Всего статей в данном разделе : 263
Опубликовано на портале: 22-03-2007Stefan Timmermans Sociology of Health and Illness. 1994. Vol. 16. No. 3. P. 322-339.
In this paper, the author employs a grounded theory approach to extend an existing theory. His starting point is the theory of awareness contexts, first formulated in 1965 by Strauss and Glaser. Using introspective ethnography, he illustrates that the way patients and relatives emotionally cope with terminal information defines the kind of awareness context. He therefore suggests that the open awareness context should be split into three different contexts. In the suspended open awareness context, the patient or kin ignores or disbelieves the message communicated by the physician. In the uncertain open awareness context, the patient or family member dismisses the bad parts of the message and hopes for the best outcome. In the active open awareness context, the patient or relative accepts the impending death and prepares for it. This revision reclaims the emotional power of terminal illness from the viewpoint of patients and relatives and adapts the theory to changed structural conditions.
Опубликовано на портале: 04-03-2007Susan A. Nancarrow, Alan M. Borthwick Sociology of Health and Illness. 2005. Vol. 27. No. 7. P. 897-919.
The healthcare professions have never been static in terms of their own disciplinary boundaries, nor in their role or status in society. Healthcare provision has been defined by changing societal expectations and beliefs, new ways of perceiving health and illness, the introduction of a range of technologies and, more recently, the formal recognition of particular groups through the introduction of education and regulation. It has also been shaped by both inter-professional and profession-state relationships forged over time. A number of factors have converged that place new pressures on workforce boundaries, including an unmet demand for some healthcare services; neo-liberal management philosophies and a greater emphasis on consumer preferences than professional-led services. To date, however, there has been little analysis of the evolution of the workforce as a whole. The discussion of workforce change that has taken place has largely been from the perspective of individual disciplines. Yet the dynamic boundaries of each discipline mean that there is an interrelationship between the components of the workforce that cannot be ignored. The purpose of this paper is to describe four directions in which the existing workforce can change: diversification; specialisation and vertical and horizontal substitution, and to discuss the implications of these changes for the workforce.
Explaining the Social Patterns of Depression: Control and Problem Solving - or Support and Talking? [статья]
Опубликовано на портале: 19-02-2007Catherine Ross, John Mirowsky Journal of Health and Social Behavior. 1989. Vol. 30. No. 2. P. 206-219.
Research on the social patterns of depression in the community finds consistently that high levels of education and income, being male, and being married are associated with lower levels of depression. Authors attempt to explain these patterns as the result of two essential social perceptions: the sense of controlling one's own life rather than being at the mercy of powerful others and outside forces, and the sense of having a supportive and understanding person to talk to in times of trouble. In theory, the sense of control reduces depression because it encourages active problem solving, and the sense of support reduces depression because it provides others to talk to. They find evidence for the first proposition: persons who feel in control of their lives are more likely to attempt to solve problems. Perceived control and problem solving decrease depression and largely explain the effects of income and education on depression. At the same time they find, however, that support has mixed effects. Support decreases depression, but talking to others when faced with a problem, which increases with the level of support, increases depression. Support explains a small part of the effect of marriage on depression. Control and support have an interactive effect on depression, suggesting that control and support can substitute for one another to decrease depression: a high level of one reduces the need for the other, and a low level of one is remedied by a high level of the other.
Опубликовано на портале: 22-03-2007Susie Scott Sociological Review. 1999. Vol. 47. No. 3. P. 432-460.
Sociological responses to the increase in recent years of psychiatric reports of multiple personality (latterly redefined as Dissociative Identity Disorder) have focused upon its discursive production as a diagnostic category. Drawing on life-history interviews with survivors of extreme childhood abuse - some of whom defined themselves as having 'multiple personalities' - this paper suggests that an adequate sociological account needs to combine analysis of the popular and clinical discourses of dissociation/multiplicity, with an understanding of the relationship between these and particular individual auto/biographies. The production of a narrative of fragmented subjectivity is considered as an active engagement with previously denied and silenced autobiographical experience and with the dominant contemporary discourse that allows for the episodic denial of self-reflexive selfhood. In the light of DID diagnoses being largely applied to/adopted by women, questions are raised concerning the possible impact of the adoption of a multiple identity on individual integrity and autonomy.
“Health Is Better Than Wealth”: Controversies of the Marketization of Vital Goods (The Case of the Moscow Dental Market). Summary [статья]
Опубликовано на портале: 01-11-2012Elena Berdysheva Laboratorium. Журнал социальных исследований. 2012. № 2. С. 264-269.
This article, based on the examination of the Moscow dental market, focuses on the social construction of market commodities out of vital goods. Through qualitative content analysis of 184 dental clinics’ websites and 25 in-depth interviews with dentists and managers of Moscow commercial clinics, I reconstruct dominant views about the nature of dental services as a commercial product, its social meanings, and parameters of quality. I show that actors categorize their commercial services in terms of medical assistance, professional duty, and qualiﬁ cations or skills. An emphasis on personalized care enables clinics to avoid suspicions of a mercenary approach to their patients. The results of my study contradict assumptions about the inevitable dehumanization of medicine through the marketization of healthcare and suggest that, instead of criticizing the expansion of markets within social life, sociologists should look more closely at the practical mechanisms, processes, and conditions of marketization in contemporary society.
