bluuebunny/crossref_metadata_2025 huggingface dataset:
Has menstruation been medicalised? Or will it never happen…
Authors: Bransen Els
Published: February 2004

In what terms do women speak about menstruation, and what does this mean for (power in) the relationship between expert/lay(wo)man and medicine/society? In this article the question is posed in the light of ‘medicalisation’, a notion that inter alia is used by the women's liberation movement to criticise medicine. Contrary to what ‘medicalisation theory’ suggests, women who were interviewed about ‘their experiences with, ideas about and life with menstruation’ are not simply parroting medicine. They construct their ‘own’ stories about their menstruation, which illustrate a dialogue with three ‘story genres’ about women and their (menstruating) bodies. In these genres respectively, ‘me’, the doctor and ‘nature’ are central figures. Although there seems to be no simple take‐over of medical language, this does not mean that ‘medical power’ is absent. It is possible to locate within each ‘story genre’ a space where the doctor has free play. In every genre s/he has a certain leeway to do good as well as to do harm.
The process of neutralisation and the uncertainties of cystic fibrosis
Authors: Waddell Charles
Published: February 2004

Abstract The epidemiological uncertainties of a terminal illness would seem to prohibit the ritual exchange of faith and hope between patient and medical personnel. However, after interviews with people involved in cystic fibrosis networks, I argue that there exists a process of neutralizing five epidemiological uncertainties of this disease: (1) aetiology; (2) genetics; (3) treatment; (4) societal reaction and (5) life expectancy. This process consists of five techniques corresponding to these five epidemiological uncertainties, respectively: (1) the modification of question; (2) the promise of research; (3) the uniqueness of each case; (4) the comparison with others and (5) the lack of an alternative to therapy. Neutralising the epidemiological uncertainties of this disease serves to support the swaying edifice of faith and hope and enables the people within the network to devote themselves to compliance with cystic fibrosis therapy.
Migration and health: perspectives on immigrant women
Authors: Anderson Joan M.
Published: February 2004

Abstract This paper is based on a three‐year field study with Indo‐Canadian and Greek women immigrants in an English speaking region of Canada. I examine how women construct ‘concerns’ or ‘worries’ in their everyday lives, and point to the discrepancy between these concerns and those for which help is sought. Women's accounts show that their ongoing experiences with health professionals determine how they present the circumstances of their lives to them. I develop the argument that the sources of distress for women are located within a social context, and I use transcript materials Obtained in interviews with women to elucidate this point. I further argue that although health professionals have defined 'social problems’ as within the domain of health care, this very ‘care’ is shaped by the dominant ideologies which determine the subjective experiences of women in the context of their daily lives. Health care practices, then, are seen to be embedded within the broader socio‐cultural context, and in turn legitimize the dominant ideologies.
Alienation as a consequence of disability: contradictory evidence and its interpretations
Authors: Romeis James C.
Published: February 2004

Abstract This study is an empirical examination of the commonly held argument that physical disability produces alienation from society. Levels of subjectively measured alienation were compared between a sample of unimpaired individuals and a sample of severely impaired workers’compensation recipients in the United States. Based on background characteristics and regression equation predictions, the findings indicate that five years after a severe work‐related injury, the workers’compensation recipients were no more alienated than might be expected if they were not impaired. The implications of these contradictory findings raise important theoretical and substantive issues.
Peer expectations about outstanding competencies of men and women medical students
Authors: Grant Linda
Published: February 2004

Abstract Men and women enrolled in a combined premedical‐medical school programme were asked as they began their clinical training to rate their anticipated competence on sixteen criteria relevant to medical practice. Competence dimensions tapped scientific/technical skills, dedication/commitment, and interpersonal skills. Students then were asked to nominate one classmate whom they expected might be‘the best’in each area. Self‐ratings revealed few differences among men and women. Peer nominations, however, revealed a preponderance of male nominees in ten competence areas. Women dominated nominations only in the category of sensitivity to patients. Patterns persisted when peer nominations were controlled for students’academic standing and self‐ratings on parallel dimensions. The data suggest that medical school peer groups share expectations about competencies of men and women as physicians which are consistent with generalized sex stereotypes and career patterns of men and women physicians.
When nurse knows best: some aspects of nurse/doctor interaction in a casualty department
Authors: Hughes David
Published: February 2004

