The Hospital: A Small Society

Daniel Menchik

SOC-CHS 410, Tues-Thurs 12:30-1:45The University of Arizona

The traditional hospital illustrates the deprivation and brutalization of the ordinary working man’s life; the modern hospital demonstrates the intractable frailties of humankind and the ultimate difficulty of any belief system—whether it be traditional religion and the humeral pathology of 1800 or the new faith embodied in computer-guided scanners and organ transplants—in the unyielding face of pain and death.

- Charles Rosenberg, The Care of Strangers

A hospital is a place where ailing people sleep and receive care. Since people sleep in it, it will always have some attributes of a hotel or dorm – some personnel will play domestic roles, and others will supervise them. Because ailing people will be cared for while at the hospital, it will always have some attributes of a school or prison – some personnel will have responsibility for the inmates. So, giving hospital care involves people who assume responsibility, those for whom responsibility is assumed, and those who keep house. The way this organization operates has varied across time and varies across social contexts. The “hospital” has looked like an urban hostel, a religious retreat, a school, a jail, a hotel, a graveyard, and a hospital.

The study of the hospital’s capacity to recontextualize legal mandates, instill larger social values, and ration care can provide a sense of how healing is choreographed in its most complex environment. In this course we will investigate the hospital as a strategic entrance point for understanding the social organization of contemporary medicine. We will pay special attention to the ways in which the hospital’s agents are authoritative in their choreography, that is, how its professionals and administrators get people to do things they wouldn’t otherwise do, especially those things that are inconvenient or uncomfortable. In our exploration of the causes and consequences of authority in the hospital, we will examine such topics as: how institutions produce insanity, how doctors seek to generate compliance, and how medical students manage the uncertainty implicit in interpreting science and performing professionally.

Course Prerequisites or Co-requisites

None

Instructor and Contact Information Dr. Daniel Menchik, mench@arizona.edu

https://arizona.zoom.us/j/9294171652

Office hours: T/Th 1:45-2:30, or by appointment.

Teaching assistant: Office hours: Th 10am-11:30am

Link to office hours Zoom room: https://arizona.zoom.us/j/8077285019

Web page: d2l.arizona.edu

Course Format and Teaching Methods Online

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Course Objectives

By the end of this course, students will learn to:- consider how taken-for-granted medical problems are developed by professionals and organizations.- explain how professionals and semi-professionals coordinate work processes. - interpret the divergent expectations on physicians that lead to work-related difficulties. - understand the hospital as an environment involving competing interests for governing patient care, and consider how these influences are resolved in the delivery of care. - evaluate how organizational changes in the evaluation, reimbursement, and training of physicians will influence relationships in the hospital. - identify the relationship between a patient’s medical treatments and a hospital’s policies, sequences of care, structures of interaction among professionals.- critically evaluate the merits and plausibility of various reforms proposed to improve medicine. - learn concepts that you will be able to draw upon when you enter healthcare settings and seek to understand the social organization of these venues.

Expected Learning Outcomes

Knowledge of the helping professions: Students will be able to demonstrate knowledge of the helping professions in contemporary society.

Knowledge of human suffering: Students will be able to demonstrate knowledge of human suffering and how issues related to human suffering are addressed in contemporary society.

Knowledge of the social causes and social consequences of health and illness: Students will be able to demonstrate knowledge of the social causes and social consequences of health and illness in contemporary society.

Knowledge of social institutions: Students will be able to demonstrate knowledge of the key social institutions in sociology (the family, education, religion, work/economy, and/or law/political institutions) and their interconnections.

Absence and Class Participation Policy

The UA’s policy concerning Class Attendance, Participation, and Administrative Drops is available at: http://catalog.arizona.edu/policy/class-attendance-participation-and-administrative-drop

The UA policy regarding absences for any sincerely held religious belief, observance or practice will be accommodated where reasonable, http://policy.arizona.edu/human-resources/religious-accommodation-policy.

Absences pre-approved by the UA Dean of Students (or Dean Designee) will be honored. See: https://deanofstudents.arizona.edu/absences

Students are expected to attend each class and to read and reflect on the assigned readings for each week before class to facilitate participation and a seminar-like atmosphere. Students will be expected to actively participate in discussion. To facilitate a collegial and participatory class, I expect you to keep on your camera. If you think you have a compelling reason to turn yours off, we can discuss it on a case-by-case basis.

