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How the Idea of Profession Changed the Writing of Medical History

John C Burnham

Wellcome Institute for the History of Medicine, £32, pp 195 

ISBN 0854840672

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So, what is a profession? The modern French word is general, referring to the civil status of having an occupation, such as being an artisan or even unemployed. The German Beruf carries the idea of the Latin "vocation"a calling to which one responds by professing. After finding no word in his language, a Japanese researcher declared that the term was parochial, only making sense in European history since late medieval times. Different then in time and place, the concept of the profession has evolved, and Burnham's intriguing thesis is that it can be understood only through a historical, if not a historiographical, approach.

And fascinating it is, to study the writing of medical history with this question in mind. We can trace no less than the rise and fall of the medical profession.

From the 17th century onwards, medical historiography can be followed as it defines, redefines, and revises the idea of professionthe one influencing the other. Physicians have always had a habit of writing the history of medicine in an attempt to understand what medicine is. To begin with, "Great Doctors" dominated, as "Great Ideas" do so now. The first key concept of the profession is the idea of a body of knowledgespecial learning that represents the joint stock, the defining and proved possession of the professional. The discoveries of scientific medicine contributed to this, redefining the professional as one who had particular expertise as well as knowledge. Gradually, the sense of belonging to a group created a collective noun: the profession was a social entity. Group standards reinforced exclusivity, disqualifying outsidersthus institutions grew, and ethical and behavioural considerations developed.

In 1804 the professional was "distinguished for liberal knowledge, and honourable from the rank assigned in society." By 1912, "professional" included an inquiring mind, hard work, tolerance of adversity, and not charging the poor. Learned, practical, disciplined, altruisticperhaps the Flexnerian definition of the professional holds good for many today.

But by the 1960s a wave of anti-establishment anger hit the professions, and expertise itselfthe original basis for professional authoritycame under attack from books such as The Tyranny of the Experts: How Professionals Are Closing the Open Society: "The failure of the professions has become increasingly apparent ... the professions justify themselves as organised efforts to assure that society's vital needs are met ... [they] are unmet, and the organised professions seem perversely or arrogantly opposed to change." Thus, Freidson asked the question Are Professions Necessary? (1984) and asserted that "societal trends, both technological and ideological, are rendering the concept of profession obsolete."

Undoubtedly, professions evolve according to changing economic and social circumstances. Whether the professions have suffered (or should suffer) irretrievable decline is arguable, but definitely topical. What seems certain, however, is that the concept of professionalism continues to intrigue, remaining historical and local, ambiguous and even contradictorylike the writing of history itself.

Footnotes

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Richard Westcott, general practitioner. 

South Molton, Devon