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This works.

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Hello, it's time to start our next session.

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I need some. Classes here. This is a session 2. In the inequality in healthcare.

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Empirical studies about healthcare professions.

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My name is Rondi Vardal. I come from Oslo Metropolitan University and I'm sharing this session on behalf of my colleagues.

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At the Arsenal Metropolitan University. And the but before we start the session I'd like to acknowledge the country.

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So on behalf of everyone gathered, I pay respect to the spirit of the country here in Narn.

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Where we are meeting. I acknowledge the past and the present, cooling nation. We're on the right, Geri, Roy Veron.

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As their sovereign people here, the cultural knowledge holders to maintain and promote the Narn Aboriginal law customs and the custodians custodianship responsibilities for country and the people that country continues to sustain generation after generation into the future for all of us.

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I recognise the important contribution that First Nation thinkers have made to sociology, including challenges to our dominant ways of thinking.

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We thank all First Nation delegates in the room today for their contributions to knowledge in the discipline. Thank you.

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Today we have 4 speakers. And 3 of them are online.

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As far as my notes go. And I think they are already here. Originally we were thinking about 15 min for each of the speakers.

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And then saving the questions to the end. Although with 4 speakers and about 2 h to do with, we'll have a short question after each speaker and the possibility of asking after one speaker but we will have a discussion at the end.

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As far as I just found out, there are no distributed paper speakers or here present. If there is, please raise your hand.

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I'm here online, Randy.

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No. So. Oh, you're, you're, there's one online? Okay, then we will give you a chance of a five-minute presentation, six-minute presentation of your paper at the end of this, the other speakers.

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Is that okay?

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Okay, okay, thank you.

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Thank you. Okay, so how do I switch to the zoom again?

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There you go.

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The first speaker today is More dividing. Hi Morta. And she's from the Oslo Metropolitan University.

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She is my colleague there and she's going to the Oslo Metropolitan University. She's my colleague there and she's going to talk about the reproduction of professional health.

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Hiarchies in today's health care field. The stage is yours. Martha, are you able to share?

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Yes, you are.

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Do you all see my? Screen in the right way.

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Yes.

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We can see your screen and your presentation. It looks wonderful. Thank you.

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Yeah.

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Yes.

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And my voice is okay. It's early morning back in Oslo. Thank you for attending this session.

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And for the opportunity to prepare this paper I've been reflection reflecting on several theoretical approaches. And, I've worked, which I have worked on for, many years.

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So my this first paper is. So, mainly and I have an empirical case at the end.

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And so and a little bit about myself. I'm a motivating professor at the Oslo Metropolitan University and a colleague of the chair from the and of the next speaker Kristin as well.

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So what I, my aim is to try to compare 2 sociological traditions for analyzing reproduction of medical dominance in today's health care.

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I go back to 1,988 as you can see. Where, 2 books and 2 works shops.

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Happened this and then I will talk about the field approach and the ecological approach. I would say more about that later.

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In part 2, I have a comparison between the 2. And then, part 3 is an empirical case on medical work.

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And then I sum up. I also have some summing up during the session and if I don't leave you can tell me when I'm 5 min left so I can kind of track.

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If I'm getting through it. So. This is the main text in this, in the first 2 parts I will talk about.

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It is the First on the left the ecological approach of the Chicago School of Theories represented by Andrea but and his Nestor Everett see use.

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And then the field approach, yeah, by Pierre, and also represented here by his. Colleague maybe or their student, This is, there is a dialogue between the 2 in the early or late ninetys and then I go to the loose paper on field anecology published in 2,016 where he is where the 2 are talking about

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how to. Do the dialogue between these 2 approaches.

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And so then we move on to. This is the the field approach and the ecological apart. Part one.

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What is the starting point for the dialogue between the 2 approaches to study professions? It is these 2 books I just talked about, the system of professions written by Andrea Abbott in, 1988 and the Homo academic has translated into English the very same year.

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And then the 2 workshops which also happened in 1,988. Around this especially around Bordeaux's work.

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The Chicago workshop in the spring and the Paris workshop in the in the winter. Or actually in the summer because it's supposed to be 3 months later.

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So in this book, which, coming came out in 1988 I bought Andrea but rights and I talk about this as an invitation from Chicago to the field approach.

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Where he says the system. As he's using it in the system or profession. It's a sense a key to BURGE US Trump or Field.

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But what do Bordeaux means by Shamp is what I later will call task area. Maybe today we could say that it is more correct to talk about the system as more closer to his term of social space.

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And task area closer to the field approach. And then, but what is? I reputation repudiation from Paris Bordeaux he recommends as the sociologist to not unconsciously deploy common sense notions.

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Introduced and critically into the scholarly discourses. And he also and this is the notional professions is what he's addressing and he and the footnote the translator says this repudiation is meant for the Chicago school type of sociology or professions.

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And this is. This is in the forward of this book where Bordeaux comes with this. Rejection of the Chicago School of Professions.

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Including as I see it also Abbot's work but that was a very very new book in those days.

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So. And then. We go to the first workshop. For you.

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And the very same year as the 2 books were published in English. 22 2 sociological workshops took place.

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One in Chicago, one in Paris, aiming to introducing the scholarship of Bordeaux to an American audience.

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The title of the book as you can see it's inviting invitation to reflexive sociology.

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The workshop was arranged by Louisa Khan. Who had studied with Berger and his mission was to percent this work to graduate student in in Chicago.

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But in this work, The main The main themes were, theory on his concepts. Like, yeah, field habitus, capital, etc.

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But we can also see they are doing some some similarities or some comparisons to Kut Levine and his field theory, which says, what do you think is a relational concept inspired by Cassier as Bordeaux himself.

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He's also linking to Judy and his concept of habit. Which is the kinship with the in this text.

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But and at the Paris workshop that took place 3 months later, there are more references to the American sociological profession included.

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Including the Chicago School. We can see that per year he's praising Mongoli Savati Larson's work on professions and the hierarchies, Randall Collins, Eliot Freudson.

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It's interesting, it's in 1,986 book that's where freights and also is including for Cordian.

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Understanding of power and Android. So he's not so. Rejecting in this second virtue.

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He's highlighting 2 scholars from the Chicago School. And one of them is is Goffman.

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And he's especially interested in government's work because he has the capacity. To to constitute objects into scientific objects.

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And he knew his work pretty well. After writing the epitaph in Lamond when he died 5 years or 5 and a half years earlier.

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But he's also a claim but but we are also at claims. Everything used and and especially his discussion of method.Ological ethnocentrism, which I think he sees is quite similar or has some of the aspect in his own a term of the method of the epistemological break he takes from Bachlard.

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So, BOJYY CHARRIS, every C use, which is one of the Nestor or the Nestor or the Chicago school working a lot on professions as one of the great mister of the Chicago School working a lot on professions as one of the great masters of American sociology.

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Despite that, he is in this workshop repeating his critic. On the concept of professions and requirements his colleagues in Chicago to replace it.

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Or at least their students with a concept of field. And this critic is published over 12 to 13 pages in the book invitation which is reporting from this workshop.

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There is a late report, a response to this critic from Abbott. As late as 2,005 and we will know Bordeaux died in 2,002 and but in this quite interesting article and also a pair on his web page he's introducing the term linked ecology similar to the field.

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So there are a dialog between the 2 schools in the late 19 eighties. And Abbott is inviting.

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Is to Bordeaux and is also telling him how his concept are a key with the field approach.

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And ever it's a use and his students. Goftman and Straus, you are included are not as I can see it included in Bodious critique.

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In other words, the these are the first generation of the Chicago School.

