by George Beaton, MBBCh MBA PhD
Associate Professor in the University of Melbourne and Executive Chairman of Beaton and WellmarkPerspexa.
Article obtained from: http://www.professions.com.au/Files/Professionalism_Beaton.pdf
Professionalism is as, perhaps even more, relevant today as it was when the concept first emerged centuries ago. Defined as a combination of knowledge, skills, trustworthiness and altruism found in those who commit themselves to a life of service to others, professionalism now covers many more disciplines than the original professions of law, medicine and divinity. The professions have steadily proliferated as knowledge has expanded, requiring ever-more specialised education and spawning neo-professions. Specialised knowledge gives professionals power over their clients. Balancing the use of this power for individual and public good, while meeting their own needs, obliges professionals to behave ethically. It also attracts government regulation and provides much of the raison d’être for professional associations. The internet, diminution of self-employment and erosion of public trust are combining to threaten many of the benefits of professionalism. True understanding of professionalism suggests that it remains indispensable to humanity and will continue to evolve its role in society.
In 1853, a meeting of one of the most influential professional associations in the world toasted the three classical professions: divinity, law and medicine. Attendees at this American Medical Association convention noted with self-congratulation that the three professions were profoundly interrelated: “Three graces, all of which combined, support each other” (Imber, 2008, p. 13).
Is there something about the professions that binds different disciplines together? If so, what is this underlying essence of professionalism? And is it still relevant in today’s world?
This essay maintains that there is an important essence underlying all the professions that must remain relevant if humanity is to continue to derive benefit from professional services. The concept of “professionalism” includes skills, knowledge and expertise, but also the virtues of trustworthiness and altruism. Josef Mengele of Auschwitz, with his infamous human experiments, was a learned doctor and scientist—but no one would call him a professional. Professionalism as set forth in the early Dialogues of Plato holds that the true professional not only possesses the practical skills and knowledge of his or her trade (tekhne in Greek) but is also disciplined in moral excellence (arête) (Reid, 1998).
This essay examines the notion of professionalism itself against the background of history and modern definitions. Further, the essay explores how professional associations and professional services contribute to professionalism, and assesses the impact of culture, economics, technology and government. Finally, the essay poses the question as to whether professionalism will survive the process of globalisation as knowledge “goes viral,” and offers suggestions why it should.
The Meaning of Professionalism
The classic “learned” professions were divinity, law and medicine—the trinity of the professions. This was recognised by British demographer Alexander M. Carr-Saunders in his definitive work The Professions, wherein he cited Joseph Addison, writing in 1711, as a source. Carr-Saunders, though, argued that the original professions were five: divinity, armed service, medicine, law and education (Carr-Saunders & Wilson, 1933). However, it may be said that the five professions Carr-Saunders depicted were outgrowths of the big three or the original trinity: the military/police were an outgrowth of law because of the need for enforcement, and education evolved from the profession of divinity— for, in medieval times, the clergy were the most learned of the various social ranks, and education became their special purview. For example, as early as the 1500s a schoolmaster needed to be licensed by the church in order to teach grammar (Cheetham & Chivers, 2005, p. 17). Indeed, the dissemination of academic learning had been dominated by monks and priests for centuries prior to this, and most of the universities of Christendom had as their founding raison d’être the necessity to educate the clergy. Accordingly, appointees to academic positions in most medieval universities were men in holy orders. Cheetham and Chivers (2005) maintain that prior to the mid-eighteenth century, the classic professions were considered to be law, medicine, divinity, architecture, commissioned service in the armed forces and teaching.
Historically, the professions were characterised by training and testing of applicants by those already in the profession, usually after a period of apprenticeship. In this they did not differ much from the craft guilds, which are examples of human beings’ seemingly intrinsic desire to organise themselves into bodies of belonging in order to exert power over the tools of a trade, including its specialised knowledge, and to project strength through numbers into society.
This appears to be universal, as there were guildlike organisations not only in England and Europe but in India and the Middle East as well, and today’s professional associations share some characteristics with these bodies from medieval times.
The word “guild” derives from an Old English word meaning “payment” or “tribute”—pliers of the craft or trade paid dues to the organisation for the privilege of belonging to it. Guilds used these dues to promote trade, to increase industrial power, to safeguard the body of knowledge and skills possessed by members, and to control markets. They also used the dues as a kind of insurance and pooled resource of mutual aid for members who were disabled and could not work. Dues, moreover, enabled guilds to serve as burial societies and, therein, both to pay for masses for the souls of deceased members and to provide for the widows and children of the deceased.
Every kind of business, from the butcher to the baker to the candlestick maker, had its own guild. Guilds guaranteed that their members knew their trades well enough to produce quality goods and services by overseeing training—thus, they served society. Mostly, however, they served the guild members by guaranteeing a certain amount of autonomy within the job role and discouraging competition from others plying the same trade outside of the guild.
In that guilds helped control prices, regulated hours worked and protected the financial interests of members when losses were incurred, they resembled today’s trade unions. They exerted great influence in society. By the latter half of the eleventh century, guilds were so powerful as to be present in every village and often congruent with municipal authority. In fact, mayors, aldermen and burghers of towns and villages emerged from guild tiers of leadership (Burton & Marique, 1910). Craft and trade guilds bore some of the earmarks of professionalism. Guilds took responsibility for the punishment or banning of members who were dishonest in their dealings. They also oversaw training and certifying of apprentices. When a boy was finished with his apprenticeship, he became an employee of his master teacher and, in time, was called upon to produce a “masterpiece” to demonstrate his skill in his craft. Then he could become a master himself and set up his own shop, being granted autonomy by the guild.
Conferring mastery or status within society, being organised into a body by occupation, requiring prolonged and specialised training and education, offering autonomy within job roles, having collective influence within society and being self-regulatory— all characteristics of the guilds—are some of the hallmarks of professionalism. These early bodies inform aspects of the behaviour of today’s professional associations (or “bodies,” as they are known in parts of the world).
What, then, if anything, distinguishes a profession from, say, a trade or craft? Or are they one and the same? Is a profession simply a body of specialised knowledge, which associations and institutions satisfactorily impart to aspirants and then give them a certificate or degree to prove that they have it? Being an electrician, which now takes several years of specialised training in modern-day apprenticeship programs and requires certification by recognised regulatory bodies, might be a profession by that definition. Is it? If not, what distinguishing features constitute professionalism? Is it indefinable? Is Andrew Abbott (1988, p. 318) right in saying that “a firm definition of profession is both unnecessary and dangerous,” and is his loose definition “professions are somewhat exclusive groups of individuals applying somewhat abstract knowledge to particular cases” really enough, as he claims it is?
