Shifting Professionalism: Navigating Patient-Centred Care and Professional Authority in Japanese Trans Medicine

In early medical sociology, Eliot Freidson was a key figure in discussing the dominance of healthcare professionals. However, as Freidson acknowledged in his later work, the traditional concept of professional dominance has become less tenable since the late 20th century due to shifts toward consumerism, managerialism, and changes in industrial structures. While these changes have introduced signs of de-professionalisation and patient-centred care, they do not signify the resolution of professional dominance. Rather, professional authority persists in more flexible and resilient forms.

Trans medicine, series of healthcare for medical transition and gender affirmation, historically rooted in practices of pathologisation, gatekeeping, and paternalism, has seen significant shifts. Guidelines increasingly emphasise patient autonomy and decision-making. However, despite these changes, traditional medical frameworks and the authority of healthcare professionals continue to shape clinical practice. For instance, studies have shown that "risk" and "uncertainty" are often invoked by professionals of trans medicine to justify their control over medical decisions, reflecting ongoing tensions between patient agency and professional authority.

This study draws on interviews with 21 healthcare professionals involved in trans medicine in Japan, focusing their assertion of their roles within their medical practices, to examine how they navigate their roles within this evolving landscape. While some professionals advocate for a more collaborative relationship with patients, their roles remain unsettled as they balance traditional gatekeeping with emerging expectations for patient empowerment. By situating trans medicine within broader debates about professional dominance and patient-centred care, this study offers a nuanced understanding of the shifting but persistent authority of healthcare professionals in contemporary healthcare.