Всего статей в данном разделе : 243
Опубликовано на портале: 23-03-2007Michael S. Goldstein Journal of Health and Social Behavior. 1984. Vol. 25. No. 2. P. 211-229.
This is a study of physicians in Los Angeles who made the performance of abortions a major or sole component of their practice in the five years (1967-72) subsequent to the legalization of abortion in California. A semistructured interview was used to obtain data on the attitudes, values, and experiences of 42 such physicians. Four distinct career patterns (entrepreneurs, academics, workers, and community physicians) were found. As expected, the physicians tended to be specialists in OB-GYN, concerned about financial rewards, and influenced by past observation of negative consequences of illegal abortions. The major finding is the existence of a subgroup of physicians whose primary identity is businessman or entrepreneur; these fit into the pattern of "outsider entrepreneurs." Elements of this pattern were also found among other types of physicians to varying degrees. There is a need to recognize entrepreneurial elements as part of the conceptualization of physicians and other professionals.
A Critical Theory of Medical Discourse: Ideology, Social Control, and the Processing of Social Context in Medical Encounters [статья]
Опубликовано на портале: 23-03-2007Howard Waitzkin Journal of Health and Social Behavior. 1989. Vol. 30. No. 2. P. 220-239.
The personal troubles that patients bring to doctors often have roots in social issues beyond medicine. While medical encounters involve "micro-level" interactions between individuals, these interpersonal processes occur in a social context shaped by "macro-level" structures in society. Examining prior theories pertinent to medical discourse leads to the propositions: (a) that medical encounters tend to convey ideologic messages supportive of the current social order; (b) that these encounters have repercussions for social control; and (c) that medical language generally excludes a critical appraisal of the social context. The technical structure of the medical encounter, as traditionally seen by health professionals, masks a deeper structure that may have little to do with the conscious thoughts of professionals about what they are saying and doing. Similar patterns may appear in encounters between clients and members of other "helping" professions. Expressed marginally or conveyed by absence of criticism about contextual issues, ideology and social control in medical discourse remain largely unintentional mechanisms for achieving consent.
A Multidimensional Model of Organizational Legitimacy: Hospital Survival in Changing Institutional Environments [статья]
Опубликовано на портале: 05-12-2006Martin Ruef, W. Richard Scott Administrative Science Quarterly. 1998. No. 43. P. 877-904.
Using data on 143 hospital organizations, this article examines the antecedents and effects of two forms of organizational legitimacy (managerial and technical) over a 46-year period. Results show that both the managerial and technical forms provide notable improvements in organizational survival chances but that the strength of each effect varies over time depending on the nature of the institutional environment. Variation also appears in the antecedents of legitimacy - for example, the ability of a hospital to secure approval for its managerial practices depends on the correspondence between its mission and the logic of the surrounding institutional environment. The results suggest that a multidimensional model can reveal nuances of organizational legitimacy that are missed by more unitary conceptions.
Опубликовано на портале: 22-03-2007Emma Rich Sociology of Health and Illness. 2006. Vol. 28. No. 3. P. 284-306.
This paper explores the ways in which young women 'manage' the complexities of the presentation of an anorexic identity, the stigma attached to it, and the relationships that are developed with fellow sufferers. A range of ethnographic data and 'voices' are drawn upon, including a small qualitative study within a leading centre in the UK for the treatment of eating disorders. The paper begins by outlining the ways in which for many young women, anorexia is a stigmatised identity which in various contexts comes to be perceived as an irrational and self-inflicted condition. It was reported by the young women in our study that many of their peers, families and teachers made sense of their eating disorder through a medicalised discourse which focused on visual aspects of weight gain/loss and often stigmatised the condition, reducing it to a position of pathology or irrationality. It is argued that these experiences form a type of 'discursive constraint' (Ronai 1994) which many of the young women attempt to resist by engaging with alternative contexts and relationships through which they can construct more positive self-representations of anorexia or anorexic identities. As is revealed through the various data sources, as these young women negotiate the various discourses which offer them alternative subjectivities, they come to manage anorexia as both an illness and an identity.