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And then we are moving to 19, 2016 and to the field and ecology article. But do you an emit buyer?

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Where they have a comparison of the 2. Approaches. The similarities between the 2. They say is in the field approach the topology talking about agency positions and relations.

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And also the ecological approach the actors locations and relations they are also similarities on their structural understanding of the homology or isomorphism.

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The temporality, how they look at change over time. And also on the ancestors. These are common ancestors for the 2 scholars.

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5 more minutes.

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How it wins.

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Then the external. Yeah, then we turn to the differences. The structure over interaction. You said 5 min around there.

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Indeed.

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Yeah. At these are at the main difference is the question of power.

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And the power and equality in the field approach and for abh and the especially not the whole ecological theory or approach.

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Power is unimaginable question. So this is a summing up. And I think I just go to my the last part.

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This is the empirical study where we are which I'm relaying to. And the title of this is Sorting It All Out.

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It is an analysis of medical doctors who work with patients who have a hand condition or hand pain. In this we have the empirical material are 23 electronic patient journals and 5 to 10 interviews with general practitioners and patients.

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So we have 3 research questions. Where we ask how we are interested in how the doctors diagnose and treat the patients but also how they refer them or transfer them to other.

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Specialists in healthcare or to self care. And then our last question is added how these professional hierarchy so the medical dominance is produced and reproduced in healthcare today because that's a very clear finding in in this study.

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So, I, doing this, I've been reflecting together with my PhD students who are also 2 of them in this project.

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And my other colleagues. On our theoretical tools. The old ones like you can see the field ecology first and second generation.

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But also on the sociology of diagnosis. This is our topic here is a medical. Diagnosis as a category and a process.

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We are, we have been, looking at unlimited users from New Zealand and who she recommend us to go beyond and between in the development of new critical approaches.

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So what we see, we need to have a study of what is within and between these. See, old theories and also analyzing boundary work of today.

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The concept of boundary work is for Thomas Gearin who also is situated at the Chicago as far after at that time when he wrote this work at least.

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But we are also looking at Susan and Carol an Australian. Sociologist well known for Samuel and her work on dynamic professional boundaries.

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So this is how we are trying like to look what we have before but to see also between them in analyzing Bond River.

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So to sum up. As we see it, the dominance of the medical diagnostic system and the medical knowledge in general need to be addressed in empirical analysis.

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We ask how the professional hierarchies in Diagnostic Centre at health care is produced and reproduced.

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And this assumed reproduction of medical dominance as we see it in this study. Needs to be analyzed.

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You could for example look at the micro power in everyday interaction using the ecological approach with emphasis on government and ever to use the culture and symbolic power as we created.

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In the field approach by and finally go beyond and look at what is within and between our theories and address the dynamic boundaries from cultural, social, historical and humanistic perspectives.

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Well, thank you. Thank you, Martha. Thank you very much. Before we move on, if there are any pressing questions directly to Marka right after.

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Representation we can Address that.

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No one burning in with a question. We can wait until the discussion. Thank you, Martha, for a wonderful journey through through our theoretical frameworks and and the developments and the discussions.

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I find this very intriguing and also a reminder that we sometimes reproduce conceptions even through the theories that we're using that we need to be critical to.

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Our own views of what we are studying or the frameworks that we are studying within. So without much further ado, we'll move on to the next presentation and then I need another pair of glasses.

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And that's Christian Larson.

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From, yeah. How do you? University Hospital Center of Health and Human Health Research, Eddie Sopitola, Denmark.

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And he's going to talk on health capital. Patient investments in their bodies and the reception in health care field.

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Tist on the stench is your for 15 min.

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Thank you very much. Can you see my slides?

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I can see your slides clearly and I can hear you well.

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Perfect. Yeah, thank you. Yes, thank you for participating. It's Very early in the morning.

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And I just participated in, with lots of people from around the world among them. Just Swedish and Norwegian.

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I should, presented this with a colleague of mine and it, but you couldn't participate.

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I'm a professor of, Department of Public Health. And and I am a research leader at UCSF.

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So This is a study about. Patients investment in the body. And it's a kind of a mixed method study.

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Where we combine, multiple correspondence analysis and interviews studies. And basically it's within. The field of inequality in health and So, Yeah, sociality of health.

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So, we have, these research questions. I will say first of all that This is this is just a research project that is in process so we haven't got results but we have We have some reflections that we want to to involve you in.

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So, We will ask a patients at hospitals in in Copenhagen.

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In which way does illness or illness experiences The hospitalized patients to invest differently in their body. And how does the diagnosis form a reform their investment in health practices?

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I need to remove you from this. Yeah. And and how are these investments strategies related to and different in relation to social class.

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H gender and DCs.

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We have, let's say, 3 different inspirations. One of them is the work of Pordian social space.

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Social position and dispossession. Capital and resources and also the strategy. concept. And biography and distinction.

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And then I have since 2,005. With colleagues among them. And the Hindu work with what I call health capital.

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Which is an aim to try to understand. Why, why or whether? Health or working with your body in different ways.

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Can be a new kind of of capital beside economic culture and social capital And then we have, have, introduced in this study, Buris work with, with, geographical disruption, which is very relevant to patients in hospitals.

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And we want to find out whether these, biographical disruptions. That people experience when they are diagnosed at their hospital so we take these interviews at hospitals and the survey and want to understand whether and how.

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Patients navigate when they have a diagnosis. So, health capital.

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Mmm, I have to remove the pictures. How do I do it up there?

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Like that. Health capital is, a new form of distinctive bodily practices among social groups.

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And it's different related to to class and age and gender and so on. I won't say much about that now, but we have so to speak.

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Try to relate health capital. And Bureau's work of disruption, geographical disruption.

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And the questions that we ask the patients is about as an example. Whether and how they invest differently in relation to surgery, chemical body.

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The diet body. Like eating habits and physical training and mental body like doing yoga and so on.

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Yes. What we found when we when we applied this study on 440 professions we could discuss whether they are professions but in in the healthcare field of Denmark and we could see that this is not very easy to read but on the right side we have relative.

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High positioned middle class higher class and on the left side, lower class in in the Danish health care field and on the right side we we have observed a more we could see a more we could see a balanced or natural relation to the body whereas in the left side.

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People are more radical more instrumental in relation to their body So what we have done now, we are we are doing we have around, 250, questionnaires now.

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We, we make questionnaires at the, hospitals in Copenhagen area. We, we visit patients.

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In the wards at the hospitals somatic and psychiatric and acute chronicle serious and less serious illnesses short term long term illnesses.

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And we have tried to to organize it so we have different different kinds of diagnosis involved. After that we will have around 30 qualitative interviews with some of the patients almost all of them say yes they accept this having interviews So we visit them at the wards.

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We have 3 students and we participate as well. Anita and I. And we contact patients and they spend around 10 min up to half an hour.

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Because depends very much on the patient. We have iPads and we use QR codes. And we help them.

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Yes, and this study has relevance to the sociology of health and illness. And results may have implications for the health care field in general and not not at least in relation to how health care institutions and healthcare professions can improve in the meeting of disparate needs and different patient groups for health care services.

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Yes, I won't say much about this, but we have this. This survey and a lot of questions where we so to speak try to ask.

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About the diagnosis and how they relate to it and what does it mean to them, er, related to these 5 categories that I presented earlier.

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I tried to draft some, very first work assumptions. As an example, we, we, we have an hypothesis that high position versus low precision patients relate to active versus more passive investment in the body that H also has.

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Means something as an example. Young people versus older people relate to high versus low investment styles If you have very old people, they are more related to have.

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Illnesses with the bodies and they they are less. Active. But we will find out and we have this a lot of other ideas about the diagnosis.

