The dislocation of medical dominance: making space for interprofessional care

Abstract

The historical transition of modern medicine from an autonomous profession to a team-based interprofessional practice can be described in terms of space rather than time, with "place" as the unit of analysis. Imagining modern medicine spatially was instigated by Foucault, who described medical dominance as a territorializing of both individual body spaces and public spaces--the former through the diagnostic medical gaze, the latter in a gaze of health surveillance. However, much has happened since Foucault's (1963) analysis. The diagnostic gaze has been dispersed to develop a collaborative gaze including patients and healthcare professionals; political interests have appropriated the public health gaze; and the medical profession is subject to democratic processes of accountability. Medicine has lost its territorial imperative as new "liquid" and "nomadic" work practices emerge, making space for interprofessional care. Such dislocation of medical dominance and its multiple relocations are poorly theorised. Deleuze and Guattari distinguish between "striated" and "smooth" spaces. Striated space is associated with hierarchies and boundaries, where smooth space includes boundary crossing and democratic collaboration. Smooth or liminal spaces in hospitals, such as corridors, can paradoxically act as catalysts for collaboration or assembly democracy, affording opportunities for improvised interprofessional encounters. Such encounters can act as an antidote to planned protocols or imperatives for interprofessional collaboration.

Ideas for the development of the interprofessional education and practice field: An update

“…These authors drew upon Foucault's work on discourse and governmentality to explore how healthcare professionals employ different patient safety discourses to protect and control their respective areas of clinical expertise when engaging in interprofessional work. Other useful sociological examples are provided by Bleakley (2013) and Goldman et al (2015).…”

Interprofessional Education and Practice Guide No. 6: Developing practice-based interprofessional learning using a short placement model

“…Indeed this has been emphasised by interprofessional leaders, who discuss the cogent role of learning based on actual real life situations, so that students see the complexity and understand the responsibility of different professional team members (Barr, 2002;D'Eon, 2005). In practice students observe professional social interactions which may be conversations in corridors and common staff spaces demonstrating the importance of positive professional relationships (Gittell, 2000;Bleakley, 2013;Gregory, Hopwood & Boud, 2014). Despite these benefits, many educators report that establishing practice-based IPE can be challenging, labour intensive in the development phase and difficult to sustain, often because of rapid staff turnover and lack of time and resources (Morison & Jenkins, 2007;Jackson & Bluteau, 2007;Furness, Armitage & Pitt, 2012).…”

Deconstructing dementia and delirium hospital practice: using cultural historical activity theory to inform education approaches

“…This recommendation is in line with others in the field who argue for the need to promote interprofessional care as a means and ''antidote'' to address the difficulties presented by prevalent medical dominance (Bleakley 2013b). The advantage of IPE is that dialogue amongst professionals can be developed and professional tensions underpinning poor practice may be reduced.…”