The Professional Culture: Medical, clinical and scientific professionals populate this culture. Most of this culture’s members hold death as the ultimate but inevitable foe. The scientific and medical professions gave over the task of understanding the meaning of life and death many years ago to religious and spiritual practitioners and the alternative culture, while they focused on the disease processes that happen to bodies.
In this they have been hugely successful. As a result of the efforts of health care professionals, countless numbers of people have been cured, had their lives extended, and had mobility stabilized if not returned fully to them. Exciting new answers emerge from the problem solving done by the professions that make up this culture. Practices improve. Harmful quackery is questioned and eliminated. A host of competent people labor in richly textured jobs. Health care professionals are proud of the work they do.
In managing pain and anxiety, this culture has very much organized itself around the need to control, at all costs, the experience of death by deferring it as long as possible for themselves and their patients. Pain is to be tolerated. Death is to be resisted and overcome no matter what the cost. Professional practitioners have invented models and organizational structures and put systems in place that try to contain pain and defer death.
Nurses have played a particularly active role in establishing these structures. Pain is a valuable source of diagnostic information. Life is a by-product of the struggle against the death of the body. In this sense, the absence of pain and the continuation of life have no meaning for the professional medical practitioner other than as symbols or signs of success. Death calls into question the very nature of and meaning of life, which is the unexplored aspect of the professional culture’s reality. As long as one is focused on the fight against death, then one never has to confront the purpose of this fight, which has something to do with the purpose of life.
We have effective systems, and successful treatment programs because patients have always come first in the professional culture. People from the professional culture have theories about how to organize for maximum effectiveness that have to do with putting patient care first, which in turn ultimately has to do with the prevention or curtailment of death. The patient comes first because it is through the patient that professional health care providers receive repeated reassurance and all kinds of support for the good job they do in thwarting death. This, paradoxically, becomes the central ingredient in the provider’s own sense of life purpose. Members of the professional culture look for strategies of organizational change that hold the promise of increasing their control over and opportunity to influence the quality of health care they provide. Ultimately, they support organizational changes that enhance their ability to heal people and delay the inevitability of death.
The professional culture has been the dominant culture in health care since early in the history of North American health care. It is now being attacked from all sides and must share power with the other three cultures of contemporary health care. The professional culture finds and takes its meaning primarily from the professional memberships and associations of its members.
