‘Good’ patient/‘bad’ patient: clinical learning and the entrenching of inequality

This article develops sociological understanding of the reproduction of inequality in medicine. The material is drawn from a longitudinal study of student experiences of clinical learning that entailed 72 qualitative in‐depth interviews with 27 medical students from five medical schools in the USA. To highlight the subtle, yet powerful, ways in which inequality gets entrenched, this article analyses ideas of the ‘good’ and the ‘bad’ patient. Bad patients question not only biomedical knowledge but also medical students’ commitment to helping people. Good patients engage with medical students in a manner that upholds biomedical knowledge and enables students to assume the role of the healer and the expert. At the same time, good patients possess cultural skills that align with those of medical practitioners. This alignment is, furthermore, central to definitions of the good patient. Distinctions drawn between good and bad patients thus both embody as well as enforce social inequality. The subtle reproduction of inequality is, however, difficult to discern because judgements about patients entwine with emotion.     

‘Bourdieu’, medical elites and ‘social class’: a qualitative study of ‘desert island’ doctors

Sociologists of professions draw on Weberian theories of closure. However they have tended to ignore Bourdieu's work, which rejects Weberian notions of class and status groups as distinct ideal types and sees these concepts as inextricably linked. Bourdieu emphasises the importance of a class‐based habitus which generates orientations, inclinations and dispositions that organise practices and the perception of practice. For Bourdieu, because individuals perceive one another primarily through the status that attaches to their practices (through a symbolic veil of honour) they fail to perceive the real basis of these practices: the forms of capital that underlie the different habitus and enable their realisation. This article draws on interviews with 17 elite doctors appearing on a national (UK) radio show during which they choose eight discs to take to a desert island. According to Bourdieu, ‘nothing more clearly affirms one's “class”, nothing more infallibly classifies, than one's taste in music’. An analysis of the doctors' musical tastes and their mode of acquisition (largely, for these elites, via their family and education at independent schools), as well as other insights into their cultural capital reveals the importance of linking class and status when exploring professional status and prestige.     

Psychotropics,sociology and women: are the ‘halcyon days’ of the ‘malestream’ over?

The purpose of this paper is to lay the foundation for the development of a gender-sensitive perspective on psychotropic drug use. This paper reviews existing research on psychotropic drug use and highlights gender biases in three ways. First, a review of the early work on gender differences in tranquilliser use reveals how ‘one-dimensional’ accounts are offered by proponents who are either ‘no-objections’, ‘cautious-no- answer’, ‘women's-role’ or ‘political’ advocates. Second, with special reference to women, a critical review of the two predominant discourses, the medical and the sociological, are outlined. It is argued that they have a common approach that makes women's drug use invisible. The paper concludes that the approach prevailing in current research is individualistic and gender blind and needs to be complemented with an analysis that problematises gender.     

‘Fat girls’ and ‘big guys’: gendered meanings of weight loss surgery

Over 80% of weight loss surgery (WLS) patients are women, yet gender is overwhelmingly absent in WLS research. This article discusses the findings of 54 interviews with twenty‐one women and six men waiting for WLS in Newfoundland and Labrador, Canada. We critically examine the ways that gender shapes the meaning of WLS in these narratives. We explore gendered meanings in participants’ perspectives on their embodied experiences before surgery, social support as they decided to undergo the procedure, and their expectations for their lives after WLS. We draw on feminist theory to explain how these findings counter the dominant gender‐neutral medical model of obesity.     

Letter – Locational variation in adolescents' concerns over ‘body image’

Introduction: A statewide study of New South Wales (NSW) adolescents' health concerns was conducted in 2001/02. The data on adolescents consisted of 81 focus groups, 56 urban and 22 rural/3 regional areas of NSW. One issue, ‘body image’, was a raised by adolescents in both urban and rural/regional locations, but in twice as many beach (coastal) than inland locations and often expressed in a more extreme way.     

Letter – Closing the ‘Targets’ Gaps: Review of 2008–2030 National Indigenous Health Equality Targets

While the 2008 National Indigenous Health Equality Targets (‘Close the Gap’) has received strong support at federal, state and territory government levels as well as among many Indigenous groups, medical associations and civil society groups, it has secured only cautious support from some Indigenous health researchers and policy analysts. We agree with the need for caution and posit that the document could be improved in a number of areas.     

‘Quality is job 1’– new directions for medical risk management

With the advent of managed care, the determination of who is a successful healthcare provider often depends on the selection process used by the managers of employee health plans and their managed care plans. Employee satisfaction and cost containment are factors relied on in selecting healthcare providers. This article discusses the risk management professional's increasingly important role in assisting healthcare providers in meeting the requirements of these third‐party decision makers.     

Changing homelessness services: revanchism, ‘professionalisation’ and resistance

This paper argues that the increasing international salience of homelessness can be partially explained by reference to the revanchist thesis (involving processes of coerced exclusion and abjection), but the situation on the ground is more complex. It reports on interviews with 18 representatives of 11 homelessness service providers in one city in England. As Cloke et al. found, these providers tended to be either larger, more ‘professional’, ‘insider’ services or smaller, more ‘amateur’, ‘outsider’ services. However, this does not mean that the former were necessarily more revanchist and the latter less so. Rather, the actions of both types of organisation could, in some cases, be construed as both advancing and counteracting a revanchist project.     

Poststructuralism and other ‘species’ in public health—a ‘Darwinian’ view

Abstract: The concepts and methods of poststructuralism are emerging as useful tools to increase our understanding of public health. This paper discusses poststructuralism within the context of a metaphoric ‘evolutionary ecology’ of knowledge (an epistemecology). It argues that claims for the importance of any programs (such as poststructuralism) are problematic. Using evolutionary and ecological metaphors, it suggests that public health may benefit from its advocates fostering the recombination of elements of knowledge to produce epistemes which adapt us congruently to the general and specific goals of public health, which should include a primary aim of minimising suffering. Choosing to act in an ethical way in regard to our construction and use of knowledge may be one way of achieving those aims. The term ‘ethical fitness’ is a way of conceptualising an evolving epistemic ethic.