Journal of evaluation in clinical practice
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This article returns to Goffman's early formulations of 'stigma' in outlining a critique of contemporary social scientific uses and abuses of the concept. We argue that whilst Goffman's discussion of stigma is not without its troubles, it has mostly been approached in a manner that treats the concept outside of an appreciation of stigma as a phenomenon of interaction order. ⋯ We analyse both social scientific and lay uses of the stigma concept in relation to care-experienced young children and self-harm to demonstrate the shared categorisational practices and logics that are often obscured through theoretical treatments of stigma. The recommendation is, then, that an attention to 'stigma' in care settings must begin with the conditions in and from which stigma might come to feature as a sense-making device for all parties.
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Screening is a useful tool for identifying potential health issues; however, it can also lead to overtreatment. Consequently, patients are sometimes harmed by unnecessary treatments and there are cost implications. Overtreatment can also occur in other areas of medicine besides screening and sometimes medical interventions are used to improve performance rather than to treat disease. ⋯ The problem with overtreatment results from the different interests involved: autonomy is the guiding idea for patients and outcome is the guiding measure for societies. A general solution will not be possible because of these inherent conflicting interests. However, medical research may improve the identification and predictions surrounding any anomalies detected during scans and reduce the problem in practice for specific conditions.
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Evidence-Based Medicine proposes a prescriptive model of physician decision-making in which 'best evidence' is used to guide best practice. And yet, proponents of EBM acknowledge that EBM fails to offer a systematic theory of physician decision-making. ⋯ Physicians are required to interpret and apply any knowledge-even what EBM would term 'best evidence'-in light of their own knowledge, background and experience. This is consequential for EBM as understanding what physicians do and why they do it would appear to be essential to achieving optimal practice in accordance with best evidence.
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Substance use disorder (SUD) is often understood as a chronic illness. ⋯ The paper concludes that the delivery of treatment services is inequitable as SUD is not treated as a chronic illness.
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When we face an equation with an unknown variable, we 'solve for x', using methods that allow us to isolate and identify the unknown. Stigma is a known variable in health care equations, but remains impactful in a variety of ways that are not fully mapped or understood. In other words, stigma is a known unknown: it presents potential obstacles to the delivery of effective health care, but what kind of obstacles, of what size and significance, and for whom is often unclear. ⋯ The present paper begins by demonstrating that stigma in mental health care remains an obstacle worthy of sustained attention. It then discusses typical methods taken in efforts to destigmatize mental illness, and suggests that additional work is needed in the clinical context of mental health care. The pervasiveness and complexity of stigma requires diligence in clinical settings to integrate the experience of mental health care service users and work towards an adequate model of recovery.