Social science & medicine
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Social science & medicine · Nov 1997
"We decide, you carry it out": a social network analysis of multidisciplinary long-term care teams.
The purpose of this study was to describe the structure of multidisciplinary long-term care teams by identifying the pattern of relationships that develop amongst staff as they go about their work. Using a social network analysis approach, team members were classified as occupying the same structural position based on their patterns of relationships with other team members. The analysis was based on the results of a self-administered survey of 93 health care workers on three teams in the same multilevel geriatric care facility in Metropolitan Toronto. ⋯ The multiprofessional sub-team has an "organic" structure and is mainly involved in teamwork that involves decision-making and problem-solving, whereas the nursing sub-team has a "mechanistic" structure and is mainly involved in task oriented work. The findings of this analysis indicate that while teamwork may be increasing the participation in decision-making by health professionals other than medicine, rather than flattening the hierarchical structure throughout the health care division of labour, its effects are limited to a group of higher status professionals. The clearly defined hierarchy remains for the lower status subdisciplines, and "I decide, you carry it out" has simply become "We decide, you carry it out".
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Social science & medicine · Oct 1997
"Painting a Leonardo with finger paint": medical practitioners communicating about death with aboriginal people.
This article describes 19 semi-structured interviews with medical practitioners working in the Northern Territory of Australia. The interviews explored the practitioners' perceptions of the differences between Aboriginal and Western beliefs about disease causation and death. The interviews further explored how these perceptions affected the practitioners' communication of mortality information and their response to the practical and legal tasks of reporting deaths to the coroner, requesting postmortems and certifying death. ⋯ The first was the variety of interpretations placed by medical practitioners on the concept of "respect", and the difficulty they had in showing that respect in light of competing Western legal and professional obligations. The second theme was that medical practitioners felt that Aboriginal people's notions of "blame" did not match their own; this led some medical practitioners to become despondent, whilst others negotiated this tension creatively. Use of the word "blame" almost solely to refer to the Aboriginal discourse served to exoticise the Aboriginal process and obscure its areas of similarity with the Western discourse of "responsibility".
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Recent evidence has indicated that physician judgments of patients can be influenced by contextual factors. This study examined three contextual factors relevant to hypothetical patients with low back pain, using vignettes that were varied in a 2 x 2 x 2 factorial design: level of reported pain (high vs low), level of supporting medical evidence (high vs low), and the valence of the physician-patient interaction (positive vs negative). ⋯ Ratings of pain and disability were lower for patients without supporting medical evidence; ratings of distress, somatic preoccupation, and disability were greater for patients who exhibited negative rather than positive affect; internist ratings of pain were lower than patient ratings among patients reporting high levels of pain, while ratings were inflated for patients with low levels of pain. The results suggest that characteristics of both the patient and the situation may influence medical judgments.
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Social science & medicine · Sep 1997
Gender differences in medical treatment: the case of physician-prescribed activity restrictions.
A growing scientific literature highlights concern about the influence of social bias in medical care. Differential treatment of male and female patients has been among the documented concerns. Yet, little is known about the extent to which differential treatment of male and female patients reflects the influence of social bias or of more acceptable factors, such as different patient preferences or different anticipated outcomes of care. ⋯ Female patients exhibit more illness behavior than males, and these behaviors increase physicians' tendency to prescribe activity restrictions. After accounting for illness behavior differences and all other factors, the odds of prescribed activity restrictions among female patients of male physicians is four times that of equivalent male patients of those physicians. Medical practice, education, and research must strive to identify and remove the likely unconscious role of social bias in medical decision making.
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Social science & medicine · Sep 1997
The ethics of euthanasia--attitudes and practice among Norwegian physicians.
The ethical guidelines of the Norwegian Medical Association strongly condemn physician participation in euthanasia and assisted suicide. A previous study on attitudes towards euthanasia in the Norwegian population, however, indicates that a substantial part of the population is quite liberal. This study explores Norwegian physicians' attitudes towards and experience with end of life dilemmas. ⋯ Seventeen percent answered yes to a question of whether a physician should have the opportunity to actively end the life of a terminal patient in great pain who requests this help, while 4% agreed that the same could be done to a chronically ill patient with great pain and a poor quality of life who otherwise would have several more years to live. Six percent of the physicians had performed actions intended to hasten a patient's death, while 76% said that they at least once had treated patients even if they had felt that treatment should have been discontinued. A multiple logistic regression analysis showed that internal medicine specialists, surgeons and psychiatrists were significantly more restrictive than their colleagues in laboratory specialties, and that physicians educated abroad and those with negative attitudes towards patient autonomy had more liberal attitudes towards euthanasia, when gender and time since graduation from medical school were controlled for.