Information Giving in Medical Care [статья]
Опубликовано на портале: 23-03-2007Howard Waitzkin Journal of Health and Social Behavior. 1985. Vol. 26. No. 2. P. 81-101.
Information giving is a crucial element of medical care. This research project considered two theoretically grounded hypotheses: (1) Doctors may withhold information and maintain uncertainty to preserve power in the doctor-patient relationship, and (2) class-based sociolinguistic differences in language use may create further impediments to information giving. A multivariate research model was operationalized to study these hypotheses and to assess other associations between information giving and the characteristics of doctors, patients, and the clinical situations in which they interact. An analysis of a sample of 336 encounters recorded from several outpatient settings revealed that doctors spent little time informing their patients, overestimated the time they did spend, and underestimated patients' desire for information. Contingency-table analysis showed that information transmittal was associated with (1) doctors' income, social class background, political ideology, and perceptions of patients' informative needs; (2) patients' age, sex, social class, education, and prognosis; and (3) situational characteristics such as the length of acquaintance, numbers of patients seen per day, and the types of patients in the doctors' practices. Multiple regression analysis assessed the relative importance of these variables in explaining the variation in information transmittal. The findings did not clearly confirm a relationship among information withholding, uncertainty, and power but did clarify the importance of class-based sociolinguistic barriers to communication.
Опубликовано на портале: 19-02-2007Samuel W. Bloom Journal of Health and Social Behavior. 1986. Vol. 27. No. 3. P. 265-276.
The emphasis of this analysis is on the social institutional history of medical sociology. This subfield is described as (1) closely connected with the patterns of development in its current discipline, (2) as containing a dual thrust between applied and basic science, and (3) as struggling with "insider-outsider" ambiguity involving the work of subgroups working either in medicine or from roles external to medicine but studying the sociology of medicine. Tracing a detailed historical fragment from the decade following World War II, it is predicted that the continuity of an accepted position for medical sociology is assured even though the style and quality of its professional life are full of uncertainty.
Managerialism in the Australian Public Health Sector: Towards the Hyper-Rationalisation of Professional Bureaucracies [статья]
Опубликовано на портале: 23-03-2007John Germov Sociology of Health and Illness. 2005. Vol. 27. No. 6. P. 738-758.
This paper draws on qualitative case-study research to discuss the impact of managerialism on the work organisation of public sector health professionals in Australia. The case studies included 71 semi-structured interviews with a broad range of public sector health professionals (predominantly nursing and allied health professionals, with some doctors and managers). The data are used to examine the implications of managerialism for the organisation of professional (public) bureaucracies. The findings show that while health professionals were able to exert their agency to influence managerial processes, the incorporation of managerial strategies into professional practice placed constraints upon professional autonomy. The impact of managerialism on professional bureaucracies is examined using the neo-Weberian framework of hyper-rationality, an ideal type derived from a combination of four forms of rationality identified in Weber's work: practical, formal, substantive and theoretical rationality. Applied to the social organisation of health-care work, this paper critically examines the utility of the hyper-rationality ideal type, noting its limitations and the insights it provides in conceptualising the impact of managerialism on professional (public) bureaucracies.
Опубликовано на портале: 23-03-2007David Mechanic Journal of Health and Social Behavior. 1989. Vol. 30. No. 2. P. 147-160.
Why is it that quantitative and qualitative researchers on health issues often have divergent findings and conclusions? Exploration of such differences can be a useful way of bringing separate intellectual enclaves in medical sociology together and also can stimulate future inquiries. Some differences can be resolved by more precise definitions, by comparable frequency and timing of measurement, and by careful evaluation of meaning contexts. The triangulation of methods, using diaries as a bridge between surveys and qualitative measurement, offers particular promise. Improved theory on the relationships of method to data, and more attention to behavioral sequences and the social context of measurement, can serve as a stimulant to innovative solutions.
Michele Rivkin-Fish, Women’s Health in Post-Soviet Russia: The Politics of Intervention. Indiana University Press, 2005. Рецензия [статья]
Опубликовано на портале: 02-03-2011И Б Кузнецова-Моренко Laboratorium. Журнал социальных исследований. 2010. № 3. С. 218-220.
Исследование Мишель Ривкин-Фиш (Michele Rivkin-Fish) посвящено репродуктивному здоровью женщин России.
Опубликовано на портале: 22-03-2007Carl May Sociology of Health and Illness. 2006. Vol. 28. No. 5. P. 513-533.
