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The physician–patient relationship is the cornerstone of care quality. Unfortunately, it may be adversely affected by physician burnout, which is becoming more prevalent according to the literature. We present a model, based on the burnout and physician–patient communication literatures, which delineates the impact of physician burnout on the physician–patient interaction and ultimately on patient outcomes. In short, when physicians use depersonalization to cope with emotional exhaustion, their communication style becomes more biomedically oriented. Faced with this communication style when interacting with their physician, patients are less satisfied, trusting, and adherent. The implications of this model and directions for future research are presented.

To shed light on how gender norms are reproduced in medical training and practice through an exploration of representations of the problem of “work–life balance.” Women physicians and women physician-researchers (WPs/WPRs) in Canada and in the United States experience social and health inequities when compared to their men colleagues. Despite current medical school acceptance parity, upon entering the medical workforce, women work harder than men to succeed within the historically male-dominated structures and value system of the medical profession.

We performed a critical discourse analysis of articles retrieved from academic databases and leading Anglo-American journals that discussed “work–life balance,” to investigate how the discourse contributed to, or challenged, the reproduction of gender norms in medicine.

While the medical literature acknowledges that the social and health inequities experienced by WP/WPR result from discriminatory norms and practices, it neglects to challenge built-in gendered inequities in benchmarks for success in the profession. Instead, proposed solutions require that WP/WPR themselves learn to cope and make better lifestyle choices, including downloading domestic responsibilities on socially disadvantaged – racialized and poor – women. Authors’ gender appears to make no difference.

Our search was limited to the Anglo-American literature, often retrieved articles inaccessible via our university library, excluded informal venues (e.g., blogs), and did not include cases of same-sex couples or interviews of WP/WPR. All these may have challenged components of our argument by revealing more nuanced debates, occurring under different political, cultural, and economic contexts.

While individual choices of WP/WPR are important to the protagonists, to successfully address the very real problem of work–life balance experienced by WP/WPR, patriarchal norms should be challenged, failure to comply with these norms should be rejected as explanations for work–life balance challenges, and norms themselves should become the focus of analysis and intervention.

The medical language used by physicians of both genders normalizes gendered inequities, favoring the success of medical men over women, and reproducing the professional and personal disadvantages experienced by the latter, further burdening socially disadvantaged women.

Health care organizations may incur high costs due to a stressed, dissatisfied physician workforce. This study proposes and tests a model relating job stress to four intentions to withdraw from practice mediated by job satisfaction and perceptions of physical and mental health. The test used a sample of 1735 physicians and generally supported the model. Given the movement of physicians into increasingly bureaucratic structures, the clinical work environment must be effectively managed.

Autonomy has long been established as a critical component of professional work. Traditionally, autonomy has been examined as the extent to which an individual or a professional group controls the decisions and knowledge used in their work. Yet, this framework does not capture the additional work activities that professionals are increasingly expected to perform. Therefore, this chapter argues for theoretically expanding our understanding of professional autonomy by bringing in the concept of articulation work. Using the case of healthcare organisational change, this study assesses how shifts in work practices impact autonomy. Data come from longitudinal ethnographic fieldwork and in-depth interviews conducted at a Neonatal Intensive Care Unit as it underwent significant structural changes. Findings show that professionals were forced to change articulation work strategies in response to new organisational structures. This included changes in the way professionals monitored, assessed, coordinated and collaborated around patient care. Furthermore, these shifts in articulation work held important implications for both workplace and professional autonomy, as professionals responded to changes in their work conditions.

The relationships of physician practice characteristics, care management effectiveness, autonomy, and managed care involvement, and physicians’ practice and career satisfaction were investigated. A panel sample (N=660) of 6800 physicians was made up of eleven physicians randomly selected from each of the sixty communities. Three latent constructs include care management effectiveness, practice autonomy, and openness in private practice. Multilevel modeling was performed. A statistically insignificant association was found between the perceived effectiveness of care management and physician satisfaction, holding the practice characteristics and other perception factors constant. The study demonstrated direct effects of practice characteristics and care management effectiveness on the practice of gate-keeping functions and on earnings. Only two contextual variables, managed care penetration and median income in the study communities, were related to physicians’ practice.

Blacks are more likely than white, in the United States, to experience a stillbirth. In this study, I use a structural perspective of race to create a heuristic model that combines medical and social epidemiological explanations to understand the racial disparity in stillbirths. Using data from the National Maternal and Infant Health Survey 1988 (NMIHS), I examine whether racial disparities in stillbirths can be explained by medical and social epidemiological variables. My findings show that medical and social epidemiological explanations do little to reduce the racial disparity. However, many medical model variables were important predictors of stillbirths including multiple gestations, being overweight, obesity, vaginal bleeding, advanced maternal age, and parity.

The tradition of medicine has until now been characterized by an aspiration to provide as complete as possible a service of care to the populations to which it owes responsibility. The same holds for nursing and caring practices, but the tradition is loosening. Despite the collective assumption that medical and nursing practice rests on solid grounds of knowledge and is framed by a caring ethos, change in practice not only has typically come about in a complex and diffuse fashion, but has also come along with sacrifices, losses and deficits.

Performance metrics have become widely used and much lamented – about tools for measuring healthcare quality. In this paper, the authors reflect on the development and use of performance metrics in healthcare regulation and clinical practice. Studying multi-actor settings of performance measurement systems in healthcare in Sweden and the Netherlands, the authors show how regulatory agencies (i.e., the inspectorate and national registries), patients, hospitals, and practitioners engage in the constitution of healthcare practices through developing performance indicators that form the input for ranking, ensuing intensive dialogues on what should be measured and accounted for, and to what effects. The authors analyze this process as caring for numbers. The authors discern two practices of caring for numbers: validating and contexting. Validating refers to the practices of making numbers reflect those practices they intend to depict; contexting is about how with the use of numbers specific contexts of healthcare are built. These processes together emphasize the performative character of numbers as well as the reflexive uses of performativity. The paper shows how collaborative and rather pragmatic practices of caring for numbers co-construct specific practices of healthcare. Though this reflexive entanglement of production and use of numbers actors not only constitute specific performance metrics and ranking practices but also perform healthcare.