Social inequality in healthcare organizations

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Tuesday, March 18, 2014


DIFFERENCE do exist in the world and I do not wish to limit my point on biological variations- differences in skin color, hair, eyes, height, etc. but also to extend my proposition to include disparities in social interactions.

Meaning to say, there exists a significant difference in the way people interact with each other in everyday living. And these differences depend on such mundane factors as wealth, social standing, sex, race, ethnicity, religion and so on and so forth.

But would you be convinced if I told that these differences have functions to portray?

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To keep you in suspense, let me start off by stating that even healthcare professionals working in healthcare organizations are not immune to this form of social inequality.

In a health facility such as a hospital, for example, it is manned by different groups of health professionals like doctors, nurses, allied medical staff- medical technicians, pharmacists, physical therapists – and the ancillary paraprofessional team- ward men, orderlies and housekeepers.

These health workers have distinct and specialized roles to play in the healthcare organization.

The doctor, for example, diagnoses the condition of the patient and then writes the medical orders that need to be done for the benefit of the latter. In such orders, the medical doctor states the diet, prescribes the medications and laboratory tests that are needed to rule in or rule out his diagnosis.

The nurse, in turn, carries out such order, contacts the dietician and laboratory personnel, directs the patient's 'watchers' to the pharmacists and administers the prescribed medicines safely to the patient.

The dietician ensures that that the patient receives the right diet – regular, soft-liquid, low salt, low fat- as ordered by the physician.

The pharmacist makes sure that the medicines are kept in its most potent condition until it reaches the patient.

The laboratory personnel take care of the diagnostic needs of the patient that would aid the physician in his management of the patient's pathology.

Lastly, the ancillary team is responsible for the safe transportation of the patient from the bed to a specialized area like operating room or laboratories when needed, making the bed every morning and cleaning the patient's room.

In short, there is a clear division of labor in a healthcare organization. Just like the human anatomy with different bodily parts performing different functions, so does a healthcare organization.

However, in these differences also rest the fact that it creates a 'Labor Aristocracy,' wherein the health worker is ranked and more special privileges are given to those at the top.

The physician, being the 'captain of the ship', enjoys all the respect, prestige and pecuniary rewards. Everything he or she says regarding the patient's condition is an infallible gospel-truth that must never be challenged unless by another physician with commensurate expertise as in a second-opinion.

In short, physicians are the 'first-class citizens' of the hospital or healthcare organization.

This physician is the sole legitimate source of information about the patient's pathology and this may explain why only doctors can write medical certificates. Furthermore, in litigations, only the opinion of a physician is given weight as he or she stands as an expert witness.

As a matter of fact, most hospitals forbid nurses to speak about the pathology of the patient's medical condition to the patient or the latter's significant others making their statements illegitimate.

Nurses, however, are directed to explain their nursing procedures and interventions to their patients. They are also authorized to give health teachings about the use of their patients' medications and some health-promoting exercises and activities the patients must know.

The nurses, together with the allied health professionals are regarded as the 'second class citizens' of the healthcare organization.

Lastly, members of the ancillary team are considered the 'third class citizens' of the healthcare organizations as they do all the 'dirty works' of aftercare of the hospital.

Belonging to a particular ordinal category means enjoying privileges that are denied of those in the lower strata of the hierarchy. Thus, making the physicians the 'boss', the nurses and allied health professionals as the immediate subordinates and the ancillary team as lowest subordinates. And this hierarchy would dictate not only the salary and benefits a health worker receives but also the respect and treatment they get.

For instance, physicians are addressed as 'doc' and the nurses and allied health professionals as 'ma'am' or 'sir'. The ancillary, however, are sometimes just called by any name.

The manner of dressing of a health worker is also influenced by his or her ordinal position in the healthcare organization.

A doctor usually wears any formal or cocktail attire under a white medical suit but no uniform is necessary for them.

Nurses and allied health professionals wear white or lightly colored uniforms to be identified as the professionals they are.

On the other hand, ancillary staff wears dark colored uniforms probably due to the nature of their job- cleaning and aftercare.

Most sociologists, especially those who are pure 'structural-functionalists' believe that these differences maintain the stability or 'equilibrium' of the healthcare organizations.

The breakdown of this inequality or differences may result in organizational disorder or disequilibrium that would bring about disharmony and upset the way things are done that could jeopardize patient care.

No social interaction ever escapes the scrutiny of a sociologist and I am trying to do just that in examining social interactions in healthcare organizations.

[Email: polo.journalist@gmail.com]

Published in the Sun.Star Cagayan de Oro newspaper on March 18, 2014.

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