Sociology of health & illness
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Recent UK health policy initiatives promote a 'no blame culture' and learning from adverse events to enhance patient safety in the NHS. Similar initiatives exist in the USA and Australia. ⋯ The Three Inquiries, a recent series of statutory inquiries held in the UK, are used as a case study to explore some of the intra- and inter-professional difficulties of reporting errors and misconduct by medical practitioners. The paper offers an interpretive social science perspective as an alternative to more policy oriented and managerial approaches to patient safety issues, focusing on deeper structural aspects of organisational phenomena implicated in the ability or otherwise of medical and other healthcare staff to report mistakes and misconduct as one aspect of patient safety.
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With the increasing corporate and governmental rationalisation of medical care, the mandate of efficiency has caused many to fear that concern for the individual patient will be replaced with impersonal, rule-governed allocation of medical resources. Largely ignored is the role of moral principles in medical decision-making. This analysis comes from an ethnographic study conducted from 1999-2001 in three US Intensive Care Units, two of which were using the computerised decision-support tool, APACHE III (Acute Physiological and Chronic Health Evaluation III), which notably predicts the probability that a patient will die. ⋯ To maintain jurisdiction over the care of patients, physicians share the data with the payers and regulators of care to prove they are using resources effectively and efficiently, yet they use the system in conjunction with moral principles to justify treating each patient as unique. Thus, concern for the individual patient is not lessened with the use of this system. However, physicians do not share the data with patients or surrogate decision-makers because they fear they will be viewed as more interested in profits than patients.
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Sociologists studying the topic of workplace injury have neglected professional athletes despite the fact that, for such employees, remaining 'active' at work is of paramount importance. This study involved semi-structured interviews with 47 current and former male professional footballers who all had careers in the English professional football leagues. The interviews focused on the players' experiences of injury and rehabilitation and their relationships with club managers, physiotherapists and doctors. ⋯ For players, the social conditions of work, for example the internal competition for places, all have implications with respect to their presentation of self when they are claiming to be injured or in pain. The often conflict-ridden relations between players and managers, combined with a culture that normalises pain and injury, means that players often find themselves in health-compromising situations. Thus, examining this highly physical vocation provides an opportunity to add to the literature in which injury at work is socially produced through interpretive social interaction.
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The distribution of work, knowledge and responsibilities in the delivery of anaesthesia has attained particular significance recently as attempts to meet the demands of the European Working Times Directive intensify existing pressures to reorganise anaesthetic services. Using Lave and Wenger's (1991) notions of 'legitimate peripheral participation' in 'communities of practice' (and Wenger 1998) to analyse ethnographic data of anaesthetic practice we illustrate how work and knowledge are currently configured, and when knowledge may legitimately be taken as the basis for action. The ability to initiate action, to prescribe healthcare interventions, we suggest, is a critical element in the organisation of anaesthetic practices and therefore central to any attempts to reshape the delivery of anaesthetic services.