More specifically: 10% is given for attendance (body-presence). If you come to half the classes, you get half the points, etc. (You can miss one class. Beyond that, please bring a doctor’s note. [Absences related to medical appointments, interviews, weddings, funerals, personal/vacation travel, jury duty, etc., are examples of absences you must discuss directly with me.]) The other 10% is for mental participation, which means coming to class prepared to answer questions and contribute to collective problem solving. This is a requirement. If you find it

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hard to speak in class, see me before the class starts. You are not expected to show off in class, but we will be trying to work together towards some understanding of what is going on, and that will require you repeatedly verbalizing your thoughts, even if you are not confident about them. That (in addition to the obvious) is what college is all about.

I’ve decided to expect a doctor’s note for absences. HOWEVER, ask your provider to omit the reason for your visit. It’s a violation of your privacy, and you shouldn’t have to share that information. You may need to ask for this specifically, as medical centers somehow are comfortable sharing your confidental medical information.

Participating in the course and attending lectures and other course events are vital to the learning process. As such, attendance is required at all lectures and discussion section meetings. Absences will affect a student’s final course grade. If you anticipate being absent, are unexpectedly absent, or are unable to participate in class online activities, please contact me as soon as possible. To request a disability-related accommodation to this attendance policy, please contact the Disability Resource Center at (520) 621-3268 or drc-info@email.arizona.edu. If you are experiencing unexpected barriers to your success in your courses, the Dean of Students Office is a central support resource for all students and may be helpful. The Dean of Students Office is located in the Robert L. Nugent Building, room 100, or call 520-621-7057.

Frequently Asked Questions about my attendance policy (with examples drawn from real life scenarios).

I have locked myself out of my apartment and my landlord will be gone at 6pm. Can I leave early?No.

My sorority has an event and I’m hosting it. Can I leave early?No.

I have a mandatory meeting and I cannot be late. Can I leave early?No.

I have a job interview today and would like to get there bit early. Can I leave early?No.

It’s snowing and I have to drive back to Peatville. Can I leave early?No.

Makeup Policy for Students Who Register Late Students who register after the first class meeting may make up one week of missed assignments, and must do so by the end of the second week.

Course Communications Course communications will occur through your official UA e-mail address, D2L, and (for office hours) Zoom. Students are expected to check email regularly (at least once every weekday).

Contact Policy and Course QuestionsThere is a discussion board on our D2L page specifically for course-related questions (“Ask An Instructor” in the Discussion tab). Before emailing the TA or me with questions about the course or about assignments: (1) check the syllabus for an answer and (2) go to the discussion board and see if the question has already been asked. If no one has asked your question, create a post with a detailed outline of your question/problem and wait 24 hours for Victoria to answer. If you have a personal/private question or concern, no need to post publicly – use your best judgement about whether your question and Victoria’s answer will be relevant to your peers’

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needs.

Required Texts or Readings Charles Bosk (1979 [2003]) Forgive and Remember. Chicago: University of Chicago Press **2nd edition only**

It is further suggested that you keep yourself informed of new developments in the world of medicine by means of a major newspaper (the New York Times is a good choice). Periodicals such as The Economist and The New Yorker (see the “Medical Dispatch” section) also contain regular reports on relevant topics. Moreover, JAMA and The New England Journal of Medicine, which also publish original scientific contributions, contain sections of relevant science news, policy, and even personal stories. It is especially interesting to contrast the stances towards medicine taken by such different periodicals: The Economist and the Wall Street Journal, for example, are consistently very different in this respect from Time, which is in turn very different from the New York Times.

Required or Special Materials None

Required Extracurricular Activities None

Assignments and Examinations: Schedule/Due Dates

Abstracts Once a week, you will write a 400-500 word abstract on a reading of your choosing. Abstracts should be uploaded in Word document format to D2L. You are to write on one article per week. The abstract will be due at midnight the evening before the class in which we will discuss the article. See Appendix A. These abstracts will be graded on a credit/no-credit basis. You will hear from me if you don’t get credit, so you can assume you’re in good shape if you don’t get a note. You get one “get out of abstract free” card. Use it wisely.

FieldnotesAs you know, in-person fieldwork is especially challenging during these COVID days. The videos you’re asked to take fieldnotes on, loosely pegged to the content of the respective week, can be found here. See the Appendix for information on fieldnotes.

Midterm The midterm will be a cumulative test of the general concepts discussed in the first half of the semester. So that you can think from day 1 about the “fieldsite” and social episodes I’ll ask you to analyze, I am putting the key articles on D2L. I encourage you to think about these articles as you read during the first half of the course. Questions will be largely short essay. I will conduct a review session before the midterm so that you can ask questions etc. You can bring to the midterm readings and a sheet of paper with notes you’ve prepared (by hand).

One of the purposes of these writing and discussion assignments is to gain practice with rapid and intense reading, understanding, and communication of new concepts and ideas. We will throughout be less interested in memorization of specifics than in developing some new ways of thinking. I will try to include at least a smattering of primary sources, although in a survey class we will need to rely a fair bit on secondary materials. This all should be thought of as fun, interesting, and relatively informal. However, the class will be more fun if you do the reading before class because I won’t be lecturing. Completing some extra credit assignments will almost always help your grade.