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And how it relates to to investments also in the different kinds of investment as an example we know pretty much that patients that are diagnosed with, with diabetes, they tend to, to, relative dramatically change their habits in relation to their own body, wells, other diagnosis say they do less.

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In terms of changing their lifestyles.

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You have 5 min.

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Yes, we have some field notes. I don't think they're very relevant for Yes.

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5 min.

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Yes. Yes, I think I, I think I will just, end of my session.

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And stop sharing. So this is it. All together we are in process with.

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With constructing this work and we, the multiple correspondence analysis can help us to somehow map.

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The different positions. That the patients So we may we may be able to see how Diagnosis H.

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Gender and social class relate and so to speak cluster together in this, mapping.

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But we also know that a lot of these things we need to have interviews. In depth interviews with patients.

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Yes, that's thank you for me.

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Well, thank you, Lorch. Nay, Christopher. Sorry. I was thinking about someone else right now.

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Okay. Yeah.

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Are there any pressing questions? Christian.

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Yes, there's one in behind there. Could you please come up here? You have a question.

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Can you do? Please come here so they can see you. Or the recording as well.

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And hear you.

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Hi, thank you both for talking. It's been good so far. Christian, I was wondering if you're looking at barriers and constraints to changing lifestyle.

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I speak a little louder.

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So how health capitals. Oh, sorry, I'm probably too far from the mic. Is that better?

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Yeah.

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I was wondering if you were looking at some of the how an equities might shape ability to perform health capital or to change behaviors as well.

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Yeah.

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Because I know you're looking at how they cluster but things like access to resources. Or social expectations or all these.

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Other forms of capital Burdue talks about or any other way that you frame it.

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Yeah. So yeah, so a good question. So we tried to, so to speak, to mix.

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We are we ask also about social capital educational capital and economic capital so this method should be should help us to sort of understand both health capital and economic capital.

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So this method should be should help us to so to understand both health capital and so to speak social position.

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Drawing on a different amount and composition of economic cultural and social capital, yes.

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Okay, thank you.

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Okay.

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Thank you. Thank you for the question. Small and we'll save up more questions towards the end.

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I know for sure that I have some interesting first 2. Speak is yeah 2 speakers here today addressing the the theoretical issues and the frameworks that we work with working within and Fristian then following up with the empirical study using these frameworks.

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This, this can turn out to be a good discussion in the end when we come. Closer to the end here.

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Now the next speaker is actually here.

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And then I need the help from the assistant to Let you guys on Zoom be on the side for a while.

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Okay, so we welcome Joanna Blackwell. Please, she's gonna talk about you're the expert.

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You tell me what I ought to do. Social-cultural influences and the cardiac patient patient journey exploring health and care relationships.

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Another empirical study as yeah, thank you for the Maybe on. Is it just? Just push the button to.

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This, should we try? Yeah, yeah, it works. Thank you. Thank you.

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Good afternoon. Thank you for being here. I just want to start by acknowledging my colleagues who were with me on this piece of work.

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I am going to talk to you about my PhD study that I did a couple of years ago. And bring in probably some of the stuff that the first 2 speakers have talked about.

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So it's a nice segue into what I'm going to discuss. So first of all, what I'm going to do is talk a little bit about how, where the data that I'm going to discuss has come from.

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The study itself, what that was constructed of. And then discussed a little bit about why health care relationships in that context might be of interest to us.

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And then again, as he's been quite popular today already, I'm going to use a Bjazian lens to explore some of the challenges that I feel opposed in those health care.

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So first of all my study was called the socio-cultural influences on exercise and health along the cardiac patient journey.

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Using a board jersey in perspective and this was my as I say my PhD study that I conducted in England.

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I collected my data over a 6 month period from the towards the end of 2,019 to 2,020.

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Why am I telling you this because we all know what happens at the beginning of 2,020 and so right in the middle literally 3 months into my data collection we had the first UK lockdown.

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Obviously the work I was trying to do was severely affected and I had to reconsider whether I could even carry on at that point.

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It was particularly important because I was doing an ethnography so I was spending a lot of time with my participants.

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And when you can't have social contact that becomes quite problematic. I conducted repeated semi structured interviews so I did the first interviews at the beginning of my engagement with the participants.

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So they were all in person and everything was fine and then obviously I had to rethink that for the second in depth interviews which happened in the second half of fieldwork.

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They were all then conducted virtually. I also did participations throughout. Now again as you can imagine that's fine in person when you're with people, that's fine in person when you're with people, you can sense the environment and and everything that's going on at that time.

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But when you switch to virtual methods and everything that's going on at that time but when you switch to virtual methods and some people opt for a phone call.

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How do you do that? It becomes quite problematic. So although I call it an ethnography, it's very much non-traditional, it's a sense of ethnography affected by the pandemic and then throughout the whole process right through to the end of data analysis.

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And then throughout the whole process right through to the end of data analysis, I was journaling constantly to the end of data analysis, I was journaling constantly in a reflexive diary.

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And as I said, I use that board Josie and theoretical framework to analyze my data. I had 17 research participants.

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10 of them had had a cardiac event. And 7 of them were significant others of those individuals.

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So these were spouses, partners, daughters, adult friends for example where they didn't have any close family ties that were snowball sampled into the study to give the perspectives of significant others.

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So in terms of my study then, I found several different relationships were quite important in the context of health care.

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And that they could be between health professional to health professionals so although I didn't interview them or engage them in the study per se.

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I was observing things between doctor and nurse for example, physio and exercise instructor involved in cardiac rehabilitation.

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I also noted the different dynamics between the person or the patient and the professional involved. Between the person and other people so that could have been significant others or it could be wider brothers as I found.

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And then also between the individual's own habitats and the field at large. And because of the people of nicely mentioned Habitas and Field already, I won't say too much about that at this stage.

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What will say though is we have the NHS, the National Health Service in the UK. It is a free at the point of access service.

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It's very much sold on that basis as this wonderful thing, but it's not accessed universally by all despite that.

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And what we know is that cardiac events are a major cause of mobility and mortality not just in the UK but across the world.

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And what we have in the UK and again in many other countries is a system called cardiac rehabilitation which is designed to support people post-cardiac event.

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However, uptake isn't great so currently around half of the patients who qualify for cardiac rehab decide not to go for whatever reason.

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And then when we look at other factors such as gender such as socioeconomic group and ethnicity, then the likelihood of attending cardiac rehab drops even lower.

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And what we've seen is in the 15 years in the UK that they've been collecting data on that that those disparities have changed very little.

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So despite us knowing that we've got issues there in terms of cardiac rehab and what it does and who it benefits.

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And all we've tried to do to try and alleviate that little has changed in that period of time.

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So my question here in this paper is could these relationships be one of the important influences on health care decision making in that regard.

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So I'm going to focus on the person or the patient and the professional relationships. I'm just going to pick one of those relationships that I identified before.

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And these are the things that came up for me in my study. There were things around pork communication, about patients feeling ill-informed and also about feeling ignored by the health professional.

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There was also this kind of paradox between a lack of faith and blind faith. And I'll talk about that in a little bit more detail but between this unquestionable belief in health care and health professionals.

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Against this. Lack of faith that is brood from this feeling that feelings have been ignored or the lack of trust that's developed.

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What was very relevant as well was the nomast within the field, so those rules and laws that are imbued by the health professionals and how they influenced decisions that patients were making.

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Also things like the power dynamics, symbolic violence and doxa and elusio in terms of our unquestioned beliefs about what we do in terms of health care.

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So for example we get the chest pain, do we go to A and E, accident emergency straightaway or do we wait?

