Changing the structure of medical discourse: implications of cross-national comparisons

In the discourse of medical encounters, social problems arise frequently. Such problems typically derive from work and economic insecurity, family life and gender roles, aging, and conditions that foster substance use or other self-destructive behavior. The structure of medical discourse tends to marginalize the social issues that generate personal troubles in everyday life. Long-range strategies to alter medical discourse aim toward basic modifications of power and finance in the larger society of which medicine is a part; such strategies seek to change the contextual issues that create personal troubles on the individual level. As shown by the examples of the Soviet Union, eastern Europe, and China, social revolution does not necessarily resolve the micro-level contradictions of the doctor-patient relationship. In contrast, the Cuban revolution apparently has succeeded in transforming both the context and the structure of medical encounters. Short-range strategies in countries such as the United States involve more direct ways in which patients and doctors can alter their communication. These alterations involve reducing devices of language that maintain professional dominance, avoiding the medicalization of nonmedical problems, attempting not to marginalize contextual issues, and encouraging active attempts to change social conditions that generate personal troubles.     

The interpreter as institutional gatekeeper: The social-linguistic role of interpreters in Spanish-English medical discourse

Increases in immigration have led to an enormous growth in the number of cross-linguistic medical encounters taking place throughout the United States. In this article the role of hospital-based interpreters in cross-linguistic, internal medicine ‘medical interviews’ is examined. The interpreter's actions are analyzed against the historical and institutional context within which she is working, and also with an eye to the institutional goals that frame the patient-physician discourse. Interpreters are found not to be acting as ‘neutral’ machines of semantic conversion, but are rather shown to be active participants in the process of diagnosis. Since this process hinges on the evaluation of social and medical relevance of patient contributions to the discourse, the interpreter can be seen as an additional institutional gatekeeper for the recent immigrants for whom she is interpreting. Cross-linguistic medical interviews may also be viewed as a form of cross-cultural interaction; in this light, the larger political ramifications of the interpreters' actions are explored. ‘Interpreters are the most powerful people in a medical conversation.’ Head of Interpreting Services at a major private U.S. hospital, May 1999.     

How Applicable are Western Models of Patient‐Physician Relationship in Asia?: Changing Patient‐Physician Relationship in Contemporary Japan

Abstract:  The social and political environments surrounding patient-physician relationship have been changing in Japan for the last few decades. This paper aims to illustrate social and cultural factors that underlie current situations and problems of patient-physician relationship in Japan through a comparison with those in western countries, and to consider how mutual participation model of patient-physician relationship could be applied and fostered in Japan as well as other Asian cultures. Four major sociocultural factors are discussed in relation to the patient-physician relationship in Japan: (1) individualism versus collectivism; (2) low context versus high context; (3) femininity versus masculinity; and (4) Christianity versus Confucianism. Two key issues in discussing the mutual participation model of patient-physician relationship in Japan have emerged; the family and the communication style. The patient autonomy in Japan should be considered within the context of the triadic relationship of patient, family, and physician. Also, since the communication style might differ between Japan and western countries, communication training programs and interventions for medical professionals as well as for patients should be tailored in a culturally appropriate way in order to improve the communication in medical encounters and to achieve the mutual participation. Beyond mere advocacy of the patient autonomy, the mutual participation model of patient-physician relationship should be pursued within our social and cultural context to be truly fruitful for patients and physicians in Japan.     

Doctors offline,activists online: an analysis of Chinese celebrity physicians’ politically oriented social media activities

This study explores the social media activities of politically oriented Chinese celebrity physicians. The results of the semi-structured in-depth interviews indicated that the celebrity physicians were dissatisfied because the government treated them as the scapegoats of the failed health care reform. They thus turned to social media to challenge the dominant narratives about the public health system and repair their professional reputations. To achieve these goals, the celebrity physicians produced media content that challenged the dominant governmental discourse about the public health system, and they collaborated to correct conventional media narratives about the medical profession when crises occurred. The findings of this study indicate the formation of a new type of online civil activism that was initiated by a group of professionals and intellectuals.     

