A geography of the swampy lowlands in primary care

[摘要] Writing about how to prepare professionals for the demands of practice, Donald Alan Schön, a professor of urban studies, famously reflected:‘In the varied topography of professional practice, there is a high, hard ground, overlooking a swamp … In the swampy lowland, messy, confusing problems defy technical solution … in the swamp lie the problems of greatest human concern. The practitioner must choose. Shall he remain on the high ground where he can solve relatively unimportant problems according to prevailing standards of rigor, or shall he descend to the swamp of important problems and non-rigorous inquiry?’1CHALLENGING TERRAIN Those who work in primary care in the UK should be forgiven for identifying with Schön’s metaphor. The professional terrain is difficult and an ‘aerial’ academic or policy view (even a sincere one) can fail to appreciate the situated realities in which we work. Those on the ground, by contrast, struggle to appreciate the larger workings of ecosystems and geography, as well as each other’s struggle. Indeed we can be frustrated by it, crushed to the point of resignation, or worse.In this issue Nada Khan examines the increasing waiting times for ambulances, finding a system under pressure rather than fault from any professional group.2 Sharon Dixon and colleagues bring home the importance of understanding the diverse ways in which the different workers in a multi-agency safeguarding team operate.3 Failure to understand the ‘multi‘ here is at the core of failures to protect vulnerable children.Peter Lindsay reviews Jeremy Hunt’s book: Zero: Eliminating Unnecessary Deaths in a Post Pandemic NHS. He describes the book as, ‘… a political document published, poorly written, and edited with obvious haste’. The implication here is that a failure to understand or adequately represent the realities of health care can contribute to catastrophic failures.

[学科分类] 卫生学