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Unpacking gatekeeping in medical institutions: A case study of access to end-of-life patients

We use end-of-life decision making as a case for examining processes of gatekeeping in medical settings. End-of-life is an exemplar in a broader context of research in professionalized and institutionalized medical settings. Influences of biomedicalization, increases in consumer (patient) options, decreases in physician authority, and a proliferation of treatment options all contribute to a context in which ethnographic study of medical settings is more complex, more urgently needed, and potentially more difficult at the same time. Building on existing literature, we suggest that gaining access to a research site is less a matter of entrée through a gate and more a long-term navigation of a dynamic social web of actors, relationships, and organizations. Further, we borrow from Nader’s (1974) concept of ‘studying up’ to examine how elite power processes may be reflected in gatekeeping. Our discussion of lessons learned considers methodological and conceptual implications with broad relevance for qualitative researchers.