bluuebunny/crossref_metadata_2025_split huggingface dataset:
Actor‐network theory, technology and medical sociology: an illustrative analysis of the metered dose inhaler
Authors: Prout Alan 
Published: February 2004

AbstractActor‐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

AbstractThe 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

AbstractThis 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

AbstractIn 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

AbstractThis 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

AbstractThe 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

AbstractBased 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

AbstractThe 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

AbstractSocial 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

AbstractThis 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.
Using private health insurance. A study of lay decisions to seek professional medical help
Authors: Cant Sarah L. , Calnan Michael 
Published: February 2004

AbstractThis 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

AbstractIn 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 recordedThe 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.
Has menstruation been medicalised? Or will it never happen…
Authors: Bransen Els 
Published: February 2004

AbstractIn 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.
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.
Income distribution and mortality: a‘natural’experiment
Authors: Wilkinson Richard G. 
Published: February 2004

AbstractThis 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

AbstractRenal 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

AbstractThis 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

AbstractThis 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.
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.