This study explains the effects of medical institutionalization on the framing of doctor—patient interviews. We draw on Weberian, Habermasian, and Foucaultian perspectives to explain the ways that occupational rationalities are embodied in doctor—patient encounters, and how these rationalities structure and are structured by occupational conceptions of medical clients. We use the results of par ticipant-obser ver methods to demonstrate specific instances of the ways in which organization—client interactions are simulated in a standardized patient training programme. Finally, we discuss findings with respect to our theoretical perspectives, showing how each perspective contributes unique insights into understandings of organizations and the communities they serve.
Anderson, L.A. & Sharpe, P.A.Improving patient and provider communications: A synthesis and review of communication interventions . Patent Education and Counseling, 1991, 17, 3324—32 .
2.
Anderson, R. Magic , science , and health : The aims and achievements of medical anthropology . Fort Worth, TX: Harcourt Brace , 1996.
Armstrong , D. A new history of identity: A sociology of medical knowledge. Basingstoke : Palgrave , 2002.
5.
Arora, N.K.Interacting with cancer patients: The significance of physicians' communication behavior . Social Science & Medicine, 2003 , 57, 791—806 .
6.
Austin, J.L.How to do things with words. Oxford: Clarendon Press , 1962.
7.
Balint, M.The doctor, his patient and the illness . The Lancet, 1955, 265, 683—8 .
8.
Barley, S.R. & Knight, D.B.Toward a cultural theory of stress complaints . Research in Organizational Behavior, 1992, 14, 1—48 .
9.
Barrows, H.S. & Abrahamson, S.The programmed patient: A technique for appraising student performance in clinical neurology . Journal of Medical Education, 1964, 39, 802—05 .
10.
Barzansky, B. & Etzel, S.I.Educational programs in US medical schools, 2003—2004. Journal of theAmerican Medical Association, 2004, 292, 1025—31 .
11.
Cassell, E.J.Talking with patients. Cambridge, MA: MIT Press , 1985.
12.
Chomsky, N.The common good. New York: Odonian Press , 1998.
13.
Chomsky, N. & Foucault, M.Human nature: Justice versus power. In F. Elders (Ed.), Reflexive water: The basic concerns of mankind. London: Souvenir , 1974, p. 171.
14.
Colliver, J.A. , Marcy, M.L. , Vu, N.V. , Steward, D.E. & Robbs, R.S.Effects of using multiple standardized patients to rate interpersonal and communication skills on intercase reliability. Teaching and Learning in Medicine, 1994, 6, 45—8 .
15.
Colson, A.C. & Selby, K.E.Medical anthropology . Annual Review of Anthropology, 1974, 3, 245—62 .
16.
Conrad, P.The discovery of hyperkinesis: Notes on the medicalization of deviant behavior . Social Problems, 1975, 23, 12—21 .
17.
Conrad, P.Medicalization and social control . Annual Review of Sociology , 1992, 18, 209—32 .
18.
Conrad, P.The medicalization of society, forthcoming.
19.
Conrad, P. & Schneider, J. Deviance and medicalization : From badness to sickness. St Louis, MO: Mosby , 1980.
20.
Crespi, F.Social action and the ambivalence of communication: A critique of Habermas's theory . European Journal of Communication, 1987, 2, 415—25 .
21.
Cuddon , J.A. A dictionary of literary terms and literary theory, 3rd edn. London: Blackwell , 1991.
22.
DiMaggio, P. & Powell, W.W.The Iron Cage revisited: Institutional isomorphism and collective rationality in organizational fields . American Sociological Review, 1983, 52, 147—60 .
23.
Elwell, F.W.Industrializing America: Understanding contemporary society through classical sociological analysis. Westport, CT: Praeger , 1999.
24.
Epstein, R.M. & Hundert, E.M.Defining and assessing professional competence . Journal of the American Medical Association, 2002, 287, 226—35 .
25.
Erickson, F.Appropriation of voice and presentation of self as a fellow physician: Aspects of a discourse of self and apprenticeship in medicine. In S. Saragni & C. Roberts (Eds), Talk, work, and institutional order: Discourse in medical, mediation and management settings. Berlin: Mouton de Gruyter , 1999, pp. 109—43.
26.
