Multiple Vulnerabilities in Medical Settings: Invisible Suffering of Doctors

Medical professionals' agency and pharmaceuticalization: Physician-industry relations in Russia

In the contemporary world pharmaceuticals have become a go-to answer to a growing number of questions. This process of pharmaceuticalization gives rise to a concern with the increasing influence of the pharmaceutical industry on physicians' decision-making. Critics suggest that companies' for-profit-interests might compromise the integrity of medical practice. This article employs qualitative research methodology to explore how Russian physicians deal with the industry's efforts to expand and shape the use of pharmaceuticals. By bridging perspectives of social studies of science and sociology of professions, we offer a contextualized account of physicians' daily practices and interpretations related to pharmaceuticalization. The findings question conventional assumptions of physician-industry relations and allow to delineate a new form of medical professionalism that emerges in the context of pharmaceuticalization and cannot be reduced to either "resisting" industry marketing activities or "giving in" to them and thus corrupting biomedical expertise. Instead, the ways in which physicians navigate abundant sources of knowledge and use industry resources to overcome constraints of their organizational environment attest to mundane forms of agency exercised by physicians in their relations with industry.

Investigating the Relationship between Fear of Failure and the Delivery of End-of-Life Care: A Questionnaire Study

OBJECTIVE

To investigate whether fear of failure (FOF) influences a clinician's perception of how confident and comfortable they are in their delivery of end-of-life (EOL) care.

METHODS

Cross-sectional questionnaire study with recruitment of physicians and nurses across two large NHS hospital trusts in the UK and national UK professional networks. A total of 104 physicians and 101 specialist nurses across 20 hospital specialities provided data that were analysed using a two-step hierarchical regression.

RESULTS

The study validated the PFAI measure for use in medical contexts. Number of EOL conversations, gender, and role were shown to impact confidence and comfortableness with EOL care. Four FOF subscales did show a significant relationship with perceived delivery of EOL care.

CONCLUSION

Aspects of FOF can be shown to negatively impact the clinician experience of delivering EOL care.

CLINICAL IMPLICATIONS

Further study should explore how FOF develops, populations that are more susceptible, sustaining factors, and its impact on clinical care. Techniques developed to manage FOF in other populations can now be investigated in a medical population.

Reproductive strategies of Russian women: results of the pilot survey

The sphere of reproduction as an integral part of the health of population today is medicalized at all stages of the formation of reproductive decisions — from conception to childbirth. The choice of reproductive strategies is influenced by two polar trends: the increasing importance of innovative methods of assisted reproductive technologies (ART) and medically-associated reproduction (MAR), on the one hand, and the growing popularity of traditional methods of pregnancy and childbirth management based on folk healing, yoga, oriental medicine and health improving practices, homeopathy, popular psychology and so on., on the other. Thus, two sides of procreative behavior manifest themselves: both the patterns reflecting a biomedical approach based on scientific innovations and the social behavioral models related to public perceptions of health, well-being and gender roles in the society. The article presents the results of a pilot survey of women of reproductive age (n=54) conducted in April 2022 via an electronic questionnaire. The study focused on two topics: ART (awareness and attitude to various ART programs) and pregnancy and childbirth (perception of different forms of preparation for childbirth, the preferred form of childbirth, attitude to medical interventions in the birth process). Data analysis showed that women's reproductive intentions remain medicalized and take into account the possibilities of ART. Also, the results of the survey confirm the growing demand for humanization of maternity care, which is reflected in the desire of women to carefully approach organization of their own childbirth and team of assistants, to attend courses for expectant parents, be more informed and comprehensively prepared.

Emotional labour as a vehicle of organisational change in maternity care: The case of Russian doulas' institutional work

Sociological scholars of healthcare professions are becoming increasingly aware of the organisational dimension of professionalism, including how professionals as institutional actors are exposed to and influence organisational transformation. By tracing the ground-level professional efforts of Russian doulas-a caring profession that has been plunged into a reforming health system-in this article I explore how meaning-making activities and professionals' emotional labour build into and advance institutional changes in post-socialist maternity care. Drawing on qualitative research materials, I define three ways through which doulas' institutional efforts engage with emotions in clinical settings: (1) redefining emotional labour as a compound of maternity care; (2) grounding emotional labour in the context of reforming institutions; (3) using emotional labour to bridge discrepancies within organisational arrangements in healthcare. My research findings provide new insights into how marketisation influences professional care, as well as about caring professionalism in post-socialist maternity care. Attention to doulas' professional efforts allows for the affective transformation and inequality in the context of healthcare reforms to be analytically grasped. In particular, I trace how doulas' institutional agency embodied in emotional labour constructs the neo-liberal patient's identity.