Abstract It is commonly supposed that the working relationship between doctor and nurses is one in which the latter are subordinate to the former. An analysis of previously unpublished data from a wider study of the processes of patient categorisation in one casualty setting reveals both areas in which nurses’ work appears to move closer to the focal tasks of diagnosis and treatment in particular and also observed patterns of doctor‐nurse interaction at odds with the common supposition.
The breath of life: medical technology and the careers of people with post‐respiratory poliomyelitis
Authors: Locker David , Kaufert Joseph
Published: February 2004

Abstract This paper examines the impact of medical technology on the careers of people with post‐polio respiratory disability. The data have been taken from multiple in‐depth interviews with ten people who contracted polio during the epidemics of the early 1950s, all of whom used or had used a variety of methods of mechanical respiratory support. It focuses on ideologies of disability and the adoption of technology, the management of respiratory insufficiency and strategies of‘trading off whereby the benefits of technology are maximized and the costs minimized. While technology made an enormous contribution to the quality of life of these people, the problems it created transformed both their experience of the illness and the character of their everyday existence.
Unemployment and health: selection or causation ‐ a false antithesis?
Authors: Bartley Mel
Published: February 2004

Abstract Observations on the effect of unemployment on health include note that the clustering in certain geographic areas of low income, job insecurity and poor housing are the experience of the same groups of people. Considerable difficulties exist in isolating the different aspects involved. Nonetheless, it is argued (1) that the effects of each separate strand are dependent upon and reinforced by the others; (2) that it is possible to clarify the ways in which the elements interrelate; and (3) that it is the whole pattern that most satisfactorily explains currently available data on unemployment and health.
Social constructionism and the development of medical sociology
Authors: Bury M. R.
Published: February 2004

Abstract Abstract This paper offers a review of recent approaches in the ‘social constructionism’ of medical knowledge. It argues that ‘constructionist’ propositions offer a bold attempt to resolve some of the problems in earlier formulations of the sociology of medical knowledge, particularly those of Eliot Freidson. However, the paper goes on to argue that social constructionism has failed to tackle the inherent relativism in its stance and that it frequently rests on contradictory intellectual and value premises. The paper concludes that both policy considerations and theoretical consistency require a critical appraisal of social contructionism and its future role in medical sociology.
Research note: Gender and the utilisation of health care services in Perth, Australia
Authors: Waddell Charles , Floate Pauline
Published: February 2004

Abstract Abstract This study examines gender differences in the utilisation of health care services in a representative sample from the city of Perth, Australia. The data were collected through interviews. The usual result from such studies, females use health services more frequently than men, was not supported by the findings of this research. The multivariate scenario we formulate to interpret our findings is that the use of health care services is determined by participation in social networks through which personal health status is defined, stress assessed and past experiences with health providers are interpreted. The notion that women use health services more often than men should be regarded more as an hypothesis than a fact.
Training the trainers: socialisation and change in general practice
Authors: Walker Michael
Published: February 2004

Abstract An ethnographic study of a one year part‐time course for potential GP trainers is reported using Bernstein's concepts of classification and framing as a means of analysis. The significance of the course and the changes it attempts to bring about are assessed by means of two comparisons. First, the course is related to the classic studies of under‐graduate socialisation within medical school where it is seen to undermine this socialisation through the development of special skills. Second, the development of such special skills is seen as part of an historical trend leading to the further separation or emancipation of general practice from hospital medicine.
Doctors and dirty work—the case of alcoholism*
Authors: Strong P. M.
Published: February 2004

Abstract Doctors’treatment of certain classes of patient as dirty work is often ascribed to irrational reasons such as ignorance and prejudice. This is certainly true of the research tradition which seeks to explain why doctors avoid or dislike alcoholics. However, based on informal interviews with a group of Scottish general practitioners, I argue that, although all may be ignorant in some ways and a few are perhaps prejudiced, there are nevertheless other and quite rational grounds for their general avoidance of alcoholics. For alcoholics break three broad principles which shape conventional medical practice: the assumption of medical expertise, the belief that medical matters fall largely within the‘natural’sphere of things; and the assumption that, despite the doctors’inability to intervene or order, patients are normally motivated to comply with medical instructions. To break one principle would make matters difficult enough, to break all three renders normal consultations highly problematic. I conclude by noting that, although alcoholism has some unique features, the difficulties which its treatment entails are common to much of psychiatric practice also.
The effects of social resources on recovery and perceived sense of control among the disahled*
Authors: Smith Richard T. , Midanik Lorraine
Published: February 2004

