'Sweating Blood': Patients' Dirty Work in Informal Complaint Biographies.

Every day patients make informal complaints directly to care professionals. Although common in care encounters, the practice remains understudied. In this study, we focus on informal complaints through an analysis of interviews with 19 patients in Sweden, many living with chronic illness. We conceptualise these complaints as 'informal complaint biographies': not merely verbal expressions, but interwoven with people's lives, identities and care trajectories. As a lens through which to examine informal complaining, this study investigates 'dirty work': work that is considered a nuisance or even humiliating. We identify three different kinds of dirty work. 'Disgusting' refers to work with physical dirt entangled with the complaint. 'Drudging' describes patients' persistence, their effort to make healthcare function. Finally, 'disrupting' characterises work that challenges expertise from a vulnerable position. Our analysis shows how informal complaining can involve various types of undignifying work that cannot be separated from the complaint itself. By including work done by others than the traditional 'worker', namely patients, this study expands scholarship on dirty work. The study calls attention to how dirty work is shaped by systemic inefficiencies in healthcare and contributes new perspectives to complaints, research and policy, which is often wiped clean from any kind of dirt.