Theorizing Heterogeneity in Rationalization: The Effects of Shift Work on Obstetrician Decision-Making in Childbirth

• In Event: 124 - Regular Session. Illness Experience and Health Care Delivery in Hospitals: Insights from Ethnographic Research

Abstract

Sociologists have argued rationalization of medicine would replace professional discretion grounded in clinical experience and the doctor patient-relationship with objectified management rules and protocols (Ritzer 1988, Starr 1982); and warned that bureaucratization would lead to dehumanized patient care (Frankford, 1994). More recent work suggests rationalization has varied forms and heterogeneous effects (Kitchener, 2005; Timmermans & Almeling, 2009; Timmermans & Epstein, 2010), but empirical work on the variety of forms and outcomes is needed. This study contributes to these efforts to develop contextual theory of the rationalization of medicine by examining the effects of shift work on clinical decision-making of obstetrician-gynecologists in childbirth. Mirroring trends across patient-care medicine in general, obstetrics has increased shift work positions in labor and delivery. Using data from 21 semi-structured interviews with obstetricians who work in shift work and on-call models of care, I ask: What does decision-making look like across a spectrum of fragmented to continuous doctor-patient relationships? The content and meaning of interactive knowledge emerge as important analytic differences; my analysis tracks these in obstetricians’ decision-making through the following stages: gathering patient information and developing rapport, deliberation of treatment preferences, and decisions and outcomes. I argue that rather than shift work leading to standardized objective decision-making, doctors still use interactive patient knowledge, but they rely on superficial impressions that include stereotypes. This increases the chance of misunderstandings, conflict, and the reproduction of social inequalities. These findings are relevant to theorizing rationalization of health care, medical decision-making, and to policy debates about restructuring care delivery.

Author

• Lauren Ashley Diamond-Brown, Boston College