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Final Project This will be a final project that incorporates the concepts from the readings, and the virtual fieldwork you’ve conducted. There is no final exam for this course. At the end of the course, students will present their surprising and puzzling observations from their Friday fieldwork. Your final presentations will be on Dec 1, 3, 8. Your final project will be due 12/16 (our “official” final exam date) at 5pm. Details forthcoming.

Extra CreditAs the semester progresses, extra credit opportunities may be provided.

Some Notes on Reading:This course will have a LOT of reading. You should expect to spend at least three hours reading per class. Some of it will be detailed reading of texts where accuracy and command are necessary. At other times, you'll need to plow through 40-50 pages for a single class, passing rapidly over the details and getting out the marrow. I am aiming at an average of 25 pages per class. The articles should all be on D2L (but please tell me if they’re not).

The aim of all this reading is partly to familiarize ourselves with the actual work done in medical sociology but more broadly to find the underlying themes and stances of that work. That means that reading needs to be not simply churning through the material, but rather should always be aiming to find themes, draw contrasts, and pose questions. Otherwise, you simply won't get through the stuff, but will get bogged down in details.

In sum, you should:Attend class and join the discussion. Write one abstract per week on a reading of your choosing (x10).Submit fieldnotes for each video you watchWrite one short midterm.Complete a final project

Grading Scale and Policies Number Grade Percentile A 90-100 B 80-89.9 C 70-79.9 D 60-69.9 E < 60

Work turned in late will receive one grade lower per day submitted.

Assignment Points Percentage of gradeAbstracts (10 abstracts times 2 points per abstract)

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Participation (attendance) 10Participation (engagement) 10Fieldnotes 20Midterm 20Final Project 20Total:

Requests for incomplete (I) or withdrawal (W) must be made in accordance with University policies, which are available at http://catalog.arizona.edu/policy/grades-and-grading-system#incomplete and

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http://catalog.arizona.edu/policy/grades-and-grading-system#Withdrawal respectively.

Dispute of Grade Policy If you feel I have made a mistake in grading your work or calculating your grade, you are entitled to ask me to review my work. (My policy is that you wait a week before appealing.) That said, a regrade might result in a raised or lowered grade.

Honors Credit Students wishing to contract this course for Honors Credit should email me to set up an appointment to discuss the terms of the contract. Information on Honors Contracts can be found at https://www.honors.arizona.edu/honors-contracts.

Classroom Behavior Policy To foster a positive learning environment, students and instructors have a shared responsibility. We want a safe, welcoming, and inclusive environment where all of us feel comfortable with each other and where we can challenge ourselves to succeed. To that end, our focus is on the tasks at hand and not on extraneous activities (e.g., texting, chatting, reading a newspaper, making phone calls, web surfing, etc.).

Students are asked to refrain from disruptive conversations with people sitting around them during lecture. Students observed engaging in disruptive activity will be asked to cease this behavior. Those who continue to disrupt the class will be asked to leave lecture or discussion and may be reported to the Dean of Students.

I usually ban laptops in my classes, because: http://www.newyorker.com/tech/elements/the-case-for-banning-laptops-in-the-classroom . However, this policy is impossible in our new virtual reality. Please refrain, however, from checking email, facebook, or even Dr. Oz’s blog. Because it reduces the quality of our collective class experience, if I detect that you are consulting these sites – and this is far more obvious than you think - I will reduce points from your participation score.

Threatening Behavior Policy The UA Threatening Behavior by Students Policy prohibits threats of physical harm to any member of the University community, including to oneself. See http://policy.arizona.edu/education-and-student-affairs/threatening-behavior-students.

Accessibility and Accommodations At the University of Arizona, we strive to make learning experiences as accessible as possible. If you anticipate or experience barriers based on disability or pregnancy, please contact the Disability Resource Center (520-621-3268, https://drc.arizona.edu/) to establish reasonable accommodations.

Code of Academic Integrity Students are encouraged to share intellectual views and discuss freely the principles and applications of course materials. However, graded work/exercises must be the product of independent effort unless otherwise instructed. Students are expected to adhere to the UA Code of Academic Integrity as described in the UA General Catalog. See: http://deanofstudents.arizona.edu/academic-integrity/students/academic-integrity .The University Libraries have some excellent tips for avoiding plagiarism, available at http://new.library.arizona.edu/research/citing/plagiarism.Selling class notes and/or other course materials to other students or to a third party for resale is not permitted without the instructor’s express written consent. Violations to this and other course rules are subject to the Code of Academic Integrity and may result in course sanctions. Additionally, students who use D2L or UA e-mail to sell or buy these copyrighted materials are subject to Code of Conduct Violations for misuse of student e-mail addresses. This conduct may also constitute copyright infringement.