Abstract This study examines the effects of social resources on recovery and perceived sense of control among the physically disabled. Data were obtained from personal interviews with 770 non‐institutionalized disabled adults. Two types of social resources are distinguished: those derived from primary group affiliations and those derived from secondary (formal) group relationships. Secondary group sources of supportive services for the disabled may be necessary but not sufficient elements in the recovery process and in determining the disabled's perceived control over the situation. It is hypothesized that recovery and sense of control will be enhanced for those disabled who tend to utilize their social resources. The results are equivocal. An absence of any marked effect of primary group resources and an observed negative effect of secondary group resources appears to enhance recovery. Use of these social resources has little effect on one's perceived sense of control at the time of recovery. The implications of these limited findings are discussed in terms of conceptual and methodological issues involved in delineating and measuring key factors in the process of rehabilitation and recovery.
The ‘eclipse’ of folk medicine in western society
Authors: Bakx Keith
Published: February 2004

Abstract Folk medicine is generally treated as a residue from pre‐scientific times. This article discusses contemporary folk medical practices and locates them firmly in postmodern economy and society. The central theme is that recent transformations in the economy have been paralleled by changes in cultural practices. This is manifest in the increased general awareness of ‘green’ issues and the rejection of ‘modernism’ in all its forms including the industrialised therapies of biomedicine which are seen to exacerbate rather than resolve public health problems. It is argued that popular dissatisfaction with biomedicine has increased and that the cultural gap between biomedical practitioners and their patients has become much more visible in recent times. This has contributed greatly to the secular expansion of folk therapies throughout western society. Finally, the article notes the gaps in current research into alternative medical practices and practitioners.
Categorizing Death
Authors: Williams Robin
Published: February 2004

Review in this article:

J. Maxwell Atkinson, Discovering Suicide: Studies in the Social Organisation of Sudden Death.
On the margins of the medical marketplace? An exploratory study of alternative practitioners’ perceptions
Authors: Cant Sarah L. , Calnan Michael
Published: February 2004

Abstract The aim of this paper, drawing on data from an exploratory, qualitative investigation of the perceptions of alternative practitioners, is to examine the role and position of non‐orthodox medicine within the medical market. It specifically looks at how alternative practitioners firstly ‘experience’ their position and secondly their perceptions and images of how it should be. Clearly, one of the key issues is how the position of alternative practitioners relates to the medical profession and how they manage to estblish and maintain their position. This question was looked at particularly in terms of whether alternative practitioners adopt the strategies used by other occupational groups in the pursuit of autonomy.
Expressivity within a time schedule: subordinated interaction on geriatric wards
Authors: Sellerberg Ann‐Mari
Published: February 2004

Abstract Field research for the current study took place at two Swedish medical institutions specialising in the long‐term care of the elderly. The data consist of taped interviews and observations. On the wards studied, both staff and patients were subordinated to a fixed element in the schedule: the mealtime system. This given frame was non‐negotiable. Instead, each of the two parties tried to emphasise its own particular side of the scheme. In the analysis, Zerubavel's ideas about social calendars as stimulators for collective actions are combined with Georg Simmers thoughts on the effects of subordination under a principle.
Hospital consultants’ views of their patients
Authors: Britten Nicky
Published: February 2004

Abstract A sample of 24 hospital consultants was interviewed and asked for their opinions about a proposed policy of patient access to their own general practice records. Tape recordings of 20 recorded interviews were analysed in order to obtain data about consultants’ views of their patients. Consultants were divided into two main groups: those opposed to and those in favour of the proposed policy.

Three factors were identified which discriminated between the views of the two groups of consultants: whether or not patients were perceived as being competent to take an active and informed part in the consultation; patients’ access to the truth; and the fallibility of medicine. It is suggested that consultants’ views about patients and patient access to medical records were related to their underlying model of illness: consultants opposed to access held a biomedical model of illness whereas those in favour of access held a more psychosocial model of illness.
The mental patient as betrayer
Authors: Warren Carol A.B.
Published: February 2004

Abstract Goffman's analysis of betrayal in relation to mental hospitalisation focuses on the betrayal of the mental patient by his or her next‐of‐relation, and is an ungendered analysis. This paper expands the notion of betrayal in the family relations of mental patients in two ways. First, betrayal is considered as a process with a number of dimensions, including not only the betrayal of the mental patient by family members but also betrayal of the family by the mental patient. Second, aspects of this process are analysed in the context of gender roles in the 1950s family.
Income distribution and mortality: a‘natural’experiment
Authors: Wilkinson Richard G.
Published: February 2004

This paper starts out from the striking tendency for life expectancy to be highest in those developed countries where income is distributed most equally, rather than in those which are richest. It goes on to discuss the shape of the relationship between income and health which this implies within nations. After reproducing evidence from the Health and Lifestyles Survey of a cross‐sectional relationship in Britain which is consistent with the international picture, the paper then reports on a test of the causality of that relationship.

