On Professional Judgement, Ethics, Patients’ Interests and Representation in Primary Health Care: Reflections on Some Dilemmas in Social Audit

This reflective paper considers the practical problems of social audit in order to empower direct patient participation in health care. It focuses on the conceptual and moral efficacy of introducing a polyvocal citizenship perspective (pcp) social audit model into the primary health care (PHC) setting. We examine possible practical representation mechanisms to enable patient involvement. The paper incorporates a critical discussion of some of the conceptual underpinnings of social audit in public service. Significantly, these concern the structural and economic constraints of patient care and patient behaviour, with implications for reflexive issues of professional judgement and ethics. The particular case of changing to generic prescribing by GPs is used to highlight some underlying tensions and dilemmas which may be hidden by grounded medical and audit praxis. An iterative social audit processes may help to identify meanings and illuminate implicit values and to re-affirm a consensual approach for future dialogue development within the public health service. These issues may have relevance and implication for the implementation of similar social accountability frameworks in other organisational sectors.