Abstract:
Why, in a healthcare context that increasingly recognizes medical racism as a problem, do healthcare providers still make racially unequal decisions? In this talk, I make the case that to better understand enduring racial inequality in pain care, we need to look at how hospital work has changed under increasing pressures to cut costs, limit care, and protect the interests of insurance companies – a process broadly referred to as corporatization. Focusing on the case of hospital-based pain care and drawing on two years of ethnographic fieldwork with clinicians at urban academic hospital, I show how corporatization has transformed what it means to be a good doctor in ways that put Black patients at a disadvantage. Today’s doctors grapple with two competing definitions of what it means to practice “good” pain medicine. The ideal of evidence-based medicine encourages doctors to keep patients in the hospital until patients themselves report improvement. The newer, corporatized ideal of high-value care pushes doctors to provide efficient pain treatment by getting patients out of the hospital as quickly as they can. Because of structural inequalities outside the hospital, doctors find it easy to reconcile these ideals when treating White and higher-income pain patients yet struggle to make them align when treating Black and poorer patients. As a result, they often feel that it is impossible to practice good medicine when treating Black pain patients. Ultimately, even well-intentioned doctors come to believe that Black pain patients should be discouraged from seeking hospital care.
A Brief Bio:
Alex Brewer is an Assistant Professor of sociology at the University of Southern California. Her research examines the reproduction of social inequalities in the U.S. healthcare system, focusing primarily on the everyday practices of healthcare workers. Professor Brewer’s research has been published in American Sociological Review, Journal of Health and Social Behavior, and Social Science & Medicine, among other outlets. She is currently writing an ethnographic book on how corporatization – or the introduction of neoliberal business-like practices into healthcare organizations – has contributed to enduring racial inequality in pain care. Research based on this project has earned recognition from the American Sociological Society’s Medical Sociology Section, including the Donald W. Light Award for Applied Medical Sociology, the Louise Johnson Scholar Award, and honorable mention for the Roberta G. Simmons Outstanding Dissertation Award.