Monday 9 April 2018

Reviewing Expectations.

I’m tempted to wonder just how much we have a right to expect finer human feelings to play a part in clinical practice. The human animal is, after all, basically a complex biological machine which needs mending sometimes, and we have people in advanced societies who are trained to do just that. We call them doctors and nurses.

It used to be – if my memory serves me right – that doctors were expected to be the technocrats who used their technical skill to do the diagnosing, the cutting, the stitching, the dispensing, and so on. The nurses were there to provide practical support and also add a good dose of sympathy and compassion to make the process easier on the mind of the patient.

I have the impression that this is now undergoing a slow and subtle change. My recent experiences in hospital led me to suspect that modern nurses, trained to a much higher level in order to keep pace with technological and other advances, are also beginning to see themselves as technocrats first and foremost. I think I detected a diminution in the old quality that used to be a primary expectation of nurses – the providing of emotional as well as practical support. So, the questions:

Am I right? Is it a problem? Should it be recognised and addressed? I don’t know; it’s just a thought off the top of my head.

2 comments:

Madeline said...

I think you're right - nursing is a much more technical profession than it used to be, and nurses certainly do command more respect as technicians and healers in their own right rather than subservient appendages of the doctors. The counterpoint to that is that doctors are supposed to have become more humanistic - at least the younger generation - and to involve themselves more in the lives of their patients outside of the boundaries of traditional medicine. Whether or not this actually happens seems to depend a lot on the individual physician. Some I know are quite compassionate. But it is the nurses who end up spending the greater span of time with the patients, getting to know them on a personal level. If they seem more reserved than they used to be it might be a consequence of their awareness that their professional status is tied to the display of "professional," what you might call "technocratic," more "doctorly" behavior.

I've seen a similar phenomenon with academics. The older generation of academic women can be quite reserved and stand-offish, even abrasive. This seems to stem from their need (very much legitimate) to project themselves first and foremost as professionals and to defend against perceptions that they are emotional, weak, and overall less qualified than their male counterparts. The younger generation of academic women has not had to defend themselves as vigorously against these perceptions, due to the path laid for them by their predecessors. Thus they are more willing to exhibit compassion and empathy towards their students and to admit to emotion and weakness - i.e., they are allowed to be human.

Doctors are in a strange position given the historical legacy of medicine (authoritarian, empirical, positivist) and its increasing authority as science advances, set against patients' demands (also legitimate) to be emotionally supported and understood as full human beings.

Nurses, I suppose, are caught between their own legacy as carers and nurturers and the opportunity to increase their prestige and respect by staking a larger claim to the technical aspect of medicine. The problem seems to be that these two roles (nurturing vs. clinical practice) are seen to be antithetical or opposed. It's not a coincidence that most nurses happen to be women. Women have had to navigate between personal and professional demeanors for a long time. It reminds me of a line from Mad Men where Peggy (the young woman character who is trying to succeed in the male-dominated advertising field in the 1960s) wonders if she should change herself to garner more respect from her colleagues. An older and wiser associate (also a woman) advises her, saying something like, "Don't try to be a man. Be a woman. it's a powerful thing when done correctly."

I'm not sure I'm going with all of this. It's just stream of consciousness rambling. But I think a) you are right and b) it speaks to a lot of strange contradictions and obstacles that arise with the professionalization of traditionally gendered roles and the staking out of power in the workplace.

There are still some wonderfully compassionate nurses (and doctors) out there. I hope - if you must continue to see doctors and nurses at all - that you come across some of them.

JJ said...

Thanks for the essay, Mad. Please excuse the short reply. You always were considerably more industrious than I could ever be, and I’m sure you have much more mental energy at the moment.

Everything you say makes sense and I can well relate to the advice given to Peggy. I’ve said much the same myself over the past twenty years or so while observing the behaviour and methodology of women taking unaccustomed roles in public life. I suppose it was natural for a woman to want to find and accentuate her masculine qualities back then because it was almost exclusively men she had to impress.

As for my own treatment, I find I’m becoming less concerned with people being nice to me and more with trying to get back to being physically right.

Thank you so much for taking the time.