Опубликовано на портале: 22-03-2007Cleave Seale, Julia Addington-Hall, Mark McCarthy Social science and medicine. 1997. Vol. 45. No. 3. P. 477-484.
Analysis of a subset of data from a survey of 3696 relatives, friends and others who knew a sample of people dying in 1990 who lived in 20 areas of the United Kingdom (the Regional Study of Care for the Dying) is reported. Using the typology of awareness contexts developed by Glaser and Strauss [(1965) Awareness of Dying, Aldine, Chicago], the prevalence of different awareness contexts is described and compared with an earlier survey done in 1969. Open awareness of dying, where both the dying person and the respondent knew that the person was dying, is the most prevalent awareness context. This is particularly so in cancer and represents a change since 1969 when closed awareness (where the respondent knows, but the dying person does not) was more common. The characteristics of those dying in open and closed awareness contexts are then compared, suggesting that having cancer, not being mentally confused, having a respondent who knew for some time that the person was dying, and being of higher social class are independently predictive of full open awareness, a condition marked both by knowledge of dying, and a value commitment towards openness. Compared with people in closed awareness, people dying in full awareness are more able to plan their dying careers, so that they and their respondents are more satisfied with the degree of choice over the place of death, they are less likely to die alone, and are more likely to die in their own homes. Additionally, these individuals are more likely to have spoken of their wishes for euthanasia, another indicator of their desire to control the manner and timing of death. If dying from cancer, people in full open awareness are more likely to have received hospice care. It is suggested that underlying these patterns, and in contrast with some other cultures where awareness of dying is seen as less desirable, people dying in Anglophone countries are particularly concerned to maintain control over projects of self-identity. Their approach to death is a reflection of this individualism.
Breaking the Ceremonial Order: Patients' and Doctors' Accounts of Removal from a General Practitioner's List [статья]
Опубликовано на портале: 05-12-2006Tim Stokes, Mary Dixon-Woods, Simon Johnson Williams Sociology of Health and Illness. 2006. Vol. 28. No. 5.
The removal of patients from general practitioners' (GPs) lists in the UK offers important sociological insights into what happens when the doctor-patient relationship 'goes wrong'. An interactionist analysis shows how removers (doctors) and removed (patients) strategically invoke 'rules of conduct' to account for difficulties in the doctor-patient relationship and for GPs' decisions to end their relationships with patients. In this paper the analysis is extended through recourse to Bourdieu's theory of practice, by juxtaposing 'paired' accounts of the same removal event by both remover and removed. The analysis demonstrates the unthinking or non-reflective nature of people's understanding of the rules governing social interactions, but also demonstrates how apparent rule violations make the rules explicit and expose patterns of power distribution. The authors argue that removal of patients amounts to a strategic exercise of symbolic power by GPs, and that this is experienced as an overtly violent symbolic act by patients. A theoretical reconciliation of interactionist theories of the doctor-patient relationship with Bourdieu's theory of practice is both possible and profitable, providing a micro-macro link in which issues of capital and power within the health (care) field are brought to the fore.
Опубликовано на портале: 22-03-2007Michael Bury, David Taylor Sociology of Health and Illness. 2007. Vol. 29. No. 1. P. 27-45.
During the last century demographic and epidemiological transitions have had a radical impact upon health and health service provision. A considerable body of research on the sociological aspects of living with chronic illness has accumulated. Debate has focused on how social environments shape disability-related experiences, and the extent to which individual responses define health outcomes. Through the establishment of the Expert Patients Programme (EPP) in 2001, the Department of Health has sought to enhance NHS patients' self-management capacities. This paper discusses three areas relevant to this: the policy formation process leading up to the EPP's present stage of development; the evidence base supporting claims made for its effectiveness; and the significance of psychological concepts such as self-efficacy in approaches to improving public health. The conclusion discusses NHS developments in primary care and public involvement in health and healthcare, and the implications that initiatives such as the EPP carry for the future. It is argued that to facilitate a constructive process of 'care transition' in response to epidemiological and allied change, awareness of cognitive/psychological factors involved in illness behaviours should not draw attention away from the social determinants and contexts of health.