Fennell, M.L.The effects of environmental characteristics on the structure of hospital clusters . Administrative Science Quarterly,1980, 25, 485—510 .
27.
Fisher, S. & Todd, A.The social organization of doctor—patient communication. Norwood, NJ: Ablex , 1993.
28.
Flyvbjerg, B. Habermas and Foucault : Thinkers for civil society?The British Journal of Sociology,1998, 49(2), 210—33 .
29.
Foucault, M.The archeology of knowledge and the discourse on language, trans. A. Sheridan Smith. New York: Pantheon , 1972.
30.
Foucault, M.The history of sexuality, vol 1. New York: Pantheon , 1978.
31.
Foucault, M.The will to knowledge: The history of sexuality, vol, 1., trans. R. Hurley. London: Penguin Books , 1998.
32.
Freund, J.The sociology of Max Weber. New York: Vintage Books , 1968.
33.
Greenhalgh, T. , Robb, N. & Scamber, G.Communicative action and strategic action in primary health care: A Habermasian perspective . Social Science & Medicine, 2006, 63, 1170—87 .
34.
Habermas, J.Communication and the evolution of society. Toronto: Beacon Press , 1979.
35.
Habermas, J.The theory of communicative action, vols 1 & 2, trans. T. McCarthy. Boston, MA: Beacon Press , 1981.
36.
Hyde, M.Treating the patient as a person . Quarterly Journal of Speech , 1986, 72(4), 456—69 .
37.
Illich, I.Medical nemesis. New York: Pantheon , 1976.
38.
Kirmayer, L.J.The body's insistence on meaning: Metaphor as presentation and representation in illness experience . Medical Anthropology Quarterly, 1992, 6, 323—46 .
39.
Kleinman, A. , Eisenberg, L. & Good, B. Culture , illness and care : Clinical lessons from anthropological and cross-cultural research . Annals of Internal Medicine, 1978, 88, 251—8 .
40.
Kleinman, A.Patients and healers in the context of culture. Berkeley : University of California Press , 1980.
41.
Kuipers, J.C.Medical discourse in anthropological context: Views of language and power . Medical Anthropology Quarterly, 1989, 3(2), 99—123 .
42.
Labov, W. & Fanshell, D.Therapeutic discourse: Psychotherapy as convention. New York: Academic Press , 1977.
43.
Lazarus, E.S.Theoretical considerations for the study of the doctor—patient relationship: Implications of a perinatal study . Medical Anthropology Quarterly , 1988, 1, 34—58 .
44.
Meyer, J.W. & Rowan, B.Institutionalized organizations: Formal structure as myth and ceremony . American Journal of Sociology, 1977, 83, 340—63 .
45.
Meyer, J.W. & Scott, W.R.Organizational environments: Ritual and rationality. Beverly Hills, CA: Sage , 1983.
46.
Mishler, E.The discourse of medicine: Dialectics of medical interviews. Norwood, NJ: Ablex , 1984.
47.
Morrow, G.R. , Hoagland, A.C. & Carpenter, P.J.Improving physician—patient communications in cancer treatment . Journal of Psychosocial Oncology, 1983, 1, 93—101 .
48.
Nietzsche, F.W.The gay science, trans. W. Kaufmann. New York : Vintage Books , 1974.
49.
Ong, L.M.L. , DeHaes, J.C.J.M., Hoos, A.M. & Lammes, F.B. Doctor—patient communication: A review of the literature . Social Science & Medicine , 1995, 40, 903—18 .
50.
Orlikowski, W.J. & Yates, J.Genre repertoire: The structuring of communicative practices in organizations . Administrative Science Quarterly, 1994, 39, 541—74 .
51.
Peacock, J.L.The anthropological lens. Cambridge: Cambridge University Press , 1994. (Originally published 1986.)
52.
Prochaska, J.O. & DiClemente, C.C.Stages of change in the modification of problem behavior. In M. Hersen , R. Eisler & P.M. Miller (Eds), Progress in behavior modification. Sycamore, IL: Sycamore Publishing Company , 1992, pp. 184—218.
53.
Razavi, D. , Delvaux, N. , Marchal, S. , de Cock, M. , Farvacques, C. & Slachmuylder, J.L.Testing health care professionals' communication skills: The usefulness of highly emotional standardized role-playing sessions with simulators . Psycho-Oncology, 2000, 9, 293—302 .
