Manuscripts available upon request
Numericalization: The Classed Discourse and Meaning of Price at Three Fertility Clinics
This article manuscript compares how providers and patients communicate about money at the three fertility clinics I observed. I find that that social class of the clinics shape the way that providers and patients talk about money and the morality tied to that discourse. This work contributes to economic sociology on relational work by documenting differences in transparency about the specific ‘dollars and cents’ of money by social class.
The Multiclinic Patient Career: Revising, Relearning, and Exercising Autonomy by Switching Fertility Clinics
The patient career has long been a core concept, but it does not adequately account for experiences across multiple medical organizations. Likewise, scholarship on switching physicians does not theorize the role these changes play throughout patients’ medical trajectories. I find that over a third of fertility patients switched clinics throughout the course of their care. To describe these findings, I develop the concept of the multiclinic patient career, or patients’ trajectories that span across multiple medical organizations. I show that switching clinics functions as a key juncture that redirects patient trajectories. I theorize that (1) switching clinics serves to ‘reset’ the patient career; (2) in moving through multiple medical organizations, patients expand their medical knowledge that had previously been delimited to a single institution; and (3) patients experience switching clinics as exercising medical autonomy.
Disentangling Pregnancy and Fertility Intentions: Personal Uncertainty, Risk Behavior, and Patterned Flexibility
The demography literature tends to treat pregnancy and fertility intentions as corresponding concepts. Collapsing the two, however, can obscure important differences between the desired number of pregnancies and children. The present study leverages the critical case of multiples related to fertility treatment to disentangle pregnancy and fertility intentions. This study finds that most people pursuing fertility treatment express consistent pregnancy intentions but modify their fertility intentions regarding the number and spacing of children resulting from that pregnancy as they progress through treatment, namely transitioning from specific numerical and spacing preferences to bounded preferences for some number of children. Most participants came to accept a twin birth outcome due to uncertainty in their ability to become pregnant, pay for additional treatment, and remain in a romantic relationship. These findings underline that flexible fertility desires are patterned for those facing uncertain conditions. This article prompts family demographers to consider the risk behavior among people hoping to promote, not just prevent, pregnancy.
The Field in the Interaction: How Physicians Establish Medical Niches in Patient Consults
Some sociologists suggest that patients are irrelevant for managing medical authority, and that physicians’ medical authority is developed and enhanced through interactions with other medical professionals. Other sociologists argue that patients are the primary conduit for medical authority, and that medical authority is animated and re-animated in the patient-physician interaction. Both of these perspectives fail to recognize the ways in which medical providers bring the broader medical field into their interactions with patients. A case in point includes patients who have elected to switch physicians. Switching medical providers or practices is usually understood as a sign of the erosion of medical authority. I argue that rather than threatening providers’ medical authority, interacting with patients who have switched clinics can strengthen their authority by juxtaposing their expertise with their colleagues and competitors. Interactions with patients who had switched clinics provided opportunities for physicians to establish and sell their medical niche, that is their particular area of expertise in the field. This article contributes to sociology on medical markets and economic sociology more generally by underlining how vendors simultaneously sell their services to the patient sitting in front of them and orient themselves to the broader field.