This innovative volume must be recognized as a major contribution to the sociological understanding of medical work. Social Organization of Medical Work has direct relevance for health planners and medical care researchers because it offers an innovative approach to studying caring activities in hospital settings. The book provides an alternative conceptual framework for examining the management of chronic disease processes by specialized teams of health workers. Health planners and evaluators have applied sociological research on clinician/patient interaction and inter-professional relations in hospitals; most noticeably, perhaps, in analyzing specific processes such as institutionalization and professionalization. Strauss and his co-authors describe clinical interaction in hospitals within a more neutral framework, and thereby avoid limiting the analysis t o a single outcome measure such as depersonalization or dominance.
Social Organization of Medical Work also offers an innovative approach to the classification and analysis of work, which contrasts with research emphasizing task analysis or case studies of the decision-making process. The authors use the concept of 'illness trajectories' as a mechanism for documenting the organization of complex tasks in the treatment of chronic illness. They describe the changing contexts in which health workers manage evolving chronic conditions.
This approach overcomes the limitations of cross-sectional analyses of hospital activities. It allows the authors to describe caring activities within a temporal sequence. Their case studies successfully describe the clusters of work activities undertaken by clinicians and patients at each stage of the progression of an illness.
Strauss, Fagerhaugh, Suczek and Wiener's development of concept of 'illness trajectories' is perhaps their most significant contribution. Their approach avoids focusing on delimited 'patient careers', because an analysis of chronic disease requires an analytical approach which can deal with sequences without defined points of onset or cure. The authors' theoretical and empirical framework extends the concept of trajectory beyond previous applications in research on terminal illness. Trajectory provides a unique framework for describing the reflexive processes in which care activities are continuously rearranged in response to progression of chronic illness. Analysis of trajectory also allows the authors to examine the reciprocal impact of medical work on the social structure of hospitals.
For health planners and researchers specifically, the concept of trajectory provides a meaningful alternative to conventional organizational analysis. The authors' observations of interaction between illness events and work processes avoid the trap of characterizing hospitals primarily as 'containers of medical work'. Their profile of the organizational structure of the hospital emerges as an aggregation of descriptions of individual work activities and treatment settings.
Strauss, Fagerhaugh, Suczek and Wiener provide detailed and poignant descriptions of the changing character of therapeutic work in San Francisco hospitals. Their observations dramatize the technological complexity and protractedness of medical response to chronic disease. They clearly demonstrate that documentation of medical work must not only describe individual clinical encounters, but must also document complex sequences of interaction involving teams of specialists working in diverse treatment settings. The introduction to the monograph summarizes their general framework for observing and classifying medical work. Subsequent chapters provide detailed analysis of the social organization of 'machine work' (i.e. activities related to monitoring,