Physicians' Discourse for Establishing Authoritative Knowledge in Birthing Work and Reducing the Presence of the Granny Midwife

This study examines regulatory efforts directed toward southern Black granny midwives in the early 20th century. Using Black feminist theory, I analyze physicians' written anti‐midwifery advocacy in The Journal of the American Medical Association and The Journal of the South Carolina Medical Association as evidence of the presence of inter‐occupational conflict between physicians and Black grannies. I argue that doctors advocated for enhanced midwifery education and midwifery supervision to eliminate midwives while defining physicians as heroes in birthing rooms. This study illustrates how physicians' professional writings substantiated doctors as veritable experts in birthing work rather than strategically targeting Black midwives.     

Influences on Professionals' Child Custody Recommendations

Professionals' recommendations of child custody in divorce cases are being viewed as increasingly important determinants of children's divorce adjustment. This study examined custody recommendations and professional and personal influences on the advice of professionals working with divorce. Subjects were 12 clergy, 24 lawyers, 25 pediatricians, 11 family physicians, 25 social workers, 24 psychologists, and 9 psychiatrists. Professionals completed a questionnaire which addressed seven areas influencing their decision making and which related professionals' recommendations in hypothetical and actual divorce cases. Data were analyzed using analyses of variance, chi-squares, and multiple regression analyses. Lawyers were found to be more professionally constrained, to have more professional experience, to be less psychologically oriented in their practice, and to be the most likely of the professionals to make custody recommendations. Sole parent custody was most often recommended in the actual case, with professional experience, professional constraints, and personal values and experience being the best predictors for sex of the custodian. Psychologicalness of practice and knowledge were the best predictors of sole parent custody with the hypothetical case, although joint custody was most often recommended.     

Domains of medical practice: physicians' assessment of the role of physician extenders

The relationship between physicians and physician extender occupations is considered in light of the stratification of medical care workers. Professional dominance between various medical occupations and professional competition among physicians are considered. Data from a national sample of physicians taken in 1981 are used to determine 1) under what conditions physicians are likely to consider the employment of physician extenders helpful for improving quality of care and 2) which characteristics and available resources are associated with the belief that the employment of physician extenders will improve medical care. Of four different service populations considered, physicians are most likely to think that the use of physician extenders to care for the urban poor will aid care and are least likely to think that their employment will improve care for obstetrics and pediatrics cases. The results indicate that physicians' beliefs regarding the employment of physician extenders are dependent on the clientele as well as on the relative position of the two occupational groups in the hierarchy of medical care occupations.     

Physician Resistance to Innovations: The Case of Contract Medicine

Abstract

Physicians' assessments of contract medicine arrangements such as health maintenance organizations (HMOs) are considered in light of innovation diffusion theory and changing professional relations in medical care. Data from a national sample of physicians reveal that physicians practicing in HMOs differed from others in that they were more likely to be primary-care practitioners and politically liberal; they were also more likely to have thought that a physician surplus was emerging and that HMOs offered better working conditions. They did not differ from other physicians in job satisfaction. After considering differences between the two groups, the research examines how physicians, who did not practice in HMOs, viewed such contract medicine arrangements. Findings indicate that physicians in fee-for-service (FFS) practices felt that working conditions and service quality in HMOs are highly related and are better in FFS practices than in HMOs. In addition, physicians who anticipated heightened competition from HMO development were more likely to favorably evaluate HMO service delivery. The findings suggest accommodation to an organizational innovation if it is seen as preserving practice autonomy, but limited acceptance otherwise.     

Medical rationalization, cultural lag, and the malpractice crisis

The theses of this paper are that (1) the practice of medicine has become more formally rationalized in the past century; (2) this rationalization process has been retarded by the professional aspects of medical practice, e.g., the service ethic and the medical profession's exclusive jurisdiction over medicine; (3) this retardation is evident in cultural lag between the development of medical knowledge and how medicine is practiced; and (4) the "malpractice crisis" is a particular force which is accelerating the rationalization process and is overcoming lag. Data from physician surveys and interviews are presented which show the utility of a rationalization-cultural lag model in generating a number of substantive questions pertinent to the quality of rationalized medical care.     

