My eyeballs bulged but I hoped that no one would notice. I had not observed hospital pharmacists at work for years. Hello short sleeves and open neck. Goodbye white coat (fully buttoned) and, for men, ties.
Enormous pressure exists for individuals to conform with the behaviour of their group, such as wearing contemporary professional livery. Conformity is efficient, minimising an individual’s requirement for thought. Presumably, frequently washed bare arms and no long ties to dangle within wounds reduce the risk of cross-infection. So does the uniform of surgeons: many still sport bow ties. My sociological sensitivity nudged me to wonder why some things changed, quickly, while others remained unchanged.
New ways of looking
As a pharmacy student in the 1960s I received zero academic input in behavioural science. All pharmacists trained since the era of the Nuffield report (1986) have received some, if limited, training in behavioural sciences; this applies whether their school of pharmacy was within a science or a healthcare/medicine faculty.
I was a sociology student in the 1990s, and the perspective of the sociology of the body, which was popular at the time, fascinated me; that showed in publications such as “The smooth and the shaggy” (PJ 1995;255:229). The sociology of the body is one of an array of incursions into social sciences that have happened over the years.
Around 1860, the zeitgeist was that human laws would be discovered that were nearly as certain as those applying to matter. Indeed statistics were applied to the social before the natural sciences; the hump-backed normal distribution curve was an early icon. However, universal laws, of the status of those in thermodynamics, were not found. Sociologists, for example, became discouraged with that search and today believe that their very plethora of perspectives makes them valuable tools.
In fact, “laws” in natural and social science are on a spectrum of uncertainty. Natural scientists proudly expect even their most hallowed laws to be “displaced” over time; that results from never-ending challenge. The social sciences have enormous complexity, feedback loops, the requirement to cope with free will and so on.1
One recent incursion into sociology excites me. In complexity theory (CT), statistics is applied to the behaviour of big numbers of individuals. Although the behaviour of individuals is seldom predictable, random behaviour of the many, in groups, is.
The chemist and physicist Philip Ball superbly overviews the dazzling insights now available.2 Illustrations include co-operation, degrees of separation in networks, game theory, ghetto formation, marketplace rhythms, riots, tipping points, traffic jams and war. A range of quantitative behavioural models mirror physical systems. One example is particles randomly adding to aggregates to branch into the fractal patterns of Mandelbrot sets, as seen in snowflakes. Another is sudden changes in phase such as the condensation of steam to water to ice. In the 1950s, during a party trick, I melted moistened sodium thiosulphate crystals in a boiling tube, plugged its end and allowed it to cool. A liquid remained that after seeding, “instantly” recrystalised, hot. Now, through that mirror or prism, perceive afresh a hindrance in the flow of vehicles (a traffic jam) — or prescriptions.
CT is a fresh approach to a centuries-old dream. Some sociologists welcome it but others do not.
My hunch is that its natural scientific models and connected social scientific metaphors would resonate with pharmacy undergraduates. Movers and shakers in pharmacy academe should encourage their behavioural scientists not to dismiss this approach as a fad but to include it in their teaching. I suspect that medical students are also ripe for exposure to CT. Pharmacy practice researchers should also delve in. They are free to cherry pick from, for example: economics, physics, psychology and sociology while economists, physicists, psychologists and sociologists seldom dare leave their respective territories, fearing attack. Interested pharmacists could reflect upon CT and produce continuing professional development reports that would wow their assessors.
I go further. In the real world of pharmacy practice, pharmacists must cope with all manner of complexity. Perhaps the most complex are ethical issues: what should be. Natural scientific laws are compellingly good at explaining and predicting the future: what is and will be. Established for centuries in prime position, natural sciences can deliver a murderous wallop to younger contenders. But natural science is silent about what should be. Social scientists know of that area; today, they tip-toe around it. However, pharmacists and other professional practitioners must venture into that territory; each individual must use ethical judgement using her or his free will to choose and then act. That does not mean just following a pre-ordained time-saving code of ethics: that removes the requirement to ponder and choose. Only an individual can decide. That may be within a hectic environment with many conflicting demands on time. Such a situation may be as difficult to quantify as attempting to create a mathematical equation for “spring”. But perhaps, given sufficient computing power, it may become possible — eventually.
A new Newton in pharmacy’s fold?
CT cries out for someone, some latter-day social scientific Newton, to amalgamate its scales or domains — and any other pertinent theory — into one astonishing whole. Its prism would integrate, for example, the laws of thermodynamics, differing behaviour by an individual and a crowd, the random Brownian walk of accumulating dust particles, patient/professional concordance and professional/employer relationships.
It would be wonderful if that Newtonian giant emerged from pharmacy’s fold. If it comes to pass, remember that you read about it in The Pharmaceutical Journal first.
References
- Brown ME, Hubbard S. Instabilities in nature & art. Philosophy Now 2013;94:27–9.
- Ball P. Critical mass. How one thing leads to another. Arrow Books, 2004.