Table Of Content

Social Organization of Medical Work Social Organization of Medical Work Anselm Strauss Shizuko Fagerhaugh Barbara Suczek and Carolyn Wiener The University of Chicago Press Chicago and London ANSELM STRAUSS is a professor in the Department of Social and Behavioral Sciences at the University of California at San Francisco. SHIZUKO FAGERHAUGH, research nurse and lecturer, and BARBARA SucZEK and CAROLYN WIENER, research sociologists, also are associ ated with the Department of Social and Behavioral Sciences at the University of California at San Francisco. The University of Chicago Press, Chicago 60637 The University of Chicago Press, Ltd., London © 1985 by The University of Chicago All rights reserved. Published 1985 Printed in the United States of America 94 93 92 91 90 89 88 87 86 85 54321 Library of Congress Cataloging in Publication Data Main entry under title: Social organization of medical work. Bibliography: p. 297 Includes index. 1. Social medicine-United States. 2. Long-term care of the sick-United States. 3. Work environment-United States. I. Strauss, Anselm L. [DNLM: 1. Delivery of Health Care. 2. Social Work. 3. Sociology, Medical. W 322 S672] RA 418.3.U6S63 1985 362.1'042 84-23995 ISBN 0-226-77707-3 To R.B. who understands this all too well Contents Preface IX 1 Chronic Illness, Technology, and the Hospital 1 2 Illness Trajectories 8 3 Machine Work 40 4 Safety Work 69 5 Comfort Work 99 6 Sentimental Work 129 7 Articulation Work 151 8 The Work of Patients 191 9 Macro to Micro and Micro to Macro Impacts: The Intensive Care Units 210 10 Theoretical Implications 238 Appendix: Methodological Note 291 References 297 Author Index 305 Subject Index 307 In the beginning was Work. The Universe had to be made by someone or something: but by which God or which com bination of natural forces we do not yet know. As for the Garden, it was not inevitable that Eve should eat the apple; it could have been Adam, and even the Serpent could not be said to have embarked on his career of villainy before he worked at tempting someone to eat the apple. So Work-or Act-is primary. -Anonymous, 5th century B.c. Marx was quite right in emphasizing the primacy of work but-transfixed by his images of human exploitation and engaged in a life/death struggle with Ricardo, Malthus, et al.-tripped into the mud puddle of a non sequitur. Work is primary; may lead to a division of labor in which ex ploitation reigns; may lead to many alternative divisions of work and many modes of relationship. -Anonymous, 20th century But in every case a study of the concrete situation whether Flaubert, Valery, or the foreign policies of the Gironde-ends up bringing Sartre back to its deap-seated structural context. His research moves from the surface to the depths, and so links up with my own preoccupations. It would link up even better if the hourglass could be turned over both ways-from event to structure, and then from structure and model back to event. -Fernand Braudel, On History Preface This book has dual messages. Both pertain to the primacy of work for shaping the divisions of labor which form around it, as well as the experiences and careers of the people who do the work, and for influencing the very structure of the organizations in which work takes place. The first message is meant to reach social scientists who may have no particular interest in the work done on hospital wards but are deeply interested in the topic of work as such and in how it may be studied, analyzed, and theorized about. The second message is ad dressed to readers who are vitally concerned with caring for hospital ized patients-who are working on, around, and with sick people. In the most general sense, that latter message consists of this: the work of physicians, nurses, and associated technicians has been radi cally and irrevocably altered by today's prevalence of chronic illnes ses-the illnesses that bring patients into contemporary hospitals-and by the technologies developed to manage them. But how, in detail, has that work changed and what are some of the experiences of those who do the work of managing those illnesses-including the patients them selves? We bring a sociological perspective to bear on that question. Our perspective has been shaped by many years of observation in hospitals, these in turn preceding the four-year observational and interview study on which this book is based. The research reported on here was done on many different types of wards, in seven hospitals in the Bay Area of San Francisco, and the interviews done there were sup- ix