Witnessing the Ward: On the Emotional Labor of Doing Hospital Ethnography

This paper examines the emotional labor performed by researchers when undertaking ethnographic research in hospitals. Drawing on emotion work theory to situate emotions at the center of qualitative and interdisciplinary research, I provide a methodological reflection based on a 20-week long ethnography at a Canadian pediatric hospital I conducted in the context of a research project examining risk communication of antimicrobial resistance. I argue that the emotional labor in which hospital ethnographers engage starts long before the fieldwork and carries on throughout the project and into the data analysis and writing of results. I divide these instances of emotional labor into four categories: gaining and maintaining access to the field site, resolving ethical concerns, managing relations with participants, and witnessing human suffering. This paper addresses a gap in the literature regarding the various barriers that hospital ethnographers encounter as I reflect upon the challenges I faced and the emotional labor I intuitively engaged in and provide advice for researchers on how to navigate these barriers.

‘They are more careful’

This chapter analyses a poorly understood health practice: transnational caring for infants and children. A reproductive paradox provides the point of departure. A majority of births were registered to foreign women in Prato, Italy, yet many parents sent their babies back to China. The chapter focuses on decisions among transnational migrants, particularly Chinese parents working in the Made in Italy fashion industry, that result in the formation of global households. The chapter draws on hospital ethnography in the intimate space of a paediatric exam room and interviews with migrant parents and health-care workers. Qualitative data analysis reveals parents’ privileging of quality care. Findings challenge health-care professionals’ critical gaze and shed light on how migrant parents cope with transnational lives as non-citizen entrepreneurs and workers. Finally, understanding parental decision making may improve how practitioners approach health problems, particularly in a context of intensified migration and mobility.

Knowing what the patient wants: a hospital ethnography studying physician culture in shared decision making in the Netherlands

ObjectivesTo study physician culture in relation to shared decision making (SDM) practice.DesignExecution of a hospital ethnography, combined with interviews and a study of clinical guidelines. Ten-week observations by an insider (physician) and an outsider (student medical anthropology) observer. The use of French sociologist Bourdieu’s ’Theory of Practice’ and its description of habitus, field and capital, as a lens for analysing physician culture.SettingThe gynaecological oncology department of a university hospital in the Netherlands. Observations were executed at meetings, as well as individual patient contacts.ParticipantsSix gynaecological oncologists, three registrars and two specialised nurses. Nine of these professionals were also interviewed.Main outcome measuresCommon elements in physician habitus that influence the way SDM is being implemented.ResultsThree main elements of physician habitus were identified. First of all, the ‘emphasis on medical evidence’ in group meetings as well as in patient encounters. Second ’acting as a team’, which confronts the patient with the recommendations of a whole team of professionals. And lastly ‘knowing what the patient wants’, which describes how doctors act on what they think is best for patients instead of checking what patients actually want. Results were viewed in the light of how physicians deal with uncertainty by turning to medical evidence, as well as how the educational system stresses evidence-based medicine. Observations also highlighted the positive attitude doctors actually have towards SDM.ConclusionsCertain features of physician culture hinder the correct implementation of SDM. Medical training and guidelines should put more emphasis on how to elicit patient perspective. Patient preferences should be addressed better in the patient workup, for example by giving them explicit attention first. This eventually could create a physician culture that is more helpful for SDM.