Self, agency and the surgical collective: detachment (original) (raw)
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Anthropology & Medicine, 2010
Year medical students in their first year of clinical training doing their surgical attachment. Previously, the authors have argued that medical curricula constitute normalising technologies of self that aim to create a certain kind of doctor. Here, they argue that a key mechanism through which these normalising technologies are exercised in the workplace is Etienne Wenger's communities of practice. In the clinical environment the authors identify communities of clinical practice (CoCP) as groups of health professionals that come together with the specific and common purpose of patient care. Fourth Year medical students join these transient communities as participants who are both peripheral and legitimate. Communities of clinical practice are potent vehicles for student learning. They learn and internalise the normative professional values and behaviours that they witness and experience within the disciplinary block of the medical school and teaching hospital; specifically, the authors suggest, it is through their participation in communities of clinical practice that medical students learn how to 'be one of us'.
Discourse, organisation and the surgical ward round
Sociology of Health & Illness, 1993
The surgical ward round is examined as an organisational strategy entered into by surgeons to enable particular claims about the success of surgery to be validated.The paper reports ethnographic data from UK surgical wards which suggest that surgeons organise the discourse of their interactions with patients around three themes: physiology, wound condition and recovery/discharge. These themes are surgeon-centred, and are organised to deny patients access to the agenda of these encounters.Within a post-structuralist and postmodern framework, these strategies of discourse organisation are understood as techniques of power. Surgeons privilege discourses which support their claims to be healers, denying those which focus on the necessary injury which surgical resection causes. The paper argues that the ‘ward round’ is a mythical structure constituted as an organisational strategy to counter challenges from patients to their hegemonic discourse.
A Clarion Call for More Qualitative Studies in Surgery
2021
Qualitative studies in Surgery are important because they contextualize the previously missing social facets of the surgical narrative and inquire into the crucial issues of quality of life/well-being, gender and other discriminations and biases faced by surgeons and patients, surgical education/training, mental issues and burnout, etc. This has resulted in an increasing trend of qualitative studies in surgery. Authors, editors and journals have to ensure that the principles of scientific rigour in qualitative research are followed; otherwise, the answers will not be valid, thus rendering the whole exercise futile. More studies, addressing these fascinating ‘social’ facets of surgery, are needed.
A Call to Conduct In-depth Qualitative Studies on the Experiences of Surgical Cancer Patients
We need to better understand the lived experiences of individuals diagnosed with cancer and their surgical management. According to Creswell (2009), social constructivists assume that we all seek to understand the world in which we live and work. The constructivist research relies as much as possible on the participants’ views of the studied situation (Creswell). Surgery is still regarded with awe and fear because of its perceived grounding in the biomedical model of disease. Perhaps the profession needs to reinvent itself and broaden its healing ability beyond surgical wounds to the whole individual. A better understanding of what goes through the mind of a surgical patient could be a good starting point.
Health Care Analysis, 2009
Many have described how illness, disorder or injury has made them not only undergo medical testing procedures in order to find out what was wrong with their bodies, but also made them question their way of being in the world as selves, including their identity. Such is the case when some organ receivers explain that they ''are no longer themselves'' after transplantation, since they have someone else's organ in their bodies . Such is also the case when Lance Armstrong [1, p. 14] describes how he, when given a testicular cancer diagnosis, engaged in a thorough questioning of ''everything: my world, my profession, my self''. He describes how he had left his home, heading towards the hospital as an ''indestructable 25-year-old, bulletproof'', and how the diagnosis changed ''everything'' [1, p. 14]. Many more examples can be given of how illness, disorder or injury can make us question who we are, our sense of self. Illness, disorder or injury can prompt us to engage in meaning-making processes as regards our selfunderstanding, who we are in relation to others and the world.
Elective surgical patients' narratives of hospitalization: The co-construction of safety
Social Science and Medicine, 2013
his research explores how elective surgical patients make sense of their hospitalization experiences. We explore sensemaking using longitudinal narrative interviews (n=72) with 38 patients undergoing elective surgical procedures between June 2010 and February 2011. We consider patients’ narratives, the stories they tell of their prior expectations, and subsequent post-surgery experiences of their care in a United Kingdom (UK) hospital. An emergent pre-surgery theme is that of a paradoxical position in which they choose to make themselves vulnerable by agreeing to surgery to enhance their health, this necessitating trust of clinicians (doctors and nurses). To make sense of their situation, patients draw on technical (doctors’ expert knowledge and skills), bureaucratic (National Health Service as a revered institution) and ideological (hospitals as places of safety), discourses. Post-operatively, themes of ‘chaos’ and ‘suffering’ emerge from the narratives of patients whose pre-surgery expectations (and trust) have been violated. Their stories tell of unmet expectations and of inability to make shared sense of experiences with clinicians who are responsible for their care. We add to knowledge of how patients play a critical part in the co-construction of safety by demonstrating how patient-clinician intersubjectivity contributes to the type of harm that patients describe. Our results suggest that approaches to enhancing patients’ safety will be limited if they fail to reflect patients’ involvement in the negotiated process of healthcare. We also provide further evidence of the contribution narrative inquiry can make to patient safety.
Nursing practices can attract concern, even criticism, when watched from the bedside, or read from fieldwork transcripts by nurse-researchers investigating patients' communication of pain. However, a secondary analysis, via a discourse analysis with Foucault's work on governmentality, allowed for a reading of how pain was governed and this provided another perspective. In these findings, the nurses' position is constructed by patients as both 'good' and 'busy', regardless of the responsiveness of nurses to patients' pain. The patients' position was that of a 'good' patient if they were 'active'; that is, undertaking self-surveillance in relation to their pain and actively working toward their recovery. Their pain was constructed on a linear and numerical scale, to which all complied. Important to all this is the examination, a disciplinary procedure with invisible but powerful effects, so powerful that the patient's body is ren...
Journal of Perioperative Practice, 2019
Surgical care practitioners are non-medical members of the surgical team, who provide direct surgical care to patients, delegated by consultant surgeons. The surgical care practitioners’ professional role is within the new non-medical or nursing workstream, practising under the medical model of care in response to staff shortages and the rising expectations that are affecting the National Health Service. This article seeks to contribute to a better understanding of the phenomenon of the emergent professional identity of surgical care practitioners. Six surgical care practitioners were purposively sampled for in-depth, semi-structured interviews whereupon their concepts of professional transition and professional identity formation from their individual points of view were explored using a phenomenological approach. Transcripts and reflective texts were subject to repeated interpretation in a hermeneutic circle of understanding. Interpretation of the results in context allowed for a ...