I artikeln beskrivs och diskuteras den historiska framväxten av kommunal familjerådgivning i ljuset av Elinor Ostroms teori om allmänningar och polycentrisk styrning. Artikeln belyser det faktum att legitimerade psykoterapeuter inte förväntas dokumentera vård och behandling när de arbetar inom den kommunala familjerådgivningen, trots att lagstiftningen påbjuder ett sådant krav. Denna avvikelse från legalitetsprincipen diskuteras som ett exempel på polycentrisk lag.
In this article the historic development of the regulation regarding municipal family counseling is described and discussed with the help of Elinor Ostrom’s theory of the commons and polycentric governance. The article stems from the fact that licensed psychotherapists are not expected to keep patient journals when working in the municipal family counseling, even though the law imposes such a requirement. This deviation from the principle of legality is discussed in the article as an example of polycentric law.
This dissertation fills part of the existing knowledge gap regarding the relationship between the legal obligation to document medical care and treatment on the one hand, and the professional practice, conditions and identities of professionals on the other. Three basic questions serve as points of departure: what are the origins of the obligation to document medical care and treatment? How is the relationship between the patient and the professions affected by the obligation? How does the obligation affect professional identities? The dissertation consists of five sub-projects performed with a combined legal and social constructivist approach. Two relate to the historical emergence of an obligation for physicians and other professions to document medical care and treatment in Swedish healthcare. One concerns how standardized forms of documentation affect the patient’s legal position and two are built upon the fact that the legal obligation for licensed psychotherapists within municipal family counselling to document their interventions has lapsed, even though the legislation clearly prescribes such an obligation. The results suggest that the form of governance known as New PublicManagement has been preceded by regulations regarding the obligation ofdocumentation, which are clearly intended to meet financial and organizationalgoals. This may have contributed to the fact that Sweden is one of the countrieswhere New Public Management has influenced the public administration the most.The thesis concludes that the effects of the regulations regarding of the obligationto document medical care and treatment, and the forms of implementation ofthe obligation, are of crucial importance for a patient’s legal position. Furtherresearch is needed in order to highlight and better understand the processes thatare at play when the regulations are enforced and implemented amongst healthcare professionals.