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The unquestioned doctor would say that we attend to that immediately. In elusio terms it is that investment in belief.

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And what will be gained from going to access that health care or that cardiac rehabilitation for example.

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So.

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I'm not going to read the quotes, I'm going to leave those for you to read.

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But what I want to talk to you about is each individual. So I'd like to tell you a little bit about Simon who was one of my research participants.

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Simon had several blocks arteries. Which he found when he had an angiogram. But he was experiencing these symptoms for quite a long time.

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He was getting angina symptoms basically but he delayed action for those symptoms because he feared what the consequences might be.

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He was a carer caring for his wife. And whilst I think you, a whilst his symptoms were already limiting what he could do, he knew that medical intervention were already limiting what he could do, he knew that medical intervention would limit them at that further.

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He knew that medical intervention would limit them at that further. So a subconscious of his habitat further.

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So as subcontracts of his habitus, his autonomy and his control were taking over, he was engaging his agency and departing from that, his autonomy and his control were taking over, he was engaging his agency and departing from that prevailing doctor to maintain his position in Being able to repair and return to

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the position was absolutely paramount in his mind. He had a family history of heart disease, he got some lived experience of what this all might be like.

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And his daughter was a nurse so he had the opportunity to talk to her and reflect upon things. He absolutely 100% believed in the advice given and in the process that that doctor and that the experts were the doctors and they were to be trusted in this situation and they were to be trusted in this situation.

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He ended up having a coronation. He ended up having a coroner artery bypass graph, so major surgery had quite a difficult recovery bypass graph so major surgery had quite a difficult recovery described feeling like he was in someone else's body, had quite a difficult recovery, describe feeling like he was in someone else's body but he attended

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cardiac rehab and he attended cardiac rehab and the difference in him was visible. But he attended cardiac rehab and the difference in him was visible immediately and the difference in him was visible immediately from clinic appointment through it.

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Peter is talking about his friend. Who experienced angina symptoms? This individual had quite a protracted journey to diagnosis which significantly impacted his quality of life.

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This person had a really healthy habitus so perhaps they didn't fit those unconscious characteristics of what a heart attack patient or a cardiac patient might look like.

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He experienced poor communication and feeling ignored by the health professional repeated visits with the same symptoms and yet no diagnosis, no treatment offered.

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He expressed feelings of incompetence in the system, a lack of trust. The fact that he had to chase everything at every interval.

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And the expectation from his significant other was that the professional should know what they are doing and that that made him question his own doctor as a friend of someone who had been through it.

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This is a reflection on one of my field notes that I took during my participant observations. And this really is about those that nomos, those rules and laws within the field and how they can be latent or they can be overt.

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So in this cardiac rehab program that I attended There's a latent hierarchy there.

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So there's lots of staff walking around with clip boards. They've got NHS lanyards on, the volunteers wear blue t shirts, the staff wear red so they differentiate themselves.

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There's no discussion about what exercise you will do when you attend cardiac rehab or how you will do it that is mandated by the experts to health professionals.

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And there's no discussion about your personal biography or your material conditions for example what you've done before or what you might feel competent to do.

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And there's times when that spills over into those overt displays of power. This has the potential to manifest in this symbolic violence, that non-physical imposition manifested in the actions of more dominant people within the field.

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So this instructive language. That can result. I am speeding through this, sorry.

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Here's another example from Elizabeth. This is leading on from the discussion on symbolic violence. The information she was given was determined by the professional.

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It wasn't spoke to Elizabeth and her needs. Now it could be that she'd already decided that this opportunity they were off in her was ill fitting with her habitus wasn't something she would feel comfortable to do.

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She perhaps had insufficient physical and cultural capital to understand the information she was being presented with and there's also the influence of the discourses surrounding age and there's also the influences of the discourses surrounding age and social class and gender of the discourses surrounding age and social class and gender appropriateness that she might

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feel. What we also can bear in mind is how health professional attitudes of their own can spill into the conversations and the discussions that they have with their patients and inform their own attitudes and beliefs.

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It's difficult to make an informed choice without the appropriate type and quality of information and that's relevant to that power differential between the person and the professional.

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So in summary What we can end up with is this level of symbolic violence which can lead to quite serious consequences for patients.

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Not just in terms of uptake and adherence to cardiac rehabilitation. But to recovery journeys in terms of physical and psychosocial outcomes.

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And our health outcomes overall. And also more seriously to the death of the patient.

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I would just like to acknowledge the funding for the presentation of this work from the Foundation for the Sociology of Health and Illness.

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Thank you.

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Thank you. It was there for just a minute. And pressing. Sorry, a minute despite speaking to the mic because of There's a recording from this session as well and we want the future to know what we were talking about as well.

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And so are there any. Instant questions for for Yuana Johanna. No. We would ask the J, but it's fine.

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Joanna. Joanna.

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I have a question in fact.

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Yes.

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Can you hear me?

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We can hear you cannot see you right now, but I think hearing is good.

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Yeah. I was just wondering about, the symbolic violence and how I really agree with you but how can you measure that that people can dive from it.

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Thank you for your question. I think the point is that the imposition by the health professional influences the health professional influences the imposition by the health professional influences the decision by the health professional influences the decision-making of the person.

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So if that person influences the decision making of the person. So if that person decides for example not to access a particular treatment or not to access a particular treatment or activity or cardiac rehabilitation then that can.

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So if that person decides for example not to access a particular treatment or activity or cardiac rehabilitation then that can have serious consequences on which is fair to say could make their health more detrimental and lead to death.

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So that's why I mean that.

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Okay.

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We could have another short question.

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We'll save it off.

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Thank you, Joe.

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I have several pairs of glasses here. Which,

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He's gonna help me figure out what to do. There we are.

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Yes, Fisher.

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But I can't see Fisher here.

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Alex Fisher, are you present?

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Is it pre recorded? Okay.

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Noises remote.

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No, I don't think there is a be recorded with

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Does anyone know Alex Fisher?

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If. Yeah. So hasn't been here and is not present. Then I'm afraid it's gonna be hard to have his or her presentation.

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That leaves us room for more discussion. First of all, I'd like to thank all the 3 speakers.

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Speakers and I do know though I need your help again that there is one Distributed paper? Excuse me?

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There's one distributed paper and then the person is online. Could you help me get back to the zoom room.

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Yeah.

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I see that Emily Value is there. She has the paper and since we are lacking the the last speaker of today will give you a chance of actually 10 min of presenting your paper.

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Do you have a presentation to share?

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Yes, thank you, Randy.

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Excellent. Then you can have 10 min from now. Thank you.

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Okay.

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It works.

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Hello, my name is Emily. Thank you for ranging my participation. I'm so glad to be here.

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And, I'll present to you the paper titled, no clinical support workers of a referral hostile in Bahia, Brazil.

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You face off COVID-19 discussing visible labor and its consequence. And I will focus on the present resumes.

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Of this research. And so the COVID panic, you sign them in Brazil. Has specific characteristics related to a serious health crisis associated with a profound social crisis.

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In the midst of all this Brazil also experienced a serious political crisis. So the no-clinical professionals in Brazil, they are often associated with very work.

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That is activities that are stigmatizing, evaluate, integrating. And their activities are often associated.

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We. With what the site rejects. For example, in the hostel.

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They are training activities, contact with their bodies, and among others. And in many aspects, the identity of these professionals as health workers is questioned and they are reserved for a and visible places.

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And this wasn't satisfied. In the Covid-nineteen pandemic. So the aim of this study is understanding the experience of support to workers.

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At a referral hospital for COVID-19 stage of Bahia, Brazil. And we conduce it 22, interviews with super 2 workers.

