66 Chapter 4 physician culture and to understand how people bidirectionally influence and are influenced by their environment. [12] Habitus has been used before to study medical culture. Hightower, for example, studied physician culture at an emergency department. [23] She defines habitus as “all actions, behaviors, and responses performed by the emergency physician as a part of their day-to-day routines” (p.2). [23] Habitus thus refers to individual views, beliefs, and actions, yet it also places those elements in a social context. [24] People’s experiences within a social environment become embodied in their habitus. [24] In a medical context, this means that physicians’ habitus is influenced, amongst other things, by medical training, interactions with colleagues and patients, and the rituals and routines in a medical department (p.31). [23] No two habitus will be exactly the same, but within the same social group, they will share similarities, as two individuals are influenced by the same external structures. In fact, the harmonization of habitus between individuals belonging to one cultural group confirms the embodied group structure. [12] Habitus, in turn, also shapes the system by reproducing all the group rules or rituals. [23] A change in habitus, therefore, also influences the environment. Habitus can change as it evolves in interaction with changing individual treats and external influences. People will unconsciously act according to their habitus, developing new and different strategies as they travel through various social fields. [25] The second concept, field, is inevitably interconnected with habitus and can be described as the individual’s social environment, with its own rules of practice. Where habitus is the “feel for the game”, field provides the “rules of the game”. [24] Field could refer to a social field, like a healthcare field such as gynecology, or another social structure where a certain power distribution leads to contesting forces. [25] The third element, capital, stands for all the resources an individual has at his disposal, including social, cultural, intellectual, and economic capital. [24] Skills and knowledge, for example, can be considered capital. Capital resources can be used both consciously and unconsciously. Bourdieu considers the three elements as interrelated elements, which together may predict practice to a large extent. This interconnection implies that altering any of the elements could consequently create a different practice. [26] It explains both differences in practice between individuals within the same social context (as their habitus differs at some points) and the different actions of one individual in different settings (as the field changes and different capital resources might be exploited). Ethical considerations This study was judged by the regional medical ethical assessment committee and the local Radboudumc research ethics board (File number CMO:2017-3887). Informed consent for observations and the use of data was received from all participants prior to conducting the observations and interviews. Participants were given identity codes to preserve anonymity.
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