Всего публикаций в данном разделе: 30
Опубликовано на портале: 25-06-2007Б.П. Красовский Социологические исследования. 2002. № 6. С. 122-127.
Анализируя отношения врача и пациента на Западе, автор фиксирует внимание на следующих факторах. Прежде всего, рассматривается специфика врачебной профессии, различие позиций врача и пациента, отсутствие четких правил выстраивания их взаимоотношений, умение врача выбирать стиль поведения, психологическую подготовку медиков и психологическое состояние больного, гендерные различия.
Medicine as culture. Illness, disease and the body in Western societies (the second edition) [книги]
Опубликовано на портале: 25-03-2007Deborah Lupton
UK: Sage Publications Ltd, 2003, 202 с.
The book provides a broad overview of the way medicine is experienced, perceived and socially constructed in western societies. Drawing on the tradition of the sociology of health and illness, Deborah Lupton directs readers to an understanding of medicine, health care, illness and disease from a sociocultural perspective. At a time of increasing disillusionment with scientific medicine and the mythology of the beneficent, god-like physician, there is also - paradoxically - a growing dependence on biomedicine to provide the answers to social as well as medical problems. This book illuminates why attitudes to medicine are characterized by such strong paradoxes, and why issues of disease, illness and the medical encounter are surrounded by controversy, conflict, power struggles and emotion.
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.
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.
Опубликовано на портале: 23-03-2007Mary Klein Buller, David B. Buller Journal of Health and Social Behavior. 1987. Vol. 28. No. 4. P. 375-388.
Research has linked the communication styles of physicians to patients' satisfaction with health care. Recently Ben-Sira (1976, 1980) offered a social interaction model to explain this relationship; this model, however, focused on a single, narrow style of communicating and overlooked the broader spectrum of styles. This survey assessed two general communication styles: affiliation and control. It also examined eight social characteristics of medical interviews as possible mediators of the impact of the physician's communication style on the patient's satisfaction. Patients' evaluations of the physician's communication were associated strongly with patients' evaluations of medical care, suggesting that competence in communication may be a facet of medical competence. Affiliative styles were related positively to patients' satisfaction, whereas dominant/active styles had a negative relationship with satisfaction. Severity of the illness, physician's age, physician's specialty, and the number of prior visits affected the importance of the physician's communication in the patient's evaluations of care.
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.
Perceptions of Patients by Emergency Room Staff: Substance-Abusers versus Non-Substance-Abusers [статья]
Опубликовано на портале: 23-03-2007Lois Biener Journal of Health and Social Behavior. 1983. Vol. 24. No. 3. P. 264-275.
Studies suggest that health care providers' evaluation of patients is related to aspects of the presenting problem, i.e., its seriousness, curability, and rarity; the extent to which the problem was self-caused; and to aspects of the patients, i.e., their age, social distance from providers and cooperativeness. Analysis of 220 emergency room staff members' perceptions of 14 hypothetical patients showed that with the exception of rarity of problem and social distance, the tested factors were significantly related to ratings of rewardingness of patient encounters. Results indicated that predictors of reward derived from substance-abusing and non-substance-abusing patients were different. While seriousness of illness was the primary predictor with non-substance-abusers, perceived cooperativeness was primary with substance-abusers. Predictors of rewarding patient encounters also differed according to staff level. Implications of these differences for emergency treatment of substance-abusers is discussed.
Опубликовано на портале: 23-03-2007Catherine Ross, John Mirowsky, Raymond S. Duff Journal of Health and Social Behavior. 1982. Vol. 23. No. 4. P. 317-329.
Authors developed and tested a model of client satisfaction with medical care in which sociodemographic characteristics of the physician affect client satisfaction under conditions of unmet expectations and a lack of choice. They hypothesized that in small fee-for-service practices such as solo practice, where the client chooses his or her physician, status characteristics of the doctor would be unrelated to client satisfaction. Conversely, in large prepaid group practices where the client is assigned a physician, nonnormative physician status characteristics would create lower client satisfaction. Because expectations are based on statistical norms, it was hypothesized that clients in large prepaid multispecialty groups would be most satisfied with physicians who fit the norm-middle-aged white males from higher status Protestant or Jewish backgrounds. In a sample of pediatricians and their clients, authors found their hypotheses to be strongly supported, with one modification-the relationship between client satisfaction and the physician's socioeconomic background is parabolic. Furthermore, the negative effect of nonnormative physician religious status on client satisfaction in large prepaid groups is offset by the client-physician match and by experience with the physician.
Returning to the Doctor: The Effect of Client Characteristics, Type of Practice, and Experiences with Care [статья]
Опубликовано на портале: 23-03-2007Catherine Ross, Raymond S. Duff Journal of Health and Social Behavior. 1982. Vol. 23. No. 2. P. 119-131.
Although a number of policy-makers have suggested that previous experiences with medical care affect subsequent use of physician services, few researchers have examined the issue empirically. Authors divide the determinants of revisiting the doctor in pediatric practice into three categories: client characteristics, organizational characteristics, and characteristics of the doctor-client interaction; and we develop a causal model. Although race, income, and education have no direct effects on the frequency of returning to the doctor, they have indirect effects through the organization of health care and experiences within the health care system. Clients who are poorly educated tend to have consistently negative experiences with the health care delivery system. These experiences affect subsequent use of services. Positive experiences with the interpersonal, psychosocial aspects of the doctor-client interaction increase a client's proclivity to return to the doctor, while negative doctor-client interactions decrease the probability of returning to the doctor.
Опубликовано на портале: 23-03-2007Marie R. Haug, Bebe Levin Journal of Health and Social Behavior. 1981. Vol. 22. No. 3. P. 212-229.