Analysis of social innovation on social networking services

ABSTRACT

Social network services are allowing more social connectivity and making possible sharing information and knowledge of a different nature. This article analyses if social workers related to active social policies from Malaga province (Spain) are using social network services to share information and knowledge and if there is a mirror between online and offline relationships. Since it is an experimental model, through virtual ethnography and through social network analysis methodology, we observed the presence, connectivity and analysed the structure of relationships that keep 235 professionals from 52 organizations in Facebook®. Moreover, the model uses the statistical technique of modularity for detecting online communities, which are compared with distribution of professionals in their organizations. Results show how social network services applied to social intervention are massively and frequently used by professionals. On the other hand, the detected communities reflect existence of analogy between online and offline relationships. The online structure shows a high degree of cohesion and how certain professionals have higher capacity of influence and diffusion depending on position in the online structure. It argues about the opportunity to incorporate social network services towards social intervention as a manner of social innovation to improve cooperation and diffusion of information and knowledge.     

Secondary victimization of rape victims: insights from mental health professionals who treat survivors of violence

Rape victims may turn to the legal, medical, and mental health systems for assistance, but there is a growing body of literature indicating that many survivors are denied help by these agencies. What help victims do receive often leaves them feeling revictimized. These negative experiences have been termed "the second rape" or "secondary victimization." If indeed secondary victimization occurs, then these issues may be raised in rape survivors' mental health treatment. In the current study, probability sampling was used to survey a representative sample of licensed mental health professionals about the extent to which they believe rape victims are "re-raped" in their interactions with social system personnel. Most therapists believed that some community professionals engage in harmful behaviors that are detrimental to rape survivors' psychological well-being. Implications for future research on secondary victimization are discussed.     

Towards an interactional approach to reflective practice in social work

Reflective practice is a key aspiration within social work; being a reflective practitioner is considered to be a foundational attribute of the social work professional. However, achieving reflective practice is not straightforward. Reflection is inevitably subject to issues of memory and recall, so that the recollection of a case is likely to differ in important ways from the original instance. Moreover, giving an account of an event to one's peers or supervisors involves aspects of justification and self-presentation that may emphasise selectively and ignore key details of the original event, whether through a process of conscious omission or subconscious forgetting. This article reports on a knowledge exchange project that sought to enhance criminal justice social workers’ reflective practice through the use of the Conversation Analytic Role-play Method, an approach that is methodologically and theoretically grounded in the study of talk-in-interaction, drawing on video re-enactments of real encounters between practitioners and service users. We argue that by engaging collaboratively in this way, the practitioners and researchers learned a great deal about how practice in criminal justice social work is ‘done’ and also about the wider context within which criminal justice social work is practised.     

Talking about culture in social work encounters: immigrant families and child welfare in Finland

This article aims at analysing the ways in which people talk about ‘culture’ in social work encounters involving child welfare in immigrant families. The empirical material includes conversations between immigrant clients, their social workers and co-operating professionals at six Finnish social service offices, as well as interviews with the persons participating in these meetings. The theoretical and methodological frames of reference are social constructionism and discourse analysis. The study suggests three ways in which the concept of ‘culture’ is used by social workers and their clients: firstly, as a means of explaining ‘the ordinary and normal ways’ of raising children; secondly, as ‘a difficulty’ in the interaction between social workers and clients; and thirdly, as ‘a methodical tool’ in creating dialogue with clients. As far as the practical implications for social work are concerned, it is emphasized that in order to avoid ethnocentric practice or ‘culturalization’ of problems, it is important for social workers to be conscious of the various meanings of ‘culture’ both in their own practice and in the ways their clients employ cultural symbolism.     

