The Usual Grind: How Patient Pain Becomes Resident Labor

• In Event: 20820 - Section on Medical Sociology Roundtables
  In Refereed Roundtable (90 minute): Table 18. Healthcare Providers & Practice I

Abstract

The U.S. healthcare system is characterized by stark racial and ethnic inequalities. Despite decades of efforts to address this problem, there is little evidence that it has improved. Why, in a healthcare context that increasingly recognizes medical racism as a problem, do healthcare providers still make racially unequal decisions? In this book chapter, I make the case that to better understand enduring racial inequality in pain care, we need to look at how hospital work has changed under increasing pressures to cut costs, limit care, and protect the interests of insurance companies – a process broadly referred to as corporatization. Focusing on the case of hospital-based pain care, and drawing on two years of ethnographic fieldwork with clinicians at an urban academic hospital, I examine how the structure of contemporary hospital work contributes to doctors’ views that many of their Black patients are “undeserving” of pain treatment. I show how doctors themselves suffer the tensions of the neoliberal organization of medicine, which make pain treatment challenging, stressful, and unpleasant. Seemingly-mundane aspects of hospital work – from how patients are placed in physical space to the lineup of meetings on doctors’ daily agendas – are designed to facilitate corporate goals of efficiency and profit. As a result, doctors find that their jobs are easiest and most rewarding when treating the primarily White and middle-class patients who are most profitable for the hospital. By contrast, work is more difficult and time consuming when treating Black and low-income patients with severe pain. As they move through routine work processes, even well-intentioned doctors come to identify with corporate priorities. Ultimately, they overlook how corporatized organizational structures make work difficult and instead blame Black patients themselves. 

Author

• Alex E. Brewer, University of Southern California