Managing the Division of Labor
The Discursive Construction of Treatment in Two Hospital Obstetrical Units
DOI:
https://doi.org/10.1558/japl.v2.i3.273Keywords:
medical discourse, hospital chart notation, professional identity, self-presentationAbstract
Medicine, as a scientific discipline, is discursively constructed, and medical discourse is constitutive of medical work. In the modern hospital, the official record of this activity is the patient’s medical chart. The medical chart both records the patient’s progress and inscribes the expert division of labor, documenting the structuring of participation and the manner in which the work is performed. This paper examines the impact of institutional structure on medical work through a comparison of notes recorded in the obstetrical units of two hospitals where the division of labor is differently distributed. Both cases involved a patient who was admitted to the hospital in apparently-normal latent labor but was found on initial examination to display signs of placental abruption, a life-threatening obstetrical emergency. By comparing the recording and management of this condition on the two units, I demonstrate the relationship of organizational structure to the structuring of medical work. In so doing, I reveal the subtext constructed by the writers’ discursive practices, through which their professional and institutional identities are enacted and displayed.
References
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Sarangi, S. and Roberts, C. (1999) The dynamics of interactional and institutional orders in work-related settings. In S. Sarangi and C. Roberts (eds) Talk, Work, and Institutional Order: discourse in medical, mediation and management settings 1–57. Berlin and New York: Mouton de Gruyter.
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Schiffrin, D. (1994) Approaches to Discourse. Oxford and Cambridge, MA: Blackwell.
Siegler, E. L. (2003) Working in teams. In E. L. Siegler, S. Mirafzali and J. B. Foust (eds) An Introduction to Hospital and Inpatient Care 28–36. New York: Springer Publishing Company.
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Weed, L. L. (1969) Medical Records, Medical Education, and Patient Care: the problemoriented record as a basic tool. Cleveland: The Press of Case Western Reserve University.
West, C. (1984) Routine Complications: troubles talk between doctors and patients. Bloomington: Indiana University Press.
West, C. (1998) ‘Not just doctors’ orders’: directive-response sequences in patients’ visits to women and men physicians. In J. Coates (ed.) Language and Gender: a reader 328–353. Oxford: Blackwell Publishers.
Atkinson, P. (1995) Medical Talk and Medical Work: the liturgy of the clinic. London, Thousand Oaks and New Delhi: Sage Publications.
Atkinson, P. (1999) Medical discourse, evidentiality and the construction of professional responsibility. In S. Sarangi and C. Roberts (eds) Talk, Work and Institutional Order: discourse in medical, mediation and management settings 75–107. Berlin and New York: Mouton de Gruyter.
Atkinson, P. (2004) The discursive construction of competence and responsibility in medical collegial talk. Communication & Medicine 1: 13–23.
Bean, W. B. (ed.) (1968) Sir William Osler: aphorisms from his bedside teachings and writings. Springfield. IL: Charles C. Thomas, Publisher.
Candlin, C. N. and Candlin, S. (2002) Discourse, expertise, and the management of risk in health care settings. Research on Language and Social Interaction 35: 115–137.
Cicourel, A. V. (1992) The interpenetration of communicative events: examples from medical encounters. In A. Duranti and C. Goodwin (eds) Rethinking Context: language as an interactive phenomenon 293–310. Cambridge: Cambridge University Press.
Cook-Gumperz, J. and Messerman, L. (1999) Local identities and institutional practices: constructing the record of professional collaboration. In S. Sarangi and C. Roberts (eds) Talk, Work, and Institutional Order: discourse in medical, mediation and management settings 145–181. Berlin and New York: Mouton de Gruyter.
Cunningham, F. G., MacDonald, P. C., Grant, N. F., Leveno, K. J., Gilstrap, L. C., Hankins, G. D.V. and Clark, S. L. (1997) Williams Obstetrics (20th edition). Stanford, CT: Appleton & Lange.
Drew, P. and Heritage, J. (1992) Analyzing talk at work: an introduction. In P. Drew and J. Heritage (eds) Talk at work: interaction in institutional settings 3–65. Cambridge: Cambridge University Press.
Engeström, Y., Engeström, R. and Kerosuo, H. (2003) The discursive construction of collaborative care. Applied Linguistics 24: 286–315.
Erickson, F. (1999) Appropriation of voice and presentation of self as a fellow physician: aspects of a discourse of apprenticeship in medicine. In S. Sarangi and C. Roberts (eds) Talk, Work, and Institutional Order: discourse in medical, mediation and management settings 109–143. Berlin and New York: Mouton de Gruyter.
Fisher, S. and Todd, D. A. (eds) (1983) The Social Organization of Doctor-Patient Communication. Washington, D.C.: Center for Applied Linguistics.
Gilbert, E. S. and Harmon, J. S. (1998) Manual of High Risk Pregnancy & Delivery (Third Edition) St. Louis, MO: Mosby, Inc.
Gorrie, T. M., Slone McKinney, E. and Smith Murray, S. (1998) Foundations of MaternalNewborn Nursing. Philadelphia: W.B. Saunders Company.
Grice, H. P. (1975) Logic and conversation. In P. Cole and J. L. Morgan (eds) Speech Acts 41–58 (Syntax and semantics, vol. 3). New York: Academic Press.
