big third-party spenders, not our personal pockets. What’s the point of comparing systems, then?

The answer lies in the nation. National peculiarities affect the exact organisation of services, so that a citizen from one country will not fit easily into the medical care system of another. German medical care has yet to recover from the deal struck between the medical profession and the Nazis, and our NHS has not escaped from the schism between generalists and specialists - to our advantage, probably.

States, Regulation and the Medical Profession cuts through professional ideology and political mystification to examine the enormous power of medicine within society. In Europe and North America the medical professions have achieved positions of great power in their relationships to the state, developing surprisingly similar structures in doing so, despite national peculiarities. Everywhere this power is under pressure from governments keen to constrain costs, but Moran and Wood are cautious about the ‘decline of professional power’, arguing that powerful professional groups have recovered from government interference before, and may well do so again.

There are some crumbs of comfort for the BMA here. The conflict between the medical profession and the government from 1989 to 1991 certainly bruised the doctors, and looked like convincing evidence of their waning power, but the same was said in 1911 and 1948, and recovery of professional power followed each event rapidly. Whether this is comforting to those not in the trade is another question.