Doctors on the medical profession

Over the past two to three decades there has been vigorous debate in the sociological literature as well as in popular forums concerning the changing social position and status of the medical profession and the extent to which consumerism has entered the doctor-patient relationship. Few qualitative sociological inquiries, however, have directly sought the views of medical practitioners themselves on these issues. To address this hiatus, this article discusses the findings from an empirical study using semi-structured indepth interviews with 20 doctors living and working in Sydney about their views on the contemporary status of the medical profession and their experiences of medical practice. Three major aspects are discussed: the extent to which the social position of doctors has changed, the impact of consumerism on medical practice and the qualities of a ‘good’ doctor. The implications of these data for theorising the nature of contemporary medical practice, power and professional status is explored, with particular reference to the insights offered by Foucauldian theory.     

Community‐consumerism: negotiating risk in online drug communities

This study explores the social organisation of risk within online drug‐related communities. Drawing on in‐depth interviews with participants from two Norwegian Internet drug forums, the paper illustrates how participation in such forums influenced notions of risk, and how it supported notions of participants as being informed, responsible and empowered. First, the forums facilitated an easy exchange of user‐generated drug information, which helped members present themselves as informed and competent. Second, members used the communal resources on the forums to negotiate their drug‐using identities, in which they resisted stigma and argued for a responsible drug‐using identity. Third, the social inclusion and sense of community within the forums formed the basis for collective support, which helped empower those involved. Conceptualised as community‐consumerism, these findings highlight the social mechanisms involved in the information self‐sufficiency and decentralisation of authority on the Internet, in which members created an alternative frame of reference for drug use and associated health. The concept of community‐consumerism offers a perspective on the social organisation of risk within online communities and ought to be of relevance for future studies on online health‐related discourses, not only those related to drugs.     

THE CHALLENGE OF WORKING WITH STAFF GROUPS IN THE CARING PROFESSIONS: THE IMPORTANCE OF THE 'TEAM DEVELOPMENT AND REFLECTIVE PRACTICE GROUP'

abstract    This paper highlights the importance of providing a regular space for teams of professionals, working in the mental health field and caring professions, to reflect on how the work impacts on the team dynamics and their own mental health. It explores the role of the group facilitator and how that role differs from working with patient and other groups. It considers the context of the current political environment within which mental health services operate and explores how this may impact on individual and team ego strength, leading to regression and reliance on primitive defence mechanisms as a means to coping and survival. Also considered is the issue of the challenges presented in working with teams where traits and features consistent with borderline personality disorder (DSM-4 Cluster B) manifest in the team. The authors propose a model called 'Team Development and Reflective Practice Groups', and suggest guidelines for providing an optimum facilitating environment for the professionals within these groups.     

Thinking with care infrastructures: people,devices and the home in home blood pressure monitoring

The growing consumer market in health monitoring devices means that technologies that were once the preserve of the clinic are moving into spaces such as homes and workplaces. We consider how one such device, blood pressure monitors, comes to be integrated into everyday life. We pursue the concept of ‘care infrastructure’, drawing on recent scholarship in STS and medical sociology, to illuminate the work and range of people, things and spaces involved in self‐monitoring. Drawing on a UK study involving observations and interviews with 31 people who have used a consumer blood pressure monitor, we apply the concept beyond chronic illness, to practices involving consumer devices – and develop a critical account of its value. We conclude that the care infrastructure concept is useful to highlight the socio‐material arrangements involved in self‐monitoring, showing that even for ostensibly personal devices, monitoring may be a shared practice that expresses care for self and for others. The concept also helps draw attention to links between different objects and spaces that are integral to the practice, beyond the device alone. Care infrastructure draws attention to the material, but ensures that analytic attention engages with both material and social elements of practice and their connections.     

The role of material deprivation and consumerism in the decisions to engage in transactional sex among young people in the urban slums of Blantyre,Malawi

Transactional sex has been associated with a high risk of HIV acquisition and unintended pregnancy among young women in urban slums in sub-Saharan Africa. However, few studies have explored the structural drivers of transactional sex from the perspective of both genders in these settings. This paper explores how young men and women understand the factors that lead to transactional sex among their peers, and how deprivation of material resources (housing, food and health care access) and consumerism (a desire for fashionable goods) may instigate transactional sex in the urban slums of Blantyre, Malawi. Data from 5 focus group discussions and 12 in-depth interviews undertaken with a total of 60 young men and women aged 18–23 years old, conducted between December 2012 and May 2013, were analysed using anticipated and grounded codes. Housing and food deprivation influenced decisions to engage in transactional sex for both young men and women. Poor health care access and a desire for fashionable goods (such as the latest hair or clothing styles and cellular phones) influenced the decisions of young women that led to transactional sex. Interventions that engage with deprivations and consumerism are essential to reducing sexual and reproductive health risks in urban slums.     

