“Your baby is suffering from a genetic skin disorder, her skin is too fragile, she’ll probably not make it over the next few days.” Shock and bewilderment summed up our family’s emotions. Now, 10 years later, although not cured, our niece Myra is doing quite well, and we can reflect on our experiences.

As medical students we are painfully aware of the different priorities of doctors and patients; as second generation members of an immigrant Pakistani family we have struggled to reconcile traditional beliefs with Western medicine.

Myra suffers from recessive dystrophic epidermolysis bullosa (EB), a congenital skin disorder characterised by blistering of skin and mucous membranes on even mild mechanical trauma. When she was born we had not heard of EB.

The first few weeks after discharge from hospital were particularly stressful. Although the nursing staff had encouraged us to handle, feed, and bandage her, being away from the hospital setting gave us great cause for anxiety. What would we do if something happened?

It was no comfort to find that medical staff seemed to share our ignorance. Nobody seemed to know what care entailed apart from careful handling to prevent blisters from forming, or what to do about blisters once they had appeared. We were advised to cover them with dressings and leave them alone, but we found that this made them worse and it was better to lance them with a sewing needle boiled in water. We felt guilty about doing something against medical advice which might cause pain, and were greatly relieved when the EB nurse specialist later informed us that this was exactly the right thing to do. If left, the blister spreads rapidly along the abnormal plane of cleavage in the skin.

Families of children with EB and other rare disorders soon become experts on their children’s condition, and are then in the unfortunate position of having to tell medical staff how to handle their child. There have been times when medical staff have unintentionally caused blisters on Myra’s skin. Such experiences, coupled with the fact that there is no known cure for EB, are hardly conducive to patient confidence. When Myra cannot walk because of blisters on her feet we wish we could get some help from the doctor, but we know there is nothing to do but burst and dress the blisters and wait for them to heal.

Perhaps the most distressing aspect of the disorder involves the problems with feeding. Blisters and raw areas in the mouth and throat mean that eating and drinking are always uncomfortable and sometimes impossible. Children with EB suffer chronic blood loss from the skin and are always anaemic and underweight.

The paediatric district nurse has been the most helpful and approachable member of the medical team. She has become a trusted family friend, providing a link with the hospital and providing considerable psychosocial support.

Coming from a Pakistani Muslim background certainly influenced our perceptions of the aetiology of EB. Myra’s affliction was seen by our elders as either a punishment from God or a result of black magic. It could not be genetic because there had never been any other known cases in the family. It could not be the result of Myra’s parents being first cousins because cousin marriages have occurred for generations and any associated risks would have been known a long time ago. The birth of two unaffected siblings after Myra reinforced these beliefs. For a time it was a case of Them (Western doctors) and Us.

Our cultural and religious background also influenced management. Doctors are highly respected and are expected to come up with all the answers. Among the Pakistani community there is always a readiness to explore other avenues for solace, some more effective than others. Prayer would play a major part in deriving hope and it was certainly the case with us. Resigning oneself to the will of God features predominantly: believing it is a test which requires forbearing may be psychologically therapeutic. Unfortunately in the case of our family it led to a false sense of security and the mistaken belief that it could not happen again. Some families would consult a hakeem in the hope of either a herbal remedy or prayers to promote cure. A relatively common thing is to attach an amulet to various parts of the body, usually around the neck, in the hope that it will promote healing.

At first we believed that Myra’s illness resulted from a supernatural force of evil, and we therefore placed an amulet, obtained from a hakeem. This was removed after a few years and replaced by prayer and hope. Prayer helped to reassure and also served as an outlet for frustration and disbelief. On several occasions family members would return from a trip to Pakistan bearing possible remedies, usually herbal, which we administered along with Myra’s other medicines. None was effective. We had no idea of what they contained, and this was a cause for concern. There was no doubt that the family would try anything that came with strong recommendations from other members of the community.

Eugene Ogrod, MD, JD, CPE is the new executive director of the Oregon Medical Association. He received his MD from Stanford University and has been a practicing physician in internal medicine and hematology/oncology. He earned his JD from Cal-Davis and focused on medical and legal issues. He is one of the founders of a large medical group and the chief medical officer for a major health system.

