Discourse, organisation and the surgical ward round

Abstract

The surgical ward round is examined as an organisational strategy entered into by surgeons to enable particular claims about the success of surgery to be validated. The paper reports ethnographic data from UK surgical wards which suggest that surgeons organise the discourse of their interactions with patients around three themes: physiology, wound condition and recovery/discharge. These themes are surgeon-centred, and are organised to deny patients access to the agenda of these encounters.Within a post-structuralist and postmodern framework, these strategies of discourse organisation are understood as techniques of power. Surgeons privilege discourses which support their claims to be healers, denying those which focus on the necessary injury which surgical resection causes. The paper argues that the 'ward round' is a mythical structure constituted as an organisational strategy to counter challenges from patients to their hegemonic discourse.

Interprofessional rhetoric and operational realities: an ethnographic study of rounds in four intensive care units

“…Key concerns include the declining art of bedside teaching and physical examination (Ramani et al 2003;Verghese 2008;Wachter 2015), rarefied time spent at the bedside (Miller et al 1992;Ward et al 2014), and the use of ''depersonalizing'' language during case presentations (Anspach 1988;Fox 1993). These are all aspects of the well-known and much decried phenomenon of patient objectivation in medical education and care (Mizrahi 1985).…”

Beyond the Team

“…Research on patient safety in intensive care units (ICUs) describes barriers to communication and teamwork that point to embedded hierarchies, differences in professional cultures, and medical dominance (5)(6)(7)(8)(9). Recent interventions that attempt to address these 'obstacles' have largely been formulated within the framework of changing 'organizational culture,' with a focus on systems rather than individual practitioners (10-14).…”

Anaesthetists, the discourse on patient fitness and the organisation of surgery.

“…I have shown elsewhere (Fox 1991(Fox , 1993a how this kind of analysis provides an interesting starting point in situations where there are conflicting perspectives on a situation. For example, clinicians and managers take very different views of how surgical services should be organized, with each group trying to fabricate and sustain its own discursive framework conceming what surgical healing is.…”