Journal of evaluation in clinical practice
-
When we face an equation with an unknown variable, we 'solve for x', using methods that allow us to isolate and identify the unknown. Stigma is a known variable in health care equations, but remains impactful in a variety of ways that are not fully mapped or understood. In other words, stigma is a known unknown: it presents potential obstacles to the delivery of effective health care, but what kind of obstacles, of what size and significance, and for whom is often unclear. ⋯ The present paper begins by demonstrating that stigma in mental health care remains an obstacle worthy of sustained attention. It then discusses typical methods taken in efforts to destigmatize mental illness, and suggests that additional work is needed in the clinical context of mental health care. The pervasiveness and complexity of stigma requires diligence in clinical settings to integrate the experience of mental health care service users and work towards an adequate model of recovery.
-
Six years ago, the Supreme Court judgement in Montgomery v Lanarkshire changed medical law. It introduced a new patient-based standard of care for the communication of treatment risks and alternatives, rejecting the doctor-based standard that had long governed all aspects of medical negligence. This is the first systematic review to analyse the literature on Montgomery. Our aim is to appraise and synthesize the literature on Montgomery's impact on medicine and the law and to identify areas for further academic enquiry and implications for professional guidance and training. ⋯ Despite the abundance of legal and medical literature on Montgomery, many issues remain unresolved. Empirical research is required for many of the questions. Doctrinal analysis informed by medical knowledge is also required to assess whether Montgomery may have unrecognized ramifications-for example, whether it will require the disclosure of risks associated with diagnostic uncertainty, where doctors advise patients without performing procedures.