title: Negotiating palliative care expertise in the medical world.
abstract: This paper explores the relationship between palliative medicine and the wider medical world. It draws on data from a focus group study in which doctors from a range of specialties talked about developing palliative care for patients with heart failure. In outlining views of the organisation of care, participants engaged in a process of negotiation about the roles and expertise of their own, and other, specialties. Our analysis considers the expertise of palliative medicine with reference to its technical and indeterminate components. It shows how these are used to promote and challenge boundaries between medical specialties and with nursing. The boundaries constructed on palliative medicine's technical contribution to care are regarded as particularly coherent within orthodox medicine. In contrast, its indeterminate expertise, represented by the 'holistic' and 'psychosocial' agendas, is potentially compromising in a medical world that prizes science and rationality. We show how the coherence of both kinds of expertise is contested by moves to extend palliative care beyond its traditional temporal (end-of-life) and pathological (cancer) fields of practice.
authors.affiliation: Department of Primary Care, University of Liverpool, The Whelan Building, Brownlow Hill, Liverpool L69 3GB, UK. dhibbert@liv.ac.uk
authors.forename: Derek
authors.initials: D
authors.lastname: Hibbert
authors.forename: Barbara
authors.initials: B
authors.lastname: Hanratty
authors.forename: Carl
authors.initials: C
authors.lastname: May
authors.forename: Frances
authors.initials: F
authors.lastname: Mair
authors.forename: Andrea
authors.initials: A
authors.lastname: Litva
authors.forename: Simon
authors.initials: S
authors.lastname: Capewell
mesh_terms: D017144:Focus Groups; D006302:Health Services Research; D006801:Humans; D007400:Interprofessional Relations; D008511:Medicine / Q000458:organization & administration; D017008:Negotiating; D010166:Palliative Care / Q000458:organization & administration*; D010817:Physician-Patient Relations; D010821:Physicians, Family; D012962:Sociology, Medical; D013038:Specialization; D006113:United Kingdom