bluuebunny/crossref_metadata_2025 huggingface dataset:
Existential and clinical uncertainty in the medical encounter: an idiographic account of an illness trajectory defined by Inflammatory Bowel Disease and Avascular Necrosis
Authors: Adamson Christopher
Published: February 2004

Uncertainty has been a central theme in the sociology of medicine. Scholars have focused on the existential uncertainty which is an aspect of the illness experience, and on the clinical uncertainty which marks the diagnosis and treatment of disease. However, there are few intensive examinations of how existential and clinical forms of uncertainty mutually affect each other. This essay draws on a personal experience of illness with inflammatory bowel disease (IBD) and a vascular necrosis (AVN), and on the clinical record of how these diseases were diagnosed and treated, in order to demonstrate that these two forms of uncertainty, by continuously playing to and playing off each other, mutually shape the nature of the medical encounter.
Modern medicine and the civilising process
Authors: Pinell Patrice
Published: February 2004

Medical sociology, mainly an Anglo‐Saxon invention, was developed almost without any theoretical reference to Norbert Elias’ work. One of the consequences of this ignorance was that a very challenging idea had been lost. This idea addressed the sociological problems associated with the historical changes that in turn affected the role played by hygiene in the normalisation of human behaviour. According to Elias’Civilizing Process, the progressive changes in human behaviour were part of global dynamics involving the transformation of both social structures and individuals’ habitus. In the construction of the ‘civilised behaviour’ characteristic of the dominant group, hygienic preoccupation played no role. The medical discoveries of the 19th century about the infectious diseases gave a posteriori an addition of legitimacy to this civilised behaviour. Adopting Elias’ perspective, I try to answer a question left unexplored in his work, i.e. the place of contemporary medical knowledge and practices within the ongoing civilising process. This question leads me to analyse:

1 the role played by ‘Pasteurian hygiene in the policy of civilization’ of the lower classes in France

2 the tendency towards the medicalisation of self‐control behaviour and the emergence of the patient as medical auxiliary involved in the division of medical works.
Myalgic Encephalomyelitis and the medical encounter1
Authors: Cooper Lesley
Published: February 2004

In the history of twentieth century western medicine several ‘syndromes’ have been denied the legitimate status of ‘organic disease’. Myalgic Encephalomyelitis (ME) and Chronic Fatigue Syndrome (CFS) are examples of such syndromes, in that their status within biomedicine as ‘real, organic’ diseases is still a matter of controversy. These ‘non‐diseases’ or ‘illegitimate illnesses’ are usually defined in terms of symptoms, with few consistent signs, and scientists and doctors have failed to agree on aetiology and pathogenesis. There are no obvious visible abnormalities present in sufferers, and ME cannot be diagnosed by standard medical tests. This paper explores the consequences of uncertainty and controversy for those who suffer from ME. It is based primarily on a series of ten life history interviews with sufferers of ME. These accounts of illness careers focus on the difficulties in obtaining a correct diagnosis and achieving legitimate sick role status, and on problems of miscommunication, dismissal and disbelief. As are sult, respondents changed their attitudes towards either particular doctors, or the medical profession. These altered perceptions are discussed in the context of the emergence of critical lay perspectives, and a growing public ambivalence towards biomedicine.
What is gender? Feminist theory and the sociology of human reproduction
Authors: Annandale Ellen , Clark Judith
Published: February 2004

Feminist theory and research on the sociology of human reproduction have historically been bound together as each has developed. Yet recently sociologists of reproduction and ‘women's health’ have lost sight of core debates in feminist theory. They still tend to work with the assumption that feminism is an internally coherent body of thought, despite the emergence of significant internal divisions since the mid‐1980s. In this paper we evaluate the challenge that feminist post‐ structuralism poses to prior conceptualisations of gender in the context of reproductive health through a critique of sociological work in this area from the 1970s and 1980s. We conclude with a critical exploration of the new insights that might emerge from a post‐structuralist ‘deconstruction’ of gender in the context of human reproduction.
Risk theory in epidemic times: sex, drugs and the social organisation of ‘risk behaviour’
Authors: Rhodes Tim
Published: February 2004

