The Pharmaceutical Journal
Vol 270 No 7255 p908
28 June 2003

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Performance in health services [more]
Chemistry for girls [more]
Pet hates [more]
Body and soul [more]

Performance in health services

The vital role of professionals within health service organisations has been discussed by Chris Ham of Birmingham University in The Lancet for 7 June. He notes that it has been found that in such organisations the ability of managers, politicians and external forces to influence decision-making within the service is more limited and constrained than it is in organisations generally.

There is an important need to understand what motivates a professional person within the clinical environment. The main motivation of clinicians is a desire to help people in a timely and courteous manner by offering a standard of service that is as high as possible. Accordingly, providing opportunities for continuing professional education and development appeals to committed practitioners more than any management view that providing more effective services requires tighter control of those who are trying to practise their profession.

In hospitals, and other health care institutions indeed, there arises an inverted power structure, those at the bottom generally having greater influence on the making of decisions from day to day than any nominal controllers at the head of the institution. "Bringing about change entails slow and painstaking work in which reformers need to engage clinical leaders and opinion formers in persuading their colleagues to do things differently," writes Professor Ham. Reform involves refocusing attention on the education and training of the clinical practitioners to achieve a newly established equilibrium between autonomy on the one hand and accountability on the other.

Hospitals and primary care practices will contain both conservatives and innovators, so that if left strictly alone any changes will be slow to arrive. Reformers may become impatient, and this atmosphere may widen the gulf in understanding between clinicians and politicians. "Creation of organisations in which professionals are willing to follow their peers who take on leadership roles needs as much attention as encouragement of clinical leadership." It is a sobering thought.

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Chemistry for girls

An interesting observation recorded in Chemistry in Britain for April suggests that chemistry may be one of the subjects of study in which women tend to outshine men at the examination stage. A series of 200 students at Cambridge university was followed throughout their university career. In chemistry the women students gained more firsts in their results than did the men. This difference was attributed to the different ways in which men and women learn. In a range of subjects among the sciences and the arts it appeared that women sought to understand the subject matter of their study, whereas men concerned themselves more with trying to achieve high performance during examinations.

Chemistry teaching at Cambridge placed significant emphasis on conceptual understanding, and so favoured women who regarded such understanding as their primary reason for taking a degree. By contrast, mathematics was viewed as a competitive subject where speedy solving of problems was the main consideration, a point of view which men tended to emphasise, holding up the final examination as their goal. In classical studies, as in chemistry, men tended to be overshadowed by women in terms of firsts in examinations. In subjects such as English and history, however, men showed generally better results. It is suggested that a tendency for women to try too hard and to fear failure may be involved.

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Pet hates

In these days of quick profit and competition, the failure of students to learn any Latin or Greek, let alone undertake serious classical studies, has certain consequences that I find singularly irritating. Neglect of the classics has resulted in a gung-ho attitude towards the principles of our language.

Take, for instance, the almost universal use in our daily papers and journals of plurals for singulars and vice versa. I keep coming across reports of the overgrowth of "an algae" in our coastal waters, or of "a fungi" on some priceless surface. I am seriously worried about the singular or plural use of the word "media'', and when I see "a media" I despair. I even find ''appendixes'' and "matrixes" offensive, even though they seem to have become almost universally adopted as plural forms.

Then there are strange pronunciation errors that have even invaded our broadcast programmes that not long ago prided themselves in being guardians of the language and grammar. It is usual today to talk of "die-sect", in place of dissect, but the first would imply division into two parts, the second a more thorough taking apart. The word kilometre is more often than not called "kil-OM-etre", although I do not hear people talking of "cen-TIM-etre" or "mil-LIM-etre". What is the objection to spreading the accent across all four syllables? Anything else is frankly barbaric.

I would suggest, in the interest of our heritage from the western classical civilisations, that we might think again about erasing classical languages from our education repertoire. To our culture they are elemental.

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Body and soul

The celebrated John Wesley was born in Epworth, Lincolnshire, on 17 June 1703. He studied at Oxford, where he lectured in Greek, and in 1728 was ordained priest in the Anglican church. He developed an evangelical style that his fellow parish clergy found alarming, and when he took to open-air preaching in Bristol in 1739 he entered a long period of persecution by the traditionalists and enthusiastic support by the simpler minded. This did not deter Wesley, who went on to establish remarkable advances in the approach to human spiritual needs. He became a prolific writer of grammars, histories, biographies, collections of hymns and sermons and journals.

Wesley not only devoted himself to encouraging spiritual health; he also advocated ways of promoting physical health. He insisted on the healthiness of a spare and temperate diet. He believed that, if someone led a good personal and social life, nature would supply all the necessities for maintaining health.

So far as medicines were concerned, Wesley wrote and published 'Primitive physic; or an easy and natural method of curing most diseases' containing more than 400 recipes for preparing medicines from natural products. It first appeared in 1747, and by 1843 had gone into 36 editions, indicating great popularity. In his definitions of diseases and prescriptions for their relief he relied mainly upon the writings of Sydenham, Dover, Cheyne, Lind and Boerhaave. Editions from 1760 advocated electrical treatment for several conditions.

A curious preparation in which Wesley placed much trust was tar-water. This was made by shaking pine tar with sand and water and filtering. It was given orally for chronic cough and bronchitis or by skin application for eczema and psoriasis. He is thought to have derived it from the Native Americans he met while preaching in Georgia. Towards the end of his life he suffered from gout and diabetes, but what remedies he adopted for their relief is unclear.

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