Introduction to Special Issue: Professional-Citizen Relations

Whether in the form of patients, clients, students, customers or inmates, professionals constantly interact with citizens and thereby exercise their professionalism through citizen relations. These relations between professionals and citizens are important in many ways for professions and professionalism. Professionals develop and maintain relations and boundaries not only vis-à-vis the state or competing occupations, but also vis-à-vis citizens. The use of expertise and specialized knowledge to solve problems among citizens and clients is thus a key aspect of how we oftentimes characterize professionalism and professional work:

More precisely, relations between professions and citizens are both structural and interactional in character. Structurally, citizens play an important role in how professions are able to constitute boundaries and claim authority, legitimacy, autonomy or status for their expertise. At the same time, the relationship between professionals and citizens is also defined in the context of the daily work tasks in which professionals interact with citizens. Professional expertise is thus understood and implemented through citizen interactions—a process that often involves the exchange of intimate details or an attempt to handle people's inner fears and emotions on a daily basis.

Even so, the relations between professionals and citizens do not play a prominent role in existing scholarship on professions and professionalism. Especially in recent years, the focus has rather been on the link between organizations and professions as well as the possible hybrids between professionalism and managerialism. Discussions about the constitution of professions similarly tend to ignore citizens, because the main focus is on how the boundaries of professions are constituted by social institutions like science or the state, or by power and social values.

Relations between professionals and citizens are mainly discussed as a matter of professional ethics, disinterestedness or the special fiduciary relationship that exists between professionals and citizens (e.g., Parsons, 1939; Abbott, 1983). Citizens’ impact on the legitimacy of professional knowledge or on the development of professionalism is, to a large extent, typically not recognized. There are nonetheless good reasons to believe that citizens do in fact play an important and even constitutive role for professions and professionals, not least in the context of late modernity and individualization.

The democratizations of knowledge and the presumed eroded authority of expertise (e.g., Beck, Giddens, & Lash, 1994; Giddens, 1990) may lead to more questioning of professional knowledge and expertise, and may lead to increased competition for professions from other occupations or alternative solutions: Who needs an architect when you can design your own house? And why use a physiotherapist when you can watch free videos on YouTube with advice on training and treatment?

Furthermore, new societal problems such as aging populations, migration, and global warming may also result in the development of new professions and new professional work tasks, including new forms of interactions with citizens. For example, social workers and teachers are increasingly involved in the integration of immigrants into their new host societies, but these professionals may at the same time be involved in surveillance, control, and the prevention of radicalization among citizens. Recent decades have also seen a progressive professionalization of care and intensification of emotional labor due to changes in labor markets and new ways of organizing family life (Hochschild, 1983). This also intensifies the involvement of professionals in the emotional and mental aspects of citizens’ lives, and it may may result in new forms of professionalism with close and emotional relationships to citizens.

We believe these developments call for a new reflection on the relations between professionals and citizens, both as a structural and an interactional phenomenon, and both theoretically and empirically. This special issue of Professions and Professionalism seeks to take further steps in the development of new scholarship on professionals and citizen relations. We present four articles that approach the relations between citizens and professionals in different ways.

First, Lars Thorup Larsen’s article “No Third Parties: The Medical Profession Reclaims Authority in Doctor-Patient Relationships” tackles the issue of professional authority and the ways in which this may be challenged by citizens and reclaimed by professions. Analysing editorials in journals published by the medical profession since 1950 in the United States, the United Kingdom, and Denmark, Larsen compares how the medical profession in these three countries perceives and reacts to challenges to authority by citizens. Among other things, he finds that in general, medical doctors do not find themselves challenged in any great measure by citizens who contest their knowledge authority or diagnose themselves. Even so, American and Danish medical doctors continuously establish a hard boundary towards citizens, whereas British medical doctors are more reflective upon and open to new ways to interact with patients.

Second, in the article “Patient-Centred Professionalism? Patient Participation in Dutch Mental Health Professional Frameworks,” Aukje Leemeijer and Margo Trappenburg explore how the Dutch policy goal of patient inclusion in mental health care involves four different professions. The article suggests that the degree of professionalization will influence how professional frameworks describe and regulate professional-citizen relations. Exploring such professional frameworks (e.g., professional profiles and codes of conduct) from psychiatrists, psychologists, mental health nurses and social workers, this suggestion is partly confirmed. The article demonstrates how social workers seem the most accommodating towards the inclusion of patients in planning and executing mental health treatments, whereas psychologists are the least open to such inclusions since they more heavily emphasize professional autonomy and expertise.

Third, the article “Welfare Service Professionals, Migrants and the Question of Trust: A Danish Case,” written by Barbara Fersch, reverses the viewpoint from professionals to citizens. Building on theories of welfare institutions and social trust as well as interview data with migrants in the Danish welfare system, Fersch explores how the frontline encounters between welfare service professionals and migrants are important to the establishment of trust in public institutions. Among other things, Fersch, therefore, points to the integrative potential of such encounters.

Finally, Gitte Sommer Harrits’ article “Being Professional and Being Human: Professional’s Sensemaking in the Context of Close and Frequent Interactions with Citizens” explores how welfare professionals make sense of their own professionalism and their relationship to clients. Building on theories on professionalism, professional identities and role conceptions, as well as on 58 semi-structured interviews with Danish health nurses, child care workers and primary school teachers, Harrits demonstrates how most professionals seem to blend a logic based on formal and practical knowledge with a logic based on emotions, intuitions, and relations to citizens. This raises questions for the traditional narrow understanding of professionalism as based solely on formal knowledge, but it also raises the issue of how to normatively legitimize professional authority.

Building on different theories, data, and angles, all four articles contribute to our understanding of the meaning and importance of professional-citizen relations. The articles were originally presented and discussed in two panels titled “Professionals and Citizen Relations” chaired by Lars Thorup Larsen at the 2015 Interim meeting of the International Sociological Association’s Research Committee 52 on Professional Groups in Milan. We thank all participants in this panel for fruitful comments and discussions.