Reactivity and Reactions to Regulartory Transparency in Medicine, Psychotherapy and Counselling (original) (raw)
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Reactivity and reactions to regulatory transparency in medicine, psychotherapy and counselling
Social Science & Medicine, 2012
We explore how doctors, psychotherapists and counsellors in the UK react to regulatory transparency, drawing on qualitative research involving 51 semi-structured interviews conducted during 2008-10. We use the concept of ‘reactivity mechanisms’ (Espeland and Sauder, 2007) to explain how regulatory transparency disrupts practices through simplifying and decontextualizing them, altering practitioners' reflexivity, leading to defensive forms of practice. We make an empirical contribution by exploring the impact of transparency on doctors compared with psychotherapists and counsellors, who represent an extreme case due to their uniquely complex practice, which is particularly affected by this form of regulation. We make a contribution to knowledge by developing a model of reactivity mechanisms, which explains how clinical professionals make sense of media and professional narratives about regulation in ways that produce emotional reactions and, in turn, defensive reactivity to transparency.
Medical regulation, spectacular transparency and the blame business
"The purpose of this paper is to explore general practitioners' (GPs') and psychiatrists' views and experiences of transparent forms of medical regulation in practice, as well as those of medical regulators and those representing patients and professionals. The research included interviews with GPs, psychiatrists and others involved in medical regulation, representing patients and professionals. A qualitative narrative analysis of the interviews was then conducted. Narratives suggest rising levels of complaints, legalisation and blame within the National Health Service (NHS). Three key themes emerge. First, doctors feel "guilty until proven innocent" within increasingly legalised regulatory systems and are consequently practising more defensively. Second, regulation is described as providing "spectacular transparency", driven by political responses to high profile scandals rather than its effects in practice, which can be seen as a social defence. Finally, it is suggested that a "blame business" is driving this form of transparency, in which self-interested regulators, the media, lawyers, and even some patient organisations are fuelling transparency in a wider culture of blame. A relatively small number of people were interviewed, so further research testing the findings would be useful. Transparency has some perverse effects on doctors' practice. SOCIAL IMPLICATIONS: Rising levels of blame has perverse consequences for patient care, as doctors are practicing more defensively as a result, as well as significant financial implications for NHS funding. Transparent forms of regulation are assumed to be beneficial and yet little research has examined its effects in practice. In this paper we highlight a number of perverse effects of transparency in practice."
Statutory Regulation and the Future of Professional Practice in Psychotherapy & Counselling
2009
This report is based on a research project funded by the GMC/ESRC Public Services Programme entitled „The Visible and Invisible Performance Effects of Transparency in Professional regulation‟. The research compared the effects of regulation for doctors with developing regulation for psychotherapists and counsellors (as outlined in the 2007 White Paper „Trust, Assurance and Safety: The regulation of health professionals‟).
Psychodynamic Practice, 2019
Whatever can be catalogued is an occasion for despair'. Gabriel Marcel (1964). Ever since the Enlightenment, knowledge has been linked to the metaphor of light. The idea that 'to see is to know' so firmly grounds our current way of being in and understanding the world it is hard to imagine otherwise. But our insistence on open government, freedom of information and the public's right to know privileges not only the visibility of information but also the visibility of the self. In this paper, I consider how we might think about and respond to the ever-increasing demand for transparency in the consulting room. I draw on the ideas of Derrida, Laplanche and Glissant to argue for what has been called 'the right to opacity', suggesting that psychoanalytic practitioners are particularly well placed to offer a critical perspective on today's culture of surveillance.
Enacting open disclosure in the UK National Health Service: A qualitative exploration
Journal of Evaluation in Clinical Practice, 2017
Background Open and honest discussion between healthcare providers and patients and families affected by error is considered to be a central feature of high quality and safer patient care, evidenced by the implementation of open disclosure policies and guidance internationally. This paper discusses the perceived enablers that UK doctors and nurses report as facilitating the enactment of open disclosure. Methods Semistructured interviews with 13 doctors and 22 nurses from a range of levels and specialities from 5 national health service hospitals and primary care trusts in the UK were conducted and analysed using a framework approach. Results Five themes were identified which appear to capture the factors that are critical in supporting open disclosure: open disclosure as a moral and professional duty, positive past experiences, perceptions of reduced litigation, role models and guidance, and clarity. Conclusion Greater openness in relation to adverse events requires health professionals to recognise candour as a professional and moral duty, exemplified in the behaviour of senior clinicians and that seems more likely to occur in a nonpunitive, learning environment. Recognising incident disclosure as part of ongoing respectful and open communication with patients throughout their care is critical.
The Australian Psychological Society Code of Ethics explicitly states that clients are to be informed about the legal limits of confidentiality prior to engaging in any psychological relationship. Maintaining and respecting client confidentiality is also seen as a major professional obligation. Despite this, little research has examined how limits of confidentiality is introduced, discussed, and oriented to in real-life psychological consultations. An initial consultation between a client and a provisionally registered psychologist was used to explore how a psychologist and client interactively managed limits of confidentiality. Using a discursive psychological framework, analysis revealed that while the psychologist complied with the ethical obligation of informing the client of the limits of confidentially before counselling began, the way in which the psychologist enacted this restricted the client’s opportunities to ask questions or seek clarification about these limits. Further, when the psychologist explicitly asked for client confirmation of understanding and acceptance of these limits, what the client confirmed and accepted appears unclear. Given that breaches of confidentiality are Registration Board matters, this lack of clarity and limiting of client interaction is concerning.