Traditionally, the sociological concept of the relationship between practitioner and patient has been the sick role, in which the physician as practitioner is in charge, and the patient is obligated to cooperate with the physician's prescribed regimen. More recently, this power relationship has been redefined by some from a consumerist perspective, in which physician and patient bargain over the terms of the relationship. Although each brings different resources to the encounter, neither participant is automatically in charge. Data from a sample of 466 members of the public and 86 physicians are used to assess the extent of reported public attitudes and behaviors that challenge the physician's traditional power, as well as physicians' reported response to such attitudes and events, as evidence of the public's propensity to a consumerist relationship and physicians' willingness to accept it. Among both the public and physicians, substantial minorities express beliefs and report actions congruent with this consumerist perspective. However, different demographic and health belief variables emerge in the two groups as explanatory factors. Doctor-patient power relationships are seen to depend on characteristics of the actors as well as on the illness situation.
"The Illness is Part of the Person": Discourses of Blame, Individual Responsibility and Individuation at a Centre for Spiritual Healing in the North of England [статья]
Опубликовано на портале: 23-03-2007Stuart McClean Sociology of Health and Illness. 2005. Vol. 27. No. 5. P. 628-648.
While the growth in usage and practice of varying forms of complementary and alternative medicine (CAM) continues apace, social science has increasingly turned to CAM's often individualistic approach to health and illness. CAM has been perceived as both partly a cause of and a response to the well-documented ideology in modern healthcare of "individual responsibility for health". This occasionally manifests in a 'victim-blaming' ideology amongst both orthodox and CAM practitioners alike. These issues emerged as key themes in an ethnographic study of a Centre for spiritual healing in the North of England. By drawing upon a range of qualitative data gained through the researcher's participation at this healing centre, author argues that the healers' focus on individual responsibility for health is not so much a part of the current socio-political health ideology of "victim-blaming", rather, it is illustrative of an important contemporary social phenomenon: the movement towards the subjectification and personalisation of public life.
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: 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: 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.
Опубликовано на портале: 04-02-2007Мариона Юозовна Кушлейкайте Социологические исследования. 2006. № 5. С. 75-78.
В свете тенденций восприятия пандемии СПИДа в различных странах авторы интерпретируют данные, полученные ими в ходе опроса, проведенного в одной из районных больниц Литвы. Выборка из 90 представителей среднего медицинского персонала была составлена посредством случайного отбора. Опрос осуществлялся методом анонимного анкетирования.
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: 28-11-2006Christian Heath
Cambridge: Cambridge University Press, 1994
This book is based on a substantial collection of video recordings of everyday medical consultations in the UK, and offers a micro-analysis of the visual and vocal aspects of the interaction between doctors and patients. Using actual examples, accompanied by numerous illustrations, Christian Health explores the moment-by-moment coordination of body movement and speech by and between doctor and patient. He discusses various aspects of medical examination, leavetaking, and the ways in which the participants sustain each other's attention. He also raises certain practical issues of medical work, such as the use of records and computers during the consultation, and the impact of 'bureaucratic' demands on the flow of information between doctor and patient. The book reveals the delicacy and precision which enter into the articulation and synchrony of visual behaviour and speech, and throws light on the systematics - the social organization - underlying the seeming minutiae of everyday life. In this way, it contributes both to our understanding of doctor-patient communication, and to the growing body of research on face-to-face interaction.
Опубликовано на портале: 28-11-2006Renee R. Anspach
USA: University of California Press, 1993
In this powerful and probing look at the reality of everyday choices in neonatal intensive care units, Renée Anspach explores the life-and-death dilemmas that have fueled national debate. Using case studies taken during sixteen months of extensive interviewing and observation, Anspach examines the roles of parents, doctors, nurses, and bioethicists in deciding whether critically ill newborns--be they premature, terminally ill, or severely malformed--should be saved by medical technology, or at least kept alive a little longer.
Опубликовано на портале: 28-11-2006Ann Hill Beuf
Philadelphia.: University of Pennsylvania Press, 1979, 212 с.
This book focuses on the social situation of the hospitalized child in twentieth-century America. It contends that the children's hospital has many of the characteristics of depersonalization and enforced helplessness that are associated with other "total institutions" in our society. The book also examines the interpersonal approaches employed by staff and patients in dealing with the tensions created by the reality of the total institution, on the one hand, and the more idealistic goals of the children's hospital, on the other. The observations that underlie this book were carried out by participant observation in two hospitals. In "County Hospital," where observations were carried out in 1971 and 1972, the researcher also acted as a visitor to ill children. At "Metropolis," observations were carried out in the admissions area, the waiting rooms, and on the floors, where the researcher acted both as a worker with the play-therapists and as a visitor. Extensive notes were made at the end of each day. Ongoing fieldnotes were maintained and written in unobtrusive areas such as in meetings or in the lobbies. This material was occasionally reinforced by notes taken in other hospital settings. Chapters include discussion of the role of person-in-a-total-institution, socialization for patienting, and coping strategies of children and hospital staff.
Опубликовано на портале: 28-11-2006Ред.: David Mechanic, Marian Osterweis, Arthur Kleinman
USA: National Academy Press, 1987
Pain--it is the most common complaint presented to physicians. Yet pain is subjective--it cannot be measured directly and is difficult to validate. Evaluating claims based on pain poses major problems for the Social Security Administration (SSA) and other disability insurers. This volume covers the epidemiology and physiology of pain; psychosocial contributions to pain and illness behavior; promising ways of assessing and measuring chronic pain and dysfunction; clinical aspects of prevention, diagnosis, treatment, and rehabilitation; and how the SSA's benefit structure and administrative procedures may affect pain complaints.