He is a past president of the California Medical Association (CMA) and served his entire career in a number of capacities for CMA and the American Medical Association. He is also past president of the American Society of Internal Medicine/American College of Physicians.

This article documents the development of career counseling in Malaysia from 1957–when the British colonizers departed–to 2000. Although counseling, psychology, and psychiatry had their roots in mental health and medical environments, career counseling had its origins in the system of schooling and has now spread widely to business and industry. This article presents information on the historic and economic context of the development of career counseling, an exploration of the educational system from which career counseling was born, the cultural elements that have formed career counseling in the Malaysian context, and the application of M. Pope’s (1995, 2000) stage development model to the development of career counseling in the Malaysian context.

The history of counseling in Malaysia has been previously documented (Halim, 1984; Lloyd, 1987; Scorzelli, 1987) along with the history of psychology (Othman & Rahman, 1991; Ward, 1983) and psychiatry (Buhrich, 1980). Each of these authors looked at one mental health profession in the context of Malaysian society. No one has, however, specifically reported on the history and development of career counseling in Malaysia.

Although counseling, psychology, and psychiatry had their roots in mental health and medical environments, career counseling had its origins in the system of schooling that has now spread in Malaysia to broadly incorporate business and industry. This article is organized around the historic and economic context, an exploration of the educational system from which career counseling was born, the cultural elements that have formed career counseling in the Malaysia context, and the stages through which the culture has gone in the development of career counseling.

Historic and Economic Context

To understand what a nation is now and may be in the future, it is important to have knowledge of its past and how it developed. Malaysia is geographically positioned at the crossroads of economic trading between the East and the West. Occupying a peninsula jutting down from Thailand, it was perfectly positioned for sailing ships in the 1500s to 1800s to follow its coastline as they searched for an entry point for trade with Asia. To reach China, traders had to pass through the Straits of Malacca, a narrow band of ocean with Malaysia on the east and the Indonesian island of Sumatra on the west.

Economic Crossroads

As trade between Asia and Europe became increasingly important to both continents (e.g., tea, tin, pepper, other spices, silks), European nations competed for control of these straits because control of the shipping lanes in the Straits of Malacca was critical to such trade (Wallace, 1869; Winstedt, 1981). The middle section of the Straits of Malacca (headquartered at Malacca itself) was controlled by first the Indians (400 B.C.E.-539 A.D.), then the native Malays (1445-1511), next the Portuguese (1511-1647), and then the Dutch (1647-1824); all the while, the Chinese kept political and economic relationships with each new ruler (Winstedt, 1981). None of these nations desired to colonize the whole of the area but only to control this important shipping port. The British gained a toehold in Malaysia in 1786 when they developed a settlement on Penang Island (at the northern beginning of the Straits of Malacca) and then in 1819 when they developed a settlement at Singapore (on the most southern tip of the Malayan Peninsula, at the southern end of the Straits of Malacca).

Malaysia was a series of independent states before the British took control, each ruled by a king or sultan. According to Tregonning (1966), nearly all of the native Malay community, however, accepted the British rule, as “the British worked with them, respecting their faith, their social structure, and their rulers” (p. 18). This was the strength of the British and led to their successful rule. The British mined the tin, gathered the rubber and tea, developed a transportation infrastructure (highways and railways) to get the goods to seaports for shipping to Great Britain, and developed governmental and educational systems that were based on their own models.

World War II, however, was the beginning of the end of the British colonization of Malaysia (Tregonning, 1966; Winstedt, 1981). Facing a rising nationalism, the British gave Malaysia its independence in 1957. As they left, they installed the Malays in government and the Chinese in business, paying tribute to a tension that had been a part of Malaysian society for hundreds of years (Mohamad, 1970). The British left a legacy upon which all modern Malaysia is built–a legacy of “communalism” (divisions into Malay, Chinese, and Indian communities), of educational institutions bearing their imprint, of remarkable roads and transportation, and of a constitutional monarchy in which a king is elected every 4 years from among the nine sultans who rule the Malaysian states.

