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Doctors' strike
426
Book Revmws
Even more important, however, and what truly elevates this volume above the mass of such publications, is the fact that Penchansky, Renthal, Robert W. Merry and Sagar C. Jain have contributed four excellent essays on the use and nature of case studies in the training of public health administrators. These essays are sophisticated reasonings and are of significance to any teacher using case studies as a teaching mechanism. The authors provide a careful evaluation of such terms as "case study", "case report" and "case method" as utilized in law, medicine, public administration, social work, education, social research and then go on to their legitimacy and role in the training of health service administrators and medical care administrators. Even the actual development of an appropriate course of case studies is given a detailed analysis. The section is a most intelligent and valuable inclusion. The entire volume is of direct relevance to social science and medicine, as well as health services administration, and I highly recommend its widest distribution and utilization. AILON SHILOH, Ph.D.
Graduate School of Public Health, University of Pittsburgh.
D O C T O R S ' STRIKE by ROBIN F. BADGLEY and SAMUELWOLFE. Atherton Press. 1967. 201 pp. $6.50. "DocToRS' Strike" tells of an explosive medical-social event which engulfed and absorbed the Canadian Province of Saskatchewan in 1962. The authors begin by relating the political economics and the historical context. The socialist movement in Canada is a moderately left opposition party nationally, yet it has often been described as a Canadian conscience. Its ideas, scorned as wildly visionary, were often incorporated later into other party platforms. Led by the brilliant and articulate T. C. Douglas, the party, in 1944, was elected to power in the wheat dependent, boom or bust, province of Saskatchewan. The book fully outlines the social needs and forces which led to acceptance of the first socialist government in North America. For a time this government moved carefully, winning guarded admiration. Hospitalization legislation provided security against financially crippling disease, other provinces watched. some copied. Following its re-election in 1960, the government slowly approached, with increased medical opposition, full medical care coverage on "Medicare". This culminated in the 23 day Doctors' Strike of 1962, a bitter debacle leaving the province sick and scarred. Drs. Wolfe and Badgley tell a persuasive story of the strike and the bitter compromise from which was born the first North America Medicare plan. The reader is warned that the authors are not "dispassionate observers", on the contrary they were involved and admittedly in favor of the government viewpoint. Most of the book is brisk and engrossing although the continuity is often broken by reiteration of tired arguments in the heat of emotional issues. Ambivalence is constantly present, the authors seem to aim for an objective historical account, yet this struggles with the desire of the protagonist to tell his story, revealing his unresolved hurts. Doctor readers at times will be pulled into unconscious reaction and will
BOOK REVIEWS
427
be tempted to lose focus. Social scientists may miss this background emotional exchange. While government policy is deeply explored and documented, one is left wondering about the motives and goals of the doctors. Did they not have some relevant intellectual contribution that might have modified or illuminated government policy? Much more important, we are left questioning the dynamics of deeper issues which would have intrigued social scientists and doctors alike. What were the gigantic miscalculations, the back room tactics ? What were the sociological interactions between human groups, the stubborn madness which lead to impasse ? The book does not analyze the true state of social theory in Saskatchewan, the state of consensus or agreement. The public readiness for medicare was argued through an election, yet there was a social context giving the doctors some sort of implicit permission to strike. Somewhere the doctors gathered powerful sympathetic support, how ? Why ? The "Doctors' Strike" offers only a tantalizing glimpse of behavior of groups out of harmony, e.g. the fascinating ladies o f the "Save Our Doctors Committee", or rank and file public and medical opinion. The very important Part Two, the "Wider Setting", gives deep insight into the realities of medical practice and society. It is cooler yet as provocative as Part One, and only occasionally strays into overstatements. The excellent Chapter 10, " D o c t o r and Society" is an example, and "must" reading for medical practitioners. If doctor readers have survived their apoplectic reaction to Part One, and can with equanimity struggle onwards, there is the reward here of some hard hitting, unpleasant premises and realities to face in Part Two. A mirror is held up to reveal the image and needs of the medical establishment. Here medicine is stripped of trappings, dignity, assurance, and self righteousness. Doctors are revealed as not so selfless, not so ethical in inter-human relations, not humanitarian. This book is an implicit normative assessment of what "ought" to be in medicine and there is good evidence that normative, as well as scientific, evaluation is a function of Social Science in Medicine. We may agree or disagree, but in this age of identity seeking analysis or self analysis, medicine is just another behavioral patient. This book opens up avenues for reappraisal in medicine, it should be read, although its partisan setting makes objective reading difficult. L. M. CATHCART, M.D.
Department of Health Care & Epidemiology, University of British Columbia, Vancouver. B.C.