‘Risk’ and ‘risk behaviour’ have become keywords in discourses about AIDS. Notions of risk behaviour in the field of HIV prevention and the addictions largely derive from epidemiological categorisations which have had a key role in constructing lay and scientific understandings of the ‘problems’ of AIDS and injecting drug use. This has encouraged are stricted vision which inadequately captures risk as it is understood and experienced by drug users themselves. Drawingon case examples from qualitative research with illicit drug users, this paper explores the utility of current theories of risk behaviour in understanding how risk behaviour is socially organised. Two key developments in risk behaviour theory are examined. These are situated rationality and social action theories. Findings illustrate that situated rationality theoriestend to be conceptually limited to an analysis of individual rationality which fails to capture the distribution and influence of power in negotiated actions and the habituated nature of risk behaviour. In contrast, social action theories aim to understand the interplay of social factors which give rise to individuals’ situated risk perceptions and actions. Findings highlight the important role that qualitative research plays in questioning, as well as complementing, dominant scientific constructions of risk. Future theories of risk behaviour in the field of HIV prevention, as well as other health domains, need to consider risk as a socially organised rather than individual phenomenon. The paper concludes by asserting that understanding what risk actually means to participants themselves provides the necessary data for public health interventions to create the conditions where risk reduction becomes possible.
Pakistani women and maternity care: raising muted voices
Authors: Bowes A.M. , Domokos T. Meehan
Published: February 2004

The paper explores the potentiality of an empowering research strategy to raise the muted voices of Pakistani women, with particular reference to experiences of maternity care. It focuses on research carried out with Pakistani women in Glasgow in 1991. It is argued that issues of power negotiation need to be addressed at all stages of the research process, including the framing of research questions, during data collection through interviews, and in the analysis and presentation of results. Women's comments on maternity care were very varied, some being very satisfied, many not so. Three particular cases illustrate variation at the individual level, and muting interpretations are considered. In conclusion, it is suggested that an empowering research strategy may indeed raise muted voices, but that it can also give researchers more power. And the issue of the response to muted voices, a key aspect of the concept of muting, remains.
Control and condoms in commercial sex: client perspectives
Authors: Plumridge Elizabeth W. , Chetwynd S. Jane , Reed A.
Published: February 2004

Indepth interviews were recorded with 24 clients of female sex workers to explore their perspectives on the control of commercial sex encounters. The men saw the encounter as falling into three phases, only the first of which ‐ the decision to have sex ‐ was under their control. Subsequent phases ‐ the negotiation of services and the performance of sex ‐ they argued to be under worker control. The men considered that they acquiesced in worker control because they saw themselves as respectful of a woman's right to control her body and because they considered themselves attentive to workers’ sexual pleasure. At the same time, this acquiescence was considered to exculpate them from any responsibility for safer sex practice. Thus while the men argued they were consistent condom users, they held their partners responsible for ensuring this consistent condom use: women supplied condoms, and were held accountable for any condom failures.

The discourse of these men therefore functioned both to present clients benignly and to exculpate them from any responsibility for ensuring the safety of the commercial sex encounter.
Culture, relativism and the expression of mental distress: South Asian women in Britain
Authors: Fenton Steve , Sadiq‐Sangster Azra
Published: February 2004

Social anthropology and medical anthropology have presented a challenge to the belief that there are universal categories of mental illness. A relativist position would suggest that there are as many categories of mental health (or physical health) as there are languages and culture in which they are expressed. Intermediate arguments suggest that there may be common elements in ideas of mental illness but that cultural expression of syndromes may differ significantly, or that symptoms may cluster in different ways in different cultures. These arguments have been raised, as well as in cross national comparisons, in the context of minority groups (ethnic, cultural, language groups) in Britain. The research, reported here, on South Asian women in Bristol, shows that they have a clear conception of mental health and illness, a clear understanding of relationships between physical and mental health, and make important distinctions between types of mental ill‐health. They describe mental distress in a culturally specific set of language terms and their accounts differ from English speakers in important ways. At the same time they describe a syndrome of mental distress which corresponds in a number of features to the category ‘depression’.
An ethnography of risk management amongst illicit drug injectors and its implications for the development of community‐based interventions
Authors: Power Robert , Jones Steve , Kearns Gerry , Ward Jenni
Published: February 2004

Qualitative research which describes the social behaviour of illicit drug users has a key role to play in refining community‐ based interventions. Such research has been used for many years in drugs research, but during the AIDS epoch its practical application has been most fully realised. Data are presented to illustrate the way in which qualitative research can inform the development of outreach initiatives targeted towards illicit drug injectors, not in contact with treatment services. Social networks of injectors from three sites in England were studied and we describe the strategies they adopted to reduce the likelihood of viral infection. We show how informal coping strategies, such as personalising syringes and ensuring a supply of sterile injecting equipment through secondary distribution can be integrated into peer education outreach. We also examine the management of risk and the social meanings that perpetuate sharing of injecting equipment, describe situations and scenarios in which syringe sharing is likely to occur, and suggest how such research can assist the evaluation and evolution of relevant and targeted interventions.
Health inequalities as policy issues ‐ reflections on ethics, policy and public health
Authors: Vågerö Denny
Published: February 2004

Social class differences in health have been found in all societies that have looked for them. In spite of an apparently stable historical pattern of upper social classes living longer and faring better than lower ones, there is a certain amount of variation in the size, trends and nature, even the direction of such differences, indicating that they might be modified by policy and social change. Social class differences in health, as well as other health inequalities, have in fact become a part of the political agenda. But policymaking in this area is weak and unconvincing in most countries. There is little consensus as to why policies to reduce health inequalities are important. Should they be pursued for the reason that health is a ‘right’, as suggested by some writers, and often in the political rhetoric? Or because they are important for a country's level of health in general?

