title: Contradictions and dilemmas within the practice of immigration medicine.
abstract: OBJECTIVE
  To identify, explore and critique features of how practices associated with immigration medicine are socially organized. Specifically, how the work of designated medical practitioners (DMP) - physicians who conduct immigration medical examinations of prospective immigrants to Canada as contractors to the Canadian government department of Citizenship and Immigration Canada - is organized to occur in interactions with applicants who are diagnosed with the human immunodeficiency virus during the immigration medical examination.
  
  
  METHODS
  Findings from a theoretically informed empirical study using institutional and political activist ethnography inform this article. Data collection and analytic activities spanning 18 months included observational work in institutional settings, textual review, 61 interviews, and 2 focus groups in three Canadian cities.
  
  
  RESULTS
  The medical examination of prospective immigrants to Canada is not organized as a therapeutic relation of care and has little to do with medicine per se. The rationale structuring the work of DMPs is actually administrative responsibilities. The work achieved by the DMP positions her/him as a key figure and important decision-maker within the Canadian immigration system.
  
  
  CONCLUSIONS
  The work of doctors who practice immigration medicine gives rise to contradictions and ethical problems. These are largely unresolvable because of the way in which the labour process in which the DMP is implicated is coordinated. The social organization of immigration doctoring practices has serious consequences for prospective immigrants to Canada, for doctors themselves, and for the Canadian immigration system more broadly.
authors.affiliation: Biomedical Ethics Unit, McGill University, 3647 Peel, Montreal, QC. laura.bisaillon@mcgill.ca
authors.forename: Laura
authors.initials: L
authors.lastname: Bisaillon
mesh_terms: D002170:Canada; D003695:Delivery of Health Care / Q000458:organization & administration*; D004641:Emigration and Immigration; D017144:Focus Groups; D015658:HIV Infections / Q000175:diagnosis; D006801:Humans; D008403:Mass Screening; D010808:Physical Examination; D010817:Physician-Patient Relations / Q000941:ethics*; D036301:Qualitative Research
keywords: Critical methods; HIV/AIDS; designated medical practitioners; immigration medical examination; immigration medicine; mandatory HIV screening; sociology