Disability,embodiment and ableism: stories of resistance

Non-disabled responses to visible impairment embody either social invisibility or over-attentiveness. The subjective and inter-subjective experiences of impaired bodies and intersubjective encounters within society are important aspects of disablement and the construction of a disabled identity. Impairment is read by and influences the social structure of ableism. This paper attempts to understand how ableist discourses about impaired bodies have impacted on and been resisted by disabled people and how embodiment is related to identity. In pursuit of these aims, a qualitative study was conducted with seven people who have visible physical impairments. The results indicate that disabled embodiment is produced and experienced within an ableist context that mobilizes the charitable gaze and the medical model to signify impaired bodies at the expense of the recognition of disabled identity. In order to deconstruct ableism and to recognize and respect the value of the disabled identity, a politics of recognition is required.     

Toward a social relational model of Deaf childhood

This paper advances a social relational model of Deaf childhood as a guiding framework for working with Deaf children in a present-day universal neonatal hearing screening and early intervention context. The authors discuss how Deaf children are contextualized in a medical model discourse, in a social model of Deaf childhood, and in a Deaf culture discourse. A social relational model is then discussed in with reference to a capability approach and to findings from the first author’s study of parents and young children participating in an American Sign Language shared reading program in Ontario, Canada.     

Socioeconomic, medical care, and public health contexts affecting infant mortality: a study of community-level differentials in Peru

Socioeconomic, medical care, and public health contexts are examined in Peruvian communities for their relationship to infant mortality. A deviant case analysis is used to uncover characteristics important in the social structure of Peruvian communities. Results from fieldwork in two "deviant" communities suggest that economic diversity, income disparity, social class fluidity, and women's autonomy, along with refined measures of medical care and public health resources, are important in understanding differentials in mortality. Attention is drawn to the community context and to the interplay of socioeconomic determinants affecting infant mortality.     

The new genetics: professionals' discursive boundaries

In this paper we examine new genetics professionals’ accounts of the social context of their work. We analyse accounts given in interview by an ‘elite’ group of scientists and clinicians. Drawing on the work of Gilbert and Mulkay (1984), we consider interviewees’ discourse about knowledge, exploring the way in which they separate science from society through the use of what we have called the ‘micro/macro split’. We then go on to consider the reasons for such a discursive boundary, exploring the interviewees’ wider discourse about expertise and responsibility for the social implications of the new genetics. We argue that interviewees’ discursive boundaries allow them to appeal variously to their objectivity, to dismiss bad science and to characterize the public as ignorant. However, these discursive boundaries are permeable and flexible, and are employed to support the new genetics professionals’ role in guiding education and government policy, whilst at the same time deflecting ultimate responsibility for the use of knowledge on to an abstract and amorphous society. Responsibility is flexibly embraced and abrogated. These flexible discursive boundaries thus promote rather than challenge the cognitive authority of new genetics professionals as they engage in debates about the social implications of their work. We end by challenging the replication of these discursive boundaries, noting some of the implications of such a critique for evaluation of the new genetics.     

Social professionals' perceptions of activating citizenship

This article reports on qualitative research among 48 social professionals, managers and policymakers and their perceptions of activating citizenship, social work roles and responsibilities, carried out in Utrecht and Tartu. Professionals from both countries agreed to the idea of activating citizenship but stressing the perspective of personalised or lived citizenship, each person to his own capacities and embedded in the personal context. Nearly all respondents were critical about the recognition of social workers as a full profession, about the new management way of steering social work and about cooperation between different groups of professionals and services. Although both countries have quite different historical and cultural backgrounds, the authors found many similarities among social workers regarding their ideas on support, participation and commitment to the people they work for and work with. International research projects contribute to a more strongly recognised social work theory and social work practice by getting a better understanding, in particular of the way social work adapts to different contexts but from a highly recognisable international discourse within social work.     

Economic Security and Financial Management Issues Facing Same-Sex Couples

Same-sex couples experience economic rights and responsibilities in a context that differs from that of married couples. Financial management and economic security issues facing same-sex couples have received little attention to date. These issues are examined in this article within changing legal and social conditions. Family professionals should be knowledgeable about the context and scope of these important issues facing same-sex couples to be able to educate their constituent groups appropriately, deal with clients in therapy, and inform and influence policy makers.     