The purpose of this article is firstly, to examine some of the moral justifications for the reduction of health inequalities and, secondly, to suggest that the public health policy agenda can be improved by focussing on the public health significance of health inequalities. It is argued that the reduction of health inequalities may represent a great potential for improving the health of the population, but there is a moral justification for equal distribution of health, risks and health resources even if this did not contribute greatly to improved general health.
From biographical disruption to biographical reinforcement: the case of HIV‐positive men
Authors: Carricaburu Danièle , Pierret Janine
Published: February 2004

In‐depth interviews were conducted with 44 asymptomatic HIV‐positive men infected through homosexual relations or medical treatment for haemophilia. The objective was to better understand interrelations between: the consequences of infection on everyday life; the meanings given to being HIV‐positive; and the reconstruction of identities. The consequences for everyday life are examined in relation to: the importance of keeping one's immune status secret; self‐imposed restraints and the constraints ensuing from the immune status; and the resources interviewees tapped to cope with their new situation. The meanings given to infection arose as these men reinterpreted their individual and collective pasts. This biographical reconstruction reinforced components of identity that, prior to HIV‐infection, had been built around haemophilia or homosexuality. This is what is called biographical reinforcement, a notion developed in relation to biographical disruption.
Research note: Decision‐making processes, ethical dilemmas and models of care in HIV/AIDS health care provision
Authors: Bennett Lydia , Duke Jan
Published: February 2004

The data reported heere is part of a larger study exploring the impact of HIV/AUDS on health care professionals. In this segment of the study, participants (16 nurses, 5 doctors and 3 social workers), from three hospital AIDS units were interviewed about the difficulties inherent in their work. Analysis of the transcript data indicated that the areas causing the greatest conflict and concern were thise surrounding the management of dying patients. A category identified in the data was the dis‐agreement about patient treatment. Non‐medical staf in one unit reported stress, frustration and conflicts about the discision‐making process with dying patients and expressed their discontent with the biomedical model of health care delivery. In contrast, staff in the other two inits, reported satisfaction with the management of patients and relief that patients were not ‘pushed’ to be treated. Accordingly, a model of care which focuses on the patient's needs and encourages a team approach to decision‐making, is recommended.
NHS managers as rhetoricians: a case of culture management?
Authors: Hughes David
Published: February 2004

In the wake of Peters and Waterman'sIn Search of Excellencefew NHS managers are unaware of culture management as a tool for shaping organisational change. Yet the first wave of post‐Griffiths studies found little evidence of ‘culture management’ in action. This paper draws on data from an ethnographic study carried out in 1988–90 to suggest that the symbolic facet of management action is an important, though neglected, element in the 1991 NHS reforms. It argues that rhetorical skills Iwere a valuable resource for general managers overseeing the change process, and explores some of the ways in which rhetoric may have influenced cultural adaptation. However, many of the specific claims of the ‘excellence genre’, including ideas about the importance of strong, homogeneous cultures, are rejected. Rhetoric is an aspect of micro‐political struggles over meaning, which rarely result in straightforward cultural ‘manipulation’, and are more likely to re‐shape organisations through pragmatic accommodation than to win the hearts and minds of members.
A literary approach to managerial discourse after the NHS reforms
Authors: Traynor Michael
Published: February 2004

The 1990 NHS and Community Care Act can be seen as the culmination of the importation into the UK National Health Service of ‘business’ language. This has entailed struggles between the values of new general managers and the traditional professions and unprecedented attention to issues of ‘measurement’. A recent study of NHS Trusts involved three yearly rounds of interviews with managers and the administration of questionnaires to the nursing workforce in the same areas. Although the main intentions of the research lay in gauging the job satisfaction of the workforce and describing the managers', approaches to organisational strategy, the way that each group used language soon emerged as an area of interest and as a pointer to the foundational values and epistemologies of each group. An approach to the texts of interviews and questionnaire responses was informed partly by an analysis of discourse, elaborated by Foucault and others and partly by deconstraction, an approach usually associated with literary texts. The approach to analysis is based on the realisation that language is structured in a way that reflects existing power relations and that attention to metaphor and other rhetorical devices can give insight into these discourses. After briefly introducing the policy context and a particular approach to literary texts, this paper offers analysis of how managers talked about measurement and financial constraints.
‘But if you look at the coronary anatomy …’: risk and rationing in cardiac surgery
Authors: Hughes David , Griffiths Lesley
Published: February 2004

