Doctors’ Orders: Specialists’ Day to Day Work and their jurisdictional Claims in Dutch Hospitals

This study analyses the nature and organisation of specialists' day to day work in general hospitals in the Netherlands and the claims for jurisdiction specialists make in their work. It is of interest because it presents a picture of specialist work from within. Most studies about the organisation of specialist work address management structures or policy processes in hospital. Not many researchers study the real work of physicians in day to day patient care by observing it directly. The information 12 1.1 collected in this study was obtained from day to day work as much as possible. The title, Doctors’ orders, is related to two aspects of this subject. In the .rst place it re.ects an element of physicians’ jurisdiction: the right to give orders to patients, nurses, and other people and parties surrounding them in hospital. In the second place, more important in this thesis, the title re.ects the ‘social orders’ doctors take part in, together with people and parties surrounding them. In hospitals these orders are kept in balance by continuous small and large negotiations. The social orders doctors work in are ‘negotiated orders’. Specialists do not form a homo­geneous group with respect to their work and jurisdictional claims. Several characteristics, for instance age, sex, family life, size of hospital, size of peer group, being self-employed or salaried, speciality, and teaching status, distribute specialists over many potential subgroups. Since this thesis is about work, it takes the speciality as one of the most important characteristics in distinguishing subgroups. The speciality de.nes the working processes in day to day life. Three categories of specialities will be used throughout this thesis: ‘medical’, ‘surgical’ and ‘supporting’. They will be de.ned in Chapter 2. It is important to know that the term ‘medical specialities’ refers to ‘non­surgical’ specialities. Throughout this thesis ‘medical’ sometimes refers to the total .eld of physicians, for instance the ‘medical profession’, and sometimes to the speci.c .eld of ‘medical’ physicians (for instance internists and cardiologists) that distinguish themselves from surgical physicians and supporting physicians. The context of the phrases will usually specify their meaning. Besides the speciality, other criteria will be used to de.ne subgroups of specialists as well, for instance men and women, and self-employed or salaried specialists. Summarising, this thesis is about specialists’ day to day work in Dutch general hospitals and about the negotiations specialists take part in when maintaining the negotiated order in their day to day work.