Drawing upon Carr-Saunders and the works of others who have studied the topic, Cheetham and Chivers (2005, p. 20) compiled a list of a profession’s characteristics, while admitting that the list was neither exhaustive nor definitive of all professions. However, it is useful. A profession, they say:
- confers status within society
- organises itself into some sort of professional body
- is learned—i.e., requires prolonged and specialised training and education
- is altruistic (orientated towards service rather than profit)
- offers autonomy within the job role
- is informed by an ethical code of some kind
- is non-commercial
- has collective influence within society
- is self-regulatory
- is collegial
- is client-focused.
By these criteria, craft and trade guilds and their modern-day counterparts do not fit into the professional mode, for they were and are commercial and profit-motivated. Unlike a profession, they are not by definition altruistic or ethical. Trade unions protect the interests of their members; professional associations protect the interests of their members but have an even stronger mandate, in effect a duty, to protect the interests of those they serve and of society itself.
Note the emphasis on ethics in the definition of a profession adopted at the Annual General Meeting, 26 May 1997, of Professions Australia:
A profession is a disciplined group of individuals who adhere to ethical standards and hold themselves out as, and are accepted by the public as possessing special knowledge and skills in a widely recognised body of learning derived from research, education and training at a high level, and who are prepared to apply this knowledge and exercise these skills in the interest of others.
It is inherent in the definition of a profession that a code of ethics governs the activities of each profession. Such codes require behaviour and practice beyond the personal moral obligations of an individual. They define and demand high standards of behaviour in respect to the services provided to the public and in dealing with professional colleagues. Further, these codes are enforced by the profession and are acknowledged and accepted by the community (Professions Australia, 1997).
In Professionalism, the Third Logic, Eliot Freidson defines professionalism as follows: “Professionalism may be said to exist when an organized occupation gains the power to determine who is qualified to perform a defined set of tasks, to prevent all others from performing that work, and to control the criteria by which to evaluate performance” (Freidson, 2001, p. 12). This definition is broad enough to include the trades protected by guilds in the Middle Ages. However, Freidson goes on to say that ethics is the very soul of professionalism.
Professionalism is not only a skills set in a given occupation; it is an ineffable something that the person exudes in manner, dress, speech and standards of practice that is palpably powerful: standards like honesty, due diligence, perseverance, willingness to listen and learn, creative thinking within a framework of training, and other qualities most people would be hard put to describe but which they expect in the professionals with whom they engage. Another word for these standards is “virtues” and the hard-todescribe something exuded is “trustworthiness”: the sum total of these virtues.
The doctor is trusted to have a patient’s best interests in mind—an expectation prevails that he or she will do no harm and is sufficiently expert at least to do some good. The degree displayed on the wall certifies this, but so do the intangibles gleaned, depending on the community’s culture, from the white coat, the clean fingernails, and the manner and the choice of words. Through these, the professional conveys intangible standards that win our trust that he or she is there to serve interests larger than him- or herself.
Wrapped up in our expectations of the professional— whether doctor, lawyer, pastor or other—is that he or she has our best interests at heart. Our medical records, our confessions of wrongdoing, the compromising and even incriminating information that may harm our wellbeing or degrade our reputation—these are safeguarded by a professional ethic of client/professional confidentiality. We can reveal ourselves in our deepest vulnerabilities—our diseases, our nakedness, our business secrets, our spiritual dysfunction—and be treated in such a way as to promote our welfare.
It is also expected that the professional will hold in trust the best interest of society. If the lawyer knows that a client is likely to kill someone, he or she is released from solicitor–client privilege in the interest of protecting society. Dentists are expected to release our records if these will aid in identifying our bodies. People understand (although they might not comply) when the pastor enjoins them to report their childhood molester to the police. It is generally accepted that a contagious dangerous disease may result in the doctor placing the patient in quarantine, or at least reporting the infection to health authorities in the interest of society.
There are personal and public expectations of the professional based on the notion that a professional is motivated by something other than raw gain. This is even an expectation of business professionals, whose explicit raison d’être is to make a profit. When a company promotes its paper as being made from recycled material or declares that no animal testing was done on its products, the public is reassured. The public is also reassured when a corporation’s CEO contributes to charity; it is, however, less reassured when he or she flaunts wealth in ways reminiscent of a Roman bacchanalian banquet. Professionals, because they are professionals, are expected to have some sense of the larger picture of life—some sense of responsibility to the whole of society and humanity.
Professionals express their altruism through serving in networks of responsibility within their profession, often on a volunteer basis. A certain degree of altruism is expected in the true professional, a certain amount of selfless service.
I have my grandfather’s Bible from the time he went to what is now Malawi in central Africa in the 1890s to serve as a medical doctor in the Free Church of Scotland mission. Travelling south because he had contracted malaria, he found himself in the middle of the Anglo-Boer war. He settled in the Afrikaner republic of the Orange Free State, where he set up practice on the banks of the water supply dam of the town of Potchefstroom. There he worked out of a tent for the rest of his life, doctoring the local community. He would not accept fees, and the local people provided for him and his family. My grandmother was ultimately supported by the medical association provident fund because my grandfather earned no money his entire life. That was a true vocation—an example of extreme altruism.
However, wishing to profit from one’s labour and still serve one’s clients optimally is not necessarily incompatible. Marc T. Law and Sukkoo Kim note that during the Progressive Era in the United States of America, when advances in knowledge and specialisation led to the adoption of occupational licensing, members of a particular profession approached the state governor to lobby for legislation that would license their profession. As each occupation was becoming more complex and specialised, it was becoming ever harder to guarantee quality of professional service. In their petitions, the professionals urged that incompetents and charlatans be eliminated by licensure so that the people would be better served and protected from unsafe practices. When questioned whether the professionals were truly concerned with advancing the people’s health and safety or whether they were more interested in monopolising their field and eliminating competition that would keep prices low, the professionals’ spokesman admitted honestly “a little of each” (Law & Kim, 2005).
There is nothing inherently wrong with professionals’ wanting “a little of each” of both altruism and profit. Professionalism only loses its calling when profit trumps altruism. However, a case can be made that altruism and service tend to generate profit, prosperity and plenty. The two are far from incompatible. This argument is not developed further here and will be the subject of a later paper.