Although China has a long history of vocational guidance, it is functionally at a beginning stage in career development and counseling because of the historical vagaries of its political leadership. Vocational guidance and career counseling services, as a professional field, are now rapidly being developed to meet the growing need of Chinese society. M. Pope’s (1995, 2000) social transitions stage model is applied to the development of career counseling in China. In particular, this article addresses historic and current trends in the economy and labor market in China and their profound impact on the development of career counseling.

In an emerging global era, high technology and new information systems promote a new economy, bringing a revolution in education, the labor market, and lifestyles throughout Asian and Pacific Rim countries. The People’s Republic of China (China) is no exception. China is now going through a total transformation, with remarkable achievement not only in its economic development but in all aspects of society. The new market economy has created a new critical condition for career development of the masses as well as openings for career professionals. As a response, vocational guidance and career counseling services as professional fields are being rapidly developed in China.

Although communication technology has transformed separate countries into a global village, it is important to look at the changes taking place in the People’s Republic China as well as the impact of the social conditions in China on career development in the country.

Pope (1995, 2000) advanced a social transitions stage model to describe the development of career counseling in the United States, with stages identified from the third author’s historical research. In an extension of this social transitions stage model, W. Zhang and Pope (1997) applied this model to the development of career counseling in China and Hong Kong. The current article expands on that analysis and discusses the present system more in depth. The purpose of this article is to increase the understanding of career development in China by highlighting the current trends in the economy and labor market in China, their profound impact on the development of career counseling, and their potentially significant professional implications.

Cultural Context for the Development of Career Counseling

Although vthe founders of China’s vocational education system were visionary in their views of individual career choice and the role of vocational guidance in that process, the road to the development of career counseling has been rocky and has been strewn with political landmines (France, 1990; Hu, Chen, & Lew, 1994; W. Zhang, 1994; W. Zhang & Pope, 1997). It has evolved from a vocational education model, to a political/ideological education model, to a guidance teacher model, to its wholesale demise, to its rebirth during the last decade.

Within the last decade, China embarked on a new program to reform its economy. In 1992, the 14th National Congress of the Communist Party of China (CPC) stated that the goal of China’s economic reform was the construction of a socialist market economic system, and since then, steps have been taken to promote the transition from a planned economic system to a market economic system (Hu et al., 1994).

The market-oriented economy brought a dramatic revolution to the Chinese employment system, which affects nearly the entire population in all urban areas of China. The first revolution to appear among education institutions was a change in student placement systems. Under the ideal Marxist system, there would be a job for all citizens, and, for nearly a half century, the Chinese government, through a national economic planning policy, undertook the responsibility of finding a job for all graduates, including college students and high school students.

During this time, career was defined by the state and was introduced to younger generations as an individual’s total contribution to communism and social improvement. People heavily depended on the government to find jobs for them; however, rarely was there any individual choice regarding which job was given to the individual. Schools convinced students to obey placement arrangements by teaching them that in order to build a socialist society, they needed to be placed in occupations that were needed, not necessarily occupations in which they had any great interest. With the economic changes of the 1990s and the market-oriented reforms, schools and universities no longer took total responsibility to present every student with a job. Students now were forced to find their own jobs.

The second revolution in the Chinese employment system was the transition from state-guaranteed job security to market-oriented job employment (State Council of China, 1986). Under the prior communist planned economy, all major entities were a government-owned business, and a job was guaranteed to all. The job-placement system was called “Unified Labor Allocation,” which was colloquially referred to as an “arranged marriage.” Unified Labor Allocation was operated by the Labor Bureau, which allocated jobs to everyone. They granted all employees in the state sector (and even in the collective sector) lifelong employment with promotion by seniority. This was known as the “Iron Rice Bowl” system (W. Zhang & Pope, 1997). It meant that people who were recruited by the state sector were guaranteed lifelong jobs and all benefits, such as pension, free medical service, cheap housing, and so on. Even workers’ children could take on their parents’ jobs after their parents had retired. These jobs could never be lost, ju st as an iron rice bowl could never be broken (Hu et al., 1994).