SPECTACLE AND SYMBOLIC SUBVERSION

I use the concepts of spectacle and symbolic subversion to analyze three student videos about the war on Iraq and consumerism. I argue that Debord's concept of spectacle provides a powerful theory for examining the erasure of histories and the obsession with the consumption of images. However, unlike Debord, I argue there is room for what Bourdieu calls “symbolic subversion.” Symbolic subversion is the act of deconstructing and reconstructing meanings of text. Symbolic subversion facilitates whole new patterns of association between items; in a hegemonic view the items do not connect, but through the act of symbolic subversion they can be explicitly connected. Although they did not name what they were doing symbolic subversion or spectacle, the dialogue between undergraduates studying to work in child‐ and youth‐serving professions and high school students demonstrated a knowledge of what it means to engage with or use spectacle to subvert dominant meanings.     

Consumer involvement in health care purchasing: the role and influence of the community health councils

Recent reforms in the National Health Service (NHS) place great emphasis on the importance of the ‘voice of the consumer’ in the provision of health care. Health purchasers are now required to adopt the role of ‘champion of the people’, traditionally that of the Community Health Councils (CHCs). In turn the CHCs have been encouraged to become more closely involved in the purchasing process. This paper draws on a national investigation of the operation of CHCs in order to examine the response of both the Councils and local purchasers to these developments. For many CHCs pressures for greater involvement may clash with their concern to retain an independent stance. This paper examines how closely CHCs are currently working with local purchasers and explores the central question of whether those prepared to work more collaboratively with their Health Authorities (HAs) are likely to have greater impact on purchasing decisions. The paper concludes that, while some CHCs are more closely involved than others, few perceive that they exert much real influence over the decision-making process. Councils share a general view that major purchasing decisions are increasingly being made without the opportunity for scrutiny by them or the wider public.     

Towards a history of choice in UK health policy

This paper examines health policy documents from the period in which the NHS was planned through to New Labour's reforms, to examine how the terms 'choice' and 'responsiveness' are used to position both users and the public in particular roles. It suggests that health consumerism is a process that has gradually appeared in the NHS through an extension of the choices offered to patients and the terms on which they were offered. Utilising Hirschman's classic framework of exit, voice and loyalty, we suggest that although there appears to be a strong relationship between the introduction of choice with the aim of securing greater responsiveness, that does not necessarily work in the opposite direction because the analysis of responsiveness suggests that there are other means of achieving this goal other than increasing choice through consumerist approaches to organisation. The implications of this analysis are explored for contemporary health service reform.     

Reflections on health care consumerism: insights from feminism

Health care consumerism is a movement concerned with patients' interests in health care, crucially those that are repressed or partly repressed by dominant interest-holders. Like feminism, health care consumerism attracts dislike and confusion as well as enthusiasm. But just as the voicing of women's repressed interests leads to their gradual acceptance by dominant interest-holders, so does the voicing of patients' repressed interests.     

The role of doctors, patients and managers in priority setting decisions: lessons from the `Child B' case

The difficulties in treating patients with life threatening illnesses were highlighted by the case of Jaymee Bowen, a 10-year-old girl with leukaemia who was refused funding for a second bone marrow transplant in 1995. Jaymee's case was widely reported at the time and came to epitomize the dilemmas of rationing in the United Kingdom's National Health Service. In reality, the paediatricians who had cared for Jaymee based their decision on clinical rather than financial considerations, and the media reporting of the case failed to reflect the complexities of the issues involved. The case also demonstrated the difficulties of determining the best interests of children and of obtaining their consent to treatment. There were disagreements between Jaymee's father and the paediatricians who had treated her about how her best interests could be served and this led to a breakdown of trust and the search for further opinions. This highlighted the rise of consumerism in health care and the challenge to doctors and managers to justify their decisions and to give reasons for these decisions. The common theme in Jaymee's story is the need for greater openness in decisions on priority setting and stronger safeguards for patients.