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Medicine and social work: An exploration in interprofessionalism
Book
cation; he decries the increasing separation and absence of cross-fertilization between professional schools and “liberal” institutions. Cecil G. Shens. who is Vice Chancellor of health sciences and Professor‘ of Social Medicine at the University of North Carolina, addresses the abyss he sees between the professional school and the real world its graduates encounter in practice. He charges the schools with promulgating “professional imperialism”. whereby separate education systems prepare their students in “highly stereotyped and traditional fashion”, rather than looking toward future roles by training them to work cooperatively with other social health-care specialists for maximum use of their skills. Alfred Kahn’s thoughtful “Institutional Constraints to Interprofessional Practice” analyzes the obstacles of system boundaries. differing goals. values and frames of reference within each system. and comes closest to identifying the realistic problems, with which workers must deal in the hospital setting. As was made clear in the discussions which followed the presentation of papers in the plenary session, these problems are social and psychological. They involves issues of interprofessional inequality-in power. influence. status, responsibility and economic revvard. These inequalities inevitably result in hierarchies and mutual mistrust. One leader suggested. in her comments. that “mutual respect was affirmed on an intellectual level but that mutual trust. which had not been explicated in that working party’s discussions. was what really needed to be developed".
Both social workers and physicians were dissatisfied w-ith their own self-concepts and their concept of “the other”. and it is here in this arena of interpersonal politics, that the real struggle to achieve interprofessional cooperation is waged daily. Only twice. and briefly. was the subject of institutional sexism broached. “The fact that physicians in our society are largely male, while nurses and social workers are largely female contributes. it was thought by some participants. to the difficulties encountered in developing interprofessional functioning”. In the long list of major differences between the professions which Dr. Kahn cites. sex is not mentioned. Research into the hierarchal structure of other major institutions and occupations in our society indicate that sex is the only variable which is significant in explaining why women are invariably found at the bottom of the pyramid of power. control and economic remuneration, The pervasive atmosphere of the discussions was one of constraint. One member commented that no one at the colloquium had anything real at stake. although “if this were a meeting to talk about Social Service budget the tone would have been different”. Any hint of controversy produced polite backing-off. Still. initial ground-breaking exercises do deal with large generalities. and as a prelimmary exploratory study. the colloquium did raise pertinent issues and questions which were well-summarized in the final section. “An Agenda for the Future of Interprofessionalism.” What should be the role (values. orientation) of professional schools and universities rrs-ir-ris interprofessional cooperation’? What demands does interprofessionalism make upon the members of the team’! How should interprofessional systems. institutions and programs be organized’? Ideally. these questions should be ansvvered before one asks. “How will an interprofessional human services operation work’!” But. as one participant remarked. the answers are already being thrashed out in the field by that mother of invention. necessit!. Perhaps it is not too late to read this book and understand the great number and complexity of issues which beg to be addressed if our social health care system is
reviews
513
to be effective in our common goal. the public welfare. It is to the credit of the many people who made Medic,inc, und Sociui Work possible that they have initiated honest exploration and identified many problem areas. without succumbing to the temptation to form premature conclusions. If there remain some basic differences which are still unconfronted, the model of their colloquium can bc used for further discussion which will be a little less polite. a little less cerebral. Those of us who experience interprofessional politics in our daily working lives will benefit and so will our beneficiaries, the public we serve.
Pesticides: Nomenclature. Specifications. Analysis. Use. and Residues in Foods, by D. ARMSTRONG L&L and A. R. STILES. World Health Organization, Geneva. 1974. (Progress in Standardization : I). 38 pp. Swiss francs 6.50. In recent years a significant change has occurred in attitudes towards international standardization: whereas it was regarded 2U yr ago as a good thing if one could afford it. today the question has become “Can one afford to do without it?” This is particularly true of manufacturers. who wish to increase their export sales and at the same time avoid having to make a costly series of modifications to their products (and anyone who has travelled widely with an electrical appliance, even if he has had a kit of plug adaptors at his disposal, can testify to the problems involved). In many areas of science and medicine (and especially the latter). however, progress has been much slower. This is not to say that standards do not exist: they do and in large numbers. but they are often hard to find. Most of them have remained buried in the journals or documents in which they were published and up to now no attempt has been made to collate them and produce an index to them. The World Health Organization (WHO). in an attempt to rectify this situation. has recently introduced a new series of publications entitled “Progress in Standardization”. The aim of these publications is to provide an index to all standards that have been published in every area directly of indirectly related to public health. The first publication in this new series is devoted to pesticides. and the principal areas it covers are nomenclature. specifications, analysis. use and residues in foods. The largest single section of the paper is given over to nomenclature. which indicates the complexity of this subject. The way in which common names for pesticides are approved by the International Organization for Standardization is explained. and a complete list of such common names (323 in all) is included. More important, however. is a list in which these pesticides are classified by chemical name. together with cross-references under a large number of other “common” names and proprietary names. This is the first time that such a list. keved to ir~ternational common names. has appeared in print and it should be of value to authors and editors who wish. or are required. to use standard names in place of the obscure names that frequently appear in manuscripts. The study also provides an index to all the international specifications for pesticides that are available. for both public health and agricultural uses. from WHO and from the Food and Agriculture Organization of the Untted Nations (FAO). A similar index is provided to all pesticides for which methods of analysis have been approved by WHO and by the Collaborative International Pesticides Analytical Council. and to the recommendation of the International Union of Pure and Applied Chemistry. The introduction to the “Progress in Standardization” serves
cation; he decries the increasing separation and absence of cross-fertilization between professional schools and “liberal” institutions. Cecil G. Shens. who is Vice Chancellor of health sciences and Professor‘ of Social Medicine at the University of North Carolina, addresses the abyss he sees between the professional school and the real world its graduates encounter in practice. He charges the schools with promulgating “professional imperialism”. whereby separate education systems prepare their students in “highly stereotyped and traditional fashion”, rather than looking toward future roles by training them to work cooperatively with other social health-care specialists for maximum use of their skills. Alfred Kahn’s thoughtful “Institutional Constraints to Interprofessional Practice” analyzes the obstacles of system boundaries. differing goals. values and frames of reference within each system. and comes closest to identifying the realistic problems, with which workers must deal in the hospital setting. As was made clear in the discussions which followed the presentation of papers in the plenary session, these problems are social and psychological. They involves issues of interprofessional inequality-in power. influence. status, responsibility and economic revvard. These inequalities inevitably result in hierarchies and mutual mistrust. One leader suggested. in her comments. that “mutual respect was affirmed on an intellectual level but that mutual trust. which had not been explicated in that working party’s discussions. was what really needed to be developed".