The need for altruism and ethics to direct professional skills is so pressing because of the differential in knowledge that exists between the professional practitioner and the client. Knowledge, as everyone knows, is power. Asymmetrical knowledge between the professional and the client is what gives the professional his or her power over the client—and hence his or her ethical responsibility.
As the half-life of specialised knowledge becomes shorter and shorter as a result of the exponential growth of information in our age, the need for ethics grows stronger. Thus, newly minted professionals like graduating MBAs at Harvard Business School find it incumbent upon themselves to take an oath similar to medicine’s Hippocratic Oath to use their power wisely, kindly and well (Morris, 2009). The need for ethics to direct the use of knowledge will only increase as specialised knowledge, and thus the number of professions, proliferates.
The Proliferation of Professionalism
Society is becoming increasingly professionalised. Since the time of the Industrial Revolution, the professions have been proliferating, and they continue to do so. As Harold Perkin observed in The Rise of Professional Society, “The twentieth is not … the century of the common man but of the uncommon and increasingly professional expert” (Perkin, 1989, p. 2). The twenty-first century promises to be even more so. In the 2009 Reith lectures, Michael Sandel eloquently showed how experts (for which read professionals) are critical to the functioning of democratic society, thus adding weight to the case for proliferation (Sandel, 2009).
As knowledge, information and technology explode exponentially, more and more jobs in society require specialised knowledge and training—hallmarks of a profession. That means, as Perkin claims, that expanding professionalisation is permeating all levels of society in a way in which the more traditional professions did not. What is more, as people gain in specialised knowledge and expertise, they are in positions to demand the greater status, improved work conditions, higher salary and other rewards of professionalism. In other words, professionalism is being democratised.
In contrast to pre-industrial and industrial societies, a professional society is based, according to Perkin, on “human capital created by education and enhanced by strategies of closure, that is, the exclusion of the unqualified” (Perkin, p. 2). Modern professions, on this view, are characterised by the specialised knowledge that they impart to their practitioners—it is their education that distinguishes such individuals from other workers. The key structural difference between the present and the pre-industrial and industrial past is that specialised knowledge is now far more accessible than it used to be. As professionalism proliferates and democratises, the cultivation of specialised knowledge is increasingly pursued by many occupations not previously thought of as professions.
We noted in the previous section that the classic “learned” professions of the Middle Ages were divinity, law and medicine—pursuits whose mastery required diligence in specialised fields of study. Cheetham and Chivers (2005), however, note that a medieval aspirant to a profession would need to possess the wherewithal—the social and economic means—to find a patron and sustain long periods of time working, without pay, under the direction of that patron. To be a professional, then, meant not only that one had to be learned, but also that one had to belong to the higher social and economic ranks. Therefore, to be a professional originally meant to come out of and continue to be part of the elite.
This is no longer the case. Information is more widely accessible today than it has ever been in the past. Professionalism’s interface with society, including the impact of the internet on information distribution, is discussed in the following sections. Suffice it to say for now that the accessibility of information means that professionalism is proliferating in part because access to knowledge is growing.
Another factor adding to the proliferation of professions is growth in the depth and breadth of the store of knowledge, with the result that professional roles are becoming ever more specialised. Associates’ degrees in science are being offered to secretaries and medical records keepers—and indeed, such tasks are becoming so complex as to need specialised training. Nursing associations are now seeking to move advanced practice nurses out of the master’s and into the doctorate category. Nurses with doctorates are only one example of the increasing professionalisation of a field some still do not consider a profession. At the same time, nurses now perform many medical functions that were previously performed by doctors, as they go on to more and more complex and specialised tasks. If the doctor, performing the same functions as a current nurse, was considered a professional at the time he (and it is still usually a he) performed them, why is the nurse not considered a professional as she (it is still usually a she) performs them now? As knowledge advances and those on the upper tiers of knowledge ascend into increased specialisation, those on the lower tiers ascend into professionalism.
The websites of Professions Australia (http://www. professions.com.au), the Managing Partners Forum (http://www.mpfglobal.com) and Beaton (http:// www.beatonglobal.com) provide contemporary and as yet incomplete compilations of professions that go far beyond the traditional professions of law and medicine. Practitioners in the traditional professions might argue that some of those cited are not professions. Nevertheless, the ethos of the listed pursuits and vocations is as professional and profound as most of the more traditional professions, and the amount of specialised knowledge and training required is often comparable. Why, then, would they not be considered professions?
For example, the professional field of (small m) medicine now includes at least dentistry, pharmacy, nursing, physiotherapy and veterinary surgery. Then there are the design professions such as engineering and architecture, and the financeorientated and business-orientated professions of actuaries, accountants and management consultants. Other professionals include scientists, journalists, surveyors, diplomats and civil servants. More recent contenders for the status are company directors.
Also in the mix are company secretaries, bankers and business administrators. Where does it stop? There are other emerging areas too, such as information and communications technology services, that bear the hallmarks of professions. Can any of these reasonably be excluded from professionalism?
The professional services firm I co-founded has come under pressure from the classic professions, particularly lawyers, to stop putting up IT services providers for Client Choice Awards in the businessrelated professions. Some lawyers tell us that IT services providers have little to do with the professions. Indeed? Their increasingly specialised knowledge and expertise and their now indispensable role in disseminating, globalising and democratising knowledge make them highly significant, and I welcome their increasing acceptance into the ranks of professionals. At the very least, IT services must be considered a neo-profession.
Another neo-profession is business management. In fact, there are more graduates from Harvard University in business administration than there are in law or medicine (Morris, 2009). Will not all those people become professionals in the course of their careers?
As the professional fields expand and professionalism is no longer the property of elites, is this not a good thing—democratising and making egalitarian entire societies by providing the stature and rewards of professionalism to growing numbers of people in increasingly diversified and specialised pursuits?
At the same time, it is appropriate to ask: how far will professionalisation go? The term “professional athletes” is used—should anyone who gets paid for work be considered a professional? Likewise professional actors and singers, who even have their own unions and guilds. Can acting and singing credibly be described as “professions”? Are their practitioners professionals?
Certain hallmarks of a profession were mentioned in the previous section, but perhaps the characteristic of a profession that stands out the most is asymmetry of its specialised knowledge. Indeed, this was Carr-Saunders’ summation of professionalism: “A professional brings asymmetrical knowledge to the service of his client, and thereby exercises power over his client. Therein lie the duties and obligations of a professional to his client” (Carr-Saunders & Wilson, 1933, p. 499).