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Between June and December, 2021. We have 7 stretcher bears, 8 cleaning workers and 6 administrative assistants.

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And to dipping the team, we formulated 2 analysis questions. Wait to worker performances and activities are not highlight by managers.

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Oh, their workers and users were many heating behind the scenes. All of the work process. And what are the impacts on the worker by maintain these performances and activities?

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This analysis questions to look at the context of interaction of work. Where the issue of recognition is in this.

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Our resodes, they must read the existence of 2 axes. So shall the valuation of super to worker.

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So super to work and interdeepness of support and assistance activities. The first axis we observed that the social appreciation of support work was linking it only to occasional recognition of personal skills.

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An occasional appreciation. The evaluation was evidence by scenes of disqualification and of the knowledge and experience of the superchub workers.

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And the second axis we found that super to work is essential for healthcare activities to a pool. And this is in overwork for these workers.

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Also in the intensification of the workload and supervision. And we observe the use of the professional experience to guarantee patients safety and help newly hired professionals.

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These 2 axes have a common. That to absence of formal and effective recognition of the centrality. Of the work with material and symbolic.

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Counterparts.

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I have here some examples that demonstrated our analysis. And the first ones are associated with social devaluation of separate worker access.

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When these workers are claiming for our respectful place in the interactional context. In the case of the for example, how many patients they needed to indicate to the newly hired clean coaching doctors, That something needed to be adjourned.

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To carry out safe transport for this. For the patient. And in this situation, this stretcher better tells us.

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The staff believe it that they stretch are better doesn't understand anything. This Richard Barrett doesn't know anything.

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That's Richard Barrett. Didn't study for that. They will come up to you. And speaking out, The raising of the voice from Morris, professional about the execution of the work transporting patients.

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The most rate is this day of clinical professionals for these activities. However, how much is the experience of a stretcher bear worth compared to the inexperience of a clinical professional.

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Discontext of interaction challenges the value of the professional experience. In many cases, that results in the legitimization of the work experience, intelligence and No, there is queues.

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And the no-clinical super workers allow they use of one self by others as treated by your Ghulji and allow the exploitation of the work experience intelligence and other cognitive Act through how they care.

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Then there's a better need to stand in confrontation with clinical professionals for meeting. To the lives of patients.

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So I have here an example. Hi. To the second axis. So interdependence of support and assistance activities.

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And professionals indicated a self recognition of the centrality of their work. This recognition leads to the commitment and moral responsibility of these workers.

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With their activities. And despite the disregard over law And in this rotation of the They have committed to the service in favor of greater good.

344
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Patience, save it, and it's in institutional success, even if this is invisible in the eyes of the managers.

345
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The cleaning agents. For example says if you weren't for us if the team hadn't cleaned the surface they wouldn't have touched many things.

346
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Materials, doors, windows, in many place, the bed. This demonstrators, the interdependence of this war.

347
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So that clinical professionals carry out their activities safely. Similarly, the stretcher barrier says living inside indifference mistreatment an alternative voice from other professionals because There is a life that's in common there.

348
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Even so, they have a great demand for attitudes and behaviors that increase the pressure to perform the work.

349
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This in the presence of overload and conflicts with in the work environment resulted in some degree of Physical are youness and psychological suffering of these workers.

350
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This our final considerations on the support work of these professionals in the house. So environment and it's consequence.

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During the curving pandemic. This super 2 workers doubt with workable load, contempt and lost part. For protection contributing to the success of the health work process.

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Providing us sufficiently safe atmosphere for patients and other workers. The sociological knowledge of the experience of non-clinical support workers in this context.

353
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May be relevant in both scientific and political sense. Reinforcing agendas committed to the So we show and a material recognition.

354
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Of these workers. So that's all. Thank you very much for your attention. And this is my email address.

355
01:00:02.000 --> 01:00:07.000
For any questions you may have.

356
01:00:07.000 --> 01:00:18.000
Well, thank you very much, Emily. Thank you. So happy that we are able to present some of the distributed papers.

357
01:00:18.000 --> 01:00:27.000
There's so much good research presented in this conference that is not even presented. And I'm really happy that we get a chance to get.

358
01:00:27.000 --> 01:00:49.000
One more speaker on board. Does anyone have a An urgent question for Emily. Also talking to the previous speakers here, if you have any questions for Emily before we start a general discussion.

359
01:00:49.000 --> 01:00:55.000
Is it a little bit early in the morning for the Scandinavians?

360
01:00:55.000 --> 01:00:56.000
No, we are awake.

361
01:00:56.000 --> 01:01:13.000
Oh. Well, we'll try to wake you up more now. As we're moving on to a more general discussion on this, I would like you know first of all I think this session highlights

362
01:01:13.000 --> 01:01:25.000
Something. Of course it does. But I think the the sequence of this session has highlighted something that is prevalent to our studies.

363
01:01:25.000 --> 01:01:40.000
Is that when Marta starts with the the traditional Frameworks for studying professionalism. And professional health care and in the Chicago school and the Bordeaux Buddhist Buddhist school.

364
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Sort of in the dialogue combine something that is valuable for our approaches and then we get a very Classical Bordillian approach from Christian.

365
01:01:50.000 --> 01:02:13.000
And maybe a more Chicago school approach with with the extension of Bordeaux from Joe. And then I'm focusing on the patient and then on the last paper that we that was distributed from Emily was also sort of using the same kind of approach to understand the health care worker.

366
01:02:13.000 --> 01:02:40.000
So I really appreciated the way these 4 contributions built on upon each other. Not much of it is about Habitas or perceptions of diagnosis or perceptions of what I am doing and I'd like to start with Actually, or I could.

367
01:02:40.000 --> 01:02:49.000
I want to challenge all of you to think about this concept that Christian brought to the table of bodily habitats.

368
01:02:49.000 --> 01:02:57.000
Or the work and that we do with our bodies, the knowledge that we have with our bodies, about our bodies.

369
01:02:57.000 --> 01:03:10.000
And the capabilities of actually doing something with our bodies. Making the choices. And I hope to get a reflection from from all of you speakers and maybe also from the audience.

370
01:03:10.000 --> 01:03:23.000
On on the different you know how these how this or I would say these in plural the bodily habitous change can change over time.

371
01:03:23.000 --> 01:03:38.000
How you can influence this bodily habitat in light of of okay there's one time is one thing it changes over time you change your perception of who you are.

372
01:03:38.000 --> 01:03:55.000
As a body. Also in terms of what diagnosis you get. I have myself lived with a diagnosis that would eventually lead to surgery operation which is a serious thing to do to your body.

373
01:03:55.000 --> 01:04:08.000
It's still sort of the final solution. Then while waiting for for a surgery you have to sort of conceptualize your body as something you know I'm powerful I can do this without the surgery.

374
01:04:08.000 --> 01:04:14.000
That does something to how you think about your body. I can do this. I can do this until you can't do it anymore.

375
01:04:14.000 --> 01:04:20.000
Then you have the surgery and then you will have to conceptualize your body in a totally different way and have different capabilities.

376
01:04:20.000 --> 01:04:27.000
So time is one thing that I'd like to address. The time of an illness, you know, the development of an illness.

377
01:04:27.000 --> 01:04:41.000
Sort of also changes the and the habitus of health. Health habitus. I think that there's another, another thing, how you are received.

378
01:04:41.000 --> 01:04:58.000
From the health personnel as a patient also changes the way you You think about yourself as a body. Because even if you are good at distinguishing or being safe on your own self-image or something.

379
01:04:58.000 --> 01:05:13.000
Health image. You will still be in influenced by Whoever's receiving you as a doctor or a nurse or a or

380
01:05:13.000 --> 01:05:20.000
Someone who's pulling your chair in the hospital. Don't afraid it's the last.

