Special Issue: Complexity, Routines, and Reflexivity in Professional Work

Smeby, Jens‐Christian

doi:10.7577/pp.2657

Cited by 2 publications

(1 citation statement)

References 122 publications

(184 reference statements)

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“…The discussion here suggests that a logical continuum appears to have been neglected which in a significant manner connects the operation of Spencer's mechanism of change in social life, the adaptation to circumstances by social individuals through spontaneous cooperation, with the recent work on "agile" agency, adaptive walks, the negotiating of complex landscapes and 19 Faced with such complexity Champy has advocated the merits of the "technique" of exercising "practical wisdom" by professionals, rather than the mechanical use of protocols and rules (Champy, 2012(Champy, , 2018. 20 The roots of this body of research go back to the 1970s (Offer, 2006).…”

Section: Spencer Professionals and Their Usersmentioning

confidence: 99%

Herbert Spencer, Sociological Theory, and the Professions

Offer

2019

Front. Sociol.

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This article presents new insights into Spencer's theoretical sociology as he applied it to the professions and professional institutions, which he discussed extensively, particularly in his Principles of Sociology. The first part of this article notes the main conceptual insights which he established and aligns them within the wider context of a re-reading of Spencer's sociology. Particular attention is paid to the "social organism" and the spontaneous cooperation of social individuals in society (with each possessing "social self-consciousness"). This part also reappraises Spencer's account of the emergence of "professionals" and their distinctive "cunning, skill, and acquaintance with the nature of things," which professionals have brought to bear on what has been experienced in the ordinary social lives of people as complexity or the unfamiliar in the world. The subsequent discussion focuses on, first, a retrieval of Spencer's theoretical stance on the activities of the professions, and on work and conditions in general, and, second, on reviewing some of the major resonances which his work has with practical problems and the associated theoretical issues concerning the sociological understanding of professional/service-user interaction in social life today.

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Section: Spencer Professionals and Their Usersmentioning

confidence: 99%

Herbert Spencer, Sociological Theory, and the Professions

Offer

2019

Front. Sociol.

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Negotiating the polypharmacy paradox: a video-reflexive ethnography study of polypharmacy and its practices in primary care

2022

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BackgroundPolypharmacy is an important safety concern. Medication reviews are recommended for patients affected by polypharmacy, but little is known about how they are conducted, nor how clinicians make sense of them. We used video-reflexive ethnography (VRE) to: illuminate how reviews are conducted; elicit professional dialogue and concerns about polypharmacy; invite new transferable understandings of polypharmacy and its management.MethodsWe conducted 422 hours of fieldwork (participant observation), filmed 18 consultations between clinicians and patients receiving 10 or more regular items of medication (so-called ‘higher risk’ polypharmacy) and played short clips of film footage to 34 participants (general practitioners, nurses, clinical pharmacists, practice managers) in seven audio-recorded reflexive workshops. Our analysis focused on ‘moments of potentiation’ and traced clinicians’ shifting understandings of their practices.ResultsParticipants rarely referenced biomedical aspects of prescribing (eg, drug-drug interactions, ‘Numbers Needed to Treat/Harm’) focussing instead on polypharmacy as an emotional and relational challenge. Clinicians initially denigrated their medication review work as mundane. Through VRE they reframed their work as complex, identifying polypharmacy as a delicate matter to negotiate. In patients with multimorbidity and polypharmacy it was difficult to disentangle medication review from other aspects of patients’ medical care. Such conditions of complexity presented clinicians with competing professional obligations which were difficult to reconcile. Medication review was identified as an ongoing process, rather than a discrete ‘one-off’ activity. Meaningful progress towards tackling polypharmacy was only possible through small, incremental, carefully supported changes in which both patient and clinician negotiated a sharing of responsibility, best supported by continuity of care.ConclusionsSupporting acceptable, feasible and meaningful progress towards addressing problematic polypharmacy may require shifts in how medication reviews are conceptualised. Responsible decision-making under conditions of such complexity and uncertainty depends crucially on the affective or emotional quality of the clinician-patient relationship.

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Special Issue: Complexity, Routines, and Reflexivity in Professional Work

Abstract: Vol 8, No 1 (2018)

Cited by 2 publications

References 122 publications

Herbert Spencer, Sociological Theory, and the Professions

Herbert Spencer, Sociological Theory, and the Professions

Negotiating the polypharmacy paradox: a video-reflexive ethnography study of polypharmacy and its practices in primary care

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