Actors, singers and athletes ascend to prominence more through specific talents than knowledge. If specialised knowledge is used as one of the main hallmarks of a professional, then it is clear that certain occupations are not professions, for all that there are now many more professions than used to be the case.
The professional, by definition, has knowledge that others do not have—asymmetrical knowledge. How knowledge is attained, maintained, passed down and certified is an important part of professionalism. How it is put into practice is even more important—in other words, how professionals use their knowledge has a great deal to do with real professionalism and its proliferation.
Eliot Freidson wrote, “If there is a single concept by which the nature of formal knowledge can be characterized, the most appropriate is likely to be rationalization … the pervasive use of reason, sustained where possible by measurement, to gain the end of functional efficiency” (Freidson, 1986, p. 3). Knowledge is arrived at by reason, yet, as author Paul Starr concluded, “The dream of reason did not take power into account” (Starr, 1984, p. 3). The difference between professional and client lies not only in asymmetry in knowledge; it lies also in asymmetry in power.
What epitomises professional people is the way in which they bring knowledge to service and to the exercise of power. Professionals incur duties and obligations as a result of the power bestowed on them by their knowledge and by their membership of the institutions that equip them with their specialised learning. It is how professionals balance their power with their knowledge for the public good that, in the long run, builds and characterises professionalism. This, more than the field itself, defines whether professionalism is present or absent.
Indeed, because of the growth of knowledge and the power that knowledge brings, it is necessary to extend the professions and to hold more and more groups of people with specialised knowledge to professional standards—that is, to proliferate both professions and professionalism. This necessity springs from a very good and simply stated reason, namely, to ensure that the power knowledge brings is used for good rather than evil.
I was originally in the profession of medicine, a profession that has been on a pedestal for a very long time. The white coat of the doctor commands our respect, and yet there are still many doctors who don’t respect patients’ time. How many have waited for lengthy periods of time in a doctor’s waiting room? Are doctors just inefficient, or sufficiently arrogant to consider their time to be more important than their patients’? Perhaps they routinely have critically ill people they are looking after: is this the explanation for their apparently cavalier administration of time? Most likely it’s the arrogance of power that determines the attitude that too many in the profession still display in this and other ways.
Professionalism is about the delivery of specialised knowledge in a way that balances the attendant power. That is why trust is the essence of professionalism and its most necessary component—that around which all the other hallmarks of professionalism revolve. The power that asymmetric knowledge gives one person over another must oblige the practitioner to act in the client’s best interests.
An interesting illustration of this is found in the movie The Doctor. William Hurt’s character is a surgeon, flushed with arrogance about his professionalism. He considers it the better part of professionalism to “cut” not “care” and to maintain impartiality towards one’s patients to a degree that borders on mockery. He and his fellow surgeons turn music up high once their patients are under anaesthetic; they dance in the operating theatre, making jokes about their unconscious patients during surgery. Only one of the other surgeons does not join in the play.
When William Hurt’s character discovers he has throat cancer, he abruptly assumes the role of a patient and experiences the arrogance of the surgeons from the other perspective. Like most surgical patients, he is frightened; he confronts his own mortality. He wants the best care he can possibly get, and yet he knows that his surgery has been scheduled for a time of the day when the surgeon will probably not be at her best—she will be at the end of a long list, and he knows, in spite of her protests, that she will not do as expert a job as she might have done earlier in the day. What is more, she is utterly uncaring. She is as icily “professional” with Hurt as he has been with his own patients. Ironically, he discovers, the person he would most trust to operate on his throat is the doctor who never joked around in the theatre suite—the serious one who showed respect for the patients he served. Hurt’s character concedes that this surgeon is the one he most trusts—whom he considers most professional.
As professionalism proliferates, there will be many people who have knowledge of a particular specialty that is asymmetrical to that of others, and how they treat those others will become more and more important as the power of asymmetrical knowledge passes into multiple hands.
Because knowledge is power, true professionals adhere to ethics when dealing with clients in order to harness that power for the good. The medical profession has its Hippocratic Oath and, as we have noted, Harvard MBAs are now taking oaths to ply their trades with honesty and integrity. Perhaps, as the professions proliferate, every group holding specialised knowledge will require an oath or code of ethics that obliges benevolent use of the power that knowledge bestows upon the practitioner.
Professional societies and associations play their role in the proliferation of professionalism. Most such associations exist to promote the professionalisation and prestige of certain occupations by providing and/ or regulating training and some form of certification. These associations are non-profit and are sustained by a combination of the volunteer efforts of members, subscriptions and fees for services. At the same time, professional associations have a strong interest in ensuring that the practice of relevant professions is undertaken by properly trained practitioners so as to enhance the professions’ prestige. The effect, in any given case, is to exclude those not sanctioned by an association or by government institutions with which it collaborates. Thus, professional associations both expand and constrict the professions. They also attempt to improve the services offered by professionals through provision of information at conferences, and via newsletters, journals and other publications containing updates in a particular field or pending legislation that may affect practitioners. In some parts of the world, professional associations still set the standards for, and administer the licensing of, their members, and it may fall to such associations to revoke privileges when ethics or standards are breached. Associations, then, wield a significant set of functions as they attempt to preserve the integrity of their professions—and it is on the effective undertaking of such functions that the acceptance, survival and expansion of the professions will in part depend (for all that the trend is for governments to make concerted efforts to remove the self-regulatory role from the professions).
For a profession to be accepted as such, it must generate trust. Practitioners must reassure the public that standards have been met, that proper training has been given, that sufficient knowledge and skills have been attained, and that practitioners will wield their power in a fair and benevolent way. By these standards and by Carr-Saunders’ summation of professionalism, more and more occupations will be considered professions as time goes by.
With this in mind, I would like to conclude the present section by drawing attention to an everyday scenario. Is it not the case that a certain degree of professionalism is expected from the worker who comes to fix our home electrical system? It is anticipated that this tradesperson will treat the customer and their property with courtesy and respect, will accurately diagnose the problem, will take responsibility for the fact that he or she is dealing with a potentially dangerous, even fatal, situation and will feel an obligation to use his or her expertise to protect us from the effects of the problem. The customer will feel reassured if they know that the repairperson is part of a recognised trade association and bears formal certification. The person has knowledge asymmetrical to the public’s when it comes to electrical systems, and the public places trust in him or her, giving him or her power over us.
