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Conflicted Health Care
Professionalism and Caring in an Urban Hospital

Author(s): Ester Carolina Apesoa-Varano, Charles S. Varano

Anyone who has spent time in a hospital as a patient or family member of a patient hopes that those who attend to us or our loved ones are at their professional best and that they care for us in ways that console us and preserve our dignity. This book takes an intimate look at how health care practitioners struggle to live up to their professional and caring ideals through (or during?) twelve-hour shifts on the hospital floor.

From 3,200 hours of participant-observation and 500 hours of follow-up interviews with twenty-one doctors, thirty registered nurses, twenty-one respiratory therapists, twenty medical social workers, and eighteen occupational, physical, and speech therapists, the authors create a complex picture of the workplace conflicts that different types of health care practitioners face. Though all these groups espouse caring ideals, professional interests and a curative orientation dominate in patient care and interoccupational relations. Because emotive caring is not supported by the organization of health care in the hospital, it becomes an individual virtue that overworked staff find hard to perform, and it takes on an ideological form that obscures the status hierarchy among practitioners. Conflicts between practitioners rest upon the ranking of each group's knowledge base. They manifest in efforts to work as a team or set limits on practitioner responsibilities and in differing views on unionization.

Biography of Author(s)

Ester Carolina Apesoa-Varano, a sociologist with research interests in nursing, health care, women's health, and geriatrics, is an assistant professor at the Betty Irene Moore School of Nursing at University of California, Davis.
Charles S. Varano, Associate Professor of Sociology, California State University, Sacramento, is the author of Forced Choices: Class, Community, and Worker Ownership.


  • "Based on literally thousands of hours of field work supplemented by focused interviews, Conflicted Health Care is a significant contribution to a long and honorable tradition of hospital ethnographies. It is a book rich in personal stories from the everyday lives of hospital workers."
    --Robert Zussman, author of Intensive Care: Medical Ethics and the Medical Profession
  • "Through seven eminently readable chapters, chock-full of case examples and direct quotations, the authors deconstruct professionalism, caring, and inter-professional conflict in the shadows of hospital status, hierarchy, and power relationships...The book asks us to reexamine our values and assumptions about collaborative care and forces us to reconsider how conflict resolution may simply follow the law of the jungle where the most powerful roars the loudest."
    --Family Medicine