UA Nondiscrimination and Anti-harassment Policy

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The University is committed to creating and maintaining an environment free of discrimination; see http://policy.arizona.edu/human-resources/nondiscrimination-and-anti-harassment-policyOur classroom is a place where everyone is encouraged to express well-formed opinions and their reasons for those opinions. We also want to create a tolerant and open environment where such opinions can be expressed without resorting to bullying or discrimination of others.

Additional Resources for Students UA Academic policies and procedures are available at http://catalog.arizona.edu/policies Student Assistance and Advocacy information is available at http://deanofstudents.arizona.edu/student-assistance/students/student-assistance

Confidentiality of Student Records See here.

Subject to Change Statement Information contained in the course syllabus, other than the grade and absence policy, may be subject to change with advance notice, as deemed appropriate by the instructor.

THINK TANK Writing Centerwritingcenter.arizona.edu

I strongly encourage you to visit the THINK TANK Writing Center this semester as you work on assignments for this class and for your overall development as a writer. It's common practice in academic and professional contexts for writers to seek out trustworthy audiences for helpful feedback on their writing. During Writing Center sessions, trained and certified undergraduate and graduate students meet with you for free and help you identify major patterns in your writing—things that are working well, and things you could improve. Research and practice shows this approach to be effective. Even really great writers benefit from attentive readers. The tutors at the Writing Center won’t proofread or line edit your work. They are not going to write your paper for you. They will, however, collaborate with you to help develop your ideas and suggest techniques that will enable you to present them clearly. The goal of the Writing Center is to provide a friendly and low stakes environment where you can become a more confident and independent writer. You can schedule an appointment or find more information at: writingcenter.arizona.edu.

And, because of the challenges we’re living with today, some resources:

Financial Support: The Richard H. Tyler Student Emergency Fund can support students experiencing temporary financial hardships. This appears to apply to graduate students and undergraduate students. Apply for funds from:https://uarizona.co1.qualtrics.com/jfe/form/SV_1TA1XvxC1kgrN1b Food Support: Research shows that a large percentage of undergraduates face housing and/or food insecurity and it is reasonable to believe numbers have worsened during the current crisis. In addition to Pima County resources, the campus has a food pantry to help reduce food insecurity: https://campuspantry.arizona.edu/ Academic advising (undergrads): If you have questions about your academic progress this semester, or your chosen degree program, advisors at the Advising Resource Cente r can guide you toward university resources to help you succeed. Life challenges (undergrads): If you are experiencing unexpected barriers to your success in your courses, the Dean of Students Office is a central support resource for all students. Call 520-621-2057 or email DOS-deanofstudents@email.arizona.edu. 

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Physical and mental-health challenges: Recent surveys show that the current crisis is taking a toll on many people’s mental and/or physical health, with a really large number of people who are college-aged having thought about suicide in the last 30 days. If you are facing physical or mental health challenges this semester, Campus Health offers medical and mental health care. For medical appointments, call (520-621-9202. For After Hours care, call (520) 570-7898. For the Counseling & Psych Services (CAPS) 24/7 hotline, call (520) 621-3334. If you or someone you know is in crisis, the National Suicide Prevention Hotline has English and Spanish speakers ready to talk 24/7 at: 1-800-273-8255

Finally, please notify me if your needs are not met with these resources and you are comfortable in doing so.

Tentative Topics/Activities and Bibliography

8/25 Introduction Introduction to the course

8/27 A refresher on sociology, and one scholar’s take on medical sociology’s ideal relationship with medicine. Berger, P.L. 1963. “Sociology as a Form of Consciousness,” p. 1-5Freidson, E. 1983. “Viewpoint: Sociology and Medicine, a Polemic.” p. 209-218

9/1:The relationship between the hospital and the cultivation of medical authority inside and outRosenberg, Introduction, p. 3-15Freidson, Profession of Medicine, Intro xv-xix.

9/3. The sick role and its interactions I.Henderson, Physician and patient as a social system, p. 819 - 823.

9/8 The sick role and its interactions II.Parsons, “Social Structure and Dynamic Process: The case of modern medical practice.” Passages

on “the sick role” p. 436-439, 454-459.