Is such a tradesperson a professional? By some parameters of professionalism, yes. Does the modern tradesperson have more specialised knowledge than, say, the medical doctor during the nineteenth century who “bled” patients on a theory of “humours” of the body—a theory that had not changed since the Middle Ages? Has the tradesperson less practical knowledge than doctors of that era? Lacking any understanding of bacteria, doctors in those times sutured wounds using silk whetted with their tongues to thread the needle, not infrequently killing the patients—as a result of the ensuing infection—whom they sought to save. Medicine was such a hit-or-miss occupation that those with dysentery were treated with an array of substances ranging from laxatives to strychnine. Medicine, nevertheless, has never been considered anything but a profession. But the tradesperson— who also holds responsibility for the lives of the people he or she serves, and is obliged to follow rigorous standards of practice—is not considered a professional. In the twenty-first century it is not improbable that both a qualified and accredited electrician and an IT technician—when compared one with the other—might reasonably be considered neo-professionals.
In a world where knowledge is exploding boundaries every few years rather than every few centuries, where knowledge is increasingly accessible to larger numbers of people, where things are so complex as to require specialised expertise to keep a home running safely, there will be more and more occupations entering the ranks of the professions.
Professionalism’s Interface with Society
In The Sociology of the Professions, Keith Macdonald insists that professions—in order to be professions— have a need for “social closure.” They have a need to keep others out of the profession, sealing themselves into exclusive domains (Macdonald, 1995). Thus, the professions are in, but not of, a society—they exist in self-created, often self-regulated, and self-priced bubbles.
It is in a profession’s interest to safeguard, regulate and husband their specialised knowledge through establishing training schools and obtaining exclusive licensure through the state. “Monopoly and credentialism are the key elements of professionalism’s economic privilege” (Freidson, 2001, p. 198). It is likewise in the public’s interest that those who do not have the prerequisite knowledge in their field are not licensed to practise a profession. Ideally, the professions exist with society in this sort of symbiotic relationship. Social closure, well managed, serves to protect both the profession and the public.
Yet for all their exclusiveness, most professions do not practise a policy of containment. Rather, according to Macdonald, the professions seek to impinge upon other provinces and thus actively promote and expand the influence and upward social mobility of their members: “A profession does not merely mark out its domain in a bargain with the state; it has to fight other occupations for it, and not only at the time but before and after as well” (Macdonald, 1995, p. 33). Thus, professions and their associations must assertively stake out their territory, wresting parts of it from others and jealously guarding the gains made. This would make them less than ideal actors in their interface with society.
Professions are interest groups and, as most interest groups do, they tend to seek their own interests first. They interface with the economic and social orders to pursue profits and prestige for their profession, not for altruism’s sake. Their exclusivity may even serve to reinforce social prejudices. Macdonald says, “The occupation and its organization attempt to close access to the occupation, to its knowledge, to its education, training and credentials and to its markets in services and jobs [and this means that] only ‘eligibles’ will be admitted … it may well exclude those of a particular race, gender or religion and thus play a part in the structured inequality of society” (Macdonald, 1995, p. 29).
At the same time, the professions should not be discounted as totally self-seeking. Freidson comments that the terms “monopoly” and “social closure” are nearly always used pejoratively in relation to the professions. Yet, he says, some professionals are genuinely interested in protecting the integrity of the work done in their profession. Monopoly and social closure achieve this: “Concern with preserving and improving the quality of work by establishing and maintaining social closures based on training cannot be waved away” (Freidson, 2001, p. 201). As was noted in an earlier section, professions and professionals seek to exclude others for “a little of each” of seemingly bipolar reasons: to protect their own interests (both economic and social) and to protect their profession and the public from unqualified and unethical practitioners.
According to Macdonald’s model, professionals seek power through legal monopolies of knowledge-based services and higher status and respectability. The legal monopoly of knowledge is granted by a contract with the state, and the base of a profession’s power, in turn, is its effective monopoly of specialised knowledge. The state grants this monopoly because it needs the services of the profession, and, in so doing, the state achieves some leverage for regulation of the profession. Professionals, accordingly, gain higher status and respectability in a contract with society by establishing and adhering to values and norms.
Yet knowledge, by its nature, progresses, and progress is enabled by the circuitry of the profession’s interface with society. This means that society has the power to act upon the profession, even as the profession acts upon society. As a profession encounters society while plying its services, it is inevitably changed by the experience, and new knowledge is gained. Freidson makes the point that:
Down at the level of everyday human experience, in schools, prisons, scientific laboratories, factories, government agencies, hospitals and the like, formal knowledge is transformed and modified by the activities of those participating in its use. Thus, the paradox that, while the institutionalization of knowledge is a prerequisite for the possibility of its connection to power, institutionalization itself requires the transformation of knowledge by those who employ it (Freidson, 1986 p. xi).
A profession that does not allow itself to be changed by its interface with society is a profession doomed to decline. Yet how does a profession control new and advancing knowledge gained from interfacing with society when its existence is predicated upon corralling knowledge and dispensing it in an exclusive manner? Much of this is done through professional associations.
Professional associations hold conferences and publish papers, keeping members—and, these days, the public—abreast of developments in the relevant profession. These associations not only have a duty to safeguard and protect the specialised knowledge of the field and to certify its attainment; they also have an obligation to keep up with innovations. In recognition of this, Lord Benson cited continuing training and acquisition of new knowledge as one of the major criteria for professionalism (Spada Limited, 2008, p. 38). The professions actively interface with society in order to keep renewing themselves and remain indispensable.
If they are not open to assimilating the new knowledge gained by interface with society, professions may stifle truth and, in so doing, become a detriment to society. A current example might be the furor, in the global-warming debate, over the exclusion from the halls of power of dissenting voices and the journals that publish them. The current outrage stems from the exposing of email correspondence between professional scientists, which included exhortations to exert peer pressure on dissenting colleagues in order to have them conform to one view.
An earlier example—dating from the mid-nineteenth century—is found in the story of Ignaz Semmelweiss, an assistant physician in the maternity wards of the Vienna General Hospital. Semmelweiss observed that women in the first section of the maternity ward contracted and died of puerperal (childbed) fever at much lower rates than women in the second section of the ward. Women in the first section were attended to by nurse-midwives, whereas women in the second (more deadly) section were attended to by medical students, some of whom had just come from dissecting cadavers in the adjacent morgue. Semmelweiss’ suspicions were confirmed when a hospital pathologist died of a fever with puerperal-like symptoms after cutting a finger on an unwashed autopsy instrument. Semmelweiss was sure that “cadaverous particles” were at fault. The medical students were bringing these particles into the maternity ward from their dissections. Semmelweiss reduced deaths and infections in the second section of the maternity ward dramatically when he instructed medical students to wash their hands in a chlorinated solution before handling mothers and their newborns.
