Nursing, Physician Control, and the Medical Monopoly by Thetis M. Group and Joan I. Roberts. Bloomington, IN: Indiana University Press; 2001. 514 pages, $37.95.
According to Group and Roberts, the successes and failures of the nursing profession cannot be understood unless they are "linked to the relationship between gender and professional roles as these have changed over time."(p.xiii) The authors' purpose in writing this book, for an intended audience of nurses, physicians, and historians of health care, is to do just that. In it, they trace the development of the "continual efforts by physicians to achieve a medical monopoly by subordinating their only genuine competitors: nurses,"(p.xxxvii) analyzing "evidence of early women healers prior to the 19th century and tracing their "increasing subordination to physician control" over the following period.(p.xxxvii) In subsequent chapters, the authors first focus on nurses and women healers in Great Britain from the 1800s to early 1900s, identifying the trajectory toward nursing subservience that influenced American health care (see page xxxviii), then turn toward discussions of different conceptualizations of American nursing history, nurse-physician relationships, the consolidation of the medical monopoly in the 1920s and 1930s, the impact of technology and science at mid-20th century, and "nurses' and consumers' critiques of the health-care system" today.
It is easy to agree with Group and Roberts that understanding the history of nursing can shed light on the present situation. It is, however, difficult to agree that the profession's successes and failures can be blamed solely on physicians, which is what the authors assert. While Group and Roberts succeed in describing the significant role that women healers played throughout previous centuries, the authors lay the blame for their demise solely on the rise of scientific medicine without noting the benefits of those changes in the 20th century and without due recognition of the fact that both men and women practice medicine. Moreover, the authors slip into the historical fallacy of assuming traditional dichotomous interpretations of medical and nursing history ("medicine = male = science" versus "nursing = female = caring"), taking gender discrimination too literally. What is disturbing is that Group and Roberts argue that the medical profession alone restricted nursing from its independent practice. Perhaps a thorough review of historical facts would have been beneficial. What the authors fail to note is nursing profession's own role in limiting scope of practice as evidenced in the American Nurses Association's model definition of nursing1-a definition that would unduly restrict nursing practice for the next several decades. In addition to negating the role of organized nursing in restricting nursing practice, what the authors miss in this account is the longstanding collaborative relationship between nurses and physicians, particularly at the grassroots level and particularly with nurse practitioners in the second half of the 20th century.
I would agree with the authors that the current system of health care is overpriced and fragmented. However, not all that is wrong can be blamed on physicians. This historic tendency not only is inaccurate, but also is counterproductive. While the book will spur discussion among historians of health care, what would have been more interesting would have been an accurate portrayal of the changing roles of nursing throughout the 20th century and the changing relationships with the medical profession.
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