Knight, L; Alexander, K; Griffin, A; O'Keeffe, C; Tweedie, J; Silkens, M; (2020) Trust, professionalism and regulation: a critical comparison of Medicine and Law. UCL Medical School: London, UK.

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Abstract

Background & Aims: Trust, professionalism and regulation are complex social phenomena, which are contextually dependent and dynamic. This project aims to explore the concept of ‘trust’ in Law and Medicine - questioning what it means to be a ‘trustworthy’ professional and how these understandings relate to ideas of professionalism and regulation. Methods: This study draws on a comprehensive review of the literature and interviews with thirty participants from within, or related to, the UK legal and medical professions. Participants included practitioners, those creating and implementing policy, and public representatives. Data was analysed using the ‘logics approach’ from Political Discourse Theory (PDT). This helped us draw out taken-for-granted ideas and beliefs about trust, professionalism and regulation and expose these to critique. Results: Participants highly valued patient/client trust, seeing it as fundamental to the functioning of their professional ‘service’. Trust was seen as attributed primarily to the individual practitioner and maintained through demonstrating measurable ‘professionalism’. Practitioners were understood to be individually responsible for preserving their image as a ‘good professional’, via evidencing their ‘professionalism’ to the patient/client and the regulator. Discussion: Current ways-of-thinking about trust permitted trust in individuals to be maintained, even when trust in the professions as a whole was challenged. However, for medical professionals particularly, this was predicated on a need to ‘evidence’ that one was a ‘good professional’ through intensive and continual regulation. This created an increased dependency on a ‘trust-industry’ of regulatory bodies and systems. This project critically questions how regulation shapes and impacts trust in the professions. It is a problem-driven approach, which seeks to break with current patterns of thinking and question: ‘what might be possible instead?’ This opens up an ideological space and new viewpoints, whereby audiences are encouraged to consider future change.

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