Suchergebnisse

"Die zentrale Fragestellung des Vortrages ist die nach der biographischen Entwicklung gegenwärtigen Interaktionen der MedizinerInnen mit ihren PatientInnen. Hierbei muss betont werden, dass es nicht darum geht, lineare Kausalzusammenhänge anzunehmen, sprich von Ursache- und Wirkungsbeziehungen auszugehen, sondern darum, die wechselseitige Wirkungsbeziehung der beiden Ebenen zu rekonstruieren. Ziel ist es also, die Entwicklungsebenen Biographie und Ablauf einer einzelnen Begegnung in ihrer Interrelation zu untersuchen. Um sich dieser Interrelation anzunähern bzw. das erwähnte Risiko der Annahme linearer Kausalitäten auszuschließen, ist eine Verknüpfung interpretativer Methoden notwendig, denn es gilt sowohl den Lebensverlauf der einzelnen Ärztin/des einzelnen Arztes zu rekonstruieren, als auch deren/ dessen konkrete Interaktionen mit ihren PatientInnen in den Blick zu nehmen. Hierzu bietet sich einerseits die Methode der biographischen Fallrekonstruktion an, andererseits eine sequenzielle und abduktive Analyse von videographierten Konsultationen der Ärztin/ des Arztes. Im Rahmen des Vortrags wird ein methodisches Vorgehen vorgestellt, das eine Verknüpfung beider Betrachtungsebenen und Verfahren ermöglicht. Zunächst sollen dazu am Beispiel einer niedergelassenen Allgemeinmedizinerin die Ergebnisse der unabhängig voneinander durchgeführten Auswertungen vorgestellt werden. In diesem Zusammenhang wird auch kurz das genannte Verfahren zur Analyse von Videomaterial erläutert. Im Anschluss daran wird der theoretische und empirische Gewinn aufgezeigt, der mit der Zusammenführung beider genannter Betrachtungsebenen erzielt werden kann." (Autorenreferat)

"Was passiert in Arzt-Patient- und Schwester-Patient-Gesprächen, wenn Patienten auf die standardisierten Fragen nicht erwartungsgemäß reagieren und wie gehen die verschiedenen Berufsgruppen im Krankenhaus mit dieser Situation um? Während die Spezialsprechstunden der Chef- und Oberärzte einen gewissen Gestaltungsraum in den Gesprächen bieten, verläuft die präoperative Aufnahme oder Indikationssprechstunde entlang festgelegter Routinen von Frage und Antwort. Die letztgenannten Interaktionsmuster sind leichter formalisierbar und werden deshalb zunehmend durch Informationssysteme unterstützt. Der Beitrag analysiert Brüche in den routinisierten Handlungsabläufen der präoperativen Aufnahme. Das aufgetretene Unverständnis in der jeweiligen Interaktion gibt Aufschluss darüber, welche Interpretationsleistungen von Ärzten und Ärztinnen sowie Ambulanzschwestern vollbracht werden müssen, damit Daten und Befunde erhoben, dokumentiert und für das gesamte Krankenhaus nutzbar gemacht werden können. Die Ergebnisse basieren auf Video-Interaktionsanalysen von Arzt-Patient- und Schwester-Patient-Gesprächen. Sie wurden im Rahmen einer innerbetrieblichen Weiterbildungsveranstaltung den bisher untersuchten Kliniken vorgestellt und dort unter dem Titel 'Was passiert, wenn Patienten nicht kooperieren? Gemeinsame Auswertung von Videos und die Folgen für Dokumentation und Datenpflege' diskutiert. Insgesamt ist es Ziel, neben der Analyse von computerisiertem Wissen auch die unterschiedlichen Formen von Handlungen zu beschreiben, in denen Wissen eingebunden, generiert und im Umgang mit dem Informationssystem angewandt wird. Die Untersuchung wird im Rahmen des DFG-Projekts 'Zum Wandel von Arbeit durch computerisiertes Wissen im Operationssaal aus der Geschlechterperspektive' durchgeführt." (Autorenreferat)

The importance of reconciling status with interests in studying elites is illustrated through discussion of the meanings behind fledgling physicians' use of the term "crock" to refer to patients who are not really sick, & are viewed as not worthy of consideration. Because they cannot be cured, & therefore cannot contribute to the status of the physician, crocks are given low status. Professional interest thereby defines patient status. The tendency of elites to make informal categorizations that would be unacceptable if categorized formally is discussed. D. Generoli

Analyzes changes in the regulation of doctors in the UK during its transition from an imperial power to a European nation, drawing on personal experience as a lay member of the British General Medical Council. The council was created in 1858 & charged with registering medical practitioners. Traditionally, the General Medical Council has been reluctant to register foreign doctors who were not trained in UK-founded medical schools. However, during the 1960s, the National Health Service experienced a dearth of competent doctors, thus increasing the pressure on the council to register more foreign doctors. The admittance of more foreign doctors produced a reaction against supposedly lax registerial standards & eventually a return to the restrictive policy. This new policy was constituted in such a way as to privilege European doctors over "overseas" doctors to reduce tension between the UK & the European Community. Recently, greater integration with the European Community & the introduction of concerns outside the province of the council have further reduced its influence. 45 References. D. M. Smith

