My Patients, Your Judgment: The Role of Status in Decision-Making Interactions between Northern and Southern Physicians

Medicine is a historically high-status profession, one that endows practitioners with considerable autonomy when making decisions about how to diagnose and treat patients. Status, however, is not evenly distributed within the profession: ample research reveals how educational and demographic factors, among others, simultaneously and differently operate to create status hierarchies within the profession. One’s position in the intra-professional status hierarchy has implications for decision-making power when interacting with other medical professionals.

Most studies on professional autonomy and status hierarchies conduct their analyses within a single country and do not examine cases in which medical professionals are mobile and provide care in other countries. Such an examination is needed since globalization is making it easier and increasingly common for medical professionals, especially those residing in Northern countries, to travel and provide care abroad, especially in Southern countries. The placement of Northern physicians in Southern medical settings creates new conditions and interaction dynamics that complicate how the usual variables associated with intra-professional status play out.

The present paper utilizes comparative ethnographic observations and interviews in three healthcare-providing nongovernmental organizations (NGOs) in Cambodia to answer the question: “How do individual-level status characteristics imbue interaction dynamics between foreign and local physicians when making treatment decisions for patients?” Findings reveal that when patients require complex surgeries, foreign physicians from the Global North exercise greater autonomy and have a stronger voice when determining appropriate treatments for patients; however, when patients need basic primary care, Khmer physicians leverage their contextual knowledge of patients’ personal histories and local pathologies such that Northern physicians defer expertise and decision-making power to them. Primary care interventions thus allow Khmer physicians to flip status hierarchies that otherwise assign greater value to the training, medical judgment, and treatment decisions reached by Northern physicians who volunteer their time in NGOs to treat patients.