Difficult, Dysfunctional, and Drug-Dependent: Structure and Agency in Physician Perceptions of Indigent Patients

Author: Chirayath, Heidi T

Source: Social Theory & Health, Volume 5, Number 1, February 2007 , pp. 30-52(23)

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Abstract:

Many physicians exhibit reluctance to care for 90 million Americans who are uninsured or on Medicaid, citing concerns about litigation, reimbursement, and complexities inherent in treating indigent patients. This paper uses open-ended data from a nationally representative group of 275 doctors to explore physician perceptions of indigent patients and the strategies they use in caring for this population. This work reveals negative physician views about the medically indigent, critical of patient consumptive habits, health decisions, and `abuse' of the system. I argue that despite negative perceptions of the underserved, physicians engage in innovative strategies to assist indigent patients by distinguishing between the deserving and the undeserving poor. This distinction, based on physician perceptions of the constraints and choices in patients' lives, enables doctors to exercise agency in choosing who and how to serve. Physicians commit `ultimate attribution error' in perceiving patients as active agents, in stark contrast to viewing their own actions as dictated by rules of medical practice. This work adds critical insight to our understanding of relational power and the recursive nature of structure and agency between doctors and patients.Social Theory & Health (2007) 5, 30-52. doi:10.1057/palgrave.sth.8700083

Document Type: Research article

DOI: http://dx.doi.org/10.1057/palgrave.sth.8700083

Affiliations: 1: 1Department of Sociology, Bates College, Lewiston, ME 04240, USA

Publication date: 2007-02-01