Nursing, Physician Control, and the Medical Monopoly: Historical Perspectives on Gendered Inequality in Roles, Rights and Range of Practice (review)

The authors’ goal in this advocacy piece is to enlighten present day nurses by making them cognizant of gendered inequality and their subordination by physicians throughout nursing history so that they can seek professional independence in the health care industry. “All these trends influence the current situation in nursing, and unless gender issues are resolved through the historical analysis of their impact in previous decades, nurses will be unable to make forward progress because they will have little clarity on the essential issues.” (p.xix) Believing that a historical perspective may provide hope for substantial change in nursing and the health-care system, helping to free women health-care workers “to provide the care and cure people really need,” (p.xxxi) Group and Roberts also present evidence that the health care system would benefit economically as well as medically by allowing the nursing profession to work independently from physicians.

This very dense book, which follows a chronological format, is divided into three parts. The organization of the text within each part is somewhat disjointed and disorganized, preventing an easy flow. Part I provides an account of early women healers as well as early nursing history, ending at the end of the nineteenth century. Part II focuses more on physicians’ widening control and increased subordination of nurses from 1900 through the nineteen seventies, whereas Part III focuses on more recent years.

The authors have made use of a wide array of primary and secondary sources, including extensive reliance on medical and nursing journals, proceedings from professional meetings and numerous reports of all types along with historical monographs. The thirty pages of references demonstrate clearly that the authors utilized many sources throughout the book, but there are far too many places in the body of the text where citations are absent, leaving the reader wondering about the source of a particular profound statement that demands a reference. Relying upon secondary sources in order to provide the historical background, on which the authors place a great deal of emphasis, Group and Roberts provide a good overview of the history of women healers and nurses. Part I of the book reads like a bibliographical essay. With entire sections devoted to particular historians’ work, there is little attempt to synthesize the work of all of the historians.

Group, a nurse, and Roberts, a social psychologist, epitomize the problems that non-professional historians often have when attempting to write history. Not only is there a lack of synthesis, but there is almost a complete and total absence of historical context. They “trace the development of the continual efforts by physicians to achieve a medical monopoly by subordinating their only genuine competitors: nurses.” (p.xxxvii) The authors recognize that the subordination of women within the health care professions occurred because the ideology of inequality of the sexes was part of mainstream thought. However, there is clearly an underlying current of blame directed toward the physicians of the past as well as current doctors. Without understanding other relevant issues and processes, the authors are unable to get beyond this. I would argue that the subordination of nurses was far more about physicians’ attempt to gain cultural authority and to professionalize, in an era when many other professions were doing the same thing. Understanding of other concerns and processes, such as race suicide and the cult of domesticity, would also serve to clarify the nurse-doctor relationship. In order to fully understand physicians’ behavior, a broad understanding of the historical context is essential.

The book also suffers from an inadequate understanding of women’s history. Characteristic of numerous women’s struggles is the inability of women to develop political unity. The authors note that “some nurses even now seem to be caught in the traditional subordination of women and exhibit little understanding of their own subjugation...