The test compared the changes between 1971 and 1981 in the position of occupations in the‘earnings league’with changes in their position in the occupational mortality league in Britain. The analysis found that changes in mortality were significantly, positively and independently related to changes in the proportion unemployed and the proportion on low relative earnings in each occupation. The percentage change in the size of each occupational group during the decade was used to control for any effects of selection in or out of occupations. The paper concludes with a brief discussion of the implications of these findings.
Organisation and change in renal work: a study of the impact of a computer system within two hospitals
Authors: Dent Mike
Published: February 2004

Renal units exist primarily to dialyse patients with end stage renal failure (ESRF) and to train them to dialyse themselves. An important aspect of the care of renal patients is the regular monitoring and recording of their condition by the nurses and doctors. In consequence, the renal units possess an extensive set of records on each of their dialysis patients. This paper reports on a study of two renal units and the consequences of the introduction of a computerised patient data system. This system was designed to ease the burden on the nurses of manually maintaining the patient records as well as improve the access and analysis of the clinical data for the doctors. The concern of the paper is not whether the system was accepted or rejected but how it came to be utilised and why. Using an approach informed by labour process analysis, this study demonstrates the ways in which the clinical division of labour, in particular the relations between doctors and nurses, shaped the ways in which the computer system was utilised.
An analysis of doctor‐parent interactions in the case of paediatric renal failure: the choice of home dialysis
Authors: Waissman Renée
Published: February 2004

This article attempts to analyse the conditions underlying the choice of home dialysis made by doctors and the parents of children suffering from end‐stage renal disease. As the illness evolves from the time of the initial diagnosis to the final phase, medical professionals and lay persons interact to build the relationships that affect the choice about the method of home care. The role of the head doctor at the Unit of Paediatric Nephrology where fieldwork was carried out was a determinant of the process of interaction. Observations within this Unit and semi‐directive interviews with its personnel, and with 15 families who had children dependent on the Unit, suggest that the parents had the means of making their own viewpoint prevail whenever there was disagreement with medical professionals.
The expressive body: a common ground for the sociology of emotions and health and illness
Authors: Freund Peter E. S.
Published: February 2004

This paper attempts to explore the relevance of the field of sociology of emotions for the sociology of health and illness. An existential‐phenomenological perspective which emphasises subjectivity and the active expressive body is used to bridge the mind‐body‐society splits that characterise both fields.

The paper briefly reviews some of the current literature in the sociology of emotions that tries to address the role of the body in emotional life and then draws on the works of Buytendijk and others on: 1) the form taken by emotional information and communication, 2) the grounding of the schema that structures feelings in bodily experience. This is followed by an outline of ‘unpleasant’ and ‘pleasant’ emotional‘modes of being’. Such modes of being are physically expressed in neuro‐hormonal, muscular skeletal forms and in the manner in which organism and environment exchange matter (eg breathing).

The paper concludes by linking emotional modes of being to social structural features that impinge upon existence. Specifically, these social structural features include a person's social position (status) and the social control activities that accompany social relationships. This final section analyses dramaturgical stress and the social construction of emotional‘false’consciousness.

It is concluded that both the sociology of emotions and health and illness need to incorporate the concept of the living, embodied human subject and recent studies in bio‐psycho‐social research into their discourses. A focus on the emotionally expressive, embodied subject, who is active in the context of power and social control, can provide a useful approach for studying distressful feelings, society, and health.
Is space bad for your health? The relationship between crowding in the home and emotional distress in women
Authors: Gabe Jonathan , Williams Paul
Published: February 2004

Abstract Literature concerning the relationship between crowding (inside and outside the home) and health is reviewed. Attention is then focused on the association between internal density and psychological health in women. This relationship is investigated using data from a community survey conducted in West London in 1977. Our findings indicate a J‐shaped relationship between internal density and psychological symptoms: that is, low as well as high levels of crowding were detrimental to psychological health. This pattern was found to persist after six possible intervening variables were controlled for. Possible explanations for these findings are discussed and lines of further research indicated.
Involvement with a disease and primary care utilization*
Authors: Ben‐Sira Zeev
Published: February 2004

