Using the survival-security-flourishing model to explain the emergence and shape of the medical profession

In this chapter, we will explore the value of Little’s theory of ‘modest foundationalism’ as a means of shedding a fresh perspective on the medical profession. In particular, we seek to determine whether we can explain why the medical profession exists, and persists, in the form it does in Western societies, without resorting to the almost taken-for-granted assumptions about self-interested striving for power and status that prevail in much of the sociological literature. We first review the development of theories about the emergence and maintenance of the medical profession, drawing primarily from sociological traditions in the USA and UK. Next, we articulate our understanding of the main elements of Little’s theory, in which he identifies three pre-normative values – survival, security and flourishing – that, he argues, exist and are expressed in any culture or society. We then propose that a shift in the level of analysis from that of society to that of the collective – in this case the medical profession – can offer new insights into the nature of the profession and its role in society. We conclude with observations about the relevance of this wider perspective for theory and for medical education and governance.