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A PROPOSAL FOR NEW CAREERS IN HEALTH CARE JAMES S. TERRY* Despite the legal recognition of over a hundred different careers in health care, there are still important functions in any hospital or medical center which go unperformed. The slack is presently being picked up by other professionals—typically, nurses and residents. But to get these jobs done well, it will be necessary to recruit and train a new cadre of health professionals in the near future. Some examples of these new professional roles are provided below, together with briefjob descriptions, as a way of indicating what we are doing, not doing, or doing only poorly. Other examples may easily be imagined. The point is to stimulate additional reflection on the present structure and function of the modern hospital and perhaps to admit a few imperfections and human foibles in the process. I. Nihilism Therapist The tradition of therapeutic nihilism in American medicine is an old and a venerable one, and it has always been asserted by a determined minority that most problems get better by themselves. Unfortunately, a tendency toward overzealous workup and treatment is still too prevalent . Thejob of voicing doubts, shattering expectations, and reminding everyone of impending mortality should be given to a person with explicit training and experience in those activities. The qualified applicant will be either a physician with at least 30 years of experience or a younger person who happened to have a very forceful and quotable grandmother. Familiarity with pertinent literature by Marcus Aurelius, William Osier, Jean-Paul Sartre, and Woody Allen is required. Relevant skills will include mobility ofthe head and neck, thick and expressive eyebrows, fondness for phrases beginning with "alas," and command of the humoral theory on the physiology of black bile.»School of Medicine, Health Sciences Center, State University of New York at Stony Brook, Long Island, New York 11794.© 1984 by The University of Chicago. All rights reserved. 0031-5982/85/2801-0418$01.00 Perspectives in Biology andMedicine, 28, 1 ¦ Autumn 1984 \ 35 II.Resident Fool Based on case studies reported in the Shakespearean literature, important social and organizational functions are performed by a fool attached to those in power. Given sufficient freedom of expression, this person can offer candid criticism, temper hasty or imperious decisions, and help in the maintenance of necessary objectivity and humility. The fool's role is especially important when others of modest rank and station characteristically believe that they cannot challenge authority due to political vulnerability—such menials, for example, as residents. Applicants for the above position should be in their first year of residency after taking the M.D. at an institution noted for curricular reforms and low board scores. Experience in ribaldry, scatology, satire, or relevant literary disciplines is required. Recommended personal and interpersonal skills include fearlessness tempered by sycophancy, tolerance for the chaotic, and outlandish appearance, preferably cap and bells. III.TurfMonitor Because hospitals are complicated institutions composed of relatively autonomous subspecialties, disputes about invasions of the functions and fields of other professionals are common. These are not only those abstract discussions about what patients should or should not have been admitted (on whose authority and under whose care). Sometimes actual physical turfis in question: for example, the area adjacent to the nurses' station, the residents' locker room, or the office provided either for the assistant to the director of volunteers or the assistant to the director of public relations. AU of this must be sorted out by a designated professional administrator. Competitive applicants will possess at least 5 years' experience in a health-related career or equivalent experience with one of the following specialized agencies: the National Labor Relations Board, the Executive Offices of the White House, the Office of the Commissioner of Baseball, or the Maginot Line. Physical size and strength are additional requisites. A shrill voice and a stubborn streak are desirable. IV. LiaisonJargonist and Director ofInitials Management (DIM) Health care is replete with special vocabulary and abbreviated versions of same. Recent infusions of lawyers, ethicists, social/behavioral scientists , holists, and others have exacerbated the problem. Whereas only the patients used to be at sea, now practitioners are almost equally mystified by many of the acronyms...


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