Reviews the status of the Belgian medical profession historically & changes to that position since the 1980s. The medical profession has traditionally enjoyed dominance in its field by virtue of several 1960s laws. The only weakness in the profession's dominance was its inability to control the growth of doctors, which became important in the 1980s & 1990s, as the national Health Insurance System sought to reduce the medical profession's autonomy through passage of new legislation. The profession has resisted this effort, but has been hampered by the high density of physicians, which adversely affects the average income & status of individual doctors & hinders the profession's ability to create a coherent oppositional voice. However, debates centered on the federalization of the Health Insurance System & the issue of financial responsibility for sickness funds have delayed any concerted effort to reduce the profession's autonomy. 19 References. D. M. Smith

Examines diagnoses of neonatal jaundice, arguing that it is a self-correcting, developmental feature of newborns, & its treatment as a pediatric disorder serves to disrupt maternal bonding & nursing. Dominant cultural expectations of medicine deem anything outside the biomedical definition of "normal" as an indication of pathology. Medical elements of neonatal jaundice are explained, & the history of its treatment is traced in relation to development of the subspecialty of neonatology. Difficulties involved in doing neonatal research to determine risk potentials are discussed, along with the tendency of many clinicians to treat all babies who fall within a "zone of suspicion," rather than chance one disastrous outcome. As a result, the added burden of exaggerated pathology is placed on the newborn period. It is contended that the practice of medicine lacks a cultural perspective, & neonatal jaundice is an example of a constructed condition where social, historical, & cultural factors have combined to create both a disease & a medical/legal dilemma for doctors & parents. 45 References. J. Lindroth

The nature & implications of the balance between work & family responsibilities among medical doctors in Russia were examined in a 1991/92 questionnaire survey of 207 female & 110 male doctors in Moscow. It is argued that the burdens of rapid economic & social change are more problematic for women in Russia who must perform dual roles as professionals & domestic servants. Although physicians were dissatisfied with their low wages & status, the majority depicted their work as purposeful & meaningful, but were unhappy with their overall lives. Women suffered disporportionately from various signs of fatigue & stress, & felt more strongly that their ability to cope with difficult situations had deteriorated, especially the 64% who were responsible for all or most domestic duties. Women's greatest concern was conflict between their professional & domestic obligations. Men were much more likely to succumb to excessive use of alcohol as a means of coping in stressful situations. 2 Tables. T. Sevier

Participant observation of three in vitro fertilization (IVF) cycles in metropolitan national health care clinics, 1990-1992, underpin a self-reflexive comparative case study of IVF procedures in Israel & Canada. Feminist critiques of infertility treatments as the epitome of male domination & a means to objectify women are discussed. IVF method & organization are detailed, noting that procedures in both countries were physician-dominated, highly technological, low in cost, & woman friendly. Israeli doctors were more patronizing, but also more personal & sympathetic, than their Canadian counterparts. Organizational & economic differences resulting from the smaller size & lower affluence of the Israeli clinic are described. A gender politics perspective suggests that the greater marginalization of women in Israeli society is reflected in uncritical acceptance of the control & dominance of male physicians. In contrast, Canada has more women on the medical staff, & paternalism is discouraged. How cultural differences are mirrored in clinic programs is explored. 48 References. J. Lindroth

Examines the role of the medical audit & clinical budgeting in the hospital sector of the British National Health Service & their consequences for the medical autonomy of hospital doctors. Traditionally, doctors had great autonomy in the medical system because of state dependency. However, the recent introduction of new systems of resource management & quality control, some of which have been imported from the US, have significantly reduced doctor autonomy. While the National Health Service system has not been completely privatized, doctors have been forced to accept a new form of responsible autonomy entailing greater oversight of their actions. Doctors initially resisted the new system, but continued economic pressure eventually forced them to acquiesce to the new market-driven system. The issue raised by the ascendance of the market is not whether doctors will abide by the new system, but whether they will be any good at managing themselves within it. 83 References. D. M. Smith

Examines policy changes in the 1980s in the British National Health Service, highlighting the impact of these changes on general practitioners. These policy changes stressed the introduction of market principles into medical care accomplished through a shift toward primary care, an alteration of funding & allocation procedures, & an enhancement of patient rights. It is argued that these changes have increased opportunities for general practitioners to manage the scope of their work & control resources used to provide medical care. While remaining beyond day-to-day scrutiny, general practitioners have gained more freedom to make medical decisions & bargain with other service providers. Thus, the main consequence of the introduction of market principles has been to retract state supervision & allow market criteria to determine medical provision outcomes. 37 References. D. M. Smith