Social science & medicine
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Social science & medicine · Sep 2004
Comparative StudyMotivation and values of hospital consultants in south-east England who work in the national health service and do private practice.
In the UK, a small private health care sector has always existed alongside the national health service (NHS). The conventional assumption is that doctors who work as salaried employees of the NHS are guided in their clinical practice by professional values which encourage them to put their patients' interests first. A common suspicion is that doctors undertaking fee-for-service practice in the private sector are motivated by self-interest, with commitment to their patients compromised by consideration for their purse. ⋯ The existence of the private sector and their own engagement in it was regarded by almost all respondents as a net benefit, not only to themselves and their private patients, but also to the NHS, so long as they handled it properly. The interviews revealed a complex range of beliefs and assumptions through which these doctors justify their activities and a variety of informal principles for dealing with such conflicts of interest as they acknowledge. Neither their values nor their actions can be adequately explained using generic concepts of professional self-interest or public service values without consideration of what such concepts represented in the specific social, economic, professional and policy context of health care in south-east England at the time of the study.
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Social science & medicine · Sep 2004
Multicenter StudyAntenatal care: provision and inequality in rural north India.
The objectives of this paper are to examine factors associated with use of antenatal care in rural areas of north India, to investigate access to specific critical components of care and to study differences in the pattern of services received via health facilities versus home visits. We used the 1998-1999 Indian National Family Health Survey of ever-married women in the reproductive age group and analysed data from the states of Bihar, Madhya Pradesh, Rajasthan, and Uttar Pradesh (n = 11,369). Overall, about three-fifths of rural women did not receive any antenatal check-up during their last pregnancy. ⋯ Thus, pregnant women from poor and uneducated backgrounds with at least one child were the least likely to receive antenatal check-ups and services in the four large north Indian states. Basic antenatal care components are effective means to prevent a range of pregnancy complications and reduce maternal mortality. The findings indicate substantial limitations of the health services in overcoming socio-economic and cultural barriers to access.
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Social science & medicine · Sep 2004
'I am not the kind of woman who complains of everything': illness stories on self and shame in women with chronic pain.
In this study, we explore issues of self and shame in illness accounts from women with chronic pain. We focused on how these issues within their stories were shaped according to cultural discourses of gender and disease. A qualitative study was conducted with in-depth interviews including a purposeful sampling of 10 women of varying ages and backgrounds with chronic muscular pain. ⋯ In several ways, the women negotiated a picture of themselves that fits with normative, biomedical expectations of what illness is and how it should be performed or lived out in 'storied form' according to a gendered work of credibility as woman and as ill. Thus, their descriptions appear not merely in terms of individual behaviour, but also as organized by medical discourses of gender and diseases. Behind their stories, we hear whispered accounts relating to the medical narrative about hysteria; rejections of the stereotype medical discourse of the crazy, lazy, illness-fixed or weak woman.
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Social science & medicine · Jul 2004
Is patient involvement possible when decisions involve scarce resources? A qualitative study of decision-making in primary care.
Greater patient involvement has become a key goal of health care provision. This study explored the way in which general practitioners (GPs) in the UK manage the dual responsibilities of treating individual patients and making the most equitable use of National Health Service (NHS) resources in the context of the policy of greater patient involvement in decision-making. We undertook a qualitative study incorporating a series of interviews and focus groups with a sample of 24 GPs. ⋯ More explicit decision-making in primary care will need to be accompanied by greater explicitness at the national level about roles and responsibilities. Increased patient involvement has consequences for GP training and ways of addressing rationing dilemmas will need to be an important part of this training. Further research is needed to understand micro-decision-making, in particular the spaces in which processes of implicit categorisation lead to distorted communication between doctor and patient.
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Social science & medicine · Jun 2004
The medical practice of patient autonomy and cancer treatment refusals: a patients' and physicians' perspective.
The idea that patients should take up an autonomous position in the decision-making process is generally appreciated. However, what patient autonomy means in the case of patients who refuse a recommended oncological treatment has not been investigated. This study aims to clarify how the concept of patient autonomy can be applied to patients who refuse a recommended oncological treatment. ⋯ The results show that the extent of pressure physicians will exert to persuade the patient to be treated as recommended depends on the medical distinction between a curative and a non-curative treatment goal. It seems that there exists a shift in respecting patient autonomy, which depends on factors like treatment goal. Discussing the respect shift may serve to clarify underlying thoughts and principles in the decision-making process for both physicians and patients.