Social Organization of Medical Work

323 Pages·1985·14.137 MB·English

by  Anselm L. Strauss, Shizuko Fagerhaugh, Barbara Suczek, Carolyn Wiener

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-
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