How ‘we’ are different from ‘them’: occupational boundary maintenance in the treatment of musculo‐skeletal problems

Abstract

Strategies of occupational control at the macro-level have been described by many sociologists. This paper draws on a study of the division of labour in the treatment of musculo-skeletal problems in New Zealand to look at micro-level strategies of occupational control. These are rhetorical strategies used by individual practitioners to establish and maintain occupational boundaries. Practitioners used these strategies to distinguish their occupation from others, creating a sense of professional identity and enabling claims to jurisdiction over an area of work. Many of these strategies involved notions of limitation (i.e. other occupations are limited because they do not possess something we do), holism (we are holistic in our approach while others are not), and prevention (we prevent problems by treating the causes, while others treat the symptoms).

Professional relations in sport healthcare: Workplace responses to organisational change

“…Norris's (2001) analysis of the jurisdictional narratives of competing musculo-skeletal treatment providers emphasised three main themes: limitation (of others), holism (of one's own techniques), and prevention (through the treatment of causes rather than symptoms). Sanders and Harrison (2008) identified various professional "legitimation discourses", including: reference to the scientific basis of work; identification of particular skills and expertise; the holistic and patient-centred nature of practice; the provision of care and emotional support; organisational efficiency and accountability; and claims to competence.…”

“…For instance, invoking the jurisdictional rhetoric of limitation (Norris, 2001), a number of interviewees described younger sport-specialists as inferior due to their restricted scope of practice: "Physiotherapists are specialising far too early in sports. A lot of very nice, young physiotherapists who have got more qualifications …but they have not got that background experience".…”

“…In this respect, the division of labour was seen as a pragmatic response to situational factors, and time constraints in particular. Invoking narratives of holism and limitation (Norris, 2001), one physiotherapist noted, "you're constantly with them [athletes]. The doctor might come in for a time and go away again but you spend time with them".…”

“…Timmons and Tanner (2004), for instance, illustrated the role of technology as discourse in the boundary disputes between nurses and Operating Department Practitioners; a group which, like those studied here, were in early stages of establishing their professional boundaries. Likewise, Norris (2001) argued that the use of machinery (ultrasound) was perceived to be part of physiotherapists' 'signature treatment' (relative to chiropractors, osteopaths and massage therapists). While the sports physiotherapists in this study reported a retreat from technology ("I used to take an ultrasound with me, but now I don't bother … in a competition setting it's not actually worth doing"), within elite sport healthcare the concession of technologicallybased dominance to doctors occurs in relation to access rather than deployment.…”

Social networks – The future for health care delivery

“…Interaction in health care encounters is also influenced by funding available for treatments, guidelines, potential profit, the desire to maintain a profession or specialty (Norris, 2001;Mizrachi et al, 2005) and custom and practice in the local situation (Joyce et al, 1967). There is evidence that the influence of non-patient factors on doctor behaviour may be increasing (Butler et al, 2009).…”