Negotiating palliative care expertise in the medical world

“Pain talk” in hospice and palliative care team meetings: An ethnography

“…It is a safe space where problems related to non-specialist practice can be talked about and threats to one's reputation can be managed in a supportive team context. It enables the boundaries of palliative care to be explicitly defined around expertise in the management of pain and symptoms as the specialist component of such work and this supports the work of Hibbert et al (2003).…”

“…In a focus group study, which examined professional boundary issues with medical staff from palliative care, cardiology, general medicine as well as primary care the importance of proven expertise and being able to be clinically effective and credible was most important in the discussions of medical staff (Hibbert et al, 2003). The team meeting is one of the settings where one's expertise and credibility is constructed around difficult pain problems.…”

Reconfiguring or reproducing intra-professional boundaries? Specialist expertise, generalist knowledge and the ‘modernization’ of the medical workforce

“…From this study, the intra-professional boundary seems every bit as entrenched as interprofessional boundaries, between medicine and related professions, studied elsewhere (Norris, 2001;Foley & Faircloth, 2003;Hibbert et al, 2003;Mizrachi & Shuval, 2005). Indeed, geneticists tended to include a different profession-genetic counsellors-within their epistemic community where they explicitly excluded GPSIs.…”

“…Geneticists" counter-arguments highlighted the indeterminacy of their knowledge (cf. Hibbert et al, 2003;Mclaughlin & Webster, 1998), and the need for immersion in day-to-day clinical-genetics work to achieve sufficient expertise to practise safely. In this way, geneticists" conceptions of the legitimacy of the existing jurisdictional boundary went to the very heart of their professional project, by locating expertise in lengthy professional training and ongoing interaction with other experts-defined relationally (Foley & Faircloth, 2003) through comparison with the "go-it-alone" model of general practice.…”

“…There is a considerable literature offering rich insights into strategies deployed by professions in legitimating their jurisdictional boundaries (e.g. Norris, 2001;Foley & Faircloth, 2003;Hibbert, Hanratty, May, Mair, Litva & Capewell, 2003;Mizrachi & Shuval, 2005), but relatively little of this studies these legitimatory strategies in relation to specific pressures of technology, policy or managerialism (Lupton, 1997;Sanders & Harrison, 2008). Rarer still are studies examining the reconstruction of professional boundaries by actors on the ground in the face of technological, managerial or policy changes which disrupt the existing division of jurisdictional responsibility (recent exceptions include Mclaughlin & Webster, 1998;Charles-Jones, Latimer & May, 2003;McDonald, Harrison, Checkland, Campbell & Roland, 2007).…”