9/10. The experience of roles in the hospital, from both the patient’s and doctor’s perspective. Moore “People like that are the only ones here” p. 3-20Goffman “Role distance” p. 115-132, 137-140

9/15. Becoming a physician and managing uncertainty #1Fox, Training for uncertainty. p. 207-41

9/17. Becoming a physician and managing uncertainty #2Becker and Geer, The Fate of Idealism in Medical School, p. 50-56.Bosk, Occupational rituals in patient management. NEJM 71-76

9/22. Some final words on uncertaintyDavis, uncertainty in medical prognosis: Clinical and functional. 41-47Szymczak & Bosk; Training for efficiency: work, time, and systems-based practice in medical residency.

9/24. Total institutions #1Goffman, Asylums, On the characteristics of total institutions, p. TBD (will break up by group)

9/29. Total institutions #2Goffman, Asylums, The Medical Model and Mental Hospitalization, p. TBD

10/1. Selecting and attracting patients in and around the hospital Roth, Some Contingencies of the Moral Evaluation and Control of Clientele: The Case of the Hospital

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Emergency Service p. 839-856. Sudnow, Dead on arrival

10/6. The NICU #1 Heimer and Staffen – For the Sake of the Children

Chap 1. Why we need a sociology of responsibility, p. 1-27. Chap 4. Responsibility as a joint enterprise p. 137-77

10/8. The NICU #2 Anspach – Deciding who lives

Chap 1. The dilemmas and their dimensions, p. 1-5Chap 3. Predicting the future, p. 55-84.

10/13. Professional self-control among elite academic surgeons #1 Errors and surveillance as social control

Bosk Chap 2. Error, rank, and responsibility, p. 35-70Chap 3. Routine surveillance as social control, p. 71-110

10/15. Professional self-control among elite academic surgeons #2 Attending authority and moral control

Bosk Chap 4. The legitimation of attending authority, p. 111-146 Chap 5. Climbing the pyramid: professional control and moral identity, p. 147-66

10/20. Review session for midterm.

10/22. In-class Midterm Exam (readings provided in advance: Groopman/Gawande)

10/27. Defining patienthoodArmstrong, Lessons in Control: Prenatal Education in the Hospital, p. 583-605

10/29. Cultural capital in the hospitalGengler. “I Want You to Save My Kid!” JHSB.

11/3. Variations in medical practiceBloor, Bishop Berkeley and the Adenotonsillectomy Enigma, p.43-61

11/5. ReimbursementsKaufman, And a time to die…. pp. 89-146

11/10. “Impure” elements in medicine: Informed consent, ethics boards Rothman, New Rules for the Bedside, Pp. 222-247 Duff and Campbell 1973. Moral and ethical dilemmas in the special-care nursery. 801-804 NEJM

11/12. Organizational and professional change #1Abbott, The future of professions: occupation and expertise in the age of organization, p. 17-30.

11/17. Organizational and professional change #2 Reich, Disciplined doctors: EMR and physicians' changing relationship to medical knowledge p. 11/26-27

11/19. The hospital and the cityHill and Madara, Role of the Urban Academic Medical Center in US Health Care, p. 2219-2220.Karlin. 2013. Loss and Gain in Translation: Financial Epidemiology on the South Side of Chicago

11/24 TBD Guest speaker?

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11/26: NO CLASS: THANKSGIVING THANKSGIVING THANKSGIVING THANKSGIVING

12/1 . Presentations and peer feedback.

12/3 Presentations and peer feedback.

12/8. Presentations and peer feedback.

Final projects due 12/16 midnight.

Appendix A. On abstracts. There’s no one way to write an abstract, but here are some key questions I’d like you to address:

What is the author trying to say? This seems obvious, but it seems to be a stumbling block for many students. I’m convinced that the failure to ask this simple question is what leads students to avoid reading, to feel that reading is a chore or, worse, busy-work. Remember, authors — academic or otherwise — aren’t in the business of writing just to bore students; there’s something important they want to communicate. Granted, not all writing communicates well, but regardless of the writer’s skill, if I assigned a reading, it’s because there’s something there worth knowing about.

How does the author say what they’re trying to say? What evidence do they use? What style of argument are they making? How are they positioning themselves? You’d be surprised how many people read an essay about, say, infanticide (the killing of newborn children) and assume the author is advocating this practice instead of simply describing it. These readers totally misread the author’s position.

Why is the author’s point important? If you can figure out why the author felt he or she needed to write the article or book in your hands, you’re a good way towards figuring out what they’re trying to say. What contribution does the work make to the author’s discipline, to our understanding of society or the world? What problems are they trying to solve?

Do you agree or disagree with the author? Why? Just because something’s in print doesn’t make it right. As a student, it is essential that you read critically, with an eye towards inconsistencies in an author’s argument or evidence. Are there other explanations for the data they present? Is the author’s interpretation colored by his or her religion, professional background, political orientation, or social position? Note: far too many students seem to think that criticizing style is a good substitute for critiquing substance. It’s not. A lot of academic writing is stilted, difficult (sometimes deliberately so), or just plain bad; this does not mean that the ideas are not good.