Recently there has been wide public debate in Britain about the denial of cardiac surgery to smokers and other patients possessing negative risk factors. While some senior medical practitioners have insisted that such decisions are based on objective clinical grounds linked to prognosis and effective use of resources, other commentators argue that doctors are policing lifestyle and making judgements about deservingness. One way of shedding light on this controversy is to examine how medical practitioners themselves talk about cases when consequential decisions must be made. This paper presents tape‐recorded data from cardiac catheterisation conferences in which cardiologists present cases to a cardiac surgeon, who must decide whether to accept them for surgery. For much of the time, decisions are linked to the technical feasibility of surgery and the details of coronary anatomy. However, in many conferences age, lifestyle, and wider social structural factors figure centrally in discussions and appear to influence outcomes. The analysis explores some of the tensions that occur as doctors move between ‘technical’ and ‘social’ discourse frames to make sense of patient histories. Far from remaining exclusively within a neutral medico‐technical discourse, doctors construct arguments and counterarguments that closely resemble the standpoints in the wider public debate on rationing and deservingness.
Actor‐network theory, technology and medical sociology: an illustrative analysis of the metered dose inhaler
Authors: Prout Alan
Published: February 2004

Actor‐network theory is a form of relational materialism that codifies a body of ideas developed in the sociology and history of technology. At its centre is a non‐dualistic account of the relation between ‘society’ and ‘technology’. In this view society is produced through the mutually constituting interaction of a wide range of human and non‐human entities (including machines and technologies). This paper outlines some of the key ideas of actor‐network theory and suggests that they might be usefully incorporated into medical sociology (and/or anthropology). An illustrative example is given which demonstrates some aspects of the application of such a non‐dualist approach to a particular medical device, the metered dose inhaler (MDI), widely used in the treatment and management of asthma. Within a shifting network of socio‐technical relations the MDI and various human actors are seen to have mutually constituted each other. Competencies were created and distributed and linked to panoptical practices of surveillance, control and modification. These included attempts to change both the technologies and the human actors who came into relationship with it. The intricate and mutually constitutive character of the human and the technological in the processes and relationships of sickness and healing is thus demonstrated.
Medicalisation reconsidered: toward a collaborative approach to care
Authors: Broom Dorothy H. , Woodward Roslyn V.
Published: February 2004

The concept of ‘medicalisation’ has informed the sociology of health and illness for several decades. Typically, it has been discussed with critical connotations, although some commentators have suggested that it is not unequivocally negative. This paper seeks to clarify the concept, suggests that medicalisation can be both helpful and unhelpful, and identifies the characteristics of beneficial medicalisation. Using data from doctors and patients who are dealing with a refractory, relapsing and disabling condition ‐ Chronic Fatigue Syndrome ‐ we explore the impact of medicalisation in different forms on the participants in the medical encounter. Both doctors and patients were, at times, uneasy about the possibility of a self‐fulfilling prophecy through which a medical diagnosis might generate deleterious consequences from a comparatively trivial complaint. However, when such motivations prompted doctors to withhold information (such as a suspected diagnosis), the results were generally increased difficulties for the patient. Whether intentional or accidental, medical dominance in any form consistently generated problems for patients. But when medical explanations were mobilised to enhance the coherence of the patient's experience of symptoms, patients found medicalisation to be helpful. Patients whose doctors took their symptoms seriously gained legitimation which helped them in a range of social relationships. They also received support for their efforts at self‐management. Legitimacy, coherence and support are all necessary components for improved well‐being, and doctors can supply such assistance even in the absence of unequivocal diagnosis and proven therapeutic interventions.
The interplay between doctors and nurses—a negotiated order perspective
Authors: Svensson Roland
Published: February 2004

This paper reports on a study of the interplay between nurses and doctors in medical and surgical wards in Sweden. The social order on the wards is seen as a negotiated order, the result of a continuous negotiation between doctors and nurses. The negotiated order perspective is argued to be a more appropriate means of understanding the interaction on wards than the traditional doctor‐nurse game model which has dominated research until now. In particular, the study shows the importance of analysing the structural basis of negotiations and its knowledge context in order to understand the interplay of doctors' and nurses' opportunities for exerting power on the wards.
Research note: Managing risks: the social organisation of indoor sex work
Authors: Whittaker Dawn , Hart Graham
Published: February 2004

