Aerosol Science

Doctors and Nurses in Industry. Social Aspects of In-Plant Medical Programs. By Rhoda L. Goldstein and Bernard Goldstein. (Pp. 96; $2.00.) Rutgers, The State University, New Brunswick, New Jersey, U.S.A. London: Cambridge University Press. I967. In reading this report it is plain that comparison of practices and results achieved by occupational health services are invalid where there is a marked difference in the social climate, customs of industry and commerce, and the attitudes of all grades of workers. In Great Britain we have grown so accustomed to the benefits which accrue under the National Health Service that we tend to forget what a blessing they are, particularly to lower income families. Where these conditions do not exist, as in the industries discussed in this report, many factors inhibit doctors, nurses, and all grades of workers from making what we, in this countrv, would consider adequate use of professional skills in the working environment. The report is, however, an interesting study of the place of doctor and nurse in what we must assume is a fair cross section of the social environment in United States industry in New Jersey. I had wrongly assumed that the place of the doctor and nurse in industry in the United States had passed through the stages which we have largely left behind in Great Britain. But it would seem from this survey by two eminent sociologists, who describe the situations in great detail, that the tasks of the medical teams in these industries are so strictly limited by the need to avoid treading on other doctors' corns -that concern for the patient can hardly extend beyond pre-employment medical examinations and the first-aid care of occupational injuries and diseases. The difficulty in the strict definition of these limitations is recognized by those working in industry but seems to be a source of friction with medical colleagues outside. It appears that the reason for the lowly opinion of the doctors in New Jersey for their own place in medicine, and the apparently equally low opinion of them held by their colleagues, is in part due to the belief that the doctors not only regard themselves but are regarded as being responsible for lowering sickness absence rates and spotting malingerers, and in so doing show little appreciation of the many social and cultural causes for sickness and absence from work. A further reason is the non-payment of workers when absent through sickness, which makes preventive measures very difficult and mutual trust almost impossible. The different relationships between the nurses and the industrial communities of which they are a part is most striking, but again the limitation which the social climate imposes on their activities within the workplace is borne out by the investigators; their relationship with supervisors is commented on, their relationship with any higher level of management seems to be very slight. It seems that we in this country have much to learn from this honest assessment, but even more, we have much for which to be thankful. J. J. O'Dwym