Abstract Is it possible to predict from the attitdues toward diseases the likelihood of primary care utilization? Moreover, considering that an attitude is frequently defined as comprising three main elements: the affective, cognitive and instrumental (1, pp.36–37), is one of these elements predominant in determining the likelihood of medical helpseeking, or does the tendency to seek a General Practitioner's help vary in accordance with the degree of one's involvement in a disease in terms of all three elements? This latter would be similar to a recently identified pattern of engaging in preventive behaviour (2).** We believe that understanding the conditions under which attitudes toward diseases will enhance prediction of actual therapeutic behaviour may be of theoretical as well as practical significance. From the viewpoint of sociological theory it may comprise an additional step in the understanding of the association between attitude and actual behaviour. It may also contribute to the theory of medical helpseeking by stressing the role played by attitudes toward diseases in primary care utilization. From the practical aspect it primarily may assist the medical community, and specifically general practitioners, in understanding the factors that underlie consultation, mainly with respect to those cases which are frequently defined as trivial. It may also elucidate factors underlying delay in helpseeking. Moreover, it may assist planners of prepaid ambulatory services in assessing the volume of primary care utilization and the underlying predominant motivating factors.
Paradoxical consequences of excess in structural complexity: a study of a state children's psychiatric hospital
Authors: Blau Judith R.
Published: February 2004

Abstract This paper examines how a unique organizational structure promotes a high level of care and treatment in a large, public children's psychiatric hospital. The structure ‐ complex and interdependent ‐ is best understood in terms of three dimensions of staff relations: administration, child care, and clinical practice. Because these dimensions are independent of one another and each delineates positions for every staff member, everyone occupies several statuses simultaneously and thus has multiple role relations with nearly every other staff member. Consequences of this multiple‐matrix organization are: the importance of emergent coalitions and diffuse exchange relations for power and influence; a treatment approach that depends on professional expertise but must be legitimized in terms of lay values concerning youngsters; problems of morale and ambivalence. The complex structure engenders a high level of humane care and expert treatment, in part because multiple role relations foster a holistic view of youngsters.
Madness and coping
Authors: Armstrong David
Published: February 2004

Abstract This paper describes the disappearance of madness from medical discourse in the 20th century and the concomitant‘invention’of the neuroses. It is argued that this change in apparent psychiatric morbidity reflects a fundamental reconstruction in the perceived relationship of the individual to the social group and of the social control mechanism of modem society.
A comparative analysis of physician estimates and levels of medical knowledge among patients*
Authors: Segall Alexander , Roberts Lance W.
Published: February 2004

Abstract This study compares the level of medical knowledge among patients with physician estimates of patient comprehension of medical information. Further, the paper evaluates the accumulated body of knowledge pertaining to patient‐physician communication and extends the available research evidence without ascribing culpability to either the patient for a failure to comprehend or to the physician for a failure to explain.

A number of propositions derived from the existing literature were tested using data from 231 patients and 23 physicians at the Family Medical Centre in Winnipeg, Canada. It was found that the meaning of most of the selected medical terms and conditions was correctly understood by the patients, while the physicans generally underestimated patient comprehension of medical terminology.

In concluding the paper, several conceptual and methodological problems are identified which need to be resolved if a more insightful understanding of patient‐physician communication is to be gained.
Medical Mythology
Authors: Figlio Karl
Published: February 2004

Book reviews in this article:

Susan Sontag, Illness as Metaphor.
Trouble in store: some thoughts on the management of waiting lists
Authors: Pope Catherine
Published: February 2004

Abstract This paper examines the day to day organisation and management of surgical waiting lists. A review of the literature on waiting lists identifies the main perspectives on waiting lists and two of these, the queue and the mortlake, are examined. This paper provides a critical analysis of these two theoretical outlooks and considers the explanatory power of each. It draws upon the sociology of work to understand the process of waiting list management, focusing particularly on the role of low level bureaucrats within the hospital setting. Using qualitative case study data on the day to day practices and street level organisation of waiting lists it is possible to identify inadequacies in our perception of waiting lists, of what they are and how they work. In the light of this the paper reconsiders the waiting list phenomenon and finally a new metaphor is proposed, that of the ‘store’ or shop which helps to explain some of the troubles with National Health Service waiting lists.
The United States medical profession: an abnormal form of the division of labour
Authors: Fryer George E.
Published: February 2004

