McCann, L. (2022). The Paramedic at Work: A Sociology of a New Profession. Oxford University Press.

Book Review by Robin Burrow

Many healthcare systems across the world are in crisis. For most, this is not a new state of affairs, though it has undoubtedly been exasperated by the devastation of the COVID-19 pandemic. In the UK we stood in our front gardens, in our doorways and windows, applauding the people who cared for us. Yet, as I write this review (summer, 2023), junior doctors, senior consultants, nurses, physiotherapists and paramedics have variously been compelled to engage in historically unprecedented waves of strike action. The complaints are not new. For paramedics they include pay levels, staffing, and concerns about turnover and the forces that drives it.

In this context Leo McCann’s The Paramedic at work: a sociology of a new profession provides a timely, detailed insight into the realities of paramedics’ working lives. The book is predicated on an understanding that, in a great many ways and for a great many reasons, the work performed by paramedics is extremely poorly understood. As McCann puts it: ‘there is strong public interest, but weak public understanding of even some of the most basic elements of what they do, how they do it, and why’ (p.19). The little that we do know is know is cut with well-worn, clichéd, heroic tropes, and generally preoccupied with the mystical allure of high-octane, ‘lights and sirens’ emergency work. The real beauty of McCann’s book is that he not only captures these facets of paramedics’ work in exquisite, nail-biting detail, but that he augments it with myriad other details. What the reader gets is a visceral insight into the full scope of paramedics’ work, and the complex dynamics of this occupation as it transitions into a profession (p.19).

Structurally, the book’s first chapter is an account of the history of this ‘new’ profession, it’s operational characteristics and the people who do it – McCann’s Homo Paramedicus. Chapter 2 situates the paramedic profession in wider (conceptual) discussions about the ‘nature of professions, professionalism and professional work’ (p.48). Here, think Abbott (2014), Barley and Orr (1997), Orr (2006) and Freidson (2001). Chapter 3 is the first of four data-rich chapters; it takes the reader, as McCann put’s in, ‘into the field’ where they connect with the ‘structures, duties and rhythms of paramedic work’. Chapter 4 is about the complexities of operational culture. Chapter 5 takes aim at the stresses and strains paramedics encounter, and routinely have to manage. Chapter 6 explores formal and informal notions of professionalism – how institutions, and paramedics, conceive of themselves professionally.

Each chapter is beautifully well written and extremely powerful. The sheer quality of the field work stands out. The empirical data is world class. The insights McCann reports are of the sort that only come from spending serious amounts of time genuinely and concertedly trying to understand the subject and the field in which they work. The result is an ethnographic masterpiece—an unparalleled insight into what it means to be a paramedic, in this particular time and place. It is ethnography at its best, and should rightly rank amongst the best.

It is also not just the quality of the fieldwork that stands out. McCann’s analysis is erudite and sharp. His empirical findings—the insights he deliverers—are contextualized and made sense of in relation to a wide academic literature. The book is primarily orientated towards a sociological audience, but it has great relevance beyond that. In particular, to people interested in work, organization and employment studies more broadly. People interested in the consequences and implications of neoliberal reforms on public services will find much of interest here. As will people interested in new public management’s penchant for metrics and the concomitant politics of such practices.

Don’t worry though: You don’t have to be a paid-up academic to glean great value from this book. Anyone with an interest in paramedics’ work, or healthcare in general, will value the read. They’ll also value the book’s accessibility. Delicately funny, deadly serious, and desperately sad, McCann carries the reader in a way that few others are able to. He is also, at times, masterly with playful understatement: “the ambulance leans very noticeably when cornering at speed” (p.119).

Inescapably, anyone with their own experiences of ambulatory care will find this a moving read. I did. The images McCann conjures are incredibly powerful. You close the book feeling like you ‘know’ the people he studied, understand more about what it is to be them and to perform their so very vital role in our society. Again, this is ethnography at its best.

If criticism is to be levelled at this book, it is that I found myself wondering about the things paramedics may not have wanted people to see—things that McCann quietly picked up on, but could perhaps have probed in more detail. For example, in chapter 4, McCann raises interesting but difficult questions about the nature and extent of paramedics’ autonomy: Do they have too much? He hints, almost imperceptibly, at what might be perceived as a kind of clinical wild-west – individuals reaching and possibly breaching the boundaries of their clinical skills, ability and licence. Autonomy and isolation apparently functioning in unintended, potentially dangerous and subversive ways?

There is also the thorny issue of healthcare in the ‘post-pandemic’ age. While almost certainly resulting in the amplification of many of the critical issues McCann describes, I wondered about the lasting effects of the pandemic? How has it changed paramedic’s work? How much further has paramedics’ professional project progressed or regressed?

In the context of what this book achieves, these are minor points. More a request for more research – for a future second edition so that we might stay connected with the “Beccas”, “Sallys”, “Chrises” who help us in our hour of greatest need.

Robin Burrow is a Senior Lecturer in Organization Studies at Cardiff Business School. He completed his PhD at the University of Warwick Business School, and his research examines the connection between emotions and behaviour, primarily in extreme organizational contexts. 

References

Abbott, A. (2014). The system of professions: An essay on the division of expert labor. University of Chicago Press.

Barley, S. R., & Orr, J. E. (1997). Between craft and science: Technical work in US settings. Cornell University Press.

Freidson, E. (2001). Professionalism, the third logic: On the practice of knowledge. University of Chicago press.

McCann, L. (2022). The Paramedic at Work: A Sociology of a New Profession. Oxford University Press.

Orr, J. E. (2006). Ten years of talking about machines. Organization Studies, 27(12), 1805-1820.