The impact of the political context on discourse characteristics in Jewish–Arab encounters in Israel: between peace talks and violent events

Research in the field of intergroup relations has developed considerably over the last two decades, influenced by events and by the historical zeitgeist. We suggest applying an interactional way of dealing with intergroup encounters, which emphasizes the situational macro‐context (political, historical and social) in which the contact takes place. Employing this approach, the impact of the social‐political context on the characteristics of two encounters in which Jewish and Arab Israeli students met to deal with the Israeli–Arab political conflict was examined. The workshops took place within two completely different political contexts. The first workshop was at the time of peace talks, following the Oslo Accords (1996–1997), the second during the al‐Aksa Intifada (2001–2002). The discussions were recorded and fully transcribed. The two workshops were compared using a typology for classification of the developmental process of discourse between groups. The analysis revealed that during the peace talks ‘ethnocentric discourse’ was the dominant speech category, characterized by two monologues that do not meet. In the second workshop dialogic categories characterized by sharing of feelings, listening to the ‘other’ and making an effort to understand how reality looks from his/her perspective were salient. The research findings are discussed with regard to the paradoxical impact of the political–social context on discourse in small groups. The findings give a new understanding of the role of small intergroup meetings against the background of violent reality in an intractable conflict.     

The social world of assisted living

This study defines assisted living as a unique social world and is based on a 22-month ethnography in three facilities and completion of the program required of certified assisted living facility (ALF) managers in Oregon. The focus was on how daily operations are affected by central values (i.e., independence, choice, privacy) defined by Oregon Administrative Rules (OAR). In their efforts to legitimize this newly constructed social world, proponents and providers have developed a package consisting of a unique vocabulary and two organizational practices, the Negotiated Service Agreement (NSA) and Managed Risk Agreement (MRA). This package is integral to the maintenance of this social world, providing the means for defining and defending assisted living. These organizational tools offer a contemporary perspective on the rights of chronically ill and disabled seniors to make choices about their health care, even choices that might be defined as risky by medical professionals.     

Building research capacity for social work practitioners: a regional perspective

This article explores the research experiences, interests and capacity of social work professionals working as frontline workers and managers in human service organizations in regional South Australia. It also draws attention to social work practice issues requiring further investigation as identified by these professionals. The research data for this paper were collected using quantitative and qualitative methods. Quantitative data provided evidence to show the extent of research interests among social work practitioners in the region. Qualitative data added depth to the findings by identifying social work practice issues as described by research participants. The study revealed that few participants had any research experience; however, the majority felt the need to undertake research, expressed interest in research training and a desire to be involved in research projects. These findings have implications for higher education providers in the social work discipline. They draw attention to the importance of better preparing students for research in practice, and also for schools of social work to actively engage in building research capacity and output in regional Australia.

Abbreviations: Frontline social work professionals (FLSWP); The Australian Association of Social Workers (AASW)     

Use of standardized client simulations in an interprofessional teaching concept for social work and medical students: first results of a pilot study

ABSTRACT

Teaching concepts with standardized clients/patients (SC) had been successfully implemented in the education of health professionals. Benefits were also demonstrated for social work education. Based on former experiences with simulated clients in medical education, we developed an innovative teaching concept for social work and medical students. We focused on the training of consultations with clients suffering from a serious illness like cancer—with different learning goals for medical students (e.g. breaking bad news) and social work students (e.g. psychosocial exploration and counseling). Both groups should gain knowledge about the other professions tasks and learn to handle clients’ emotional reactions. In addition to role-plays with simulated clients in small groups, the concept includes an interprofessional lecture by physicians, psychologists, social workers, and lawyers as well as a visit on the palliative care ward (for social work students only) and a research colloquium. A formative evaluation shows high satisfaction with the teaching concept. The students underline the realistic setting, interprofessional contact, authentic talks and direct feedback. The SC method and its interprofessional application proved to be a practicable and motivating way to enhance conversational skills.