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Breaking the ceremonial order: patients' and doctors' accounts of removal from a general practitioner's list

Tim Stokes1, Mary Dixon-Woods, Simon Williams

  • 1Department of Health Sciences, Division of General Practice and Primary Health Care, University of Leicester, Leicester General Hospital, Leicester LE5 4PW. tns2@le.ac.uk

Sociology of Health & Illness
|August 17, 2006
PubMed

Insights

Patient removal from general practitioners' lists reveals how doctors and patients interpret relationship rules. This study highlights GPs' use of symbolic power and patients' experience of this as symbolic violence.

Area of Science:

  • Sociology of Health
  • Medical Sociology
  • Social Interaction Theory

Background:

  • Doctor-patient relationships can deteriorate, leading to patient removal from general practitioner (GP) lists.
  • Existing interactionist analyses explore how doctors and patients account for relationship difficulties and terminations.

Purpose of the Study:

  • To extend interactionist analysis of patient removal using Bourdieu's theory of practice.
  • To examine the micro-macro link between social interaction and power structures in healthcare.
  • To analyze the strategic invocation of conduct rules and symbolic power in doctor-patient relationship terminations.

Main Methods:

  • Analysis of 'paired' accounts of patient removal events from both doctors (removers) and patients (removed).
  • Application of Bourdieu's theory of practice to understand social actions and power dynamics.
  • Juxtaposition of different perspectives to reveal underlying social rules and power distributions.

Main Results:

  • Patient removal involves strategic invocation of 'rules of conduct' by both doctors and patients.
  • The study reveals the often unthinking nature of adherence to social interaction rules.
  • Apparent rule violations serve to make rules explicit and expose power distributions within the healthcare field.

Conclusions:

  • Patient removal is a strategic exercise of symbolic power by GPs, experienced as symbolic violence by patients.
  • Reconciliation of interactionist and Bourdieu's theories offers a valuable micro-macro link in health sociology.
  • Understanding these dynamics illuminates issues of capital and power within the health (care) field.

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