1). The two qualitative methods used to collect data for the study, and for the broader research project, were observations and interviews (Messenger 362, 369). The observation was of the participants, who were engaged in ER practices (369). The interviews were with the clinical staff members (369). Everything was recorded by hand, inasmuch as audio taping was prohibited for confidentiality reasons (369).
2). The main goal of the research project was the promotion of critical exchanges, discussions, concerning the “complex social natures of cosmopolitan medicine”, for the purposes of ascertaining the impact of clinical perspectives on clinical treatment interventions (367-368). In other words, the author’s goal was to analyze the social construction of treatment practices, the actualization in a bounded social setting of the various theoretical paradigms and clinical perspectives (368). By using a case study, the author was able to highlight his contention that cosmopolitan medicine is the product of a variety of disciplines, an assemblage of traditions and practices from disparate sources, all of which have coalesced into the seemingly-unitary cosmopolitan clinical paradigm (368).
For example, Messinger explains that 19th century physicians drew upon a variety of traditions, and practiced in all of them (368). These traditions included homeopathy, osteopathy, and allopathy (368). The practitioners of still other traditions, like root work and bonesetting, worked alongside them (368). Toward the end of the nineteenth century, they were joined by practitioners of the new discipline of social work (368). The historical roots of these practices are of considerable interest to the sociocultural formation of complex medicine today, inasmuch as they continue to shape the practices (368-369).
3). In essence, the reason that the research lacks any sort of external validity regarding the specifics of Alex’s diagnosis and treatment is the nature of the psychiatric discipline, which is highly subjective and situation-specific regarding diagnoses. The specific course of treatment advocated for Alex might or might not have worked for a patient with similar presenting symptoms, or different ones, and so on. Messinger explains that for psychiatry, mental disorders are endogenous, originating within the patient, and “limited to the individual in etiology” (371). Moreover, Alex’s case was particularly difficult, due to how opaque his symptoms were, not to mention his violent tendencies and deeply problematic family life (375).
4). The findings are certainly not generalizable to other ER settings. For one thing, different ER settings require different professionals. For example, this psychiatric ER had a psychiatrist, a social worker, an addiction counselor, and an activities therapist. These are not all the sort of professionals that one would expect or need at other ER settings, because of the unique requirements of a psychiatric ER as opposed to those other ER settings. A case in point is the psychiatrist, a necessity for a psychiatric ER but probably not for a standard emergency room associated with a hospital: because the entire raison d’être of psychiatric ERs is mental illnesses, obviously psychiatrists are needed. The same is true for social workers. By contrast, most of the patients in regular ERs will probably not require the services of either of these professionals, and when they do such professionals could be brought in from psychiatric wards.
5). There are certainly similarities between the psychiatric ER described, and regular, hospital-associated ERs. For one thing, a number of different professionals are needed in regular emergency room situations. Police, and in some cases social workers, would need to be involved in the case of a stabbing incident and a 911 call. Forensics technicians would have to collect samples from the patient who was the victim of the stabbing. A psychiatrist would probably also have to be brought in. Of course, there are important differences regarding the professionals needed, since a surgeon and nurse practitioners would carry the cardinal responsibility.
Messinger, Seth D. “’That’s Not His Only Problem…’ Clinical Teamwork in a Psychiatric Emergency Room”. Culture, Medicine & Psychology, 30 (2006); 363-387. DOI: 10.1007/s11013-006-9023-1