How does this work connect with other works? What’s new about it (or, if it’s an older work, what was new when it was published)? What disciplinary debates is the author engaging? How does this work build on, or refute, earlier works by other authors? How does it fit with the author’s other work? What other work is the one you’re reading like?

What is the social context of the work? Always consider the historical moment in which a work was created. What kind of person wrote it, and for what kind of audience? What historical events shaped the author’s perceptions and ideas? How was their world different from yours, and how was it similar?

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Most important is that your engagement allows you to come to class and contribute to discussion about the readings. Discussion will surely touch on questions such as these. On D2L I have placed an abstract that I have marked up with comments.

Tips for writing a good abstract1. Unless otherwise instructed, you can write about any one or more of the readings assigned for the week when the abstract is due.2. The easiest way to choose a topic is to write about something that ‘jumped out at you’ while reading the text. It could be something that seems interesting, strange, unfounded, biased, brilliant, difficult, etc. Explain why you find it to be that way.3. Don’t summarize, except as much as is necessary to make your point. Really. Please.4. Remember, the word guideline is just that—a guideline. Always make your abstracts the length they need to be in order to make your point, and then stop. But, if you go especially far either over or under 4-500 words then you probably need to rethink the topic of your abstract.5. For these abstracts, you do not need a bibliography, unless you use unassigned sources. If you want to discuss or quote particular passages from an assigned text, then use page numbers in parentheses, e.g. “(p. 12),” to show the passages you are discussing.6. Always bear in mind that the purpose of these abstracts is to prove that you have 1) carefully read the assigned material and 2) carefully thought about the assigned material.

Appendix B. Fieldwork write-up

These are some key features that, at minimum, I would like you to introduce into your virtual fieldwork write-up.

1. Date, time, and place of observation2. Specific facts, numbers, details of what happens at the site3. Sensory impressions: sights, sounds, textures, smells, taste4. Personal responses to the fact of recording fieldnotes5. Specific words, phrases, summaries of conversations, and insider language6. Questions about people or behaviors at the site for future investigation7. Ways that your observations resemble (or contradict!) the concepts you’ve read about in class

The following is a sample set of fieldnotes, from a previous semester’s fieldwork class. NOTE: YOU WILL DO A VIRTUAL VERSION OF THIS FIELDWORK. Still, these are a reasonable model for items 1-6 above. #7 is not evident because the class focused more on fieldwork than sociological content. In the first, I include elements I’d like to discourage, those I would like to encourage, and those for which I wanted a few more details.

Sparrow Emergency Department

            I attended Sparrow hospital on ___ September ___ to volunteer from _to _ PM. During my time there I started to get a feel for the emergency department and attempted to make myself useful while taking notes of what was occurring around me. Although there was a lot to absorb, I was very interested in how the department functioned and the hierarchy involved in taking care of patients.

          The hospital is very large and is in the downtown Lansing area on Michigan Avenue. After arriving and taking 10 minutes to find a parking spot, I walked through the doors to the lobby. There was a long narrow hallway that served multiple purposes. There was a stand for valet parking, people with wheelchairs to assist incoming patients

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and families, a small pharmacy, a café, an information center, and what looked to be a gift shop. If you were to walk in from the parking structure as I did, the Emergency Department entrance is immediately to your left. The main floor of the parking structure is for select people only (not sure who yet) but is where ambulances arrive to drop people off. The actual layout of the department is very confusing, and leads to disorientation when walking through it. Essentially there are five main sections, which include pediatrics, G Hall, S Hall, Q Hall, and R Hall. Between G, S, Q, and R Hall I am unsure what the specific differences are but I intend to find out. Pediatrics was obviously for kids or young adults, and it seemed S Hall was intended for patients needing intensive care. I came to this conclusion about S Hall because the rooms are bigger and is right next to the door where the ambulance arrives. Also, some of the rooms in S Hall are labeled T1, T2, which stands for trauma. I could not make any other clear distinctions. I also noticed that G Hall was slightly separated from the rest of the department, and am still unsure why.

