Exploring the interplay of discourses, jurisdictions and restratification in medicine and the implications for intraprofessional collaboration
This study builds on calls to explore the tensions and dynamics of intraprofessional collaboration and boundary work. It reaches beyond the literature describing the micro-level strategies deployed by physician subgroups to establish legitimacy and defend jurisdictions in the face of health care re-...
| Main Authors: | , , |
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| Other Authors: | |
| Format: | Journal Article |
| Language: | English |
| Published: |
2024
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| Subjects: | |
| Online Access: | https://hdl.handle.net/10356/178347 |
| _version_ | 1811676797160390656 |
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| author | Wong, René Whitehead, Cynthia R. Kitto, Simon |
| author2 | Lee Kong Chian School of Medicine (LKCMedicine) |
| author_facet | Lee Kong Chian School of Medicine (LKCMedicine) Wong, René Whitehead, Cynthia R. Kitto, Simon |
| author_sort | Wong, René |
| collection | NTU |
| description | This study builds on calls to explore the tensions and dynamics of intraprofessional collaboration and boundary work. It reaches beyond the literature describing the micro-level strategies deployed by physician subgroups to establish legitimacy and defend jurisdictions in the face of health care re-organization. Specifically, it offers a view of how macrosocial imperatives shape intraprofessional boundaries, relations, and the possibilities for collaboration. Drawing on empirical data from a case study of intraprofessional collaboration in caring for patients with diabetes - a clinical context in which patients commonly receive care from family physicians (FPs) and specialist physicians (SPs) – Foucault's concept of governmentality and the sociology of the professions are employed to make visible the sociohistorical construction of intraprofessional collaboration within discourses of evidence-based medicine, and its implications for the [re-]negotiation of professional jurisdictions and restratification of the medical profession. This analysis contributes to the intraprofessional literature through two analytical moves. First, it outlines the discursive mechanisms through which the meso-level deployment of the referral-consultation process provides an arena for SPs to maintain and reinforce their position of influence at both the micro-level of daily clinical work and across broader health care delivery. Second, it provides an understanding of how the transmission of governmental rationality in diabetes occurs through the social relations between SPs and FPs, making the restratification of medicine possible without tension or conflict. |
| first_indexed | 2024-10-01T02:27:11Z |
| format | Journal Article |
| id | ntu-10356/178347 |
| institution | Nanyang Technological University |
| language | English |
| last_indexed | 2024-10-01T02:27:11Z |
| publishDate | 2024 |
| record_format | dspace |
| spelling | ntu-10356/1783472024-06-16T15:38:01Z Exploring the interplay of discourses, jurisdictions and restratification in medicine and the implications for intraprofessional collaboration Wong, René Whitehead, Cynthia R. Kitto, Simon Lee Kong Chian School of Medicine (LKCMedicine) Medicine, Health and Life Sciences Consultation and referral Evidence-based medicine This study builds on calls to explore the tensions and dynamics of intraprofessional collaboration and boundary work. It reaches beyond the literature describing the micro-level strategies deployed by physician subgroups to establish legitimacy and defend jurisdictions in the face of health care re-organization. Specifically, it offers a view of how macrosocial imperatives shape intraprofessional boundaries, relations, and the possibilities for collaboration. Drawing on empirical data from a case study of intraprofessional collaboration in caring for patients with diabetes - a clinical context in which patients commonly receive care from family physicians (FPs) and specialist physicians (SPs) – Foucault's concept of governmentality and the sociology of the professions are employed to make visible the sociohistorical construction of intraprofessional collaboration within discourses of evidence-based medicine, and its implications for the [re-]negotiation of professional jurisdictions and restratification of the medical profession. This analysis contributes to the intraprofessional literature through two analytical moves. First, it outlines the discursive mechanisms through which the meso-level deployment of the referral-consultation process provides an arena for SPs to maintain and reinforce their position of influence at both the micro-level of daily clinical work and across broader health care delivery. Second, it provides an understanding of how the transmission of governmental rationality in diabetes occurs through the social relations between SPs and FPs, making the restratification of medicine possible without tension or conflict. Published version This study was funded by the Robert Maudsley Fellowship for Studies in Medical Education provided by the Royal College of Physicians and Surgeons of Canada. 2024-06-12T06:35:11Z 2024-06-12T06:35:11Z 2024 Journal Article Wong, R., Whitehead, C. R. & Kitto, S. (2024). Exploring the interplay of discourses, jurisdictions and restratification in medicine and the implications for intraprofessional collaboration. SSM - Qualitative Research in Health, 5, 100411-. https://dx.doi.org/10.1016/j.ssmqr.2024.100411 2667-3215 https://hdl.handle.net/10356/178347 10.1016/j.ssmqr.2024.100411 2-s2.0-85185813732 5 100411 en SSM - Qualitative Research in Health © 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/bync/4.0/). application/pdf |
| spellingShingle | Medicine, Health and Life Sciences Consultation and referral Evidence-based medicine Wong, René Whitehead, Cynthia R. Kitto, Simon Exploring the interplay of discourses, jurisdictions and restratification in medicine and the implications for intraprofessional collaboration |
| title | Exploring the interplay of discourses, jurisdictions and restratification in medicine and the implications for intraprofessional collaboration |
| title_full | Exploring the interplay of discourses, jurisdictions and restratification in medicine and the implications for intraprofessional collaboration |
| title_fullStr | Exploring the interplay of discourses, jurisdictions and restratification in medicine and the implications for intraprofessional collaboration |
| title_full_unstemmed | Exploring the interplay of discourses, jurisdictions and restratification in medicine and the implications for intraprofessional collaboration |
| title_short | Exploring the interplay of discourses, jurisdictions and restratification in medicine and the implications for intraprofessional collaboration |
| title_sort | exploring the interplay of discourses jurisdictions and restratification in medicine and the implications for intraprofessional collaboration |
| topic | Medicine, Health and Life Sciences Consultation and referral Evidence-based medicine |
| url | https://hdl.handle.net/10356/178347 |
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