Опубликовано на портале: 22-03-2007Cleave Seale Social science and Medicine. 1991. Vol. 32. No. 8. P. 943-952.
The literature suggests that doctors' and nurses' openness about communicating with the terminally ill and their families has increased in the past two or three decades, partly influenced by the hospice movement. The present study reports the perceptions of relatives, hospital doctors, general practitioners and nurses who knew a random sample of 639 adults dying in England in 1987. The results from professionals suggest a general preference for openness about illness and death, tempered by the consideration that bad news needs to be broken slowly, in a context of support, while recognising that not everyone wishes to know all. In practice people dying from cancer were more likely to be reported as knowing what their illness was and that they would die than were people dying from other conditions. This difference held when controlling for the fact that death was more likely to be medically expected in cancer. Comparisons with 1969 show that the increases were due largely to cancer patients being told the truth more frequently by hospital doctors. This may be due to changed practices, or to the increase in the number of hospital episodes in the last year of life. Nevertheless, situations of 'closed awareness' where relatives were told and patients were not, and situations where patients were left to guess the likely outcome for themselves, were still quite common in 1987. Nurses and hospice practitioners were only marginally involved in breaking bad news, this remaining the province of hospital doctors and general practitioners. Relatives in general praised the manner in which they and patients were told, although a small proportion reported insensitive practice. In retrospect a high proportion of both relatives and professionals felt that the levels of awareness were best as they were, although this preference may have been influenced by a desire to see things in a good light. Most relatives reported adequate support and information being given by professionals to them during the patient's illness. On the whole, doctors provided information, and friends and family provided emotional support to relatives. Again, hospital doctors played an increasingly important role compared to 1969 in providing information, with general practitioners' role decreasing in this area. Gaps in information included not being told enough about what was wrong with the patient, not being told the reasons for decisions about treatment and, to a lesser extent, not being given information about how to care for the patient.
Опубликовано на портале: 23-03-2007Diane Hayes, Catherine Ross Journal of Health and Social Behavior. 1987. Vol. 28. No. 2. P. 120-130.
Most research on the determinants of protective health behaviors examines health beliefs as the major motivating force. Authors hypothesize that concern with appearance is also a motivating force in eating diets low in calories and cholesterol and high in fruits and vegetables. Using a representative sample of 400 adults in Illinois (collected in 1984), they find that both health beliefs and appearance concerns affect eating habits. Health beliefs are modeled as an interaction between concern with health and health locus of control, since it is expected that concern with health has the largest impact on eating habits for persons who believe they have some control over their health. This interaction term is significant. For the average person, appearance is as large a motivating factor in eating habits as is concern with health. The implications of this finding for the health of the population, especially women are discussed.
Опубликовано на портале: 19-02-2007Katrina Hargreaves Sociology of Health and Illness. 2006. Vol. 28. No. 3. P. 261-284.
This paper presents some central findings of an exploratory qualitative study of New Zealand families with children conceived by donor insemination (DI). Drawing on social anthropological and sociological theorising about kinship and contemporary Western families, the paper explores the ways in which parents and their kin actively construct parent-child relationships and kin connections through the notions of biological and social ties, nature and nurture. The paper discusses three major themes emerging from the data: the social construction of the 'natural facts' of procreation, physical resemblance, and the construction of families through choice, not biology. Whilst the primacy of biological or genetic connection is a powerful cultural theme, particularly evident in the ambiguities and uncertainties for social fathers and their kin, these families also deconstruct this notion. Drawing simultaneously on the power of social and biological connection, using biology as a metaphor for social relations, or by privileging social ties and the formation of families through choice, over time these families strategically establish themselves as the sole parents and kin of their children conceived by DI.