Abstract During the last century, the US medical profession, once dominated by general practitioners, has been transformed into a body of highly specialised physicians. Sweeping technological advances have fueled this evolution in which broadly trained primary care physicians who provide relatively inexpensive comprehensive medical care have become a professional minority. This country's specialty‐oriented system of medical education has produced far more specialised doctors than are required to meet the need for their services among the general population. As a result, medical specialists have invaded the province of primary care physicians. They now compete with generalists for patients who do not have conditions requiring sophisticated specialised medical procedures. Their intrusion into the field of primary care, for which they have not been trained, is bitterly resented by general physicians. This largely unregulated division of labour has been insensitive to patient need and has disrupted the collaboration between general and specialty physicians which previously served the public interest.
Volunteers in the independent hospice movement
Authors: Hoad Peter
Published: February 2004

Abstract This paper explores the roles played by volunteers in independent hospices in Britain. After a brief description of the development of this movement, some findings are given from a postal survey of 401 volunteers from 33 hospices. A considerable internal differentiation was found in the types of responsibility taken by volunteers and they could be distinguished as Administrators, Counsellors, Carers or Ancillaries. Some of these had considerable specialised skills, either derived from work elsewhere or developed specifically for their hospice work. The use of these skills and access to required information could be seen as a challenge to the professional power and knowledge base of the paid staff.
Angels and interfering busybodies: the social construction of two occupations
Authors: Symonds Anthea
Published: February 2004

Abstract The aim of this paper is to look at the creation, function, and ‘meaning’ of the two occupations of health visitor and district nurse. Drawing upon the historical construction of both occupations within specific discourses, the current work practices and training, and upon interviews with current students, a theory of the class nature of these two occupations is proposed. This involves a definition of class as a form of work practice and not a social‐economic or occupational classification. The division between theory and practice, manual and non‐manual labour, and in this instance, between ‘nursing’ as a natural ascribed female quality and ‘education’ as an artificially acquired facility which is gender contradictory is, it is argued, primarily a class division. The title of this paper derives from a summation of some of the perceptions of recipients of community health services collected in a previous research study on their satisfaction with these services.1
How do cancer patients express their points of view?
Authors: Pinell P.
Published: February 2004

Abstract This paper analyses the representations of cancer on the basis of a corpus of letters addressed by cancer patients to the ‘Concertation Nationale sur le Cancer’.

Whenever social agents tackle the question of the aetiology of their cancer, their act consists of retaining data borrowed from medical models and organising it into a narrative reconstruction that gives a meaning to the appearance of their disease. In our case, this reconstruction is based upon a homology between social disorder and biological disorder, which constitutes their frame of reference for defining their personal responsibility. Being able to classify oneself as ‘innocent’ seems to be a necessary condition entitling one to convey one's point of view in public and, in particular, a condition for expressing a critical discourse with regard to the representations of cancer made by non‐afflicted persons. The very act of writing to the Concertation Nationale Cancer is a political act ‐ an ‘official’ intervention in regard to representations is sought through the invalidation of the opinions of the healthy

However, these critical discourses are not free from the very representations which constitute the targets of their criticisms. Cancer patients are still prisoners of ‘archaic representations of the disease’.
Professional autonomy and the opthalmic optician
Authors: Larkin G. V.
Published: February 2004

Abstract The growth of the medical division of labour has been associated with a decline in the ability of the medical profession to determine the work content of para‐medical occupations. The professional emergence of opthalmic opticians is discussed in this paper, and the broad thesis of a historical decline in medical dominance rejected. The pre and post NHS boundary disputes between doctors and opticians are reviewed in terms of a continuing logic of subordination. A shift in the forms of subordination is identified, prior to a concluding discussion of future change.
Background, attitudinal and behavioural patterns of individuals occupying eight discrete health states1
Authors: Fredric D. , Wolinsky Sally R.
Published: February 2004

Abstract This paper examines the backgrounds, attitudes, and behavioural characteristics of individuals occupying the eight discrete health states posited in Wolinsky's recently developed comprehensive health status model. Analysis of variance indicates that age, occupation, education, income, private indemnity insurance coverage, expecting sick role legitimation, use of physician specialists, and having regular sources and sites of health care delivery are differentially distributed across the eight health states. Multiple classification and discriminant function analyses indicate that the pattern reflected in these data is the traditional relationship of health status to socioeconomic status, its second‐order benefits, and its correlates. Forty‐one per cent of all the individuals studied could be correctly placed into their proper health states by using two discriminant functions reflecting socioeconomic status and related characteristics. Regression models using these same socio‐economic and related characteristics explained 32 per cent of the variance in both an abbreviated form of the polytomous health status measure and a continuously coded version of it. Based on the differential utility of regression models severally predicting the individual health states, we propose merging the social class and drift hypotheses to explain the pervasive relationship between socioeconomic status and health status.
Towards a theory of perceived and medically defined need
Authors: Magi M. , Allander E.
Published: February 2004