          When I walked in from the lobby (which was the main entrance for everyone not coming in on an ambulance) I had to go through security. There was someone sitting at a desk, and he asked me if I was a patient or a visitor, and gave instructions to proceed to the security guard. From a glance the security guard did not look heavily armed, just had some standard materials. Everyone that comes through has to go through a body scanner, and their belongings go through a scanner as well so that the guard can check the contents. After observing the entrance process I realized that once the guard cleared the visitors, visitors received a nametag with the room number they are associated with and are escorted to the room they need to go to. Patients must talk to another person at a desk and give their name, D.O.B. (date of birth), and a wristband is printed out for them. Wristbands and nametags are the main indicators that tell who the individual is. Once the patient has gotten their wristband, they must consult another person at a separate desk. I am not sure what the purpose of this step is, but I believe it is to record the reason for the visit, and amount of pain you are experiencing, etc. I believe a nurse plays this roll, and I assume the computer they sit at is used to put the patient in the system and record their issues. Once the patient has cleared this step they must wait in the waiting room with the other patients that are waiting to be admitted. One of the things I was wondering was how they determined who got to be cared for first. Someone (or a group of people) have to determine who needs care the most so that they may be treated. If you came in with a minor problem and the department was full of patients with more serious illnesses or injuries you could be sitting there for hours. I also wondered if there was a time limit for patients having to wait. In other words, if after a certain amount of time a patient would be able to “cut in line”. I also thought it was interesting that virtually no one looks after all the people waiting to be admitted. Where do you draw the line regarding what illness or injury is serious enough? Who and how does someone obtain such a position?

            I spent a large amount of my time in the emergency department walking the halls, checking to see if things were stocked, and doing some patient rounding. The patient rounding was interesting for a couple reasons. First of all, I assume most volunteers are not qualified to be involved in any direct patient care. Even though this is a pretty obvious fact, the hospital still wants us going into patients rooms to see if we can help out. I do not see why they want us going into rooms when we are so limited with what we can actually do. The trainer I had for the volunteer explained that we should go in about every hour and ask “what is the most important thing I can do for you right now?” One elderly man that I helped asked for a couple pillows so that he could make himself more comfortable. I stated that was no problem, and proceeded to obtain a couple blankets for him. He was very nice when I returned with the pillows even though he did not look like he was in great shape. The nurse and two other visitors were in the room when I returned and the family just smiled at me. The male nurse that was in the room was on the portable computer that was in the room and just turned his head for a second to see who I was. The nurse seemed to be very busy and did not have a lot of interest in what I was doing. For the most part, nurses always looked busy. They were always going somewhere or doing something. I did find a chance to talk to a trauma nurse who was quite nice. I asked her what her patient assignments were like as a trauma nurse, and she replied that they usually obtained one trauma, and one regular patient. She also stated that nurses normally are responsible for four patients. As we were talking the training guy walked past with some new trainees. After he had passed she asked me about him. I replied that he was alright and that he took his job seriously. She went on to bluntly say “he’s a dick” and shook her head while saying it. I chuckled and smiled, saying “I definitely see where you are coming from” and that I never would have admitted that myself to any of the staff. I went on to ask her about how strict they were about keeping volunteers from seeing patient care. She told me that it really depended on who you ask, and which supervisors were working. She stated that she was fine with it and would try to get me in a room to see some stuff. I thanked her, and got the feeling that I was taking up too much of her time so I let her go. I was pleased with how relaxed she was, and that she took the time to have a conversation with me. A lot of the staff are hard to approach because they are so preoccupied with the job at hand.

            Overall, the four hours I spent in the emergency department was very interesting. I was exposed to the

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healthcare team in action and started to get a feel for how emergency healthcare is carried out. I am looking forward to continuing my investigation of the selection process from the waiting room and getting a better grasp of peoples roles on the job.

Here is one more set of fieldnotes, from someone without the “insider” status of the previous author.

The Waiting Room

Despite all efforts made to make the waiting room a comfortable and soothing area it never seems to exceed a realm of discomfort and anxiety. This waiting room is no exception with all its coordinated elements hoping to nullify the effects of nerves. The color scheme of the waiting room is over all much brighter than those chosen for patient and examination rooms. The walls are always some shade of yellow or orange, but never red. Reproduced copies of famous paintings hang on the walls, usually depicting some seriene landscape. Presently the one to my left depicts a small boy fishing in a mountain lake. I half expect to hear some sort of soft elevator music playing to accompany the strange physical array sprawled before me. To my left sits an older man silently staring at a wall, to my right sit an older couple quietly talking in muted tones. I make an effort to seem inconspicuous by writing in my notebook when a male nurse approaches the older couple.

Dark blue scrubs differentiate the male nurse from the other nurses I have seen walking around. Each nurse wears a brightly colored suit as a silent determinate of the role they play within the hierarchy of the Hospital. It reminds me of a sports team. In the heat of the moment you look up to ask for assistance and find the jersey of your teammate. In essence the Hospital’s use of color coordination is the same: it distinguishes who is on your team. The nurse approaches the couple from behind their chairs, his body language communicates that this conversation must be quick. He uses the same techniques Parsons described, he speaks with soft reassuring tones and uses hand gestures to explain visually what he and the physicians have done. He tells them that everything is fine and that their son can expect a full recovery. Again I am reminded of Parsons when the young nurse produces a skematic drawing of the care that will be needed when the patient returns home. The drawing serves as a simplification of a complex process that the nurse is mearly acting as translator for. While speaking the nurse slowly begins to back away from the couple, communicating that the conversation is ending and there will be no time for questions now.

