Sociologists have written surprisingly little about the role emotions play in medical decision-making, largely ceding this terrain to psychologists who conceptualize emotional influences on decision-making in primarily cognitive and individualistic terms. In this article, I use ethnographic data gathered from parents and physicians caring for children with life-threatening conditions to illustrate how emotions enter the medical decision-making process in fundamentally interactional ways. Because families and physicians alike often defined emotions as useful information to guide the decision-making process, both parties could leverage them in health care interactions by eliciting or demonstrating emotional investment, strategically deploying emotionally charged symbols, and using emotions as tiebreakers to help themselves and one another make choices in the midst of uncertainty. Constructing emotions as valuable in the decision-making process and effectively marshalling them in these ways offered a number of advantages. It could make decisions easier to arrive at, help people feel more confident in the decisions they made, and reduce interpersonal conflict. By connecting the dynamic role emotions can play in the interactive process through which medical decisions are made to the social advantages they can produce, I point to an underappreciated avenue through which inequalities in health care are perpetuated.
Using data drawn from interviews and observations with 18 families whose children were diagnosed with life-threatening, often rare diseases, I examine how families accessed and negotiated medical care at a top 10-ranked university research hospital. Access to highly specialized and technologically advanced care was essential in these critical cases. Combining analysis of these high-stakes cases with recent work highlighting the interactional dynamics of care delivery, I show how families followed different paths to elite care and used different illness management strategies throughout the treatment process depending on their ability to mobilize what Janet Shim terms cultural health capital. These diverging illness management strategies reproduced inequality even at the top of the U.S. healthcare system by allowing some families to secure microadvantages throughout the illness experience. These findings suggest a complex interplay between structures of care delivery and families' illness management strategies and point to the need for broader conceptualizations of healthcare advantages.
In this article, we contend that turning a sharp dramaturgical lens on the dynamics of fieldwork clarifies a number of longstanding ethical challenges in ethnography—challenges that have shifted and deepened in the new technological landscape in which ethnographers work. We encourage fieldworkers to adopt an intentional approach to what we call methodological impression management to navigate the research process more strategically. Drawing on our experiences conducting fieldwork in settings where some of our research participants had power over others (a women’s shelter and a substance abuse treatment program), we delineate the strategies we found useful for successful methodological impression management in complex settings and point to the dramaturgical underpinnings of their effectiveness. By bringing dramaturgical theory into direct conversation with the literature on ethnographic methods, we hope to illuminate a path through which ethnographers might make more deliberative methodological decisions and thoughtfully balance ethical responsibilities to their participants with their commitment to analytic rigor.
Scholars across many disciplines have amassed a mountain of research documenting how social differences along lines of race, class, gender, and sexuality shape how those who need medical attention are cared for in the US healthcare system. Here, we aim to succinctly review a selection of studies that have considered the many ways both patients' and healthcare providers' social identities can impact care delivery. After establishing how these differences influence patient–provider interactions and patient diagnosis, treatment, and outcomes, we argue that a critical sociological perspective can help us to better understand why these inequities persist despite decades of research calling attention to them. Specifically, we suggest that research guided by symbolic interactionist and intersectional frameworks can generate more comprehensive analyses of inequality in healthcare delivery and help researchers delve deeper into the complex interactional processes undergirding disparities in care provision. We conclude by highlighting recent work that illustrates the value of this approach.
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