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Health Care Practitioners: An Ontario Case Study in Policy Making.

Patricia O'Reilly, Health Care Practitioners: An Ontario Case Study in Policy Making (Toronto: University of Toronto Press, 2000)

HEALTH CARE PRACTITIONERS provides detailed, descriptive documentation of the social history of a wide variety of health practitioners in the province of Ontario. One table alone represents the positions of 45 different practitioner groups after the Regulated Health Professions Act (RHPA) of 1991. Calling her work a story, O'Reilly provides a post-positive analysis of the history of policy-making and change in the positions and divisions of various health care practitioner groups from their own perspectives and the perspectives of various representative spokespersons, as well as written documentation. She argues for the method of hermeneutics, which involves placing herself in the position of those studied in order to get at their version of reality, their story. The analytical base is the dialectic of the interaction between ideas and institutionalization as understood hermeneutically in the dynamic development and growth of these practitioner groups.

This is a valuable book that brings together extensive documentation of Ontario health care from the point of view of the role of practitioners vis a vis one another, the state, and the public dating from 1788 in British-governed Quebec. Here a particular group of practitioners was elevated above the others. They were said to be scientific as they were educated in Great Britain. This elevated status was legislated and stricter licensing procedures began to be enforced. From the early beginnings to the modern period, O'Reilly documents the processes whereby various practitioner groups were embedded, marginalized, and excluded in and through health care legislation. She summarizes some of these processes in several interesting tables that divide practitioners into those who deal with the whole body and are independent such as medical practitioners; those who are merchant-service providers such as dentists; those who are technique specialists such as chiropractors; technology specialists, such as dental technolo gists; and those who are assistants such as registered nurses. These groups are categorized at several points in time in terms of their degree of embeddedness, marginality, and exclusion.

The book itself is 244 pages long but it includes 100 more pages of footnotes based on readings of a myriad of historical policy documents of numerous practitioner groups, "associations," "colleges," "boards," and "societies," as well as legislation. It also includes over 100 interviews with representatives of all of the colleges and some of the associations of health care practitioners governed under the RPHA, key policy advisors, bureaucrats, government officials, and a sample of non-RHPA-regulated and non-regulated health practitioner organizations as well as health practitioners themselves. Finally, O'Reilly includes a participant-observation component to background herself in this research. She worked in the provincial health care bureaucracy during the drafting of the RHPA.

This is a book of detail, of history. It is not a book of explanation and prediction. It is not a book that tries to understand the processes observed through any new or even older theoretical/explanatory lens. The interviews, while claiming to represent the viewpoints of variously situated bureaucrats and practitioners, are not actually situated in any systematic way that would allow them to be seen as representative and allow generalizations to be made on their behalf. This is the story of the things said, about ideas and institutions from the perspectives of the health care practitioners and their groups and associations. It is not, however, a study of their actual behaviour. Nor is there a window on the ways that conflicts and complex negotiations were worked out. As such, although its focus is on change overtime, there is little discussion of the difficult processes through which change was worked out. Max Weber is mentioned once, in the introduction. Karl Marx is never mentioned. This is not a study tha t contextualizes the local (Ontario health care practitioners) by paying attention to larger theories of social and political/economic change. Rather it is a story, well written and full of rich detail based on interviews and written reports with a focus on the 1960s to the 1970s.
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Author:Clarke, Juanne
Publication:Labour/Le Travail
Article Type:Book Review
Date:Mar 22, 2002
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