Multiple Vulnerabilities in Medical Settings: Invisible Suffering of Doctors

Abstract

While there is a substantive amount of literature on vulnerability of different kinds of patients in different settings, medical professionals are usually considered as the ones who possess power and gain a privileged position. In this paper, we aim to demonstrate that in a certain context physicians—a social group which is usually referred to as “powerful”—consider themselves vulnerable, and this positioning may influence patients in turn. This perspective highlights the complexity of interactions within medical organizations and contributes to the studies of sensitive topics and vulnerable groups. We conceptualize vulnerability of doctors and discuss what can be problematic in powerful doctors’ position. We describe some features of the post-Soviet context of Russian healthcare system and maternity care, both of which can be conceptualized as a hybrid of legacy of Soviet paternalism and new neoliberal reforms, managerialism and marketization. Empirical research is based on the ethnographic evidence from the study of a Russian perinatal center. In this article, we explore specific “existential” and “moral” vulnerabilities of medical professionals who routinely have to cope with multiple challenges, such as complicated clinical tasks, rigid control of different state bodies and emotional responses of suffering patients. We argue that there is a bond between the vulnerability of doctors and that of patients, whose position becomes more problematic as professionals become more vulnerable. At the end, we discuss methodological and theoretical implications of our research.

COVID-19 in Russia: Should we expect a novel response to the novel coronavirus?

“…Soviet doctors kept out of politics, were not likely to be agitators of the system, and maintained low civic profiles given that they were state employees (Feshbach & Friendly, 1992). Moreover, doctors in Russia are a socially vulnerable population and work in an 'overregulated and centralized' healthcare system that does not offer much professional autonomy (Litvina et al, 2020). Russian doctors find themselves in a difficult situation in negotiating how to provide reasonable care to patients and operate in the bureaucratic healthcare system filled with contradictory rules and regulations (Temkina, 2020).…”

“Soldiers of the System”: Maternity Care in Russia Between Bureaucratic Instructions and the Epidemiological Risks of COVID-19

“…On the other hand, from Soviet times to the present day, the logic of bureaucratic control continues to play a decisive role in the Russian healthcare system and has even increased in recent years ( Litvina et al, 2020 ). The threat of prosecution against doctors has intensified, as evidenced by several high-profile trials of obstetricians-gynecologists and neonatologists.…”

“…Only 11% agree with the statement that a doctor is interested in their health ( FOM 2019 ). The high vulnerability of doctors and the high risks of their work contribute to the fact that they themselves are not inclined to trust the system in which they work ( Litvina et al, 2020 ).…”

Active mistrust' of doctors: A case study of legal support during childbirth

“…Сфера родовспоможения характеризуется особенно высоким уровнем недоверия, что получило освещение в целом ряде исследований (Rivkin-Fish 2005; Здравомыслова, Тёмкина 2009; Тёмкина 2016, 2017, 2018). Отмечается, что существующие в акушерстве высокие риски создают не только уязвимого пациента, но также повышают уязвимость медицинских работников (Litvina, Novkunskaya, Temkina 2020). Действительно, по данным Следственного комитета РФ, акушерство традиционно занимает лидирующее место по количеству жалоб пациентов (Петрова 2017), а по данным судебно-медицинских экспертов -по числу установленных дефектов оказания медицинской помощи (Лобан и др.…”