381
01:05:20.000 --> 01:05:31.000
Last speaker. So, so who you are received by when you need help? Also influences the what your your bodily habit is.

382
01:05:31.000 --> 01:05:50.000
Okay, so these are the 2 dimensions that I can think of but I'm sure there are many others And then the next, so the final challenge to me is then how do we conceive these things in these new, how do we conceive these things in these new developments where you are supposed, you know, the freedom of choice of

383
01:05:50.000 --> 01:06:03.000
medical. Help versus an informed decision. Because sometimes these these 2 axes are Yeah, our.

384
01:06:03.000 --> 01:06:10.000
Contradictory. So I would call upon the.

385
01:06:10.000 --> 01:06:20.000
The Speakers to reflect on on this concept about bodily habitats and how that can change over time.

386
01:06:20.000 --> 01:06:30.000
With who you meet and how you receive it.

387
01:06:30.000 --> 01:06:31.000
I can start.

388
01:06:31.000 --> 01:06:36.000
Who would like does anyone volunteer to start? Yeah, it. Okay, we'll let we'll take it in the order of variance then .

389
01:06:36.000 --> 01:06:37.000
Please

390
01:06:37.000 --> 01:06:51.000
Yeah, and then then because when you talk about this changing of the bottle inhabitants. I think in my empirical case Oh this hand pane or hand Ossteoarthritis.

391
01:06:51.000 --> 01:07:02.000
When these clients or these persons go to the doctor. It is the doctor has to kind of sort out is this kind of old age.

392
01:07:02.000 --> 01:07:09.000
Disease, just handles that arthritis or or a hand pain or is it a rheumatic factor.

393
01:07:09.000 --> 01:07:31.000
In case the first there are no treatment. So, so and in the second there are medical treatment. So in this cases, I think the prestige of the clients is to be like for the doctors if there is a rheumatic factor like in rheumatoid I tried this.

394
01:07:31.000 --> 01:07:40.000
That then you get. Then the URL of interest by the doctor medical doctor or the roomatologist even there.

395
01:07:40.000 --> 01:07:56.000
Used to be the for surgery, but today there is more medical. Treatment but But the first part, if you if it's only hand ostrich right there's no treatment then you are referred to.

396
01:07:56.000 --> 01:08:05.000
Self care and then also Emily you mentioned the term dirty work then you are kind of this is not of interest for the doctors.

397
01:08:05.000 --> 01:08:12.000
So it's very so you have a hand pane about and you go to the doctor you might be very interested in.

398
01:08:12.000 --> 01:08:21.000
At not being too serious, but if it's just. Oh, steel tried this then then you don't get anything except.

399
01:08:21.000 --> 01:08:29.000
Self-care. How to you have to train and to exercise yourself? I think that is what I will say about that.

400
01:08:29.000 --> 01:08:39.000
And So there you get like the clients are. In that hierarchy as well.

401
01:08:39.000 --> 01:08:41.000
Alternate on to you.

402
01:08:41.000 --> 01:08:52.000
Yeah, I have many reflections about this, but basically, At least we see in in the Nordic countries, but Almost.

403
01:08:52.000 --> 01:08:56.000
Yeah.

404
01:08:56.000 --> 01:09:09.000
Yeah, at least in the northern countries we see as Bordeaux and Wakan work with with the state that we talk about the withdrawal of the state that the state was saying in the sixtys and the seventys.

405
01:09:09.000 --> 01:09:20.000
Protecting us all, so to speak. It made a safety net. And helping people in the health care feel that as an example when I was a nurse.

406
01:09:20.000 --> 01:09:48.000
Many years ago the patient's average, stay of length was about, 10 of, 12 days today you are pushed out next day after surgery and when we talk about the theme about inequality we we can see that I mean worldwide that, people with a lot of, capital, a lot of

407
01:09:48.000 --> 01:09:59.000
resources, especially in in in some countries economic capital but in the Western Nordic countries a culture and social capital.

408
01:09:59.000 --> 01:10:13.000
Because we have free access and so on. We see that that the those people that have a lot of capital, a lot of resources, they can manage, they have resources, they have relatives, they can help themselves.

409
01:10:13.000 --> 01:10:25.000
But the it's a heavy burden on those that used to be let's say 50 years ago have to be let's say 50 years ago have a safety net so I think.

410
01:10:25.000 --> 01:10:39.000
Change that we see in the in in the welfare system and that that the states is withdrawing say take care of yourself we can't help you we have we have a war in Ukraine and so on.

411
01:10:39.000 --> 01:10:51.000
We you have to take care of yourself. So that's the I think the very big question. About, the body and inequality.

412
01:10:51.000 --> 01:11:00.000
And and investment that if you haven't got resources you can't invest.

413
01:11:00.000 --> 01:11:11.000
Well, that is that is a good invalid point. Having the resources doesn't always give you access to more help because you can get access to this.

414
01:11:11.000 --> 01:11:20.000
Alora, you can help yourself. You know, you're strong enough. And that changed the changes definitely the perception of who you are.

415
01:11:20.000 --> 01:11:37.000
But there's another dimension here. And especially for the Nordic countries, I'm not really sure maybe in the UK or Europe in general but we have this sort of what we call the package run you know that whatever so it's sort of a uniform uniformification of of illnesses.

416
01:11:37.000 --> 01:11:56.000
So for instance that you you know, have arthritis. I'm not sure if they have a package run for arthritis but they do for cancer for for knee surgeries like was my my my issue I mean all kinds of illnesses has this standardizations though okay so you have these symptoms and

417
01:11:56.000 --> 01:11:57.000
Yeah.

418
01:11:57.000 --> 01:12:13.000
then you have you know you go to training first and then you go to training first and then you go to this and finally you have a surgery or some other.

419
01:12:13.000 --> 01:12:14.000
Yeah.

420
01:12:14.000 --> 01:12:19.000
Treatment. And this also does something to this freedom of choice. You see what I mean? It has to do something about, you know, how we think about ourselves, the what that we are.

421
01:12:19.000 --> 01:12:29.000
We're all the same and we all need the same route through through this treatment process. How, how can, would you explain that?

422
01:12:29.000 --> 01:12:35.000
How can we help understand what happens to us or inequalities in light of this.

423
01:12:35.000 --> 01:12:49.000
The main thing in the Nordic countries at least, but I think is worldwide that if you have a single diagnosis it can be cured you can you can you can have these standards you can have fast track.

424
01:12:49.000 --> 01:13:11.000
It's it's it's very good. It's been very good in cancer areas, but you if you have multi diagnosis and you are elderly and you have no resources you you really have no choice of freedom freedom of choice you you are you are I mean we started this in Denmark and how vulnerable you basically are Because then

425
01:13:11.000 --> 01:13:18.000
the healthcare system has no safety net. You are pushed out. There are no relatives. And you have.

426
01:13:18.000 --> 01:13:21.000
No,

427
01:13:21.000 --> 01:13:24.000
So if your if your illness is too complex Yeah. So.

428
01:13:24.000 --> 01:13:35.000
Yeah, because we have studied this about diagnosis and specialities. You fall between different.

429
01:13:35.000 --> 01:13:45.000
Yeah. Okay, I know that Joe. Also has a lot of reflections.

430
01:13:45.000 --> 01:13:49.000
Thank you. Yeah, I have made quite a few notes actually and it's interesting what you just said about packages because I think we'd call them pathways.

