Reconstructing Medical Practice examines how doctors see health care and their place in it, why they remain in medicine and why they are limited in their ability to lead change in the current system. Doctors are beset by doubts and feel rejected by systems where they should be leaders - some see their role as 'flog[ging] a derelict system to get the last breath of workability out ... for their patients'. Others simply turn away. Rigorous studies carried out at large public teaching hospitals in Australia found that doctors were reluctant to increase safety in the wider health system, despite making every effort for their 'own' patients. Doctors' self-esteem was found to be delicate due to the uncertain nature of their work; colleagues provide the support doctors need to deliver good care. However, these essential relationships and their cherished connections with patients have disadvantages: reducing doctors' ability to admit to error. On top of this, senior doctors predict a future bereft of professional values - one where medicine is 'just a job'. While the loss of professional identity introduces new risks for patients and doctors, the repercussions of the more self-serving attitudes of younger doctors are unknown. Reconstructing Medical Practice concludes that regulation, despite its recent proliferation, is a clumsy and limited approach to ensuring good care. It presents original and much-needed ideas for ways to rebuild the critical relationship between doctors and the system. By better valuing communicative interactions and workplace relationships, safe and satisfying medical practice can be reconstructed.
'This book provides instructive insights into how medical specialists think about their professional lives, ethical dilemmas, and various problems of healthcare delivery. It should interest professional leaders who need to address the part that doctors may unwittingly play in the genesis of these problems, and health service managers who need to re-engage them in finding solutions.' Michael Ward, Commissioner, Health Quality and Complaints Commission, Australia 'One of the sharpest minds I've come across in applied HSR/medical sociology.' Trisha Greenhalgh, Professor of Primary Healthcare, Queen Mary University of London 'Doctors are dedicated to the welfare of their patients, yet many are resistant to changes designed to improve clinical outcomes. Christine Jorm is able to empathise with the doctors she interviews, while seeing the wider consequences of their lack of engagement and setting out a vision for a new medical identity which can encompass both patient care and system improvement.' Charles Vincent, Imperial College London 'Dr Jorm has made a significant contribution to our understanding of the mood and misgivings of clinicians in the public health system of New South Wales and is of relevance to all jurisdictions with a public hospital system in the Western World ...this research will provide bureaucrats and politicians with an understanding of the opposition they will face, and hopefully the wherewithal to constructively turn the situation around. Jorm is to be congratulated for the work and thought she has put into this project. I for one am proud that she has contributed with good cheer to a cause that many walk away from in despair - hopefully for the public good others will be as dedicated.' Review posted on Amazon.co.uk ’...a probing insight into contemporary doctoring. It is a clarion call to practising doctors: if you care for your patients, you can’t turn away from the system of care. To understand and act on the system, open yourselve