David Maddison

TAKE ME TO YOUR LEADER: THE PSYCHIATRIST IN THE HEALTH CARE SYSTEM*

Within the collected works of A. A. Milne the creative genius who introduced to the world the tales of Christopher Robin, Pooh, Piglet and a host of lesser animals any psychiatrist who takes the trouble to look can uncover a vast treasure house of descriptive psychopathology and clinical wisdom. One of these stories has a special relevance to my theme tonight. Many of you, I am sure, will recall the exciting chapter in which Christopher Robin musters what he chooses to call an Expotition to discover the North Pole. The ensuing drama has many salutary lessons for those of us who care to define what we are seeking, and to establish the most effective means of progressing towards our goal. Pooh, the conscience of the party (was he perhaps a social worker?), puts the question to Christopher Robin before they set out: “What is the North Pole?” to which Christopher Robin, not being quite sure himself, replies carelessly “It’s just a thing you discover”. Later in the day, as Christopher Robin’s courage begins to wane, he initiates the following illuminating dialogue with Rabbit (who was probably training to be a health service administrator, as he is described as “looking important”): C.R.: “Rabbit, I suppose you don’t know, what does

Professionalism and community responsibility

Abstract The extremely privileged position occupied by professionals in todays society has not, it is suggested, always been matched by a corresponding accountability of the professional to the community which rewards him so well. The professional is subjected to many stresses, not the least of which is the inseparability of hisprofessional image and private lifestyle. Pressures of this kind tend to force professionals into an increasingly restrictive association with members of their own tribe. A further stress arises from the substantial changes in the professional/client relationship, which have been induced by a number of contemporary social influences; an important consequence of these changes is that the professional is much less likely to receive gratification of his needs for mastery and power. The response of professionals and professional associations to these new circumstances has been less than appropriate in many instances.

Health orientation in medical education, Australia

Abstract A new medical school has the opportunity to examine afresh some of the conceptual bases of medical education, but for a variety of reasons this opportunity is all too frequently ignored. This paper describes a new school in Newcastle, Australia, where a number of circumstances made it desirable and possible to develop an education program which incorporated an appropriate emphasis on prevention, both in individual and population terms. Epidemiology, demography, and medical sociology are seen as the fundamental disciplines required to underpin such an approach. First, the technique is described by which concepts of prevention are incorporated into that strand of the curriculum which comprises a problem-solving approach to the complaints of individual patients; there follows a description of strategies to involve students in the health problems of groups, and examples of some projects which are planned and implemented by students at different stages of this program. Students are expected, by the time of graduation, to have learned how to integrate the individual and group perspectives in their approach to preventive medicine.