431
01:13:49.000 --> 01:14:11.000
In the UK but similar idea that you know you receive your diagnosis you put you immediately onto a pathway you follow that track And so in cardiac we have terms, you're given so many weeks of rehab and then you pushed out and that's you that's recovery done we don't work like that human beings you know we work

432
01:14:11.000 --> 01:14:19.000
in very personal ways and we're influenced by lots of different things and I find that concept of those quite rigid pathways quite problematic.

433
01:14:19.000 --> 01:14:26.000
They're heavily medicalised. They're not personalized. We've got this huge agenda about person-centered care.

434
01:14:26.000 --> 01:14:41.000
But is it really person centred or is it making the person fit to the model as opposed to making the model or the pathway of the package fit to the individual and that's a real challenge I think for health services certainly in the UK and possibly in other areas.

435
01:14:41.000 --> 01:14:51.000
One of the other reflections that I just wanted to make as well from the data in the study that I presented was around This notion of the habit has been shaken.

436
01:14:51.000 --> 01:15:07.000
And that's kind of how I described it in my thesis. So you have this event or you get this diagnosis or have these symptoms and it almost shakes who you are and in some circumstances that can all fall back to where it was before but in many cases it doesn't.

437
01:15:07.000 --> 01:15:15.000
And there's this reformed self, this different body that we need to adapt to and what it's capable of and where that leaves us.

438
01:15:15.000 --> 01:15:23.000
And we're not very good at helping people to do that and to do it to adjust in terms of what health professionals offer.

439
01:15:23.000 --> 01:15:34.000
But what I did also find in my data is the primary habitus that we have. That we get in the early life is very heavily related to our social class.

440
01:15:34.000 --> 01:15:54.000
And it's really strongly felt. So quite often what you'll find is people with working-class backgrounds for example will stick quite severely to their working class feelings and roots despite the major disruption that has occurred as a result of something like a heart attack or a heart surgery.

441
01:15:54.000 --> 01:16:04.000
For me, there are certain things that remain really strongly felt and pervasive. But we still get the shaking effect that happens when we have something quite serious happen in our lives.

442
01:16:04.000 --> 01:16:13.000
You say that because I have additional question to that. Would you say that If you have a working-class habitat.

443
01:16:13.000 --> 01:16:24.000
That. The diagnosis having you know that the doctor is telling you that your condition is serious. Does that help you?

444
01:16:24.000 --> 01:16:34.000
Or does that make you worse in a way? You know, how do I deal with diagnosis differently from someone who is more informed.

445
01:16:34.000 --> 01:16:47.000
I think probably I would come back to what Christian said about resources and capital so If you feel something is within your gift to change the realm of possibilities.

446
01:16:47.000 --> 01:16:53.000
Could be heavily linked to your class so you may be more inclined to do something if you have those resources at your disposal.

447
01:16:53.000 --> 01:17:03.000
If you don't, well that should you know as we would say in the UK that's your lot you know that's that's what you've been given this is within what's my possibility to change.

448
01:17:03.000 --> 01:17:11.000
And therefore I'll take what it is because that's linked to who I am and my identity.

449
01:17:11.000 --> 01:17:25.000
That's just linked to some of my work. That diagnosis can sometimes be something that you rest in you know you're satisfied as soon as you get in diagnosis you can like oh finally Now we know what's wrong with me.

450
01:17:25.000 --> 01:17:26.000
And then I can just, I don't have to do anything more because I'm sick or I'm ill or anything like that.

451
01:17:26.000 --> 01:17:56.000
But there are also other people in these. Runs or what do you call it pathways? I think it's interesting how you warrant the the personal work the people that meet you as a person as a holistic person that has fears and needs and who really meets a person when you come to a professional facility and Emily, maybe you

452
01:18:01.000 --> 01:18:29.000
can. You can talk about this personal meeting with What do you call them? When they're non-educated nurses or helping nurses or they helping professional professions in in a hospital how they can also influence You know, my question to you or my challenge to you is the think about how they can influence the patient's perception of their own

453
01:18:29.000 --> 01:18:36.000
health or Yeah, or the past or their agency to do something about it.

454
01:18:36.000 --> 01:18:49.000
The non-clinical professionals in the, in COVID-19 pandemic. And try to, I don't know.

455
01:18:49.000 --> 01:19:07.000
Sorry. With the patients and, substituted the family in the isolation. Time. So they are not visible for the patients or for the managers.

456
01:19:07.000 --> 01:19:14.000
Oh, and this labor is not.

457
01:19:14.000 --> 01:19:28.000
For in this context.

458
01:19:28.000 --> 01:19:39.000
Okay, I missed on my question there then because I thought maybe the, non-clinical workers were the ones that actually took time to speak to the patients.

459
01:19:39.000 --> 01:19:56.000
While doctors just passed with their clipboards. We still have some time to For questions or do I mean that includes the speakers Christian has a question or a comment Yes.

460
01:19:56.000 --> 01:20:17.000
Yes, I just want to say thank you for the good presentations. And Marz is a colleague of mine and so so we somehow work together and I like your presentation Marks about about, Aberdeen and Butcher and these, theoretical discussion.

461
01:20:17.000 --> 01:20:34.000
But I think also What is a good question is how do we empirically what kind of empirical data material do we construct in order to see really not only theoretical but also empirically.

462
01:20:34.000 --> 01:20:44.000
How do they? How, how do they work together and what are the match and mismatches between the, between the 2?

463
01:20:44.000 --> 01:20:58.000
So I don't know. Matt, if you If you, if you have a response to how could we construct a good empirical data that we could really.

464
01:20:58.000 --> 01:21:08.000
Empirically discuss abbot and field and so on.

465
01:21:08.000 --> 01:21:20.000
Yes, thank you, Christian. I can start off, I had like one. Comment on how to use where Bordeaux is best.

466
01:21:20.000 --> 01:21:29.000
And that is in my empirical material. We have of these 23 different electronic diagnostic.

467
01:21:29.000 --> 01:21:40.000
Material from the doctors. 2 of the the electronic 2 of the texts the 2 of the patients. They had private.

468
01:21:40.000 --> 01:21:54.000
Insurance and they were very soon sent to surgery because they could pay for it themselves. So in that regard, you see that because they have this private insurance that might be a question of class or.

469
01:21:54.000 --> 01:22:19.000
So that is I don't think that's issues you can, actually. Is study using the perspective of the of from But when I look into diagnosis and the diagnostic process quite on a micro level, how do the the doctors diagnose?

470
01:22:19.000 --> 01:22:34.000
And like Util is saying that this or I think it's not her original but this is both a label and this is both a label and a process and if you look at it as a process so how all actually the doctors.

471
01:22:34.000 --> 01:22:36.000
And if you look at it as a process. And if you look at it as a process, so how are actually the doctors doing this?

472
01:22:36.000 --> 01:22:44.000
And we found in our using use, Util, but also, but I think they diagnosed maybe Goffman is even better here.

473
01:22:44.000 --> 01:22:59.000
They diagnosed this hand pain in 4 different ways. One was that the just because we are expected to find the ICD or the diagnose.

474
01:22:59.000 --> 01:23:21.000
In the in the journals, electronics, but very few only one third of the material had the ICD or the ICPC diagnose like the formal diagonals from WI show but what they did a lot of the journalists just had they had symptoms what are the symptoms what are the symptoms for how it was

475
01:23:21.000 --> 01:23:35.000
the pain, what are the symptoms, how for how it was the pain, the function, etc. And then, so one had symptoms and then so one had symptoms and one third of the function etc and then so one had symptoms and one third of the material had symptoms functions and activities so they kind of describe what they Couldn't do that can't write

476
01:23:35.000 --> 01:23:56.000
on the PC for example, on the computer But then we had the like a few also had this ICD or this formal dialysis but a last group that had this very composite diagnosis they wrote partly what was the symptoms what was the activities and then the treatment.