Semmelweiss’ germ theory was not well received by the medical establishment. The political, social and economic powers of Vienna of the day united against Semmelweiss, discrediting him and isolating him until he ended his days in the asylum to which he was committed (Carter & Carter, 1994). The protection of the profession’s viewpoint mattered more than ethical treatment of a dissenting messenger and more than the public interest. When this happens, a profession will lose its power, prestige and, ultimately, its profits if its faulty outlook is not corrected.
In 1992, Lord Benson proclaimed that a profession, in order to be considered professional, must operate within certain ethical principles, most of which ultimately pertain to the public interest. In fact, he said that ethical standards in a profession “should be higher than those established by the general law” and “designed for the benefit of the public and not for the private advantage of the members” (Spada Limited, 2008, p. 38). State protection makes it incumbent upon the profession to act in the public interest. Acting in the public interest is a distinguishing hallmark of a profession—perhaps the distinguishing hallmark, as noted in the first section of this essay. Lord Benson again: “Indeed, it is the duty to serve the public interest which distinguishes a profession from a representative body such as a trade union” (Spada Limited, 2008, p. 38).
Not only is it ethically desirable for professions to act in the public interest, but it is necessary for them to do this in order to remain viable. Professions are unlike other goods and services in that they operate on trust. The great majority of the public are forced to trust the professional because they do not have the same amount of knowledge as he or she does in the matter at hand. Patients take it on trust that their doctors know what they are doing—even when some patients inevitably die or do not improve—and they continue to engage doctors at the asked-for fees. Litigants take it on trust that their lawyers did the best in the circumstances, even if they were the losing party. If trust is absent, no one will seek the services of the professional—as exemplified in Semmelweiss’ Vienna, where, in a demonstration of public mistrust, women preferred giving birth on the street to being admitted to the hospital because of the infamously high death rates in the maternity ward.
In Macdonald’s model of professionalism attaining its goal of social closure, trust mediates between the professions and their desired social and economic stature. It is central to the attainment of the professions’ goals (Macdonald, 1995).
An article from Oxford Saïd Business School makes the point that, initially, trust merely needs to be perceived, not proven (Oxford Saïd Business School, 2000). Professional services help an organisation to improve itself in ways that may not manifest for years. Professional services are largely taken upon trust. Different from tangible goods that may be examined and found to function or be flawed, professional services usually promise intangibles like improved morale, performance, security, functionality and efficiency. Some of those services may be measured, but usually only with the passage of time. When the professional services provider is hired, it is on the basis of trust that has been built up by its portfolio of clients and its track record.
When professionals prove themselves unworthy of trust, public approval of the profession goes down, and the prestige and presumably—over time—the profits of the profession go down with it. There is some evidence that public trust of professionals is eroding.
A 2008 US Harris Poll of prestige in the professions found that doctors have declined in prestige by 15 percentage points since 1977. Lawyers have declined in public esteem by 12 percentage points over the same period. Accountants and bankers rank lower than “entertainers” (who, for all the celebrity-obsession that they attract, enjoy little real prestige). What is more, business executives rank slightly lower than union leaders in the United States (Harris Poll, 2008).
When it comes to confidence in the leaders of institutions, the heads of medical, religious and educational institutions impress between 30 and 40% of people as being worthy of a great deal of confidence, but only around 10% of people can be said to have great confidence in legal, political and business leaders, and in leaders of the press (larger percentages of people are “somewhat” confident in these leaders). Only 4% of people have a great deal of confidence in the leaders of Wall Street (Harris Poll, 2009).
Approval of accountants in British society has declined from 61% approval in 1999 to 58% approval in 2004. Lawyers went down from 58% approval in 1999 to 54% approval in 2004 (Spada Limited, 2008).
The professions do well to generate trust, because society’s perception of them bears significantly upon the degree of success that they enjoy. What is more, where trust is high, transaction costs are low. If people trust each other, a handshake can close a deal and there may be little need for lawyers and accountants to spend months on assessment and documentation. Adam Smith noted that there was not only an invisible hand in the market place; there was also an invisible handshake—the handshake of trust. Lack of trust generates the need for independent observers and analysts to be called in to protect one another’s interests—and costs, accordingly, escalate.
Trust is fundamental in society, and the way in which professionals practise their calling leads to greater or lesser trust. Anything that damages trust in the professions—arising from the behaviour either of individuals or of groups—needs to be met with disciplinary proceedings and, where necessary, with suspension or loss of licensure. These are appropriate ways for the professions to preserve public confidence.
This discussion leads naturally to the issue of regulation. Where self-regulation of the professions occurs it may be an anomaly, serving the interests of the profession’s monopoly more than the public interest. Perhaps more of a balance or creative tension between self-regulation and external regulation is needed. Governments, however, may all too often be inclined to regulate and intervene to a degree that may be in the public interest but is detrimental to the profession, which needs sufficient independence to grow and sustain itself. Governments sometimes venture into regulating professions in ignorance of the consequences. Historical experience tells us that too much governmental interference—resulting in the imposition of too many operational restrictions—can hamstring an enterprise. Recall the old joke about the inefficiency of over-controlling governments such as the former USSR and its five-year plans: “What would happen if the Soviets took over the Sahara Desert? At first, nothing. Then, little by little, there would be a shortage of sand.”
Professions enter into economic, social, political and licensing contracts with society; and, in turn, society influences the development of the professions. Society and the professions exist in dynamic, creative tension—which, when well managed, promotes the public good as the first goal, but is not incompatible with the profit motive.
Professionalism is compatible with the profit motive. In fact, a professional economy is a wealthy one. In professional economies, services are replacing manufacturing and agriculture, to the economic benefit of the societies concerned. Professional services have balanced Britain’s trade-of-goods deficit for most of the past decade. The professional sector is the largest employer in the United Kingdom, and it accounts for the largest single share of UK output—8% (Spada Limited, 2008, p. 19). Living standards are higher for all—not just for some—in a professional society, as larger and larger proportions of the workforce enter into professional servicesrelated work. Comparable American and Australian figures bear this out. Professionalism generates new businesses as well.
