Hospital consultations and jurisdiction over patients: consequences for the medical profession

Abstract

Advances in biomedical technologies and the increased specialisation of the medical profession have made collaborations among specialty physicians integral to care delivery. As physicians increasingly must share patients, how does this shape the jurisdiction that physicians hold? The sociological literature has extensively documented inter-professional jurisdictional claims and conflicts to maintain the professional power of physicians in relation to allied occupational groups. However, less is known of intra-professional avoidance and resolution of conflict over jurisdiction. This case study considers how jurisdictions are shared, maintained and challenged in a single profession. Drawing from ethnographic and interview data collected from September 2010 to October 2012 on the internal medicine service of a teaching hospital in the USA, I demonstrate the variation in jurisdictional conflicts that emerge between internal medicine and other specialties during the consultation process. Ignoring shared jurisdictions and refusing to accept jurisdiction of patients generate disputes among the principal medical and specialist teams. These disputes ensue due to blurred boundaries dividing the various specialties. To avoid conflicts, internal medicine physicians adopt strategies behind the scenes to facilitate smooth consultations.

Experiences and perspectives of implementing antimicrobial stewardship in five French hospitals: a qualitative study

“…The situation is more complex in medical units where physicians may refrain from involving ID specialists in patients care. Their reservations could be explained by: the overlap of medical knowledge and common training among medical specialties, the sense of ownership of clinical decision-making, the high specialisation of hospital physicians and patients' specificities (comorbidities, severe conditions) [23,27,28]. Physicians frequently consider they can manage infectious diseases by themselves, especially the ones within their own speciality, and sometimes fail to acknowledge the input of a specialist, especially regarding diagnostic issues.…”

“…In hospitals, ASPLs had a role as consultants on antimicrobial treatments or infections, while ward physicians are medically and legally in charge of patients. Moreover, Oh explained that in teaching hospitals, the hierarchical structuring of care delivery forms another obstacle for consultants, as interns and residents receive orders from their superiors which they feel compelled to carry out [28]. Many studies described how hierarchical influence and prescribing etiquette weigh on junior and even more experienced doctors, leading them to adopt usual practices that could not be questioned by their colleagues [29][30][31][32].…”

The Resurgence of Medical Education in Sociology: A Return to Our Roots and an Agenda for the Future

“…Yet power and conflict are rarely at the center of interdisciplinary IPE research (Paradis and Whitehead 2018). Work that does highlight such power dynamics is often conducted by sociologists, like Oh's (2014) ethnographic study of hospitalists, which focused on professional jurisdiction and boundary work within medical specialties. Notably, sociologists have provided evidence for the counterintuitive argument that IPE may in fact increase professional boundaries and hierarchical divides rather than foster collaborative relationships (Whyte et al 2017).…”

Communication and Culture in the Surgical Intensive Care Unit

“…Within interprofessional health care teams comprised of health professionals such as physical and occupational therapists, as well as doctors and nurses, team members also participate in these practices within a more layered interprofessional hierarchy and context (Apesoa-Varano, 2013; Nugus, Greenfield, Travaglia, Westbrook, & Braithwaite, 2010; Reeves et al, 2009). Within medicine, several examples from sociology demonstrate how doctors engage in boundary work among themselves to differentiate and position the authority of their medical or surgical subspecialties (Burri, 2008; Oh, 2014; Serra, 2010).…”