Governing Virtuous Regulatory Bodies: A Matter of Nudge or Smudge?

Medical regulation in the United Kingdom has undergone a period of substantial reform in the last decade, with the regulatory body responsible for overseeing doctors - the General Medical Council - becoming more open, transparent and publicly accountable than at any time since its inception in 1858. This paper argues that this state of affairs signals the beginning of a shift toward a new form of neoliberal medical professionalism where medical virtue is being recast in a form more congruent with the of the risk adverse governing conditions associated with high modernity. As a result, both individual practitioners and their professional institutions must increasingly manage their affairs using the formal calculative regimes of the business marketplace; such as, audit, best-evidenced case management and performance appraisal. All of which seek to performance manage professional working practices in order to better economise and risk-manage occupational tasks. Noting that such developments are at odds with the tacit dimensions of medical expertise and the inherent messy nature of everyday clinical practice, this paper focuses on exploring the possibility that instead of acting to ‘nudge’ practitioners to act more virtuously such processes in fact often end up ‘smudged’, with doctors often adopting a stance of ‘paperwork compliance’ toward them. The paper concludes by considering what the implications of this state of affairs may be for the profession, policy makers and the public given that trust in medical regulation is at an all time low.