Called to Medicine: Physicians’ Experiences of Career Calling

Using consensual qualitative research methodology, the authors explored physicians’ (N = 17) career calling experiences through semistructured interviews. Eight domains emerged: definition of calling, development of calling, calling's fit with career, maintenance of calling, emotional well‐being, relationships, recreation, and future. Within these domains, 17 general and 40 typical categories emerged. Results suggest physicians’ callings were influenced by others, met with both support and barriers, and chosen because of fit with interests, prosocial motivation, or religious/spiritual influences. Calling positively and negatively influenced emotional well‐being, relationships, and recreation and was expected to continue after retirement. Counselors are encouraged to use a narrative lens to conceptualize clients’ calling development, use job crafting techniques to support calling maintenance, and prepare clients for postretirement career calling development. Future research might examine when and why a medical calling's strength may change over time.     

Perceived Professional Gains of Master's Level Students Following a Person‐of‐the‐Therapist Training Program: A Retrospective Content Analysis

The Person‐of‐the‐Therapist Training (POTT) is a program designed to facilitate clinicians' ability to consciously and purposefully use themselves at the moment of contact with their clients in order to connect, assess, and intervene effectively. This qualitative study explored the experiences of 54 master's‐level students who were enrolled in an accredited marriage and family therapy program in the United States and examined their perceived professional gains following a 9‐month POTT course. Content analysis of trainees' reflections which they wrote at the end of the training revealed 6 primary themes: (a) increased awareness, (b) emotions, (c) improved clinical work, (d) humanity and woundedness, (e) meta‐awareness, and (f) factors that contributed to the learning process. Findings suggest that key outcomes of this training curriculum are congruent with its stated goals. Clinical and training recommendations are additionally provided. Video Abstract     

Developing a Common Language in Children's Services through Research‐based Inter‐disciplinary Training

Two sources of inertia to improving services for children in need are the difficulties of getting evidence into practice and the complications of inter‐agency working. Current training arrangements in social work and disparities between children's services professions as regards training requirements are contributory factors. The Common Language project is a work in progress, adopting a research‐based, inter‐disciplinary approach to working with social workers and other children's services professionals. It comprises core ideas and methods to complement the more specialist knowledge and skills required in each profession. Underpinned by a child development perspective and a scientific development cycle, it rests on a conceptual framework including need, threshold, service and outcome. The approach has three components (each of which includes training): (1) the implementation of practice tools; (2) the planning and development of integrated services; and (3) supporting materials, including practitioner‐orientated modules and a curriculum for PhD students. Distinguishing features include research utilisation, notably a focus on inculcating research‐mindedness as opposed to imparting findings, and also collaborative professional working, in particular via practical connections between different agencies, stakeholders and countries. The project is being evaluated in terms of uptake, change in professional thinking and practice and effects on child well‐being. Next steps for the project relate to broader lessons for social work training emerging from research and development elsewhere.     

Briefly Noted

The U.S. Preventive Services Task Force (USPSTF) recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school‐aged children and adolescents. However, there is not enough evidence to recommend tobacco‐cessation interventions in this population, according to the draft recommendation, released in June. The USPSTF is not part of the U.S. government, but its recommendations are taken into consideration by clinical and payer organizations. It only makes recommendations for interventions when it has found adequate evidence that the interventions do more good than harm. In the case of tobacco interventions, the task force found no evidence at all of harms of providing behavioral prevention interventions. However, once kids are already using nicotine, there is not enough evidence to recommend for or against cessation options. The recommendations were first published in the Annals of Internal Medicine and in Pediatrics in 2013; the final draft recommendations were issued in June, for public comment by July 22. For a link, go to https://www.uspreventiveservicestaskforce.org/Page/Document/draft‐recommendation‐statement/tobacco‐and‐nicotine‐use‐prevention‐in‐children‐and‐adolescents‐primary‐care‐interventions .     