In this research note we begin to develop ideas drawn from studies concerned with the social context of sex work, and contribute to the literature on the sociology of risk, by investi‐ gating the social organisation and conditions of work of a group of female sex workers whose work has not so far been described in any detail ‐ fiat‐working women. These are preliminary findings from an ongoing empirical study comparing occupational risk of violence between women working in flats and street‐working women in central London. Here we report on the flat‐working women's employment of protective strategies, such as co‐working with ‘maids’ who serve as gatekeepers, allowing clients access to the women and monitoring the time clients spend in the flats. Rather than focus on women's self‐efficacy or health beliefs, we argue that it is through the social organisation of their work that we are best able to understand the nature of their risk exposure, and their strategies for managing risk and safety in relation to their occupational health.
Accounts of health and illness: Dilemmas and representations
Authors: Radley Alan , Billig Michael
Published: February 2004

This paper argues that people's views of health and illness are best understood as accounts that they give to others. In that sense, such beliefs are neither the expression of fixed inner attitudes, nor evidence for shared social representations. Instead, we emphasise the importance of seeing health talk as both ideological and dilemmatic. The paper explores the way in which individuals who speak of health (or illness) in general must also give an account of their health in particular. Reviewing the distinction between ‘private’ and ‘public’ accounts, the article discusses the various rhetorical devices by which this is achieved. This shows how people's talk about health both defines their social fitness and exemplifies their claims to being ill or healthy.
Medical sociology, chronic illness and the body
Authors: Kelly Michael P. , Field David
Published: February 2004

The sociological conceptualisation of chronic illness requires a sociology which indicates the physicality of the body theoretically. The aim of this paper is to demonstrate how the body might be integrated into sociological accounts of the experience of chronic illness in a way that acknowledges biological and social facts. Central to our argument is the connection between bodily aspects of self and identity. Self and identity are core aspects of everyday experience and of the everyday experience of illness. With the onset of illness bodily functioning alters and self‐conceptions and identity may also change. The body, which in many social situations is a taken for granted aspect of the person, ceases to be taken for granted once it malfunctions. The bodily basis of chronic illness has to be attended to because it limits or interferes with other physical and social activities. The connection between biological and social facts is explored using the concepts of self and identity.
Beyond constructionism and pessimism: theoretical implications of leprosy destigmatisation campaigns in Thailand
Authors: Navon Liora
Published: February 2004

Based on a study of leprosy destigmatisation campaigns conducted in Thailand since the 1970s, this article examines the difficulties in their implementation, the extent of their success and the degree to which they are actually needed. The findings indicate that these campaigns are doomed to fail because of problems inherent in any attempt to transmit a normalising message, and also because of stigmatisation derived from the metaphorical use of leprosy in spoken language. The study also found that educating the public about leprosy only increased the risk of stigmatisation. However, it appears that the stigma itself bears the potential for destigmatisation, since the worse the image of the disease, the less likely its identification with the patients diagnosed today, thus sparing them actual negative reactions. These conclusions serve as a basis for examining assumptions about knowledge and power underlying the constructionist analysis of destigmatisation processes. The paper calls to abandon these presuppositions, as they have led constructionism to a pessimistic view of the possibility of destigmatising diseases and disabilities.
Measuring inequalities in health: an analysis of mortality patterns using two social classifications
Authors: Bartley Mel , Carpenter Lucy , Dunnell Karen , Fitzpatrick Ray
Published: February 2004

The paper investigates relationship between mortality and social class as measured by the Erikson‐Goldthorpe schema, a validated measure of employment conditions, and compares this with differentials found using the Registrar General's social classes. Two cohorts of men aged 15/16–64 were drawn from the OPCS Longitudinal Study for 1971 and 1981. Mortality differences between social classes were estimated using deaths occurring between 1976 and 1980 in the first cohort and 1986 and 1989 in the second. The two classification were formally compared by means of the Relative Index of Dissimilarity and a likelihood‐based statistic. Similar mortality differentials were found using both classifications in the two time periods. The Erikson‐Goldthorpe schema showed a clear pattern of higher mortality in those groups without a career structure and with lower discretion over their work. The paper concludes that inequalities in health are seen when a validated social class schema based on employment conditions is used. The use of validated measures will make it possible for health differences to be more clearly interpreted in policy terms.
How large are the differences ‐ really? Self‐reported long‐standing illness among working class and middle class men
Authors: Elstad Jon Ivar
Published: February 2004

