Sociocultural roles are multidimensional, even within a presumably narrow context such as health care provision. For instance, the disciplinary roles of most health care professionals are typically developed in disciplinary isolation during their pregraduate education and training, such that nurses in nursing school are educated separately from medical physicians in medical school. Without adequate preparation, new clinical practitioners “may transition to the workplace unprepared for collaboration at a time when chronic illnesses require the concerted effort of coordinated, fully cooperative health care teams”.1
Innovations such as interdisciplinary clinical training programs encourage clinical trainees to explore the terrain of adapting their singular disciplinary roles to fit the actual exigencies of clinical practice; for example, their clinical roles. In other words, disciplinary roles and clinical roles are 2 distinct, though related, concepts. The necessary transition and negotiation between singular disciplinary role and interdisciplinary clinical role may require a substantial commitment, willingness, and ability to explore issues of role if potential clinical collaborations are to be effective, mutually satisfying, and actualized.1,2
Disciplinary roles may be considered structural in the sense that they are largely shaped during standardized credentialing processes, such as disciplinary-specific education in accredited health professions institutions that prepare and qualify the individual to meet proscribed legal requirements to obtain professional licensure and relicensure (initial clinical competency testing, and continuing education). Clinical roles, however, are functional, and as “form follows function,” so too may new clinical roles both shape, and be shaped by, the specific environment in which the clinician practices. That is, mutual acculturation, or role bargaining, of all parties can occur, be they clinicians from different disciplines, clinical staff or administrators, or patients. The social ecology or context in which contemporary chiropractors practice varies greatly, and that variation is growing ever greater over time.
The historical norm of solo practice for chiropractors becomes ever less typical, as newly graduating chiropractors increasingly seek out group or multidisciplinary practices, and as the increasing integration of chiropractic into new clinical domains opens new opportunities for chiropractors to practice in interdisciplinary clinical practice environments, such as in Veterans Administration (VA) or other health delivery systems. It is reasonable to posit that singular factors such as patient attributes (eg, values, preferences), provider attributes (eg, additional clinical expertise beyond their basic disciplinary training), and higher-order relational factors such as those that may manifest within a patient-provider relationship (eg, trust) may also vary as the social ecology or context surrounding that relationship varies. For example, the nature of patient-provider relationships within a context of enclosed health care systems such as VA3
or closed-panel managed care arrangements may differ markedly from those that occur within differing contexts such as open insurance plans or self-pay arrangements.
Such a broad range of unknown potential factors are perhaps most appropriately and comprehensively explored using both qualitative4
and quantitative approaches, at varying levels of analyses from macro-level to micro-level. Quantitatively, units of analysis operationalized as variables describing ecological context as well as both collective and individual attributes might be best measured along a continuum to better capture and measure the distribution of variation and to better ascertain potential sources of that variation. Useful conceptual frameworks for theoretically grounding such inquiry may be found in multilevel, multidimensional sociological study of the behavior of collectivities. For instance, it is useful to examine collectivities with multidimensional aspects, such as health care delivery organizations, as rational, natural, and open systems.5
As rational systems, collectivities are oriented to the pursuit of specific goals and exhibit highly formalized social structures. As natural systems, the participants share a common interest in the survival of the collective system and thereby engage in informally structured collective activities to secure that end. As open systems, coalitions of shifting interest groups develop goals by negotiation, and the structure, activities, and outcomes of the coalition are strongly influenced by factors external to the coalition (ie, its environment).