Abstract This paper presents a theoretical model to be used for comparative studies of lay and medically defined need for medical care. The model is based on an analysis of the concept of need and need statements, lay and medical concepts of ill health and the relationships between need, ill health and utilization of medical care. It is concluded, on both theoretical and empirical grounds, that need is relative to time, place and assessor. The most important determinants of assessments of for what and when one should seek medical attention are assumed to be the assessor's perception and valuation of the health status and his expectations of the probable out‐come of medical care use. Assessment of need is seen as a process in which past experiences and expectations of the future course of the health status affect decision‐making. It is emphasized that the points of view of both client and provider should be taken into consideration in medical practice, as well as in health care planning, because the two perspectives tend to be only partially congruent. The nature and extent of these incongruences could be studied by the application of the proposed model.
What do you get when you fall in love? Some health status effects
Authors: Kemper Theodore D. , Bologh Roslyn Wallach
Published: February 2004

Abstract Students of the effects of life change events on health have asked for studies in which single, desirable, life events that are appropriate to the life stage of the population sampled are examined in relation to health status. We do this with a single event — romantic involvement — that moves through a number of phases. We found in our college student sample that adverse health reactions are more likely to occur among those who have never been in love or who have been in love more than three times; among those involved in a relationship of two to six months duration as opposed to a shorter or longer period; among those who have just broken up a relationship; among those who attribute the break‐up mainly to the other person; and among those who, having broken up, have not found a new romantic interest, or have plunged deeply into a new relationship. Some of the results are moderated by interaction effects with sex of respondent.
Deciphering chronic pain
Authors: Baszanger Isabelle
Published: February 2004

Chronic pain is a problematic reality at least for two reasons. First, pain is a person's private experience, to which no one else has direct access. Second, chronic pain is lasting proof of a failure that questions the validity of actions and explanations, both past and future, of all involved. Because pain is a private sensation that cannot be reduced by objectification, it cannot, ultimately, be stablised as an unquestionable fact that can serve as the basis of medical practice and thus organise relations between professional and lay persons. This fragile factuality increases the work a physician has to do to decipher a patient's pain. The aim of this paper is to examine how physicians specialising in pain medicine work at this deciphering. Because of these characteristics of pain, physicians are forced to work on the elusive information provided by patients so as to bring into being something called chronic pain. When doing this they tap various, nearly incompatible, resources. I shall study the way these multiple resources are put to use by physicians as they form judgements about cases. By using as a field experiment two pain centres with opposite conceptions and practices, it can be shown how physicians in each centre determine patients' pain situations and formulate advice to them, how the characteristics of this work involve physicians in specific systems of relations with patients, and how these systems are related to dimensions of this work: either to a justification of physicians' actions or else to a confirmation, or realignment, of the initial doctor‐patient agreement.
Images of scientific medicine
Authors: Calnan Michael , Williams Simon
Published: February 2004

This paper draws on empirical evidence from recent survey and qualitative research to develop an analysis of lay perceptions of modern medicine and medical practice. It builds on previous exploratory work and examines lay evaluation of a range of medical procedures which include medicines and drugs; elective surgery; reproductive technology and life saving technology. Overall, there was an ambivalence to modern medicine and the criteria used to evaluate modern medicine included whether it was: life saving or life threatening, quality of life enhancing or diminishing, natural or unnatural, restored independence or created dependence, and whether it was good value for money or not. The theoretical implications of these findings for understanding the structure and nature of lay perceptions are discussed.
Taboos and excesses: lay health moralities in middle class families
Authors: Backett Kathryn
Published: February 2004

The paper is based on a multi‐interview qualitative study of whole family groups. The sample comprised a randomly selected group of home‐owning, middle‐class couples, each with two children. It was hypothesised that, by virtue of their socio‐economic circumstances, such a group would be likely to have a positive view of health; to be receptive to health education messages; to be less likely to engage in health‐damaging behaviour; and to have sufficient material resources to provide an environment conducive to health promoting practices. The study aimed to understand health‐related beliefs and behaviours within the social contexts of everyday domestic and work life.