Wives' Relative Wages,Husbands' Paid Work Hours,and Wives' Labor‐Force Exit

Economic theories predict that women are more likely to exit the labor force if their partners' earnings are higher and if their own wage rate is lower. In this article, I use the National Longitudinal Survey of Youth (N = 2,254) and discrete‐time event‐history analysis to show that wives' relative wages are more predictive of their exit than are their own or their husbands' absolute wages. In addition, I show that women married to men who work more than 45 hours per week are more likely to exit the labor force than are wives whose husbands' work approximately 40 hours per week. My findings highlight the need to examine how women's partners affect women's labor‐force participation.     

THE GLOBAL VORTEX: SOCIAL WELFARE IN A NETWORKED WORLD

This paper examines the impact of economic globalization on the organization and delivery of social welfare services. Sennett's analysis of the modern networked organization is linked to psychodynamic theory in relation to the loss of ‘containment’ resulting from the demise of the post‐war welfare bureaucracies. This changing environment has generated an anxiety‐ridden and risk‐obsessed society that features surveillance, control and the gradual diminution of civil liberties. The impact of these changes on the ethics of professional social welfare practice has been profound. It is argued that public moral debate in the context of pluralist ethics is required not only for upholding a relational based social welfare practice, but also for preserving an open and compassionate democratic society. The paper concludes with a set of questions that provides a framework whereby practitioners can assess the extent to which different practice organizations support relational practice. This typology can be a tool to enable practitioners to exercise moral agency when making career choices in today's fluid organizational world.     

Inter‐professional Learning to Prepare Medical and Social Work Students for Practice with Refugees and Asylum Seekers

Social workers and medical practitioners, particularly those in general practice, provide services for individuals who experience social exclusion. Access to medical, health and social care services has been identified as problematic for refugees and asylum seekers, reflecting their marginalised status within society. It is widely accepted that multi‐agency responses and working together are key requirements in improving access to services and promoting social inclusion; however, achieving this across professional and agency boundaries often remains challenging. Joint planning and training have been suggested as being important in improving communication, leading to more flexible and creative services.

This paper describes the genesis and implementation of a series of innovative inter‐professional workshops for medical and social work students, focussing specifically on marginalised groups. Learning and teaching input was developed by, and came from, service users and qualified medical, health and social work practitioners. The paper focuses particularly on the sessions relating to refugees and asylum seekers. The content and structure of the sessions are discussed and students' responses are reported. The implications for future inter‐professional learning and practice in relation to socially excluded groups are highlighted.     

Coordinated Action in the Massively Multiplayer Online Game World of Warcraft

In tandem with the technological advancement of immersive virtual environments, digital games have evolved into complex social worlds where people play collaboratively to achieve individual‐ and group‐oriented goals. The massively multiplayer online games genre has received international attention for the large numbers of users that commit a significant amount of time and effort to online play. Play styles within such game worlds are diverse, but “raiding” is generally considered among gamers and scholars alike to be the most challenging form of collaborative play. Like other forms of social activity, raiding is predicated on players' abilities to successfully coordinate individual lines of action. Yet the vast majority of raiders are not physically copresent during their collaborative efforts. Using Couch's theory of coordinated action as an interpretive frame, we explore the computer‐mediated process of raiding in the massively multiplayer online game World of Warcraft by analyzing ethnographic data and audio/visual recordings of gameplay. Our study expands Couch's theory of coordinated action in two ways. First, we demonstrate how individuals and groups simultaneously engage in multiple forms of coordinated activity (e.g., conflict and cooperation). Second, we reveal two semiotic layers of coordinated action—the “subject‐subject” (i.e., intersubjective) layer that is facilitated through the game's user interface, and the “subject‐object” layer that comprises players' interactions with the user interface itself. Our study thus considers the potential of Couch's theory for the study of computer‐mediated communication and nonhumans in interaction.     