54.
Rorty, R.Unger, Castoriadis, and the romance of a national future. In R. Rorty , Philosophical papers, vol. 2. Cambridge: Cambridge University Press , 1991.
55.
Roter, D.L. & Hall, J.A.Doctors talking with patients, patients talking with doctors. Westport, CT: Auburn House , 1992 .
56.
Schlenzka, P.F.Safety of alternative approaches to childbirth. Unpublished dissertation, Stanford University, Palo Alto, CA , 1999.
57.
Schneider, J.W.Deviant drinking as a disease: Deviant drinking as a social accomplishment . Social Problems, 1978, 25, 361—72 .
58.
Schutz, A. & Luckmann, T.The structures of the life-world. Evanston, IL: Northwestern University Press , 1973.
59.
Scott, W.R. , Ruef, M. , Mendel, P.J. & Caronna, C.J.Institutional change and healthcare organizations: From professional dominance to managed care. Chicago, IL: University of Chicago Press , 2000.
60.
Searle, J.Speech acts: An essay in the philosophy of language. Cambridge : Cambridge University , 1969.
61.
Shavelson , L. A chosen death. New York: Simon and Schuster , 1995.
62.
Silverman, D.Interpreting qualitative data: Methods for analyzing talk, text, and interaction , 2nd edn. Thousand Oaks, CA : Sage , 2001.
63.
Steedly, M.M.Severing the bonds of love: A case study in soul loss . Social Science & Medicine, 1988, 27, 841—56 .
64.
Swartz, M. & Colliver, J.Using standardized patients for assessing clinical performance . Mount Sinai Journal of Medicine, 1996, 63, 241—9 .
65.
Szasz, T.Law, liberty and psychiatry. New York: Macmillan , 1963.
66.
Taussig, M.Reification and the consciousness of the patient . Social Science & Medicine, 1980, 14, 3—13 .
67.
Townley, B.Foucault, power/knowledge, and its relevance for human resource management . Academy of Management Review, 1993, 18, 518—45 .
68.
Vu, N.N. , Barrows, H.S. , Marcy, M.L. , Verhulst, S.J. , Colliver, J.A. & Travis, T.Six years of comprehensive, clinical, performance-based assessment using standardized patients at the Southern Illinois University School of Medicine . Academic Medicine, 1992, 67, 42—50 .
69.
Waitzkin, H.The second sickness: Contradictions of capitalist health care. New York: The Free Press , 1983.
70.
Waitzkin , H. A critical theory of Medical Discourse: Ideology, social control, and the processing of social context in medical encounters . Journal of Health and Social Behavior, 1989, 30, 220—39 .
71.
Waitzkin, H.The politics of medical encounters: How patients and doctors deal with social problems. New Haven, CT: Yale University Press , 1991.
72.
Wallace, P.Following the threads of an innovation: The history of SPs in medical education . Caduceus, A Humanities Journal for Medicine and the Health Sciences, 1997, 13, 5—28 .
73.
Weber, M.The methodology of the social sciences. New York: The Free Press , 1949.
74.
Weber, M.Economy and society, vol. 1. New York: Bedminster Press , 1968 .
75.
Weber, M.The protestant ethic and the spirit of capitalism. London : Routledge , 1992. (Originally published 1930.)
76.
Williams, S.J.Sociological imperialism and the profession of medicine revisited: Where are we now?Sociology of Health and Illness, 2001 , 23, 135—58 .
77.
Williams, S.J. & Calnan, M.The `limits' of medicalization? Modern medicine and the lay populace in `late' modernity . Social Science & Medicine, 1996, 42, 1609—20 .
78.
Zandbelt, L.C. , Smets, E.M.A. , Oort, F.J. , Godfried, M.H. & deHays, H.C.J.M.Determinants of physicians' patient-centered behavior in the medical specialist encounter . Social Science & Medicine, 2006, 63, 899—910 .
79.
Zola, I.Medicine as an institution of social control . Sociological Review, 1972, 20, 487—504 .
80.
Zola, I.Socio-medical inquiries. Philadelphia, PA: Temple University Press , 1983.
81.
Zucker, L.G.Institutional patterns and organizations. Cambridge, MA : Ballinger , 1988.