Professional societies are characterised by social mobility. Increasing professionalism ensures wider access to higher education, particularly as the professions proliferate and technical and vocational schools become accredited on the level of colleges and universities.
The development of professional structures does not occur in a vacuum, but happens in interface with society. Society and the professions interact in a symbiotic relationship that flourishes particularly well when the professions take a leadership role in being ethically devoted to serving the public good over and above their own interests.
Professionalism, Globalisation and the Future
Globalisation tends to be thought of as a current phenomenon, but that is not the case. There were marked periods of globalisation prior to World War I and the Great Depression (Alden, 2009). In fact, globalisation dates back to the fabled “Silk Road” trade routes linking China to Europe in the third to the seventh centuries. Goods were traded along this 10,000-kilometre network of roads crossing Central Asia, but, more importantly, political, social, cultural and religious ideals were transmitted along the route too.
In modern as in ancient times, globalisation has often been carried along by trade. Perhaps no other force besides war contributes as much to the process of globalisation as business. Cultural exchange rides on the back of trade.
The traditional professions are globalising largely by following their clients in the business professions and, perhaps to a lesser extent, by exploiting the offerings of technology. Globalisation has been embraced by all the professions, with some progressing faster than others. The faster movers are those led by business— the locomotive of globalisation. See, for example, the speed and scale of change in the legal profession at http://www.beatonglobal.com/thebigpicture/.
Of the business professions, accounting and advertising are well advanced, while the legal profession has for jurisdictional reasons experienced less globalisation. In contrast, the medical profession—although universally needed—still tends to act locally. Primary healthcare is not attached to international business and thus its globalisation is taking place more slowly; however, some diagnostic services, such as radiology, are now being delivered remotely through the internet.
The professions deal with universal human needs that are understood the world over: health, independent advice, justice, education, ethical conduct, data integrity. The professions lend themselves automatically to globalisation through this attribute of universality.
Because of the universal nature of their work, the power that their knowledge gives them and the trust that society reposes in their conduct, professionals have the special obligation to share their knowledge and expertise appropriately—that is, ethically—with the world and to its benefit. Indeed, several sources see a lack of ethics as the potential death knell of the professions—particularly in the global information age.
In its study of professionalism, Spada recognises several threats to the future of professionalism. These threats include consumerism, the desire for instant gratification, lessening client loyalty, declining deference to and respect for authority, increasing media scrutiny and growing regulation. Yet Spada considers ethics to be of the first importance to the future of the professions: “A real or perceived lack of ethical standards should be considered the most serious of threats,” for “even more than the highquality provision of services, professional ethics are paramount to maintaining the public trust” (Spada Limited, 2008, p. 7). Michael Robinson, a doyen of the Australian legal profession, put this pithily: “Every one has the right to a competent solicitor, but no one can be guaranteed an honest one” (personal communication).
The professions are built on trust. The doctor or the lawyer is trusted to do the best he or she possibly can for a good outcome, even if some patients are not cured and if some cases are lost. Trust remains because of a basic faith in the disinterestedness and selflessness that is instinctively sensed as the essence of professionalism.
Trust is especially important in an increasingly transparent world, where a damaging reputation can be flashed across the globe via the internet in a few minutes. Erosion of trust due to unethical conduct by professionals can go viral in the wink of an eye.
Even when it comes to everyday decisions, people are influenced by ethical considerations. A survey has found that 80% of people said they made a decision to buy from a corporation or firm based upon what they perceive about its ethics. Similarly, 74% of people said they only buy shares in a company known to be ethical (Josephson Institute Report, 2004). Although there is a great deal of trust vested in the professions simply because they are professions, it will reflect poorly on them, and on their prospects, if their practitioners prove themselves unworthy of the societal trust that sustains them.
The internet is transforming the way in which the world conducts its transactions. Now a potential client can read extensively about a company or individual by consulting any number of internet sites. Information resources are available beyond a person’s or company’s own self-reporting on a website that they control. People can now meet and organise through social media and, therein, exercise enormous influence. The internet is a rapidly growing forum. It is estimated that by the year 2011, the internet will reach two billion people, nearly one-third of the world’s population.
Each year, hundreds of thousands of new blogs are added and, each day, millions of posts occur (Arthur W. Page Society Report, 2007, p. 12).
In The Creation and Destruction of Value, Harold James argues that the greatest danger of the current financial crisis is not the destruction of wealth but the destruction of value in the moral sense—the erosion of trust. There is an uncertainty impinging upon values, prompting people to wonder if the rules of the game still hold. Likening current times to the bank failures of 1931, James says that people are once again drawing back from institutions out of mistrust: “Ethical questions have become again absolutely central … We are back in a world in which trust is a virtue that is required as a logical precondition of being an effective participant in markets” (Alden, 2009).
This applies to the professions, which, as we have shown, are experiencing some erosion of public trust. Professionals do not escape unscathed the power of such media as the internet to make or break their own reputations and those of their professions.
In addition to having the power to make scandals go viral, the internet has the power to enable knowledge to go viral. Since specialised knowledge is the province of the professions, is the future of professionalism threatened as information is widely disseminated? The democratisation of information and knowledge (and the attendant power) via the internet may be seen as a potential threat to professionalism. The Spada report says: “The internet revolution threatens the information asymmetry that has always been a key feature of the relationship between professionals and clients” (Spada Limited, 2008, p. 6).
Will professionalism survive the information age? Almost certainly. As much as a person may be able to self-diagnose somewhat through Web MD (the pervasive, contemporary Dr Spock) rather than consulting a doctor, the limits of internet-gained knowledge soon become apparent. Very few of us are likely to hand a scalpel to a friend and ask him or her to Google an appendicectomy. Nevertheless, the professions must recognise that the internet is serving as the cyber Silk Road, disseminating knowledge and putting more of its attendant power into the hands of consumers.
Freidson makes an argument for maintaining exclusivity in the professions, saying that it helps maintain the integrity of professional discipline and keeps knowledge undiluted. The popularisation of the knowledge and skills of the professions would not be a good thing, he argues. The elitism of the professions is different from the types of social and political elitism that lead to oppression and exploitation. It is a simple fact that a large proportion of specialised knowledge is more reliable and valid than everyday or popular knowledge. This is simply the division of labour:
True inequality of knowledge and judgment in specialized affairs exists by virtue of the very existence of a division of labor. Those who have had intensive training and then work full-time as a specialty can hardly fail to know more about that work than others … such inequality is not unjust, as would be inequality based on race, gender, or other criteria (Freidson, 2001, pp. 203–206).