477
01:23:56.000 --> 01:24:07.000
So it was a very complex process where the kind of included all of it. And I think in to just to deconstruct that type of processes.

478
01:24:07.000 --> 01:24:17.000
I think it's easier to go to the ecological school than to, So that's.

479
01:24:17.000 --> 01:24:31.000
Yeah, is that that's And I think also about in his book he has. He's looking at the diagnostic process and the treatment and how you use knowledge to go in between.

480
01:24:31.000 --> 01:24:59.000
I think he's more detailed in studying and the health professionals. But when you come to his issue on power I think is quite problematic I had actually a foil on that which we could discuss in a later later but but he's saying that Power is an empirical issue and and so he he has no and he has no concept

481
01:24:59.000 --> 01:25:14.000
for for discussing or for analyzing power and I think that's and he's writing that on his own page but I think that is different from Strauss and other of his colleagues and Eliot Frazen as well.

482
01:25:14.000 --> 01:25:23.000
So I think he's quite. I'm sure what you are, what I would say in that regard.

483
01:25:23.000 --> 01:25:31.000
I was thinking also about the fact that with with you we would always say the Genesis and the structure.

484
01:25:31.000 --> 01:25:45.000
So we have to look at the genes as an example of the health care field or the medical field and this would involve also to look at the pharmaceutical industry, the technological industry, patient groups and so on.

485
01:25:45.000 --> 01:25:53.000
So I agree with you that would you would be more on the on the broader picture so to speak. And showing the broader.

486
01:25:53.000 --> 01:26:05.000
Field. Within which professions can struggle and so on

487
01:26:05.000 --> 01:26:18.000
Yeah, I agree with you, but I think if you go for example to Strauss, who is also the Susan Lay Star might be known for several of you working in this.

488
01:26:18.000 --> 01:26:28.000
Diagnostic. Sorting out is for a title of one of her books. But, but, but if you look, I see, answer strong was her, advisor.

489
01:26:28.000 --> 01:26:37.000
But if you look at his concept of negotiating order or social order, I think that is it's not.

490
01:26:37.000 --> 01:26:48.000
A big enough concept but that is heart of it because the order there is is close to structure, to more formal structure.

491
01:26:48.000 --> 01:26:59.000
But like Leo and Emerberry saying that. The ecological approach interaction is in front of structure and it's the opposite in the Bordeaux concept.

492
01:26:59.000 --> 01:27:10.000
You have this the structure is about is coming first.

493
01:27:10.000 --> 01:27:18.000
But what I also think, how can we, can we combine? How can we can combine? How can we can combine it?

494
01:27:18.000 --> 01:27:29.000
You are doing it in your research with Anette and it's like to be like more. Poctic, but it's.

495
01:27:29.000 --> 01:27:53.000
And I think it's quite interesting that. For you in this conversation with. With at the workshop in 98 that he is kind of highlighting one book of Eliot Frazen and not the one on the medical knowledge from 1,970 but the one where he actually has a lot of references

496
01:27:53.000 --> 01:28:05.000
to, So the book I think is named for a power of professions. Professional power. I think yes, because of professional powers.

497
01:28:05.000 --> 01:28:35.000
So then to refer to address the power issue. You have maybe to go outside that. That approach. There is another, the another exception maybe 2 because if you go to the first generation of the The Chicago School, they are very much influenced not only by Cassie but but also symbol and Simul has in this in his one of his

498
01:28:35.000 --> 01:28:51.000
famous articles on superiority and subordination. So it's a more, visible in the first generation than in the post war generation, I think.

499
01:28:51.000 --> 01:28:59.000
Of the Chicago school.

500
01:28:59.000 --> 01:29:03.000
Are there any questions from the audience?

501
01:29:03.000 --> 01:29:13.000
Although I say, you know, I'm taking over here. None of you are just jumping to the

502
01:29:13.000 --> 01:29:25.000
Look, cause I would like just to continue on that. Distinction between you know the board use and the ethnographic approach.

503
01:29:25.000 --> 01:29:36.000
And of course, having a structural approach, I mean, you only put into the tool that you're using, whatever you can see.

504
01:29:36.000 --> 01:29:45.000
And using a relational approach to power. You can only, you know, Detect in these.

505
01:29:45.000 --> 01:29:59.000
Fields the relations that you're already aware of. So I believe that the the combination of the 2 is partly fruitful.

506
01:29:59.000 --> 01:30:15.000
In terms of. Uncovering the agencies that are not visible to you when you're producing your your statistics or your surveys for the duty and field analysis.

507
01:30:15.000 --> 01:30:25.000
Such as, for example, these in-between work. That Emily is talking about. You know, it's in social work, it's classified as in-between work.

508
01:30:25.000 --> 01:30:43.000
The the work that is not acknowledged by managers or by by theories or by relations, any of these. Studies, not very many studies acknowledge the work that you do in between just the first meeting person to person.

509
01:30:43.000 --> 01:30:53.000
Saying you are okay or oh I'm so sorry, getting some emotional support. During your dirt patient journey.

510
01:30:53.000 --> 01:31:00.000
That's not really acknowledged in the pathways or package runs. Or, you know, what we could say.

511
01:31:00.000 --> 01:31:12.000
So, so having this combination always go from structure to individual and back. I think is very fruitful for for a more thorough analysis of

512
01:31:12.000 --> 01:31:15.000
Of inequalities. Well, that's.

513
01:31:15.000 --> 01:31:24.000
And I don't, there is also one concept on that, the, in which Emily when you talk about, the, in which the Emily, when you talk about, and that is the Emily when you talk about and that is the invisible work and there is a lot of, and that is the invisible work and there is a lot of

514
01:31:24.000 --> 01:31:26.000
Yeah.

515
01:31:26.000 --> 01:31:31.000
invisible not counted work in how is a lot of invisible not counted work in hospitals and in the health services and in the health services.

516
01:31:31.000 --> 01:31:38.000
Exactly. And they are also incremental to

517
01:31:38.000 --> 01:31:59.000
To creating or or either creating or covering up differences between patient groups. How you are met by the first by the people, you know, emotionally when you come to the doctor's office or to a hospital or admitted to health services.

518
01:31:59.000 --> 01:32:03.000
Okay.

519
01:32:03.000 --> 01:32:12.000
Are there more Joe would you? You like to comment on this? No.

520
01:32:12.000 --> 01:32:21.000
If there are no more comments or questions here. I think we're all at the end of a very long week here in Melbourne.

521
01:32:21.000 --> 01:32:28.000
You're in the middle of the night in Scandinavia and where are you Emily?

522
01:32:28.000 --> 01:32:29.000
I'm from Brazil. It's. It's one am.

523
01:32:29.000 --> 01:32:40.000
Yes, you are in Brazil right now. Oh, there you go. So I think it's fair to all of us now that we can close this session.

524
01:32:40.000 --> 01:32:53.000
And say thank you for a very, you know. I really enjoy the connection between these these papers and looking forward to see the continuation of your work.

525
01:32:53.000 --> 01:33:02.000
Well, thank you all for all present here today and for all. On Zoom, you can go to bed now.

526
01:33:02.000 --> 01:33:03.000
Okay.

527
01:33:03.000 --> 01:33:06.000
It's 60'clock in the morning. No it's 60'clock so we wish could get up.

528
01:33:06.000 --> 01:33:07.000
Yeah. Okay.

529
01:33:07.000 --> 01:33:12.000
Thank you.

530
01:33:12.000 --> 01:33:14.000
Bye.