THE HISTORY OF THE NEGRO IN MEDICINE by HERBERT M. MORALS. Publishers Co., New York. 1967. 317 pp. No price given. DR. HERBERT MORALS, a distinguished scholar and specialist in American History, has written an inspired, timely and definitive book. The History of the Negro in Medicine is the first comprehensive account in the field, a work which begins in colonial times but which chiefly concentrates on the last hundred years. A book over 300 pages, it contains many profiles of distinguished Negroes in medicine, background material of a historical and statistical nature, pertinent quotations from original sources and a bibliography of
Book Revmws
Even more important, however, and what truly elevates this volume above the mass of such publications, is the fact that Penchansky, Renthal, Robert W. Merry and Sagar C. Jain have contributed four excellent essays on the use and nature of case studies in the training of public health administrators. These essays are sophisticated reasonings and are of significance to any teacher using case studies as a teaching mechanism. The authors provide a careful evaluation of such terms as "case study", "case report" and "case method" as utilized in law, medicine, public administration, social work, education, social research and then go on to their legitimacy and role in the training of health service administrators and medical care administrators. Even the actual development of an appropriate course of case studies is given a detailed analysis. The section is a most intelligent and valuable inclusion. The entire volume is of direct relevance to social science and medicine, as well as health services administration, and I highly recommend its widest distribution and utilization. AILON SHILOH, Ph.D.
Graduate School of Public Health, University of Pittsburgh.
D O C T O R S ' STRIKE by ROBIN F. BADGLEY and SAMUELWOLFE. Atherton Press. 1967. 201 pp. $6.50. "DocToRS' Strike" tells of an explosive medical-social event which engulfed and absorbed the Canadian Province of Saskatchewan in 1962. The authors begin by relating the political economics and the historical context. The socialist movement in Canada is a moderately left opposition party nationally, yet it has often been described as a Canadian conscience. Its ideas, scorned as wildly visionary, were often incorporated later into other party platforms. Led by the brilliant and articulate T. C. Douglas, the party, in 1944, was elected to power in the wheat dependent, boom or bust, province of Saskatchewan. The book fully outlines the social needs and forces which led to acceptance of the first socialist government in North America. For a time this government moved carefully, winning guarded admiration. Hospitalization legislation provided security against financially crippling disease, other provinces watched. some copied. Following its re-election in 1960, the government slowly approached, with increased medical opposition, full medical care coverage on "Medicare". This culminated in the 23 day Doctors' Strike of 1962, a bitter debacle leaving the province sick and scarred. Drs. Wolfe and Badgley tell a persuasive story of the strike and the bitter compromise from which was born the first North America Medicare plan. The reader is warned that the authors are not "dispassionate observers", on the contrary they were involved and admittedly in favor of the government viewpoint. Most of the book is brisk and engrossing although the continuity is often broken by reiteration of tired arguments in the heat of emotional issues. Ambivalence is constantly present, the authors seem to aim for an objective historical account, yet this struggles with the desire of the protagonist to tell his story, revealing his unresolved hurts. Doctor readers at times will be pulled into unconscious reaction and will
BOOK REVIEWS
427
be tempted to lose focus. Social scientists may miss this background emotional exchange. While government policy is deeply explored and documented, one is left wondering about the motives and goals of the doctors. Did they not have some relevant intellectual contribution that might have modified or illuminated government policy? Much more important, we are left questioning the dynamics of deeper issues which would have intrigued social scientists and doctors alike. What were the gigantic miscalculations, the back room tactics ? What were the sociological interactions between human groups, the stubborn madness which lead to impasse ? The book does not analyze the true state of social theory in Saskatchewan, the state of consensus or agreement. The public readiness for medicare was argued through an election, yet there was a social context giving the doctors some sort of implicit permission to strike. Somewhere the doctors gathered powerful sympathetic support, how ? Why ? The "Doctors' Strike" offers only a tantalizing glimpse of behavior of groups out of harmony, e.g. the fascinating ladies o f the "Save Our Doctors Committee", or rank and file public and medical opinion. The very important Part Two, the "Wider Setting", gives deep insight into the realities of medical practice and society. It is cooler yet as provocative as Part One, and only occasionally strays into overstatements. The excellent Chapter 10, " D o c t o r and Society" is an example, and "must" reading for medical practitioners. If doctor readers have survived their apoplectic reaction to Part One, and can with equanimity struggle onwards, there is the reward here of some hard hitting, unpleasant premises and realities to face in Part Two. A mirror is held up to reveal the image and needs of the medical establishment. Here medicine is stripped of trappings, dignity, assurance, and self righteousness. Doctors are revealed as not so selfless, not so ethical in inter-human relations, not humanitarian. This book is an implicit normative assessment of what "ought" to be in medicine and there is good evidence that normative, as well as scientific, evaluation is a function of Social Science in Medicine. We may agree or disagree, but in this age of identity seeking analysis or self analysis, medicine is just another behavioral patient. This book opens up avenues for reappraisal in medicine, it should be read, although its partisan setting makes objective reading difficult. L. M. CATHCART, M.D.
Department of Health Care & Epidemiology, University of British Columbia, Vancouver. B.C.
THE HISTORY OF THE NEGRO IN MEDICINE by HERBERT M. MORALS. Publishers Co., New York. 1967. 317 pp. No price given. DR. HERBERT MORALS, a distinguished scholar and specialist in American History, has written an inspired, timely and definitive book. The History of the Negro in Medicine is the first comprehensive account in the field, a work which begins in colonial times but which chiefly concentrates on the last hundred years. A book over 300 pages, it contains many profiles of distinguished Negroes in medicine, background material of a historical and statistical nature, pertinent quotations from original sources and a bibliography of