Expert Breakfast Report for 23 May 2018: Prof Ruth Fitzgerald, Dept of Anthropology and Archaeology

Prof Fitzgerald, Medical Anthropologist, gave a most interesting talk mainly on anthropology in health

Prof Fitzgerald began by commenting on the ‘delightful . . convivial breakfast’, contrasting it with her usual rather rushed meal at home, punctuated by fending off her rather large dogs!

She went on to touch on flexibility and diversity in the workforce, and how this is increasingly apparent, noting the need for members, even those training for a specific professional course, to talk across disciplines and mix with other people in order to give back to the community the best possible return from the “wonderful course of study that you are embarking on.”

She illustrated the flexibility needed using her own career, which began as a radiation therapist and included working out, with the aid of detailed anatomical knowledge, sketching, maths. and physics, the best way to apply radiation for particular cancers. This all changed with the introduction of computers, which took away most of the above skills through CT scans, MRI’s and the ability to rapidly calculate, although there remained the need to talk to people a good deal, a very important aspect of the job, but now it was not as satisfying, and so she retrained.

Having become interested in media, she started to work as a radio journalist which she continued for some time. Then, through ‘romantic entanglements’ she came to New Zealand where she finished her degrees, including a PhD in Anthropology while working in a hospital. This was the time when the old triumvirate governing hospitals - Matron, Medical Superintendent and Financial person - was being replaced by Managers. Astonishingly, it was seen as a disadvantage for such posts if you had any health work experience - they wanted a new way of thinking about things.

Guided by this development, one of her early research studies was about what it means to try to give care in this changing environment “What does care mean if you are a Health Care Worker?” This involved interviewing a wide range of hospital workers, including the more obvious, but also receptionists, cleaners and orderlies, all of whom, she was somewhat surprised to find, played a part in the caring aspect of health, sometimes with patients, sometimes with visitors of patients, with a bit of counselling going on.

One of the orderlies she interviewed, at this stage in his sixties, gave a long story, “You know, I was just a young boy, . . . fresh out of the bush, and I and reported in, and they said to me, ‘OK, lad, just go and get that man’s leg out of the car.’” The patient had had his leg disarticulated in an accident, and this young boy had to go and get it as his first introduction to medicine. “I tell you, that was a strange thing for a boy from the bush to see.”

Prof Fitzgerald used the orderly's experience to illustrate how entering Health Care is like entering a gateway to another world, “A world where suffering, where you see pain every day. It’s not a world ... you want to visit if it’s in your own life or the life of your loved ones. . . It becomes, not the norm in the sense you are anaesthetised to it, but you develop an expertise and a compassion . . . So he was a wonderful carer, that man. . . I asked him ‘what does care mean for you, then?’” He described taking frightened patients from one part of the hospital to another. Sometime he would tell a few jokes, but for other patients he would just chat about unimportant things, and other times he would be asked about the department to which he was taking them, and he would say a little about it, trying to allay their fears. “He was exhibiting a really nuanced intelligence. He was evaluating people. He had worked out a series of classical presentations of people who are reacting to their situation and developed his own little repertoire of how to respond. . . Good Health Care practitioners tend to do that.”

Early in your studies you are preoccupied with becoming technically competent and learning everything because of the consequences of not getting it right. “Believe me, as you progress through your training, you will acquire that knowledge. You will have it so confidently and competently set in your head . . . Later, you will develop even more strongly the ability to use your emotional intelligence sensitively.”

Physicians trained in oncology said to her that the most important job they had was to talk to cancer patients about dying. “You are sort of OK about dying in the end, it seems, but you want to know how you will die.” These practitioners develop a sort of quiet courage and confidence and compassion - "I’ll wait with you. I’ll be beside you. I’ve seen this before, I can offer you some help.” At this point Prof. Fitzgerald mentioned a surgeon in the US, Atul Gawande, “a deeply sensitive and deeply compassionate person . . .He’s really good to read. Anthopologists will love him, Health Science people will love him, too.”
[Ed. - Atul Gawande’s book,”Being Mortal” is held in the Medical section of the College's library].

Ruth also touched on the fact that everyone she had interviewed on the subject of care in health had admitted that there were days when they didn’t really care. This has led to what Arlie Hochschild refers to as ‘emotional labor’*, which involves "reproducing emotional memories, and transferring them to another situation in order to . . deliver this emotional connection with people that helps them move forward.”

Returning to hospital managers, Prof. Fitzgerald noted the turmoil they produced, with their emphasis on clinical staff being too fixated on tradition, expressing the view that“You think it’s a vocation, this is a job. We can split off these competencies. We can train an assistant to work with you at a third of your salary” - and so on. “It would be tempting to be very rude about those managers, and denigrate them. But what I came to finally understand was that they cared too. But what they cared about was the system. They loved numbers . . flow charts .. They wanted to use money wisely and invest it well.” They saw the patient as a customer, who had paid their taxes and needed to be looked after. “And in fact there is something about these two understandings, these rich, personalised interpersonal encounters, from the clinical side, and this process view of the customer from the other side. They actually still can talk to each other, because if you want good customer service, you actually want good care.” So it was possible to find points of communication between these two approaches. . . . Learning to see the other side is just very important these days. It is very important in multidisciplinary teams, looking at the triple bottom line is important as well.”

Questions raised yet more interesting information, - on biological anthropology, cultural understandings of genetics, the complications of genetic abnormality and pregnancy termination, medical use of marijuana, the Brompton Cocktail, friendship research (including ‘frenemies’** and how good friends in Hall may not make good flatmates! - but once again, I have reached (and passed) my word limit.

*[For more on ‘emotional labour’ see:]
**Try the Urban Dictionary for that one!

Posted: Wednesday May 23, 2018