Witt/Kieffer is a corporate sponsor of the Health Management Academy, which means that twice a year my colleague Alexander H. Williams, III (known to all as Sandy) and I meet with senior physician executives from high-profile organizations to discuss industry issues. Recently, this group asked us a question: “What’s the hardest thing for search consultants in working with physician executives?” Sandy and I didn’t have to consult on our response. As one, we replied: “Getting them to move.”

Physician executives are not unique in not wanting to move. No one does, usually. (But I want to win the lottery, too. You don’t always get what you want.) Although moving doesn’t seem too complicated for other executives (both in and outside of health care), it continues to be a more difficult matter for physician executives to resolve.

In theory, it certainly seems simple: an executive must occasionally move to a new organization (new city, new region, etc.) to enhance or further a career. Ask anybody from IBM (”I’ve Been Moved”) or any other Fortune 1000 company if at some time in their careers they took a promotion or new job that required a major move. You won’t find many executives who haven’t taken that step–sometimes, several times. The career move is accepted as a fact of executive life.

However, as a group (and I know there are many exceptions, of course) physician executives and their families have not been as accepting of the career move as a key part of executive life. They feel it’s their right to stay put and they do. Career limitations and even stalls are often the result of that limited thinking.

Executive careers have attracted increasing numbers of physicians in the past few years, indicating how the challenges presented to ambitious executives are appealing and exciting. Physicians who enter the executive suite exchange their clinical responsibilities for executive ones–to create health policy and manage people for change. However, the transition from clinician to executive is even deeper and more profound than what is demanded by a careful look at education and skills sets. This distinction makes it important to see where the key shift occurs by re-examining some basics of career planning.

Career emphasis changes

Every time an individual makes a career decision, three factors–position, location, compensation–are considered as tradeoffs to achieve suitable balance. One factor can take precedence at one time in a career and be less important at another.

For example, it’s only natural that location would have great significance in the career decision-making process of a clinician. After all, a good physician should be able to earn a decent living anywhere (though not as much as in years gone by)–so why not make the location of your practice the most important factor in your choice? The lifestyle of the clinician’s spouse and family is affected by location, so it’s a key choice for them as well, And, once clinicians have built relationships with patients and institutions, they may find it difficult to think of making a move to another area and starting over–even when it might be in their own best interests. So, they tend to stay put.

However, an executive who has left clinical work behind (or is attempting to do so) will do well to refocus that location mindset by understanding the new priorities. An executive emphasizes position over other factors when making a job decision. An executive’s position and role are essential to his or her effectiveness and success-and the truth is, exciting opportunities don’t come around every day. When a great opportunity is on the table, an aspiring executive knows that the actual location where one works is less important than the work itself–and is willing to move to accept an attractive position.

The third career decision component, compensation, is obviously important–but for physician executives, it’s a matter that often takes care of itself. Marketplace salary levels are pretty well-known and accepted. (I can’t recall ever hearing a physician executive say that he or she either took or left a position solely because of compensation issues. There’s always more to the story.)

Spouse support is essential

Before you consider stepping forward in even the most casual kind of job search, be sure your ducks are in a row. Organizations expect that any married executives who present themselves as candidates will have considered a move with their spouse and agreed on the subject as a team. Lack of commitment will make itself known at some point. At the extreme, it’s manifested by an executive accepting a job offer and then backing out. (It happens among non-physician executives, too, but less often.)

The pact you and your spouse made when you went to medical school included expectations around lifestyle, both for stability and for economic considerations. Your transition into a corporate career-building track can seem to be a sudden, disruptive “defection.” Hence, the importance of discussions at home early and often.

The literary career of Mark Akenside, including an edition of his non-medical prose.

Dix, Robin.

Fairleigh Dickinson U.P.

2006

410 pages

$52.50
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Hardcover

PR3314

Mark Akenside (1720-1770) is best known for his Pleasures of Imagination, which was published in 1744, but Dix (English, Durham U.) examines the full range of Akenside’s literary achievements in satire and the lyric. Dix discusses Akenside’s apprentice work as well as the themes and theories of his major poems. Dix’s critical analysis is supplemented by appendices containing Akenside’s essays and letters and a list of the books Akenside reviewed for the periodical The Museum. Distributed by Associated University Presses.

