Review

Tribes and tribulations

NURSING, MEDICINE AND PRIMARY CARE
Anne Williams
Open University Press, 2000, £16.99

This book is written by a researcher who approaches her subject like an anthropologist studying interesting tribes. In her case, the tribes are nursing and medicine in the territory of primary care and she provides a fascinating journey into familiar terrain, where one might know a lot of the language but many of the customs are confusing.

Because policymakers now see primary care as central to health care provision this book provides a salutary cold shower for excessively optimistic expectations. If the change to primary care trusts is to be successful, the two tribes need to work together, dress themselves in modern clothes and learn the catechism of modernism – and they need to do this when the missionaries carrying the message of managerialism make threatening injunctions to change their customs.

Williams reaches three conclusions from her interviews with nurses, doctors, and users. The first is that nurses and doctors share culture, especially in seeing the primacy of the patient and respect for their integrity; the second, however, stresses the important differences between the groups, in particular, because nursing has a subordinate role to medicine. Finally, Williams points out that, as primary health stresses team-working, differences in status will have considerable bearing on the ability to deliver the aims of the health reforms.

For the reforms to be successful, Williams argues that a responsive professionalism is needed to fill the increasingly ambiguous space the tribes occupy as role boundaries become fuzzier. Nurses will have to become less defensive and more involving in their approach.

Given the key role of managerialism, and that managers are the new tribe on the block, the book would have benefited from a more detailed examination of each group’s personal perspectives.

When tribes fight it is usually over resources, and it is not clear whether they will settle into ritual battles or whether one or more sides will become dominant within the primary care trusts. Such issues have enormous implications for the morale and commitment of NHS staff. This thoughtful and balanced book is one that all tribal members will find valuable and accessible in understanding the world they now inhabit.