Social inequalities in health are regularly found in health interview surveys, but it has been doubted whether respondents’ self‐reported morbidity can accurately describe social class differences in health. Two hypotheses are current: members of the working class are commonly more preoccupied with their illnesses, and overreport them, compared with those of the middle class: secondly, the latter are more sensitive to their illnesses, have a better chance of getting them diagnosed, and consequently claim a wider array of illnesses in comparison with the former. This paper analyses answers to questions about long‐standing illness from working class and middle class men, aged 25–64, in Norwegian surveys during the 1980s. Working class respondents experience their illnesses as more serious. An analysis of diagnostic categories of the illnesses of both sets of respondents indicates that this subjective experience is realistic. The hypothesis that a high level of psychological malaise among working class men produces a tendency to somatise psycho‐social stress is not supported. The paper concludes that social inequalities in morbidity as shown by self‐reported long‐standing illness will often underestimate true class differences.
Practices of reading and writing: the constitutive role of the patient record in medical work
Authors: Berg Marc
Published: February 2004

This paper contributes to a reappraisal of the sociological significance of the medical record. Building upon re‐evaluations of the notion of ‘representation’ in ethnomethodological and science and technology studies, it attempts to portray the medical record as an artefact which mediates the social relations that act and work through it. Through practices of reading and writing, it is argued, the medical record figures as a fundamental, constitutive element of medical practice. To address some of the dimensions that are involved, three case fragments are discussed. The way the medical record enters into the process of ‘medical decision making’ in the doctor‐patient interaction, and into that interaction itself, is discussed first. Subsequently, some aspects of how the record mediates medical work as it is performed in the wards of a hospital are outlined. A third instance of its prominent role demonstrates how practices of reading and writing tend to produce particular renderings of patients’ histories ‐ including notions of how medical work is structured.
Making sense of mortality
Authors: Prior Lindsay
Published: February 2004

Abstract This paper focuses upon the collection and processing of government mortality statistics, and especially upon the organisational and theoretical contexts within which such statistics are assembled. Two items of mortality data in particular are examined with a view to illustrating the broader issues: medical cause of death, and social class of deceased. Using a 10 per cent sample of 1981 Belfast death certificates as a base, the paper attempts to trace the specific stages through which the cause of death and social class data have to pass prior to their incorporation into mortality reports. The paper indicates that there are numerous grounds for believing that both kinds of data are flawed at their points of origin, and that the transformations which the data undergo during coding procedures leads to further distortions of our image of mortality and its social base. It is argued that these flaws and distortions are only partly due to technical and organisational shortcomings, and more likely due to weaknesses in the theoretical frameworks through which the data are sifted. The paper concludes by suggesting that the existing arrangements for registering deaths, dominated as they are by the principles of forensic medicine, are more properly viewed as a system for policing the dead, than as a mechanism for generating worthwhile data about diseases and their social distribution.
Consciousness of time and time for the development of consciousness: health awareness among women flight attendants
Authors: Lessor Roberta
Published: February 2004

Abstract The occupational health beliefs and experiences of flight attendants in five United States airlines were analysed in a three‐year interview and field study. The development of career longevity in the flight attendant occupation, once seen as short‐term ‘women's work’, has given rise to increasing occupational health problems. The health concerns of flight attendants have correspondingly heightened their consciousness of collective occupational interests as self‐care practices alone have proved insufficient to combat environmental health hazards. The case of flight attendants illustrates the problems workers face in legitimising health concerns in a female‐identified occupation, yet suggests the changes in consciousness that occur when women no longer view their work as temporary but as a long‐term career.
Getting rid of patients: contradictions in the socialisation of internists to the doctor‐patient relationship
Authors: Mizrahi Terry
Published: February 2004

Abstract This article examines the impact of the professional socialisation of internists on the doctor‐patient relationship. Utilising observation and interviews, the study found that the world of house staff (interns and residents) was defined by a paradoxical perspective on patients ‐ characterised as a‘Get Rid of Patients’(GROP) orientation. This perspective was shaped by the poor conditions of public institutions, administrative mandates, demographic and disease factors, a narrow definition of professional practice and normative standards of professional conduct. There was active support and reinforcement from colleagues for GROP behaviour; peers, rather than attending faculty became the most important socialises. To implement the GROP perspective, coping strategies emerged within the house‐staff culture. These included the utilisation of the hierarchy and techniques such as negotiation, objectification, intimidation, omission and avoidance. No time in their training was identified as the right time to acquire humanistic doctor‐patient relationship skills. Contrarily, the structure of the socialising institution was organised into a hierarchy in which the most obvious criterion and consequence of status was autonomy over or removal from the establishment of meaningful doctor‐patient relationships.
The formation of coalitions: interaction strategies in triads
Authors: Coe Rodney M. , Prendergast Christine G.
Published: February 2004