Heath, C. (1992) The delivery and reception of diagnosis in the general-practice consultation. In P. Drew and J. Heritage (eds) Talk at Work: interaction in institutional settings 235–267. Cambridge: Cambridge University Press.
Henderson, V. (1966) The Nature of Nursing. New York: Macmillan.
Hobbs, P. (2002) Islands in a string: the use of background knowledge in an obstetrical resident’s notes. Journal of Sociolinguistics 6: 267–274.
Hobbs, P. (2003) The use of evidentiality in physicians’ progress notes. Discourse Studies 5: 451–478.
Hobbs, P. (2004) The role of progress notes in the professional socialization of medical residents. Journal of Pragmatics 36: 1579–1607.
Hobbs, P. (2007) The communicative functions of the hospital medical chart. In R. Iedema (ed.) Hospital Communication and Clinical Interaction: discourses of health care organization 39–66. Houndmills, England: Palgrave Publishers, Inc.
Hunter, K. M. (1991) Doctors’ Stories: the narrative structure of medical knowledge. Princeton, New Jersey: Princeton University Press.
Iedema, R. and Scheeres, H. (2003) From doing work to talking work: renegotiating knowing, doing, and identity. Applied Linguistics 24: 316–337.
Iedema, R. and Wodak, R. (1999) Introduction: organizational discourses and practices. Discourse & Society 10: 5–19.
James, D. C., Simpson, K. R. and Knox, G. E. (2003) How do expert labor nurses view their role? Journal of Obstetric, Gynecologic, and Neonatal Nursing 32: 814–823.
Kovner, C. T. (2003) Nurses and nursing care. In E. L. Siegler, S. Mirafzali and J. B. Foust (eds) An Introduction to Hospital and Inpatient Care 37–43. New York: Springer Publishing Company.
Lefevre, M., Sanner, L., Anderson, S. and Tsutakawa, R. (1992) The relationship between neonatal mortality and hospital level. The Journal of Family Practice 35(3): 259–264.
Lingard, L., Garwood, K., Schryer, C. F. and Spafford, M. M. (2003) A certain art of uncertainty: case presentation and the development of professional identity. Social Science & Medicine 56: 603–616.
Maynard, D. W. (1992) On clinicians’ co-implicating recipients’ perspective in the delivery of diagnostic news. In P. Drew and J. Heritage (eds) Talk at Work: interaction in institutional settings 331–358. Cambridge: Cambridge University Press.
Peräkylä, A. (1998) Authority and accountability: the delivery of diagnosis in primary health care. Social Psychology Quarterly 61: 301–320.
Pettinari, C. J. (1988) Task, Talk and Text in the Operating Room: a study in medical discourse. Norwood, NJ: Ablex Publishing Company.
Phibbs, C. S., Bronstein, J. M., Buxton, E. and Phibbs, R. H. (1996) The effects of patient volume and level of care at the hospital of birth on neonatal mortality. Journal of the American Medical Association (JAMA) 276(13): 1054–1059.
Rees, C. (1981) Records and hospital routine. In P. Atkinson and C. Heath (eds) Medical Work: realities and routines 55–70. Westmead, England: Gower Publishing Company, Ltd.
Roter, D. L. and Hall, J. A. (1992) Doctors Talking with Patients/Patients Talking with Doctors. Westport, CT: Auburn House.
Sarangi, S. and Clarke, A. (2002) Zones of expertise and the management of uncertainty in genetics risk communication. Research on Language and Social Interaction 35: 139–171.
Sarangi, S. and Roberts, C. (1999) The dynamics of interactional and institutional orders in work-related settings. In S. Sarangi and C. Roberts (eds) Talk, Work, and Institutional Order: discourse in medical, mediation and management settings 1–57. Berlin and New York: Mouton de Gruyter.
Sauls, D. J. (2002) Effects of labor support on mothers, babies, and birth outcomes. Journal of Obstetric, Gynecologic, and Neonatal Nursing 31: 733–741.
Schiffrin, D. (1994) Approaches to Discourse. Oxford and Cambridge, MA: Blackwell.
Siegler, E. L. (2003) Working in teams. In E. L. Siegler, S. Mirafzali and J. B. Foust (eds) An Introduction to Hospital and Inpatient Care 28–36. New York: Springer Publishing Company.
Stein, L. I. (1967) The doctor-nurse game. Archives of General Psychiatry 16: 699–703.
Stein, L. I., Watt, D. T. and Howell, T. (1990) Sounding board: the doctor-nurse game revisited. The New England Journal of Medicine 322: 546–549.
Weed, L. L. (1969) Medical Records, Medical Education, and Patient Care: the problemoriented record as a basic tool. Cleveland: The Press of Case Western Reserve University.
West, C. (1984) Routine Complications: troubles talk between doctors and patients. Bloomington: Indiana University Press.
West, C. (1998) ‘Not just doctors’ orders’: directive-response sequences in patients’ visits to women and men physicians. In J. Coates (ed.) Language and Gender: a reader 328–353. Oxford: Blackwell Publishers.
Published
2008-04-11
Issue
Section
Articles
License
Equinox Publishing Ltd.
How to Cite
Hobbs, P. (2008). Managing the Division of Labor: The Discursive Construction of Treatment in Two Hospital Obstetrical Units. Journal of Applied Linguistics and Professional Practice, 2(3), 273-298. https://doi.org/10.1558/japl.v2.i3.273