The United States Army provides training in medical laboratory science–from associate’s and bachelor’s through post-doctoral degrees–for individuals who want careers that provide growth opportunities, increased responsibilities, variety, and a chance to see the world. Active-duty enlisted personnel, reservists, National Guard, and international military students who are interested in the medical laboratory field can obtain the basic skills and education necessary to support the U.S. Department of Defense medical mission during peacetime, mobilization, wartime, and support operations. The program–311-91810–is divided into two phases:

* Phase 1 consists of a 26-week resident course conducted at the U.S. Army Medical Department Center and School (AMEDDC & S) at Fort Sam Houston, TX.

* Phase 2 provides clinical training at any one of 22 U.S. hospital clinical laboratories.
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Graduates earn 60 semester credits but must also earn 12 additional credits to receive their Associate in Integrated Studies (AIS) degree and receive the Army’s military occupation-specialty designation of medical laboratory technician (MLT). The entire course is affiliated with George Washington University in the District of Columbia, which offers graduates the opportunity to eventually earn their bachelor’s degree. It complies with the requirements of the Department of Defense’s Clinical Laboratory Improvement Program and is accredited by the National Accrediting Agency for Clinical Laboratory Sciences.

After a tour of duty, medical laboratory technicians can apply for an additional skill identifier, such as cytology or biological-sciences assistant. The cytology course is accredited, and all graduates receive a bachelor’s degree. The biological-sciences assistant must have a bachelor’s or master’s degree in a biological science and must perform professional-medical and medical-research duties. Enlisted personnel may work in a hospital, research facility, or in the field.

Enlisted personnel train for the future

At AMEDDC & S, enlisted servicemen and women who are enrolled in the medical laboratory program usually enter with definite goals and discover career advantages upon completion. Sgt. Derwin Johnson is currently training at the AMEDDC & S. “This is a very challenging program, and I am learning a lot. I am from the Bahamas and plan to work in the clinical lab for the military in my country. The certificate that I receive from this program will be very beneficial to my military career there.”

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Spc. Antwone Wilson, who already had a teaching degree, graduated from the AMEDDC & S program last December. “I wanted to pursue a future in the Army, and I was interested in science and the laboratory. The program I studied provided me with an AIS degree as an MLT, which was a great incentive. I plan to use my skills in the William Beaumont Army Medical Center (WBAMC) at Fort Bliss, Texas, and if I should be deployed to Iraq.”

Enlisted AMEDDC & S graduates are challenged in their ensuing career posts, particularly when they are given the chance to serve at posts overseas. As the non-commissioned officer in charge of Blood Services at Landstuhl Regional Medical Center (LRMC) in Germany, Sgt. 1st Class Joe Yglecias–currently stationed at the WBAMC–confronted many issues. Few local nationals qualified for the positions he needed to fill; and because the majority of his technicians were military, he was constantly training new civilian and military techs. “We did not have the benefit of a pool of applicants, as in the United States, to provide long-term stability.”

He also experienced some difficulties with blood testing and FDA-compliance. Blood collected by the LRMC Blood Donor Center was tested by Fort Hood in Texas, which could take as long as seven days before collected blood could be issued to patients. “Because of this,” says Yglecias, “we could not make our own platelets. Platelets and blood less than 10 days old for NICU patients had to be purchased from local German blood banks, often delaying the issuance of blood products for hours. And while those local blood products were tested similarly to U.S. blood products, they were not FDA-approved.” These circumstances meant that patients who received local blood had to be counseled and tested initially, then at regular intervals for the following year, followed by testing at whatever hospital they went to after leaving LRMC.

Other opportunities for medical lab service personnel

The Army directly commissions lab officers in the fields of microbiology, biochemistry, clinical laboratory science, and research psychology. The mission of Army medical laboratory scientists is to ensure the readiness of the nation’s fighting forces; provide clinical laboratory support to the deployable armed forces; assure survival against chemical and biological warfare weapons, disease, trauma, combat stress, and environmental threats; and provide biomedical leadership to military personnel.