Abstract Audio tapes of encounters between a physician, an elderly patient and an accompanying relative are used to describe the formation of coalitions in triadic relationships. A coalition is defined as interaction between two members of a triad who adopt a common strategy in contention with the third member. Preliminary analysis suggests that each medical encounter may contain several coalitions which vary in duration, topic, objectives of members and alignment of members.
Artefact explanations of inequalities in health: an assessment of the evidence
Authors: Bloor M. , Samphier M. , Prior L.
Published: February 2004

Abstract Artefact explanations seek to account for inequalities in health as a construct of the measurement process. The Black Report believed that the artefact explanation was relatively unimportant in accounting for the persistence of class inequalities in health. This paper reviews the evidence on artefact explanations of class differentials in specific‐cause and all‐cause mortality data, and also of differentials by occupation, by geography, and by gender. It is concluded that the role of artefact explanations in mortality differentials is larger, more pervasive, and more complex than Black and his colleagues believed.
Reforms in pharmacy education and opportunity to practise clinical pharmacy
Authors: Birenbaum Arnold , Bologh Roslyn , Lesieur Henry
Published: February 2004

AbstractThe impact on 357 newly licensed pharmacists, graduates of two colleges, of efforts to turn pharmacy into a clinical profession, was examined by way of a self‐administered questionnaire. Perceptions and expectations about work, differences in consulting practices, relationships between practice and attitudes, and the presence or absence of an identifiable general value orientation (which could account for specific perceptions and attitudes), were examined. Results indicated that hospital practice was more likely to be associated with clinical pharmacy and clinical pharmacy practice was more likely to meet the expectations of recently graduated pharmacists. In addition, 52 per cent of the community‐based pharmacists were found to engage in patient counseling, as compared with 39 per cent of hospital‐based pharmacists. Newly licensed pharmacists are deepening the existing divisions in the profession, while moving toward a revision of their place in the health care delivery system.
Fragmentation and integration in health care: the referral process and social brokerage
Authors: Dartington Tim
Published: February 2004

Summary Studies of institutional care raise issues about the transitions that people make as patients moving from one system of care to another. Hospital and Community are unreliable concepts, but they are still useful in understanding a fragmented reality. If we examine the referral process, we see how it is necessary to fit people to a succession of fragmented systems, with separate tasks. How these systems define their different tasks determine the transitions that patients have to make. Ambiguity about task is protective of caring staff. But there are also ways in which care systems can be integrative and take shape around the needs of the individual. There is a need for a kind of social brokerage in the interests of patients to make the best use of integrative care systems.
Coping with uncertainty: decisions and resources within health authorities
Authors: Hunter David J.
Published: February 2004

Summary This article reports on a two‐year study which looked at decision‐making in two Scottish health boards. The study, which focused on the allocation of development funds (growth monies), is about understanding and not about reform. It was prompted by: (1) a dearth of knowledge concerning the dynamics of decision‐making in the National Health Service (NHS) at local level, especially since the 1974 reorganisation of the Service; and (2) a desire to understand the factors at local level which might help to explain the persistence of resource imbalances between different sectors of health care despite successive attempts by central government to remove them. The study suggests that, contrary to much popular opinion, decision‐making in the NHS is decentralised ‐ the two health boards featured in the research possessed a large measure of influence over the services they provided. Aside from rational and incremental theories of decision‐making which were of value in compre‐hending the decision process observed, the notion of puzzlement as a factor determining decision outcomes was found to be of particular value in the context of the allocation of development funds. The main study findings were: (1) that a policy of appeasing competing, and equally demanding, interests rendered change exceptional although not impossible, as was shown by the emphasis placed upon community health services; (2) that various constraints, both internal and external, operated on decision‐makers; and (3) that a number of coping strategies were adopted by decision‐makers in order to structure their uncertain and unpredictable environment and to manage the constraints on them.
Normal rubbish: deviant patients in casualty departments
Authors: Jeffery Roger
Published: February 2004

Summary This paper describes typifications of good and bad patients made by staff working in three English hospital Accident and Emergency departments, commonly known as Casualty departments. The staff explain or defend their behaviour and their hostile evaluations by accounts which in many respects parallel the classic description by Parsons of the sick role.1 The data presented are most easily interpreted as cases where certain sorts of patients are unable to achieve entry into what is essentially the legitimate career of sickness, and this will lead into a disussion of the relationship between sicknesses and deviance.
The relationship between qualified and unqualified workers in health care: the case of the remedial therapy professions
Authors: Alaszewski Andy , Meltzer Howard
Published: February 2004