Conventional models of 'evidence' for clinical practice focus on the role of randomised controlled clinical trials and systematic reviews as technologies that promote a specific model of rigour and analytic accountability. The assumption that runs through the disciplinary field of health technology assessment (HTA), for example, is that the quantification of evidence about cost and clinical effectiveness is central to rational policy-making and healthcare provision. But what are the conditions in which such knowledge is mediated into decision-making contexts, and how is it understood and used when it gets there? This paper addresses these questions by examining a series of meetings and seminars attended by senior clinical researchers, social care and health service managers in the UK between 1998-2004, and sessions of the House of Commons Health Committee held in 2001 and 2005. These provide contexts in which questions about the value and utility of evidence produced within the frame of HTA were explored in relation to parallel questions about the design, evaluation and implementation of telemedicine and telecare systems. The paper points to the ways that evidence generated in the normative frame of HTA was increasingly seen as one-dimensional and medicalised knowledge that failed to respond to the contingencies of everyday practice in health and social care settings.
Models of Illness and the Theory of Society: Parsons Contribution to the Early History of Medical Sociology [статья]
Опубликовано на портале: 05-12-2006Uta Gerhardt International Sociology. 1990. Vol. 5. P. 337-355.
Parsons medical sociology has recently been recognized for its importance to his theory of society. But the double focus of his explanations of illness is not yet widely understood. It comprises a capacity model based on economic thinking and a deviancy model based on psychoanalytic thought. In the 1930s and 1940s Parsons undertook to understand medical practice in order to focus on liberal democracy in modern society. He used medical practice as an example and also as a metaphor to demonstrate the mechanisms of liberal democracy as against those of capitalism , socialism and the then contemporary racism. By considering this background, the link between models of illness and the theory of society, established in The Social System, ought to be recognized by Parsons’ critics who then might not have charged him with advocating a non-democratic solution to the problem of how the social order is possible. By recommending the recognition of the double focus of Parsons’ illness explanation, and its viability for his theory of action system, it is argued that Parsons was criticized too readily in the 1960s and that his humanistic standpoint can be recovered by focusing on his early contribution to medical sociology.
Опубликовано на портале: 23-03-2007Renee R. Anspach Journal of Health and Social Behavior. 1988. Vol. 29. No. 4. P. 357-375.
This paper examines a segment of medical social life that has not been studied extensively: formal presentations of case histories by interns, residents, and fellows. Because they are presented by physicians in training to their status superiors, who are evaluating them, case presentations are exercises in self-presentation which serve as a vehicle for professional socialization. This analysis of the language of case presentation is based on case presentations collected in two intensive care nurseries and an obstetrics and gynecology service. Four features of case presentation are identified: 1) the separation of biological processes from the person (de-personalization); 2) omission of the agent (e.g., use of the passive voice; 3) treating medical technology as the agent; and 4) account markers, such as "states," "reports," and "denies," which emphasize the subjectivity of patients' accounts. The language of case presentation has significant, if unintended, consequences for those who use it. First, some features of case presentation eliminate the element of judgment from medical decisions and mitigate responsibility for medical decision making. Second, some are rhetorical devices which enhance the credibility of the findings that are presented. Third, the language of case presentation minimizes the import of the patient's history and subjective experience. Finally, case histories socialize those who present them to a culture or world view which may contradict the explicit tenets of medical education.
On Practices of 'Good Doctoring': Reconsidering the Relationship between Provider Roles and Patient Adherence [статья]
Опубликовано на портале: 23-03-2007Karen Lutfey Sociology of health and illness. 2005. Vol. 27. No. 4. P. 421-447.
Questions pertaining to patient adherence and provider roles are part of the classical repertoires in sociological and health services research. While extensive research programmes consider why patients do not follow medical advice, less is known about how practitioners assess patient adherence. Similarly, there has been much work on provider roles changing with the organisation of healthcare, but less attention to the ways providers conceptualise, choose and strategically enact practices in the course of their work. Using data from a year-long ethnographic study of two diabetes clinics, the author examines some of the stances medical practitioners actively choose and enact in their treatment of diabetes patients – educators, detectives, negotiators, salesmen, cheerleaders and policemen – and how they tailor their actions to specific patients in order to maximise their adherence to treatment regimens. Findings suggest that the notions of 'patient adherence' and 'physician roles' are conceptually broader and more fluid than what is captured in existing literature, and this rigidity potentially impairs our ability to learn more about the everyday practices of medical work.
Опубликовано на портале: 23-03-2007Simon Johnson Williams Health. 2005. Vol. 9. No. 2. P. 123-144.
This article revisits Parsons’ insights on medicine, health and illness in the light of contemporary debates in medical sociology and beyond. A preliminary balance sheet of the Parsonian legacy is first provided, taking on board standard accounts and criticisms of Parsons’ work within medical sociology to date. The remainder of the article, in contrast, involves a close re-reading of Parsons in the light of contemporary sociological debates on the body, emotion, trust, uncertainty and health, including late modern and postmodern interpretations of his work. Parsons, it is concluded, despite his (many) critics and detractors, has much to contribute here, not simply in terms of past insights, but also with regard to the present and future