4.2 People knowledge
Stacey (1994) has made a passionate plea to understand the ‘power of lay knowledge’ which she prefers to call ‘people knowledge’. Stacey claims that two fundamental assumptions underline the importance of listening to lay voices. One is that all people are of equal worth and so their views should be heard. The other is that people are health producers as much as they are health consumers. She maintains that patients do a great deal of hard work, whether it is direct as with labouring mothers or whether it is in maintaining hi-tech apparatus. Women in particular take on a great deal of caring work in the home and constitute what has been referred to as an army of unpaid carers (Qureshi and Walker, 1989). Stacey would prefer to see these unpaid health workers as part of the health team rather than be seen as ‘other’.
Stacey goes on to draw out the difference between ‘people knowledge’ and ‘professional knowledge’. People knowledge derives from experience. This experiential knowledge is not written, systematised or generalised but it is frequently modified in the light of experience and sometimes derives from medical knowledge and experience of medical practice. One of the reasons why she dislikes the word ‘lay’ is that it has traditionally referred to people who do not belong to a particular profession and who lack qualifications; it implies less competence and sometimes less moral worth.
Stacey reminds us that the major justification for professionalism is service, and that qualifications are no cause for arrogance. She goes on to draw out some lessons for health service workers:
The first and most important point is that at all times one should have respect for people knowledge – for lay knowledge. A first reaction may understandably be ‘They don't understand’ and a feeling of helplessness that meaningful communication may never be achieved. But just stop and think ‘Could it be that I don't understand their knowledge-base?’ The aim should be to understand the people's point of view in their terms (not yours) and to work out where they are coming from. Only then will you be able to convey your own view of the situation in ways salient to them; or alternatively, you may realise it needs rethinking ... It can also be helpful to remember that while each health worker may be an expert in their own area, faced with expertise of another kind they are just one of the people. The division between people and professional is not a rigid one. Each one of us is sometimes people and sometimes professional.
(Stacey, 1994, pp. 95–6)