Stability and change in disease prestige: A comparative analysis of three surveys spanning a quarter of a century

Album, Dag; Johannessen, Lars E.F.; Rasmussen, Erik Børve

doi:10.1016/j.socscimed.2017.03.020

Cited by 64 publications

(63 citation statements)

References 41 publications

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“…The highest status is given to diseases that manifest suddenly, in organs in the upper part of the body, where patients become unconscious and are immediately admitted to hospital, and where doctors, through the use of advanced medical technology, can make the patient live, return to normal life and be grateful. [22][23][24][25] The prestige hierarchy is transferred from senior to junior doctors through the telling of clinical anecdotes and stories that have a basic structure that aligns with the trope of the hero's journey seen in literature, 26 both informally in daily work 27 and in published case stories. 28,29 Louise's experience now makes more sense: doctors may not be aware of how gender is used as a social marker that sets up different expectations and norms for men and women.…”

Section: Lou Is E: G Ender and Who G E Ts To B E A Heromentioning

confidence: 99%

Beyond the cultural myth of medical meritocracy

et al. 2019

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Background We examine the cultural myth of the medical meritocracy, whereby the “best and the brightest” are admitted and promoted within the profession. We explore how this narrative guides medical practice in ways that may no longer be adequate in the contexts of practice today. Methods Narrative analysis of medical students’ and physicians’ stories. Results Hierarchies of privilege within medicine are linked to meritocracy and the trope of the “hero's story” in literature. Gender and other forms of difference are generally excluded from narratives of excellence, which suggests operative mechanisms that may be contributory to observed differences in attainment. We discuss how the notion of diversity is formulated in medicine as a “problem” to be accommodated within merit, and posit that medical practice today requires a reformulation of the notion of merit in medicine, valorising a diversity of life experience and skills, rather than “retrofitting” diversity concerns as problems to be accommodated within current constructs of merit. Conclusions Three main action‐oriented outcomes for a better formulation of merit relevant to medical practice today are suggested: (a) development of assessors’ critical consciousness regarding the structural issues in merit assignment; (b) alignment of merit criteria with relevant societal outcomes, and (c) developing inclusive leadership to accommodate the greater diversity of excellence needed in today's context of medical practice. A reformulation of the stories through which medical practitioners and educators communicate and validate aspects of medical practice will be required in order for the profession to continue to have relevance to the diverse societies it serves.

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Section: Lou Is E: G Ender and Who G E Ts To B E A Heromentioning

confidence: 99%

Beyond the cultural myth of medical meritocracy

et al. 2019

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“…This includes different levels of prestige for particular medical and surgical specialties, associated with particular conditions (Album et al . ). In general, specialist knowledge is more highly regarded than generalist knowledge (Brown and Webster ).…”

Section: Introductionmentioning

confidence: 97%

Re‐structuring the negotiated order of the hospital

Nugus

2019

Sociology Health & Illness

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Researchers continue to lament the lack of organisational focus in the sociology of health and illness. Although studies have increasingly focused on boundaries between organizations, little such research has focused on the formal boundaries within the hospital itself. Given its dramatic compartmentalisation, and continuing prevalence in health systems, the lack of organisational perspective in hospital research limits insights into the effects (as well as the construction) of the order of health work and care. With a greater emphasis on 'ordering' in the concept of negotiated order, the aim of this study is to examine the manifestation and consequences of the formal boundaries of hospital departments. Fieldwork featured 12 months of ethnography, including formal and informal observations, 80 audiorecorded, semi-structured interviews, and 56 field interviews, in the Emergency Departments (EDs) of two tertiary referral hospitals. Compared with in-patient hospital departments, the ED has limited legitimacy claims of organ-specific knowledge to transfer patients out of the ED. The manifestation of specialised knowledge hierarchies in organisational structures disadvantages patients who are older and who have chronic conditions, underpinning the argument that effects as well as the negotiation of stable organisational orders deserve increased attention in the sociology of health and illness.

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“…In general, categories of disease more common in young patients 14,15 ; those allowing for greater demonstration of "power" (e.g., specialist vs. general practitioner) 14 ; those whose treatments do not yield helplessness or dis gurement, 15 and; those that can be resolved or cured, 16 particularly via innovative or advanced technological or surgical interventions 14,17,18 are apportioned greater respect. Lower prestige is conferred on delocalized diseases -that is, those not con ned to a particular location in the body.…”

Section: Introductionmentioning

confidence: 99%

“…Researchers have noted that the relative prestige of diseases has remained stable over time, 15 with evidence that general practice and gerontology consistently sit at the bottom of the prestige hierarchy. 19 Additionally, there is striking similarity in scoring across physician and nurse samples 20 indicating that a shared order of prestige appraisal exists across health professions.…”

Section: Introductionmentioning

confidence: 99%

High turnover in clinical dietetics: A qualitative analysis

Hewko

Oyesegun

Clow

et al. 2020

Preprint

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Background: Relationships between dietitians and other healthcare providers can impact the degree to which patient care is collaborative; inefficient communication can lead to suboptimal care. It takes time for multidisciplinary team members to build collaborative, trusting relationships. For this reason, frequent dietitian turnover (or “churn”) is of concern. Consequences include fewer referrals to clinical dietetic services and limited provider continuity. The characteristics of clinical dietetic jobs associated with churn have not been identified. The principal investigator’s professional experience and a review of the literature led us to predict that managers would identify disease prestige as having an impact on churn. In this article, we report the qualitative results of a multi-method study that we conducted to explore: 1) characteristics of clinical dietetic jobs in the public sector associated with the most churn, and 2) consequences of churn on patients and managers of clinical dietitians. Methods: We conducted semi-structured interviews with ten managers of clinical dietitians in the Canadian public health care system. We conducted a thematic analysis that was both inductive and deductive. Results: We identified four themes: i) Avoidable factors that contribute to churn often reflect intersecting human resource management issues; ii) Unavoidable factors that contribute to church frequently result from a decision made by the departing dietitian; iii) High churn in select positions has a disproportionately negative impact on patients served by dietitians in those high churn positions, and iv) Consequences of churn can be long-lasting and result in less efficient dietetic practice and reduced access to medical nutrition therapy. As predicted, prestige was perceived as playing a role in triggering dietitian turnover – however, prestige was more commonly attributed to employment in a respected institution than to providing treatment for a particular disease or condition. Conclusions: Managers of publicly-employed dietitians identified many factors as contributing to churn. Managers observed churn resulting in low provider continuity and limiting patient access to dietitians. More research is needed to better understand factors contributing to churn among Canadian clinical dietitians.Trial Registration: Not applicable.

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Stability and change in disease prestige: A comparative analysis of three surveys spanning a quarter of a century

Cited by 64 publications

References 41 publications

Beyond the cultural myth of medical meritocracy

Beyond the cultural myth of medical meritocracy

Re‐structuring the negotiated order of the hospital

High turnover in clinical dietetics: A qualitative analysis

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