It was evident that knowledge about health was not necessarily translated into behavioural practices, even in a health promoting environment. Differences also existed between respondents' initial accounts of their ‘usual’ behaviours and the detailed descriptions of their daily lives obtained in later interviews. A concern for good health was simply one amongst many competing sets of priorities which affect daily behaviours. Choices amongst such priorities often included wider social and moral evaluations. This paper focuses on the role of such evaluations in respondents' accounts of health; in their everyday health‐relevant decisions; and in interactions between family members.
Discourse, organisation and the surgical ward round
Authors: Fox Nicholas J.
Published: February 2004

The surgical ward round is examined as an organisational strategy entered into by surgeons to enable particular claims about the success of surgery to be validated.

The paper reports ethnographic data from UK surgical wards which suggest that surgeons organise the discourse of their interactions with patients around three themes: physiology, wound condition and recovery/discharge. These themes are surgeon‐centred, and are organised to deny patients access to the agenda of these encounters.

Within a post‐structuralist and postmodern framework, these strategies of discourse organisation are understood as techniques of power. Surgeons privilege discourses which support their claims to be healers, denying those which focus on the necessary injury which surgical resection causes. The paper argues that the ‘ward round’ is a mythical structure constituted as an organisational strategy to counter challenges from patients to their hegemonic discourse.
The role of social support in mediating the psychological consequences of economic stress
Authors: Whelan Christopher T.
Published: February 2004

The idea that social support can act as a buffer against the negative consequences of stress has been a particularly influential one. Most of the relevant research has focused on the impact of life events as measured through the standard life‐event inventory methodology. Such research has lacked a sociological character in that the structural contexts of people's lives are treated as if they were extraneous to the stress process. In this paper I have drawn on the sociological literature relating to the conceptualisation and measurement of poverty in order to situate the stress process in the context of people's location within an unequal distribution of resources. The measure of chronic stress which is employed is based on enforced absence of socially defined necessities. Exposure to such stress is the primary determinant of psychological distress. Both instrumental and emotional support, however, serve to buffer the effects of extreme life‐style deprivation.
Coalitions and conflict in the national health service: some implications for general management
Authors: Thompson David
Published: February 2004

Abstract This paper suggests that conflict is an inescapable feature of National Health Service organisational life, and that it is legitimate area of study. It describes a number of powerful coalitions whose interactions can produce conflict as they attempt to influence the distribution of scarce resources. In particular, it focusses on the beliefs and power of a ‘practitioner interests’ coalition and an ‘administrative ethic’ coalition.

To survive in this world of coalitions, NHS general managers need to assert their own positions. Are they to be agents of the existing coalitions or can they construct their own and achieve its dominance? The paper concludes by discussing how a distinctive general management coalition might emerge.
Grounding the alienation of self and body: a critical, phenomeoological analysis of the patient in western medicine1
Authors: Bologh Roslyn Wallacli
Published: February 2004

Abstract The treatment of the body as a tiling separate from the social self is made the object of inquiry. The implications of this separation are explored as follows: (1) The failure on the part of the medical profession to treat differences in morbidity and mortality rates due to social class, occupation and environment as an object of medical concern; (2) Domination by the medical profession, subordination of the patient and a corresponding sense of entitlement on the part of one and vulnerability on the part of the other; (3) The control of medical knowledge by the profession for its own interests which do not always correspond to the patient's interests; (4) The failure to communicate successfully with patients; (5) The intentional avoidance of informing patients about the nature of or prognosis for their illness; (6) Exploitation of the patient by the medical profession (e.g. unnecessary surgery); (7) The difference in the quality of care and attitudes toward patients according to social or imputed moral differences among patients; (8) The loss of autonomy arid dignity on the part of the patient. This state of affairs is analysed in terms of the definition of the physician as curer, the treatment of medical knowledge as private property, and the context of a market economy.
Medical norms and medical innovation: adoption of genetic counselling and new drugs among primary care physicians
Authors: Weitz Rose
Published: February 2004

Abstract This study analyses the differential impact of physicians’traditional professional norms on their use of two innovations, genetic counseling and new drugs. These two medical innovations require rather different practice orientations, since the former (genetic counselling) necessitates a non‐traditional preventive and psychosocial approach, while the latter (prescribing new drugs) can occur within a traditional interventionist treatment framework. It is hypothesized that acceptance of traditional norms will be positively correlated with use of new drugs, but negatively correlated with use of genetic counselling. Data obtained through mailed questionnaires received from 307 primary care physicians practising in or near Phoenix and Tucson, Arizona, provide tentative support for the research hypothesis. The discussion suggests some dysfunctional aspects of traditional medical norms, and points to the need for further research on the unanticipated consequences of that normative structure.