Turning the gaze: Digital patient feedback and the silent pathology of the NHS

Online review and rating sites, where patients can leave feedback on their experience of the health-care encounter, are becoming an increasing feature of primary care in the NHS. Previous research has analysed how digital surveillance is re-shaping the clinical gaze, as health-care professionals are subject to increased public monitoring. Here, we draw on an empirical study of 41 GP practice staff to show how the gaze is turning, not simply from the patient to the health-care provider, but additionally to the body politic of the NHS. Drawing on focus group and interview data conducted in five UK practices, we show how discourses of online reviews and ratings are producing new professional subjectivities among health-care professionals and the extent to which the gaze extends not only to individual health-care interactions but to the health-care service writ large. We identify three counter-discourses characterising the evolving ways in which online reviews and ratings are creating new subjects in primary care practices: victimhood, prosumption versus traditional values and taking control. We show how the ways in which staff speak about online feedback are patterned by the social environment in which they work and the constraints of the NHS they encounter on a day-to-day basis.

Barriers to Colorectal Cancer Screening Among Russian-speaking Immigrants: The Importance of Culture and Home Country Experiences

There is potential to improve low colorectal cancer screening rates, reduce mortality, and narrow health disparities, if the distinctive screening barriers among Russian-speaking immigrants were better understood. However, there is little relevant research about the topic. To address this gap, this study aimed to identify barriers to timely colorectal cancer screening, especially colonoscopies, among Russian-speakers in New York City. Thirteen key informant interviews were performed with providers, community leaders, and academics. Eight focus groups were then conducted with 81 Russian-speaking individuals, age 50-75, who had not had a timely colonoscopy. Results were translated, transcribed, coded and analyzed. Barriers identified included individual, communal, and structural issues. Distinctive barriers, such as those related to culture and to the experiences of living under the Soviet system, were uncovered. Barriers identified can potentially be reduced through interventions suggested by the research, including more education and more effective provider recommendations.

"Soldiers of the System": Maternity Care in Russia Between Bureaucratic Instructions and the Epidemiological Risks of COVID-19

Preventive measures taken by the Russian maternity care system in response to the COVID-19 pandemic are very tough. Supporting persons (doulas and partners) are being completely excluded from the maternity hospitals. Pregnant women and newborns are distributed in different types of hospitals according to their epidemiological status (confirmed, suspected, contact, or "clear"). Severe infection control measures are introduced for women with confirmed or suspected COVID-19: separation from newborns and weeks of hospital quarantine. How do obstetricians and other perinatal specialists perceive these measures? What strategies do they choose and what new practices are being created? The study is based on interviews conducted between March and August 2020 with obstetricians-gynecologists, midwives, perinatal psychologistsdoulas, and women who gave birth during the pandemic and is focused on their subjective interpretations of COVID-related changes in maternal care. My data indicate that this pandemic with its high risks and uncertainties reveals multiple ethical and organizational conflicts among bureaucratic, managerial and professional logics in Russian health care in which mistrust has played an important role.

Patient-centered care in Russian maternity hospitals: Introducing a new approach through professionals' agency

The article relies on qualitative research methods to investigate how by the means of institutional work healthcare professionals introduce patient-centered care in Russian maternity hospitals. Post-socialist healthcare is commonly viewed in academic literature as a highly centralized and state-controlled domain, where autonomy and agency of both patients and practitioners are significantly restricted. Our research contributes empirically to scholarly debate by questioning this assumption and by providing shreds of evidence of healthcare professionals' ground-level initiatives. On the conceptual level, we add to the discussion about the dynamic interrelation between institutional change, clients' demands, and the transformation of professionals' position. We argue that neoliberal reforms in Russian healthcare have created institutional uncertainty which is strategically used by professionals to expand the scope of their workplace autonomy and to develop patient-centeredness as an institutional innovation. However, our research shows that the resulting model of patient-centeredness contributes to empowering healthcare practitioners, rather than to increasing patients' participation in decision-making.