This paper draws on classical theories of wisdom to explore the organisational impact of nurses on Australian general practice. Between 2004 and 2008, numbers of general practice nurses doubled, the most rapid influx of nurses into any Australian workplace over the decade. Using data from the Australian General Practice Nurses Study, we argue that nurses had a positive impact because they introduced techne at the organisational level and amplified phronesis in clinical activities. In its Hippocratic formulation, techne refers to a (...) field of definable knowledge, which is purposeful and useful and requires mastery of rational principles. Nursing, with its focus on system and accountability, brought techne out of the GP’s consulting room and into the general practice as a whole. Nurses also exemplify phronesis, an Aristotelian virtue connoting a reasoned and honourable capacity to make judgements: the practical wisdom that defines the interaction between clinician and patient in general practice. At a time of significant GP shortage, doctors and nurses began to collaborate around their more complex and time-consuming patients, leading to a deepening of phronesis in the workplace. By bringing techne to bear on the organisation, and complementing and enhancing phronesis, nurses propel organisational wisdom in general practices. (shrink)

In a globalised world, healthcare professionals will inevitably find themselves caring for patients whose first language differs from their own. Drawing on experiences in Australia, this paper examines a specific problem that can arise in medical consultations using professional interpreters: whether the moral objections of interpreters should be accommodated as conscientious objections if and when their services are required in contexts where healthcare professionals have such entitlements, most notably in relation to consultations concerning termination of pregnancy and voluntary assisted dying. (...) We argue that existing statements of professional ethics suggest that interpreters should not be accorded such rights. The social organisation of healthcare and interpreting services in Australia may mean those who have serious objections to particular medical practices could provide their services in restricted healthcare contexts. Nevertheless, as a general rule, interpreters who have such objections should avoid working within healthcare. (shrink)

Every day doctors bear witness to others about the experiences, needs and feelings of their patients, drawing on what they have learnt from clinical consultations. This paper considers the medical task of bearing honourable and truthful witness through an examination of the role and actions of Horatio in Hamlet. Horatio is simultaneously located among the background machinery of the play, separate from the lives of the protagonists, and in the foreground, where his authoritative witness is repeatedly called upon by the (...) play's characters. Horatio is invited to watch an unfolding disaster, his warnings are not heard, and at its conclusion he stands apart from the drama to give its account. The tensions between engagement and observation, and between partial and impartial accounting echo those faced by doctors in everyday clinical practice. The act of bearing witness, Shakespeare suggests, even for those who are tasked with being objective, is necessarily imperfect, and not dispassionate. Those people, including doctors, who are expected to construct authoritative accounts of the motives and actions of others may find in Hamlet a small lesson on the need to approach their summary narratives about others more humbly, aware of the narrowness and partiality of their perspective. (shrink)