Point Counterpoint: The Function of Contradictions on an Interdisciplinary Health Care Team

Abstract

In this qualitative study we used Dialectical Theory to analyze contradictions occurring between medical doctors (MDs) and nurse practitioners (NPs) working collaboratively on a health care team. The analysis of interview data revealed contradictions in two areas: (1) NPs espouse a need for heightened autonomy in their working associations with medical doctors, whereas conversely, MDs emphasize a need for ongoing connection, and (2) MDs argue that NPs should be more proactive problem solvers and frame their working relationships as educational. However, NPs argue that MDs enact patterns of behavior that limit proactive problem solving and curtail the educational potential of those relationships, thus reinforcing predictable work routines. Both areas of contradiction constitute what dialectical theorist Leslie Baxter refers to as "oppositions." Examples of these oppositions are provided in the analysis. The study concludes with an assessment of how such contradictions might constitute developmental opportunities for NPs and MDs working in collaboration.

Assessing the facilitators and barriers of interdisciplinary team working in primary care using normalisation process theory: An integrative review

“…The included studies were: qualitative ( n = 39) [39–77], quantitative ( n = 2) [78, 79], and mixed method ( n = 8) [80–87] (S1 Table). The studies were from 11 countries and most of the studies were conducted in Canada ( n = 17) [45, 51–53, 55, 57, 63, 65, 66, 71, 78–80, 82–84, 87], followed by the USA ( n = 12) [40, 43, 44, 47, 49, 56, 58, 72, 76, 77, 85, 86], the UK ( n = 7) [39, 48, 59, 64, 68, 70, 81], Australia ( n = 4) [42, 73–75], New Zealand ( n = 2) [41, 62], Sweden ( n = 2) [54, 67], France ( n = 1) [50], Spain ( n = 1) [46], Netherlands ( n = 1) [60], Brazil ( n = 1) [61] and Republic of South Africa ( n = 1) [69].…”

“…Within the review all 49 papers referred to enactment [39–77], [78, 79], [80–87]. Seventeen were from Canada, 12 from the US, seven from the UK, four from Australia, two each from Sweden and New Zealand, one each from France, Brazil, The Netherlands, Republic of South Africa and Spain.…”

“…They’re never rude [MDs] but there’s an attitude you pick up that you can tell , you know [Nurse practitioner] [USA] [77]. …”

Interdisciplinary Geriatric and Palliative Care Team Narratives: Collaboration Practices and Barriers

“…Cultural patterns, perceived absences of equity and fairness in expectations, and a lack of understanding between team members can contribute to power differentials among team members (Martin, O'Brien, Heyworth, & Meyer, 2008). Especially among physicians, there is a lack of understanding of professional team roles (Martin et al, 2008), and many physicians believe that they have the right to alter patient care plans developed by the team (Leipzig et al, 2002).…”

Comunicación, participación y liderazgo en la percepción del clima emocional en un hospital universitario de Andalucía, España

“…El estatus médico privilegiado imprime relaciones interprofesionales desiguales y una estructura de poder hegemónico, donde las contradicciones y conflictos alrededor de las identidades profesionales son comunes y de difícil resolución 28,29 . En este sentido, promover un modelo de gestión más igualitario que permita la participación y reconocimiento de todos los agentes implicados, podría ser una alternativa eficaz al modelo tradicional 13 , lo que también generaría una mejor satisfacción laboral de todo el personal 30 .…”