Sociologists at Work
The Sociologists at Work feature exposes students to the importance and application of social science research.
Elevator Talk Among Doctors and Nurses
We all take for granted, when visiting a doctor’s office or a hospital, that the doctors and nurses will protect the confidentiality of their patients. Yet even for these professionals, the temptation to talk about patients behind their backs (“back stage”) is often hard to resist. Dr. Peter Ubel and his colleagues (1995) sent observers to five Pennsylvania hospitals to determine the frequency and nature of inappropriate talk about patients among hospital personnel. The researchers were particularly interested in conversations that could easily be overheard by people who shouldn’t have access to such information. They decided to focus on elevator talk.
Of the 259 elevator rides they observed during which passengers had a chance to converse, inappropriate comments were made 14% of the time. The observers found that the remarks fell into four distinct categories:
- Comments violating patient confidentiality: The majority of back stage comments inappropriately disclosed factual information about a patient’s condition. These remarks were usually simple declarations, such as “Mr. X was readmitted last night for more chemo.” In other situations, the comments exposed professional disagreement over a particular course of action. For instance, in one case two physicians had a heated debate over the merits of removing parts of either one or two lungs from a patient.
- Unprofessional remarks and motivation: Another category of comments consisted of remarks that raised questions about medical personnel’s ability or desire to provide quality care. For instance, doctors or nurses sometimes complained that they were too tired or too sick to do their jobs well. On some occasions, physicians were heard talking about how they were just biding their time in the hospital until they could go elsewhere and make large amounts of money. Such comments clearly call into question their professionalism.
- Comments raising questions about the quality of patient care: Some conversations consisted of personnel complaining about hospital resources and facilities, thereby raising doubts about whether the institution offered good patient care. Other times, nurses or doctors would question the qualifications of a colleague. Although the motivation behind such remarks is not always clear, people who come to visit their loved ones in a hospital and overhear these casual conversations are not always capable of detecting unsubstantiated information.
- Derogatory comments about patients or their families: The last category of inappropriate back stage comments was direct insults about patients, focusing on traits such as weight or body odor. Such comments reflect poorly on the compassion of health care workers. In addition, visitors’ anxiety about the quality of care may increase if they are led to believe that the staff don’t like them or their loved ones.
This research points to the institutional importance of maintaining boundaries between front stage and back stage. Health care workers will always talk about patients behind their backs. But in a field such as medicine, which deals with extremely delicate personal information and life-and-death decisions, the credibility of the profession depends on workers’ ability to correctly determine when a location is, in fact, private back stage. Public awareness of these sorts of remarks can have serious economic, political, and perhaps even legal consequences. The problem has become so bad that elevators in some hospitals carry posted warnings reminding medical personnel to refrain from talking about patients.
Sociologist Elijah Anderson carried out observational research in a racially, ethnically, and economically diverse area of Philadelphia he called Village Northton. The area is home to two communities: one black and poor, the other middle to upper income and predominantly white. Anderson was particularly interested in how young black men—the overwhelming majority of whom were civil and law abiding—managed public impressions to deal with the assumption of Village Northton residents that all young black men are dangerous.
Anderson discovered that a central theme for most area residents was maintaining safety on the streets and avoiding violent and drug-related crime. Incapable of making distinctions between law-abiding black males and others, people relied for protection on broad stereotypes: Whites are law abiding and trustworthy; young black men are crime prone and dangerous.
Residents of the area, including black men themselves, were likely to be suspicious of unknown black men on the street. Women—particularly white women—clutched their purses and edged up closer to their companions as they walked down the street. Many pedestrians crossed the street or averted their eyes from young black men, who were seen as unpredictable and menacing.
Some of the young black men in the area developed certain dramaturgical strategies to overcome the assumption that they were dangerous. For instance, many came to believe that if they presented a certain appearance or carried certain props with them in public that represented law-abiding behavior (e.g., a briefcase, a shirt and tie, a college identification card), they would be treated better in contacts with the police or others in the neighborhood. In addition, they often used friendly or deferential greetings as a kind of preemptive peace offering, designed to advise others of their civil intentions. Or they went to great lengths to behave in ways contrary to the presumed expectations of Whites:
I find myself being extra nice to Whites. A lot of times I be walking down the streets . . . and I see somebody white. . . . I know they are afraid of me. They don’t know me, but they intimidated. . . . So I might smile, just to reassure them. . . . At other times I find myself opening doors, you know. Holding the elevator. Putting myself in a certain light, you know, to change whatever doubts they may have. (E. Anderson, 1990, pp. 185–186)
Such impression management requires an enormous amount of effort and places responsibility for ensuring social order on this man. He feels compelled to put strangers at ease so he can go about his own business. He understands that his mere presence makes others nervous and uncomfortable. He recognizes that trustworthiness—an ascribed characteristic of Whites—is something Blacks must work hard to achieve.
Other young black men, less willing to bear the burden of social order, capitalized on the fear they knew they could evoke. Some purposely “put on a swagger” or adopted a menacing stance to intimidate other pedestrians. Some purposely created discomfort in those they considered “ignorant” enough to be unnecessarily afraid of them. According to Anderson, law-abiding youth have an interest in giving the impression that they are dangerous: It is a way to keep others at bay. The right looks and moves ensure safe passage on the street.
The irony of such survival tactics is that they make it even more difficult for others to distinguish between those who are law abiding and those who are crime prone. By exhibiting an air of danger and toughness, a young black man may avoid being ridiculed or even victimized by his own peers, but he risks further alienating law-abiding Whites and Blacks. Members of racial and ethnic minorities face many such special dilemmas in impression management, whether they attempt to contradict stereotypes or embrace them.