Making and Meanings of Difficult Patients: Doctors' and Nurses' SubjectiveUnderstandings and Experience of Difficulty

摘要

This dissertation investigates how health care providers in their everydaypractices with patients and with each other construct meaningful understandings of difficult patients, and examines what those meanings are. The study utilizes methods for conducting intensive, empirically grounded, naturalistic field research. Data derive from detailed long-term observations of three clinical settings in an urban, community hospital, a series of in-depth interviews with doctors, nurses and patients, and investigations of patient case studies. The central findings of the dissertation are the following: First, provider's understandings of difficult patients are multiple, complex, and often (but not always) shared. Second, providers' understandings of difficult patients and are marked by regular and systematic differences that relate to their status, level of training, self-perceptions of their roles and responsibilities, and expectations of appropriate patient behavior. The findings reveals as unreliable the common presumption in medical research that health care providers view patient difficulty in essentially the same ways. Third, the dissertation suggests that doctors experience behaviorally difficult patients as threats to their senses of professional entitlement and empowerment, thus exposing as overblow the claim in much medical sociology anthropology theory that doctors and nurses exercise total power in patient-provider encounters.