Опубликовано на портале: 23-03-2007Chris Shilling British Journal of Sociology. 2002. Vol. 53. No. 4. P. 621-638.
This paper revisits Parsons's conception of the 'sick role' and examines the relevance of his writings on the cultural understanding of sickness to the consumption of health in the contemporary era. In terms of current developments, the author focuses on the development of pro-active approaches towards the healthy body, and the growth of "information rich" consumers of health care. These have become prominent themes in sociology, and while Parsons's writings are usually viewed as anachronistic he argues they remain highly pertinent to understanding the emergence of informed, body conscious lay people. If Parsons's analysis of health is more relevant to current circumstances than many critics assume, however, it is not unproblematic. The residual categories associated with the sick role obscure the continued utility of his work on the general cultural values informing health care. It is Parsons's analysis of these values, Chris Shilling suggests, that needs rescuing from restricted understandings of the sick role and highlighting as an important resource for contemporary theorists.
Опубликовано на портале: 04-03-2007Stefan Timmermans Sociology of Health and Illness. 2005. Vol. 27. No. 7. P. 993-1013.
Death brokering refers to the activities of medical authorities to render individual deaths culturally meaningful. Social scientists and others agree that mortality provokes existential ambiguity in modern life requiring cultural coping mechanisms. In contemporary Western societies, medical professionals have sequestered the dying in institutions, and have classified the causes of death to explain suspicious death. Over the last decades, the institutionalisation of the dying process has been challenged by social movements and the sudden onset of some deaths while forensic medicine has struggled for professional legitimacy in the borderland between mainstream medicine and the legal system. In this article it is argued that medical death brokering persists in spite of challenges because medical experts offer increasingly flexible cultural scripts to render the end-of-life socially meaningful while accentuating death's existential ambiguity. Medical professionals help create the ambiguity they promise to resolve, reinforcing the cultural need for more expert death brokering.
Опубликовано на портале: 04-03-2007Robert E. Clark, Emily E. LaBeff Journal of Health and Social Behavior. 1982. Vol. 23. No. 4. P. 366-380.
This research focuses on the strategies used by various professionals in delivering news of death. The lack of well defined, normative guidelines for such deliveries adds to the problematic nature of the interaction. From in-depth interviews with physicians, nurses, law enforcement officers, and clergy, a loose framework based on common themes was generated providing a processual view of death telling. Five distinct strategies of delivery developed within the framework. Discussion of each strategy indicates the significance of situational and occupational factors in delivering news of death. This study, though exploratory in nature, clarifies some of the processes involved in the delivery of bad news, and identifies several important problems surrounding death telling, such as lack of training and preparation among professionals for this role and their dislike for this aspect of their work.
Dilemmas in Fetal Medicine: Premature Application of Technology or Responding to Women's Choice? [статья]
Опубликовано на портале: 04-03-2007Clare Williams Sociology of Health and Illness. 2006. Vol. 28. No. 1. P. 1-20.
It is argued that innovative health technologies (IHTs) may be changing the roles of both patients and health practitioners, and raising new issues, including ethical, legal and social dilemmas. This paper focuses on the innovative area of fetal medicine. All fetal treatment necessitates accessing the fetus through the pregnant woman's body, and non-surgical treatments have long been a part of pregnancy care. However, recent developments in this area, including the increasing routinisation of sophisticated antenatal ultrasound screening and the introduction of treatments including fetal surgery, may mark a shift in this specialty. The paper explores such shifts from the perspectives of medical and midwifery practitioners working in two Fetal Medicine Units. It examines the apparent effects of the orientation of fetal medicine on prevalent conceptualisations of the maternal-fetal relationship, and some of the consequences of this. It is argued that new forms of uncertainty, including complex risk and diagnostic information, and uncertain prognostic predictions set within the rhetoric of non-directive counselling and women's choice, are leading to unprecedented ethical dilemmas within this area. More widespread debate about such potential dilemmas needs to take place before, rather than following their introduction.
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.