Vaginal Douching Practices Among Women Attending a University in the Southern United States

Abstract

The authors assessed the frequency, characteristics, and motivational antecedents of vaginal douching practices among 125 White and 155 Black female college students. Overall, 40% of the students had ever douched and half of those women currently douche. Black women were most likely to be encouraged to douche by their mothers, whereas White women were more influenced by television advertisements. Among the sexually active women, being Black, using oral contraceptives, using spermicides, and being encouraged to douche by their mothers or by the media were independently associated with ever having douched. These associations were present among both Black and White women and were stronger when current douching was compared with never having douched. Women who were discouraged from douching by a physician or nurse were more likely to have stopped the practice. Douching is common, even among educated young women; nurses' and physicians' advice to stop douching appears to have a salutary effect.     

Enhancing Learning and Learner Satisfaction Through the Use of WebCT in Social Work Education

Emerging technology has produced changes in the ways that social workers learn, practice, and interact. As communication and educational innovations have increasingly involved the use of ever-improving technologies for social work practice, so too has social work education evolved to incorporate these advances in the classroom setting. This article describes and evaluates various aspects of one particular type of web-based learning environment, WebCT, and its incorporation into five face-to-face foundation courses in a bachelor's and master's level social work program. The authors utilized an online survey to assess frequency of access of the web-based course management system and perceptions of the features. Results of this online survey assessing student use and perception of hybrid courses are shared along with implications and recommendations.     

From here to Recovery: One Service User’s Journey through a Mental Health Crisis: Some Reflections on Experience,Policy and Practice

This article documents the experiences of a service user through a mental health crisis, the experience of detention under Section 136 of the Mental Health Act, admission to hospital and eventual recovery. It gives a unique first person account of the experience of a psychotic episode together with a reflective commentary based upon the service user's auto-ethnographic analysis of both the event itself and her medical records, which were obtained post-recovery, as well as interviews with professional practitioners. The reflective commentary considers the practice of various professionals encountered during the service user's illness, treatment and recovery. The service user, whilst critical of some of the treatment she received, has engaged in a positive way with her local police force, involving herself in training sessions for officers about good practice under the Mental Health Act.     

WHEN THE DOCTOR IS A “LADY”: POWER,STATUS AND GENDER IN PHYSICIAN-PATIENT ENCOUNTERS*

An extensive body of research indicates that men interrupt women much more often than the reverse, across a variety of situations. Some conclude that men's interruptions of women in cross-sex conversations constitute an exercise of power and dominance over their conversational partners. To be sure, power is an important facet of many other social relationships, such as those between whites and Blacks, bosses and employees, and—of immediate interest—doctors and patients. Moreover, much of our existing knowledge of sex differences in behavior confounds gender with status. This paper reports results of an exploratory study of interruptions between physicians and patients during actual “visits to the doctor.” Findings based on detailed analyses of videotaped encounters offer empirical support for an asymmetrical view of the physician-patient relationship: physicians interrupt patients disproportionately—except when the doctor is a “lady.” Then, patients interrupt as much or more than physicians, and their interruptions seem to subvert physicians' authority. Discussion focuses on the respective roles of power, status and gender in face-to-face interaction.     

Parental After‐School Stress and Psychological Well‐Being

The mismatch between employed parents’ work schedules and their children's school schedules creates the structural underpinning for an as‐yet‐unstudied stressor, namely, parental after‐school stress, or the degree of parents’ concern about their children's welfare after school. We estimate the relationship between parental after‐school stress and psychological well‐being in a sample of 243 employed parents of children in grades K–12. Parental after‐school stress is related to psychological well‐being. This relationship did not differ by parent gender or child age but was significantly stronger for parents of girls versus boys. Our results suggest that parental after‐school stress is an important stressor that affects the well‐being of a large segment of the work force and warrants further research.