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RN16_03c_H: Neoliberalism and Challenges to Medical Professionals II
6:00pm - 7:30pm
Session Chair: Ekaterina Borozdina, European University at St.Petersburg Session Chair: Anna A. Temkina, European University at St.Petersburg
Location:HA.1.3 HAROKOPIO University
70 El. Venizelou Street
17671 Athens, Greece
Building: A, Level: 1.
Medical Doctors Savaged to Death in China: Whose Fault?
Cheris Shun-ching Chan
University of Hong Kong, Hong Kong S.A.R. (China)
On March 23, 2012, a medical resident in Harbin, north China, was stabbed to death by an angry young patient. More recently on May 5, 2016, a stomatologist in Guangdong, south China, was stabbed to death by a middle-aged patient. These were, unfortunately, not isolated incidents. Physical violence against doctors in mainland China has been happening every year throughout the past decade. A study published as early as 2008 found that more than half of the surveyed medical professionals reported having been verbally abused, and 3.9 percent physically assaulted, by patients in the past year. How can we explain patients’ violence against medical professionals? In this paper, I analyze the institutional factors that have led to the increasing tension between doctors and patients. Changes in the health care system in post-Mao China drove public hospitals to operate according to commercialized economic principles while maintaining their socialist appearance. The pressure to raise revenues and the low basic salaries of medical doctors lured hospitals to associate doctors’ incomes with the economic benefits they brought to the hospitals. This resulted in a blatant conflict of interests between doctors and patients. At the same time, while patients are increasingly aware of their rights and lifting their expectations on medical professionals, the Chinese health insurance system imposes a number of constraints on the professional autonomy of doctors, forcing them to select profitable patients and treat patients unequally. These institutional problems have made doctors the scapegoat for patients’ frustrations and anger.
Trust in the doctor in a changing society
UiT The Arctic University of Norway, Norway
Trust in the doctor in a changing society.
Jorid Anderssen, UiT, The Arctic University of Norway
This paper present result from a study on trust in doctors/general practitioner over time. The paper is based on four separate fieldworks over a period of almost 35 years (1981-2015) in a small coastal community in Norway. The village was traditionally an isolated fishery community. Some years before my first fieldwork, they got a road that connected the village to the municipal center. The village is located in an area where doctors work for a short period before they move on to more urban parts of the country.
In 35 years, there has been a tremendous change in what kind health problems people present for the doctor. There has also been a big change in how they perceive the doctor. During my first fieldwork, they felt safe that they had access to a doctor in the municipal center. In the last fieldwork, most of them say that they trust the current doctor. They think that health is an individual responsibility, and say they would not trust an incompetent doctor. However, they often add, “A doctor is a doctor.” They do not travel to another doctor to get a second opinion, and they do not think that internet can compete with a doctor’s knowledge.
Their trust in the doctor in all four fieldworks is discussed in relation to individualization, and the role of the doctor in a modern society.
Healthcare providers’ perspective on the new Family Medicine Model in Turkey.
Pinar Oktem1, Ayca Gelgec Bakacak2
1Visiting Lecturer at Ankara University,Member of Board Positive Living Association, Istanbul, Turkey; 2Hacettepe University, Turkey
The ‘Family Medicine Model’ (FMM), referred to as General/Family Practice in Europe, was implemented across Turkey in late 2010, as part of the recent major revision of the healthcare system. While aimed at strengthening primary healthcare services and harmonising Turkey’s health system with the EU, its legislative framework and practical implementation have been subjected to important criticism, including the commoditisation of healthcare and de-prioritisation of preventive healthcare. The Model is still considered as ‘new’; and its implications are not thoroughly comprehended by the general public or by decision makers.
This paper aims to understand the healthcare providers perspective, through authors’ observations in the field and review of related legislation and evaluation reports.
1) Structural problems causing disruption in healthcare delivery -such as longer working hours, increased financial burdens on physicians, perceived ‘dual’ authority regime in healthcare organisation and related professional conflicts-
2) Socio-cultural aspects of healthcare delivery -particularly affecting sexual and reproductive healthcare and increased violence against healthcare providers as a persistent issue in Turkey-
3) Perceived transformation in the ‘professional identity’ –learning new skills in management, technologies, law and so forth, causing change in the meaning and definition of primary healthcare and decrease in professional ‘satisfaction’-
Subjectivities in ER: analysis of conflictual interactions between patients and caregivers in the emergency room of a local hospital in northern France
Université d'Artois, France ; LEM UMR 9221
Emergency departments in public hospitals in France are open 24/7. During the night, the emergency room (ER) becomes the main point of admission to the hospital. Each patient arriving in the ER must be examined. The ER staff typically deal with organizational constraints and a variety of patients, whose conditions range from “life or death emergencies” to “routine consultations”. In performing their duties, the ER staffs are constantly confronted with individual patients’ subjective perceptions of their own health. Analyzing professional practices and caregivers’ victimization, this proposal, based on ethnographic fieldwork (combining observations and interviews) conducted over six months in the ER of a local hospital in northern France, will discuss the conflictual interactions caregivers face in their daily practice. Three situations experienced as potentially violent will be highlighted:
• Patients leaving against medical advice or refusing to take treatment despite medical advice can be experienced by healthcare professionals as a negation of their professional identity.
• Applying medical restraints during certain medical procedures to restrain patients and prevent them from injuring themselves is often considered by caregivers as a “dirty work”, raising the question of individual rights and freedom.
• The use of patient flow management systems by nurses involves monitoring patients, who are asked to comply with the role of the “good patient”.
These three examples underline how subjectivities of health professionals in an ER can be in conflict with patients’ personal subjectivities, and that both parties experience forms of stress and discomfort in ER.