After a while in the waiting room I decide to go for a walk in search of a bathroom. Wondering down a hallway I come across a sign that reads as follows:

A Friendly Reminder: Staff and Physicians1.) SMILE2.) Ask patients and family what else you can do to help.3.) Do not eat or drink on the units.4.) Maintain Patient Confidentiality (HIPPAA)5.) Remember: The Patients that we take care of consider YOU the Most

Important person in this Hospital

It seems as if the humanitarian aspects of medical care were condensed into an easy to remember list for the busy staff and physicians. With such a comprehensive list it is a wonder that bedside manner need be taught at all in Medical School. However, when back in the waiting room the only staff I saw smiling were the nurses. Those physicians that did pass by kept their gazes averted to their charts or the interesting pattern of their shoelaces. They avoided spending too much time in the waiting area where many eyes would turn expectantly for help. I made a game of trying to get each physician to make eye contact with me, of the ten that passed by in those hours only one smiled at me.

In conclusion my stay in the waiting room was enlightening. In my opinion it remains an awkward limbo between medicine and humanity that physicians seem uncomfortable dealing with. It is within the waiting room that not just potential patients but also their families exist outside medical categories of classification. The physicians simply do not deal with the administration of this area. It is, as Freidson would note, outside of their professional aura and better left to the nurses. However, as I witnessed, the waiting room is the only area where the physician is made painfully aware of the expectations that come with his or her role. Indeed, it is the only room in the hospital where the physician is directly confronted by the societal assumptions that come with the white jacket that so distinguishes him or her. I imagine that walking through the waiting room is much like being under a telescope for the physician. Everyone is looking to you for guidance regardless of your flaws and uncertainty because all they know is that if you are wearing a white coat you are expected to be able to help.

A potentially useful guide:

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Appendix C. Guidelines and Expectations for Class Presenters and Discussion Leaders

Near the semester’s end, you will present and lead class discussion for approximately 30 minutes. This appendix provides suggestions for this process and identifies those criteria according to which you will be evaluated.

Suggestions for Effectively Leading Discussion

#1 suggestion: BE CREATIVE! (This is your course, so take ownership of it!) -be enthusiastic, energetic, and engaging and have a positive attitude -lead your classmates in a discussion of the reading’s main points -briefly offer a critical analysis of the author’s argument and ask the class to respond (e.g., evaluate the logic, organization, clarity, strength, and effectiveness of the author’s argument) -help your classmates critically evaluate the author’s writing quality and effectiveness -create and ask discussion questions stemming directly from the reading -create and ask discussion questions that relate the reading to prior readings (e.g., you may especially want to address recurring themes in the course) -create and ask discussion questions that relate the reading to current events -or, better yet, help your classmates create such questions and guide them in discussing them -utilize audio/visual aids to facilitate discussion and enhance your classmates’ participation (e.g., PowerPoint slide shows, chalkboard drawings, musical selections, video selections) -utilize handouts to quickly convey important information or stimulate class discussion -plan simulations or activities to facilitate class participation

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-don’t be afraid to get a little goofy

Evaluation Criteria Points Possible 1. discussion of the substantive content of the reading 10 identification of main points; breadth and depth of analysis 2. overall organization of class discussion 8 efficient organization of topics, questions, and activities; time management

3. ingenuity 3 effective use of audio/visual aids; creation of informative handouts; use of innovative simulations and group activities

4. collaboration with discussion co-leaders 3 ability to work well together and coordinate ideas, questions, and activities

5. engagement with classmates 3 maintenance of a reasonable level of productive engagement with classmates

6. attitude 3 ample display of enthusiasm and energy

A Few Words of Advice Job titles matter. Class discussion leaders are expected to lead class discussion. Your goal as a class discussion leader should be to talk less and engage your classmates to talk more. For instance, rather than tell your classmates what the reading is about, you can ask them questions so they can tell you what the reading is about, or you can design an activity through which they ask and answer their own astute questions about the reading.

Acknowledgments: This syllabus is influenced by syllabi by P. Bearman, S. Valles, G. Montgomery, A. McCright, G. Hougham, V. Johnson, JL Martin, GA Fine, S. Gold, S. Bell, J. Dodson, T. Medvetz, J. Sallaz, C. Jerolmack, C. Heimer, M. Burawoy, and E. Hughes.

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