Exploring the interplay of discourses, jurisdictions and restratification in medicine and the implications for intraprofessional collaboration

Abstract

This study builds on calls to explore the tensions and dynamics of intraprofessional collaboration and boundary work. It reaches beyond the literature describing the micro-level strategies deployed by physician subgroups to establish legitimacy and defend jurisdictions in the face of health care re-organization. Specifically, it offers a view of how macrosocial imperatives shape intraprofessional boundaries, relations, and the possibilities for collaboration. Drawing on empirical data from a case study of intraprofessional collaboration in caring for patients with diabetes - a clinical context in which patients commonly receive care from family physicians (FPs) and specialist physicians (SPs) – Foucault's concept of governmentality and the sociology of the professions are employed to make visible the sociohistorical construction of intraprofessional collaboration within discourses of evidence-based medicine, and its implications for the [re-]negotiation of professional jurisdictions and restratification of the medical profession. This analysis contributes to the intraprofessional literature through two analytical moves. First, it outlines the discursive mechanisms through which the meso-level deployment of the referral-consultation process provides an arena for SPs to maintain and reinforce their position of influence at both the micro-level of daily clinical work and across broader health care delivery. Second, it provides an understanding of how the transmission of governmental rationality in diabetes occurs through the social relations between SPs and FPs, making the restratification of medicine possible without tension or conflict.

Keywords

• Consultation and referral
• Discourse
• Evidence-based medicine
• Foucault
• Intraprofessional collaboration
• Systems of professions