Social science & medicine
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Social science & medicine · Jan 1985
Managerial procedures and hospital practices: a case study of the development of a new medical discipline.
In anesthésie-réanimation, a discipline that brings together anaesthesiology and emergency as well as intensive care, the managerial methods of evaluation and control of needs in personnel, were not adequate for describing medical practices. Around four managerial standards that were used by the Paris public hospital administration, new situations have crystalized. The historical analysis of how these standards have been put into use, used and put in question throws light upon the way organizations function. The present day situation in this speciality seems to be mainly determined by the strategies of specialists for obtaining professional recognition of their discipline and for advancing their careers.
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Social science & medicine · Jan 1985
Historical ArticleMissionary doctors vs Chinese patients: credibility of missionary health care in early twentieth century China.
This paper deals with the encounter between the Chinese and Western medical missionaries in early twentieth century China. Based on data of two Canadian Protestant missions in China before 1937, this study reveals that medical missionaries were generally ignorant of Chinese medicine, and they regarded Chinese medicine as part of an inferior, heathen culture. ⋯ The functional complementarity of Western medicine to the pluralistic Chinese medical structure enabled missionary medicine to gain increasing credibility from the Chinese, although few Chinese actually understood the basic principles of Western medicine. Implications of this missionary doctor-Chinese patient relationship in China are discussed.
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Deinstitutionalization, originally hailed as a major advance in public policy towards mental illness, has recently become increasingly controversial. This paper reviews the implementation of this policy in the United States, providing a critical examination of some of the central issues and problems that are the focus of current debates. It concludes with a pessimistic assessment of the likelihood of substantial improvements occurring in the lot of the chronic mental patient in the contemporary United States.
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Social science & medicine · Jan 1985
Difficulties involved in taking health services to the people: the example of a public health care center in a Caracas barrio.
This paper discusses the difficulties faced by a typical Ministry of Health and Social Welfare maternal and infant health care services center. These service modules are usually located in the lower income barrios of Venezuela's urban centers. Recent experiences as seen by supervisors of the regional and district offices of the Ministry and the center's staff were evaluated following in-depth interviews, direct observation and scanning of clinical records over a three month period. The study concludes that the major problem areas influence the Ministry's primary goal of extending coverage to a greater proportion of the needy population and maintain the quality of the services: inadequate administrative structure leading to logistics difficulties; and the clinic location and the characteristics of the barrio itself and of the client population.
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Social science & medicine · Jan 1984
Doctor-patient interaction, patients' health behavior and effects of treatment.
Studies of doctor-patient communication and its consequences are usually limited to factors that may determine patients' compliance with doctors' instructions. But many patients besides or instead of following doctors' advice undertake additional activity in order to get well. The purpose of this study was to explore the whole range of patients' health behavior, its connection with the process of doctor-patient interaction (as an independent variable) and with the treatment results (as a dependent variable). ⋯ It was found that some characteristics of the doctor-patient interaction; doctors' directiveness, doctors' emotional attitude towards the patient, patients' activity, patients' partnership status had an effect on patients' health behavior (compliance with doctors' orders and patients' spontaneous health activity). Even stronger was the connection between these with the degree of patients' compliance with doctors' instructions but were positively connected with the amount of patients' spontaneous health activity. Authors analyzed these findings in the light of psychosomatic medicine.