Summary The role of knowledge has traditionally been studied in terms of education and training, not in terms of job practice and the division of labour. This article examines the meaning of knowledge in the work context and its role in legitimating the division of labour between qualified and unqualified remedial therapy workers. The main analytic framework is derived from the work of Schutz.
Emergency room use and access to alternative sources of care
Authors: Kleiman Michael B.
Published: February 2004

Summary In recent years a great deal of attention has been called to the extent to which emergency rooms (ERs) in the United States are being used for routine‐rather than emergency‐care. In attempting to explain this extensive routine use, many scholars have surmised that much of this use occurs among people for whom the emergency room is the only—or is the most convenient‐health care facility available. That is, many researchers have posited that the emergency room serves to extend health services to medically disadvantaged persons who might otherwise have no convenient access to care. Of course, such a claim has profound implications for the role of the emergency room in bringing about an equitable distribution of medical resources. Yet in spite of the importance of this issue, few studies have provided empirical evidence useful for assessing the claimed relationship between emergency room utilization and access to alternative sources of care. The present study seeks to close this research gap by employing national survey data to examine emergency room visits in light of the accessibility of more traditional provider settings. Multiple Classification Analysis is used to analyze the data, and comparisons are made for the sample as a whole as well as for three critical explanatory variables: income, age, and residence. In addition, four indicators of illness are used as controls. Findings suggest that, contrary to what has previously been surmised, emergency room visitation often occurs independently of, rather than as a substitute for, access to non‐ER health care settings. Finally, implications of these findings and directions for future research are discussed.
Some social meanings of tranquilizer use
Authors: Cooperstock Ruth , Lennard Henry L. , Cooperstock Ruth , Lennard Henry L.
Published: February 2004

Summary With approximately 20 per cent of all prescriptions written for psychotropic drugs, a large proportion of which are tranquilizers, it becomes necessary to examine the consequences of such use and the functions served by these drugs in social as well as pharmacological terms. This paper reports data from an exploratory study of the social and behavioural effects of use based on group interviews with current and former tranquilizer users. It adopts a natural history approach. The informants reflected the age and sex distribution of tranquilizer users generally, predominantly female and middle‐aged. The thematic material dealt largely with a variety of role conflicts. Discussion focussed on these conflicts and the individual's ability to perform expected roles or adapt to them. Among females the roles included those of wife, mother, and houseworker, while males primarily discussed tranquilizer use as a means of controlling somatic symptoms in order to perform their occupational role. The function of tranquilizers in maintaining the individual in a dependent patient role was also discussed by a number of informants. This study demonstrates the inadequacy of the biomedical model of disease in explaining continued tranquiliser use.
Using private health insurance. A study of lay decisions to seek professional medical help
Authors: Cant Sarah L. , Calnan Michael
Published: February 2004

This paper examines the decision making process associated with the use of private health insurance. In particular, it focusses on the criteria respondents draw on to decide when to use the private health sector and when not to. This is an important issue as it gives insight into how the use of the private sector relates to use of the National Health Service. It also informs the theoretical debate about help‐seeking behaviour, in particular, the usefulness of the notion of choice and ‘shopping around’ in the health care market. It is concluded that users of health care do exhibit a reasoned approach in deciding between different medical care settings, although due to lack of knowledge and passivity in the patient role, the final decision is usually made by their general practitioner.
The work‐relatedness of disease: workers' own assessment
Authors: Thorslund Mats , Wärneryd Bo , Östlin Piroska
Published: February 2004

In the routine compilation of statistics on the relation between occupation and ill‐health it is usually possible to demonstrate links to certain physically demanding occupations. However, studies of the causal links between work and ill‐health present problems. Besides the difficulties that often occur in collecting information on present and previous occupations, exposure periods, latency, duration, etc, the analysis and interpretations themselves are complicated.

The aim of this paper is to study the interviewees' own views on whether or not any ill‐health they may suffer could be caused by any particular job they may hold or have held in the past. Does one get the same picture of the relationship between occupation and ill‐health as when routinely compiling statistics? The study population comprised 12,664 men and 12,942 women between 25 and 75 years of age. For all respondents, detailed occupational histories were recorded

The results indicated that health problems are more common among persons who have or have had physically demanding work. On the other hand, in certain heavy jobs with high numbers of persons reporting long‐term illnesses it is rare for individuals to blame their health problems on working conditions. Conversely, other occupations have relatively low numbers of persons with long‐term illnesses, yet high proportions of these attribute their health problems to their work.