Specialised knowledge, in other words, cannot and should not be democratised. What can be democratised is access to specialised knowledge, or access to professionalism itself. In the information age, it is possible that more and more people can become professionals by gaining specialised knowledge in a specific field of endeavour, through online learning as one avenue. The proliferation of professionalism is the outcome of democratisation of knowledge delivery. The professional in one field is a neophyte in all others—though the internet, and other means of knowledge delivery, may offer neophytes greater access to professional information than has ever previously been possible. If many or most people in the information age attain a type of specialised knowledge, we thus become professionals in one field and informed neophytes in many others, making us, in a sense, more equal.
Freidson would agree with the Spada report that more important than safeguarding knowledge and skill is professionalism’s attachment to a higher ideal—this alone assures professionals of the independence and longevity of their profession:
Members of the profession claim the right to judge the demands of employers or patrons and the laws of the state, and to criticize or refuse to obey them. That refusal is based not on personal grounds of individual conscience or desire but on the professional grounds that the basic value or purpose of a discipline is being perverted … there is … still some popular foundation for the professional’s claim of license to balance the public good against the needs and demands of the immediate clients or employers. Transcendent values add moral substance to the technical content of disciplines. Professionals claim the moral as well as the technical right to control the uses of their discipline (Freidson, 2001, pp. 221–222).
Professionals cannot escape ethical considerations due to the asymmetry of their knowledge and the attendant power that such knowledge brings. Knowledge and its applications may be put to uses of good or evil. It is up to the professionals to safeguard that knowledge not only through exclusivity and credentialing, but by ethical refusal to use their knowledge or allow it to be used in ways that harm or do not help humanity. Ethics are the essence of professionalism—or the “soul of professionalism,” as Freidson puts it.
Abbott says on the topic of globalisation: “At present, professionalism seems to hold its own … But it may ultimately lose out to organizations”—a state of affairs that will lead to “a much weaker control of work by the professions themselves” (Abbott, 1988, p. 325). This would be a loss of independence, resulting in ethical degradation, and it might spell the end of professionalism.
An example is the profession of medicine in western countries. The mid-twentieth century was something of a Golden Age for modern medical practice (Freidson, 2001). Practitioners of the profession—doctors—were in control. They operated what amounted to small independent businesses throughout the land. They staffed hospitals but were not beholden to hospitals for their employment. They charged what they deemed their services were worth, and patients paid it out of pocket.
Once managed health care arrives and begins dictating what is to be paid for by whom, both doctors and patients lose some of their independence. Patients no longer choose their doctors. Rather, they choose from a network of providers listed by an insurance company. Some insurance companies determine how much medical treatment a patient should receive—without a doctor having seen the patient. Do the doctors working for insurance companies who recommend such limited courses of treatment have the independence to exercise full medical judgment? Or are they required, if they want to keep their appointments, to make diagnoses and recommend treatments favourable to the insurer’s—not necessarily the patients’—best interests? This scenario is playing out in not dissimilar ways in many other professions.
If the professions indeed become dominated by organisations that employ their practitioners—or by the profit motive itself—independence of thought and conscience may be irrevocably lost in the trend. The profession and professionalism will be compromised, perhaps terminally. Professionals must be attached to, and actuated by, a transcendent ideal in order to maintain their integrity, and even their existence. What must be resisted are the forces of false rationalisation, of desiccated efficiency, that tarnish the offerings of organisations. And self-destructive forces operative at the heart of professionalism itself—notably, imbalanced preoccupation with prestige and profit—must also be checked. The essence of professionalism is its integrity—a sense of being beholden to use its asymmetrical knowledge and the attendant power for the greater good of humanity and in service of truth. As long as professionals and professions hold on to this essence of professionalism—even, and especially, in an age of globalisation—they will survive and flourish, and professionalism will fulfil its role in serving humanity. As such, professionalism is not only relevant in today’s world—it is indispensable.
Professionalism is more relevant in today’s world than ever before. As knowledge increases exponentially, specialisation of and access to knowledge are also proliferating, leading to the emergence of many neo-professions with concomitant claims to the power, prestige and profits accorded to the traditional professions. An understanding of what professionalism is, its characteristics and obligations, is important in the face of these new realities. This understanding must both include and go beyond regulation by professional bodies and/or governments.
This essay maintains that ethical considerations and obligations lead to and maintain trust on the parts of those served and are the essence of professionalism. There is no definition of professionalism—even a rough outline of professionalism’s characteristics—that does not include a central component of ethics and altruism.
The need for ethics and altruism to direct professional skills is pressing because of the asymmetrical knowledge that professionals enjoy in relation to others. Knowledge is power, and where power is wielded, ethical concerns come into play.
Professionals are expected to be ethical towards the individuals they serve and altruistic towards society as a whole. This tacit expectation of ethics and altruism leads to trust. The individual and society have a right to trust implicitly that the professional will adhere to standards that are, in many ways, unenforceable except for the professional’s sense of professionalism. Herein lies an unresolved conundrum.
Thus, professionalism involves not only knowledge and expertise—skills of the head and hand—but also the virtues of trustworthiness and altruism—attributes of the heart. With head, heart and hand working in concert to benefit individuals and society with his or her specialised expertise, the professional person exercises what has always been recognised as the hallmark of professionalism and its summation: integrity.
On the foundation of professional integrity, a professional not only performs specialised services, but he or she increases the trust quotient in a society, lowering transaction costs and enabling the invisible handshake of trust—about which Adam Smith spoke— to energise the market along with the invisible hand. Professionalism contributes to economic growth and social mobility. It also affords wider access to education, as more specialised knowledge stimulates tertiary education.
Professionalism is more crucial now than ever before to society’s economic, social and moral wellbeing. The impact of professionalism on society is both wide and deep. Its essence defines and directs many of society’s endeavours in an ever more interdependent, informed and complex world.
I thank Don Larkin, President of Professions Australia, for suggesting that I write this essay, June Saunders for her dedicated research and drafting assistance, and David Parnham for his helpful comments on the role of the church and his skilful editing. Rob Moodie, Helen Laburn, Caron Beaton-Wells, Stuart Hamilton, Michael Gill and Friedrich Blase each contributed to the work in various ways, including pointing to the paucity of continental European and Asian sources and warning against elitist overtones. Moreover, I thank all those who have taught me the essence of professionalism in the halls of the academy and in practice.
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