We also hear a lot of other feedback, like “good, great, nice job” … and more. But don’t take our word for it. Talk to just a few of the students who have taken any of the almost 200 professional development open-enrollment classes we offer each year in cities across the United States.

In fact, recent evaluations have been so positive that 98.8% of students rated their class good, very good, or excellent overall “in terms of learning activities, instructor performance, content, and organization.” And 98.4% agreed or strongly agreed that “the ideas/skills presented will improve their job effectiveness almost immediately.”

Put these comments in perspective

To put this feedback in perspective, consider the source …

Over the years, many of our open-enrollment students have taken a lot of courses at all levels–beginning, intermediate, and advanced–and from a lot of different sources such as major colleges and universities, so they who know a good class when they see one.

As you can imagine, these classes fill up quickly, so don’t put off registering for the class that meets your needs.

KEY CONCEPTS

* Preserving Your Soul in Corporate America

* Discovering Your Life’s Calling

* Infusing Meaning into Work

* Being Creative in the Workplace

* Building a Rich Soul Life

Many professionals spend 60 or more hours a week at work. If work is a place where you just bide your time and wait for weekends and vacations, where you just make money to do and buy the things you want, you will feel cheated at the end of your life and perhaps resentful while you are getting there. David White in The Heart Aroused explores ways to preserve your soul in corporate America. While saying it is too elusive to truly be defined, he tries to describe the soul: “It is the indefinable essence of a person’s spirit and being. It can never be touched and yet the merest hint of its absence causes immediate distress.” (1)

He thinks most people check their souls at the door of their workplaces and then wonder why they feel empty during day. “We simply spend too much time and have too much psychic and emotional energy invested in the workplace for us to declare it a spiritual desert bereft of life-giving water. The belief has been that we can drink only on weekends or vacations and must proceed to shrivel slowly as the desiccating years roll by. … We are eventually compelled to bring our work life into the realm of spiritual examination. Life does not seem to be impressed by our arguments that we can ignore our deeper desires simply because we happen to be earning a living at the time.’ (1)

Stop checking your soul at the door

How can you stop checking your soul at the door and take it to work? Here are some ideas to help physician executives reevaluate their reasons for pursuing medical management and preserve their souls in an increasingly corporatized American health care system.

1. Figure out what you are meant to do as your life’s calling

Think about these questions: What do you feel called to do? What will make you say at life’s end, “I made a difference; I spent the time well; if you are a religious person, I did what God called me to do?” “Preservation of the soul means the palpable presence of some sacred otherness in our labors, whatever language we may use for that otherness: God, the universe, destiny, life, or love.” (1)

KEY CONCEPTS

* Search Firm Consultants

* Evaluating Search Firms

* Career Counseling

* Career Stewardship

* Making Connections

* Developing Relationships with Search Firms

Executive search consultants have become an inevitable aspect of life for health care executives and those who aspire to their ranks–and that includes physician executives. And they can work to your advantage–here’s how.

When the health care industry began to mature in the late 1960s, the “old boy” network was no longer enough to find and hire excellent executives who were needed for the new, more complex, era. Board members with business backgrounds had experience with search firms in their own industries. They understood the value of having the broadest possible (objectively chosen) candidate slates and began engaging search consultants to identify the best senior health care executives. The successes of those earliest searches–those great executive “stars” who took on some of the most visible arid complicated jobs in the country-ensured that other organizations would follow suit and use search firms as well. A new service industry for health care arrived on the scene.

At first, these firms were employed to assist boards with CEO searches. Less-senior roles were still filled the old-fashioned way, by health care executives contacting their colleagues for leads. Over time, as the stakes increased, the professional methods of search firms became the norm for populating health care’s executive suite.

Enter (in the early ’80s) physician executives-the new breed” as they were once described–the direct descendants of the medical director/chief of staff positions, but with greater executive responsibility and less direct clinical involvement, If it’s difficult to find talented executives for any industry, its even tougher to identify physicians who can manage people and budgets within an administrative structure. Once the need was established, health care institutions increasingly came to rely on executive search firms as a source of qualified physician executive candidates.