Both social workers and physicians were dissatisfied w-ith their own self-concepts and their concept of “the other”. and it is here in this arena of interpersonal politics, that the real struggle to achieve interprofessional cooperation is waged daily. Only twice. and briefly. was the subject of institutional sexism broached. “The fact that physicians in our society are largely male, while nurses and social workers are largely female contributes. it was thought by some participants. to the difficulties encountered in developing interprofessional functioning”. In the long list of major differences between the professions which Dr. Kahn cites. sex is not mentioned. Research into the hierarchal structure of other major institutions and occupations in our society indicate that sex is the only variable which is significant in explaining why women are invariably found at the bottom of the pyramid of power. control and economic remuneration, The pervasive atmosphere of the discussions was one of constraint. One member commented that no one at the colloquium had anything real at stake. although “if this were a meeting to talk about Social Service budget the tone would have been different”. Any hint of controversy produced polite backing-off. Still. initial ground-breaking exercises do deal with large generalities. and as a prelimmary exploratory study. the colloquium did raise pertinent issues and questions which were well-summarized in the final section. “An Agenda for the Future of Interprofessionalism.” What should be the role (values. orientation) of professional schools and universities rrs-ir-ris interprofessional cooperation’? What demands does interprofessionalism make upon the members of the team’! How should interprofessional systems. institutions and programs be organized’? Ideally. these questions should be ansvvered before one asks. “How will an interprofessional human services operation work’!” But. as one participant remarked. the answers are already being thrashed out in the field by that mother of invention. necessit!. Perhaps it is not too late to read this book and understand the great number and complexity of issues which beg to be addressed if our social health care system is
reviews
513
to be effective in our common goal. the public welfare. It is to the credit of the many people who made Medic,inc, und Sociui Work possible that they have initiated honest exploration and identified many problem areas. without succumbing to the temptation to form premature conclusions. If there remain some basic differences which are still unconfronted, the model of their colloquium can bc used for further discussion which will be a little less polite. a little less cerebral. Those of us who experience interprofessional politics in our daily working lives will benefit and so will our beneficiaries, the public we serve.
Pesticides: Nomenclature. Specifications. Analysis. Use. and Residues in Foods, by D. ARMSTRONG L&L and A. R. STILES. World Health Organization, Geneva. 1974. (Progress in Standardization : I). 38 pp. Swiss francs 6.50. In recent years a significant change has occurred in attitudes towards international standardization: whereas it was regarded 2U yr ago as a good thing if one could afford it. today the question has become “Can one afford to do without it?” This is particularly true of manufacturers. who wish to increase their export sales and at the same time avoid having to make a costly series of modifications to their products (and anyone who has travelled widely with an electrical appliance, even if he has had a kit of plug adaptors at his disposal, can testify to the problems involved). In many areas of science and medicine (and especially the latter). however, progress has been much slower. This is not to say that standards do not exist: they do and in large numbers. but they are often hard to find. Most of them have remained buried in the journals or documents in which they were published and up to now no attempt has been made to collate them and produce an index to them. The World Health Organization (WHO). in an attempt to rectify this situation. has recently introduced a new series of publications entitled “Progress in Standardization”. The aim of these publications is to provide an index to all standards that have been published in every area directly of indirectly related to public health. The first publication in this new series is devoted to pesticides. and the principal areas it covers are nomenclature. specifications, analysis. use and residues in foods. The largest single section of the paper is given over to nomenclature. which indicates the complexity of this subject. The way in which common names for pesticides are approved by the International Organization for Standardization is explained. and a complete list of such common names (323 in all) is included. More important, however. is a list in which these pesticides are classified by chemical name. together with cross-references under a large number of other “common” names and proprietary names. This is the first time that such a list. keved to ir~ternational common names. has appeared in print and it should be of value to authors and editors who wish. or are required. to use standard names in place of the obscure names that frequently appear in manuscripts. The study also provides an index to all the international specifications for pesticides that are available. for both public health and agricultural uses. from WHO and from the Food and Agriculture Organization of the Untted Nations (FAO). A similar index is provided to all pesticides for which methods of analysis have been approved by WHO and by the Collaborative International Pesticides Analytical Council. and to the recommendation of the International Union of Pure and Applied Chemistry. The introduction to the “Progress in Standardization” serves