Health
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Conflict in health service delivery is common. It is often attributed to disputes between clinicians and patients or their families about treatment decisions and is particularly common in intensive care units (ICUs), in the form of ;futility disputes' between families and medical clinicians about decisions to terminate the active treatment of a dying family member. More common, but less prominent in the literature, is conflict within the medical profession about patient care goals and treatment. ⋯ Improving patients' and families' experience of care requires medical clinicians and medical managers to accept responsibility for institutionalizing effective communication and decision-making processes within clinical networks and between clinical and managerial domains. Thus, strategies to improve patient care will need to extend beyond the medical profession to incorporate administrative management. We conclude that restructuring communication and decision-making processes is imperative to achieve clinical accountability in the workplace and systems accountability in the organization.
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The resources of rhetorical theory, the classical theory of persuasion, can be marshaled to help physicians evaluate patient complaints for which there is no corresponding objective evidence and which rely, therefore, on the persuasiveness of patients to be taken seriously (contestable complaints). An appropriate focus for the evaluation of such complaints is argumentation itself: what, in the absence of objective evidence of disease, counts as a good argument for a patient to be eligible for medical attention? How do patients convince physicians that they are ill and in need of care - and, conversely, how do physicians convince patients, when the need arises, that they are well and not good candidates for medical intervention? Two rhetorical concepts are especially productive for the analysis of argumentation. One is kairos, the Sophistic notion of contingency, and the other is pisteis, the Aristotelian catalogue of persuasive appeals. A focus on types of arguments directs attention away from types of patients (difficult, suspect, malingering and so on), and provides a more neutral means of judging claims to illness.
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Health circulates inside bodies, as a condition of cells, tissues and organs, and outside bodies as signs. Health stories offer people bits of a subjectivity of health: an awareness of what is interior, expressed in signs that are exterior. ⋯ Stories connect people who may become patients, providers of health services, health products, images, fears and desires. Following Latour, health stories are understood as a form of plug-in: resources that provide people with an ability to recognize and connect what was disparate.
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Despite larger numbers of women in medicine and strong statements against gender discrimination in written policies and the medical literature, sexual harassment persists in medical training. This study examines the everyday lives of women and men resident physicians to understand the context within which harassment unfolds. The narratives explored here reveal how attention is deflected from the problem of sexual harassment through a focus on women's 'sensitivity'. ⋯ Ultimately, both tactics of resistance fail. Closer examination of the relations shaping everyday actions is key, as is viewing the rigid hierarchy of authority and power in medical training through a gender lens. I conclude with a discussion of how reforms in medical education must tend to the gendered, everyday realities of women and men in training.