The precarious character of routine practice in social and primary health care

Abstract

Summary This article presents a description and analysis of the written narratives of problematic situations given by social workers and general practitioners (GPs) within the framework of the sociology of professions and organisations. The narratives were collected from 28 social workers and 24 GPs, working in several Swedish counties. Findings Our findings show that the professionals rarely described lack of knowledge or difficulties choosing the right intervention or treatment as problematic. Rather, the problematic situations contained encounters with clients perceived as disruptive to professional routine practice. We conclude that there were three different types of problematic situations where the professional routine practice was disrupted: (1) Situations related to ‘client-making work’, where the professionals perceived it difficult to, e.g., gather enough information about the client to make a diagnosis, set a timetable or decide on adequate interventions; (2) Situations related to ‘wicked work’, where the professionals experienced clients unable to articulate their problems or understand and follow the interventions suggested by the professionals; (3) Situations related to ‘dirty work’ were only present in GPs’ narratives and typically occurred when GPs perceived that they were dealing with clients who endangered their professional status. Applications Contrary to previous studies, this study indicates that problematic situations are not necessarily connected with traits and characteristic of the client or a lack of professional competence. Instead, they might be connected to situations where professional routine practice is disrupted. Furthermore, it is questionable to what extent problematic situations connected to such disruption can be managed by evidence-based methods, manualisation and standardisation.