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Biomedical subjects

M Calnan

Publications and source records attributed to M Calnan.

At least 19 recordsLinked to original sources
PubMed1996

The 'limits' of medicalization?: modern medicine and the lay populace in 'late' modernity.

Taking as its point of departure the medicalization thesis and its limitations, this paper provides a critical discussion of certain more recent theoretical perspectives on life in contemporary society, and their relevance for understanding the relationship between modern medicine and the lay populace. In particular, attention is paid to the contours and existential parameters of life in 'late' modernity in terms of the following four key themes: (i) modernity as a 'reflexive' social order, (ii) 'risk' and the dialectic of scientific and social rationality; (iii) the "mediation' of contemporary experience; and (iv) lay 're-skilling' and the 'life political' agenda. On the basis of this, it is argued that far from being simply passive and dependent, a 'critical distance' is beginning to emerge between modern medicine and the lay populace; a situation which resonates with broader social trends and currents within society at large.

Aged↗
PubMed1995

The role of the general practitioner in health promotion in the UK: the case of coronary heart disease prevention.

This paper examines the approach taken to health promotion and disease prevention in primary care in the UK, using coronary heart disease prevention (CHD) as an illustration. The paper considers the approach taken by the UK's government, the level of involvement of general practitioners (GP) and community nurses in CHD prevention, the factors that influence variation in involvement and the evidence for effectiveness.

Community Health Nursing↗
PubMed1995

Why do people go to their doctors?

The evidence presented here suggests for most people deciding to consult a doctor is not a common event and that they have 'good' reasons for consulting, when they do, which are tied up with their own personal and social circumstances. Their evaluation of the care they receive will be tied to how far their specific problems and associated needs are met.

England↗
PubMed1995

Challenges to professional autonomy in the United Kingdom? The perceptions of general practitioners.

Theoretical analysis has suggested that so-called threats to professional autonomy in the United States might also be manifesting themselves in the United Kingdom through the introduction of market principles and the new "managerialism" into the National Health Service by the government and through the emergence of complementary medicine and the role of the "articulate" consumer. The authors explore these issues by focusing on how a sample of the "rank and file" of general practitioners perceive these potential challenges from "above and below." The evidence suggests that the social, economic, and clinical freedoms of general practitioners remain intact although these external influences appear to have changed the style of clinical practice, which is a source of concern and dissatisfaction to some general practitioners.

Adult↗
PubMed1994

A spoonful of sugar helps the medicine go down? Perspectives on the use of sugar in children's medicines.

This analysis examines the policy issues involved in the removal of sugar from paediatric medicines. It reports a study which investigates the perspectives of professionals, consumers, and the pharmaceutical industry. Interviews were conducted with: parents of children receiving long term medication, dental professionals involved in influencing policy or caring for such children, and drug companies who produce medication for long term use by children. Results showed that the parent group preferred the tablet over the liquid form of medication; this was also considered acceptable by the key dental professionals interviewed. The removal of sugar from liquid medicine (rather than the alternative use of smaller tablets) was not therefore a policy generally preferred by the groups involved in the issue. It was concluded that the singular concern of the dentist, doctors and pharmacists to remove sugar from liquid paediatric medicines was a reflection of their altruistic intentions. The limited biomedical perspective of clinically trained occupations prevented them from exploring the wider issues of the various needs of consumers. Thus, the analysis highlights the problems which have been introduced by professional dominance in the issue of medication caries.

Attitude of Health Personnel↗
PubMed1994

Major determinants of consumer satisfaction with primary care in different health systems.

It is becoming increasingly recognized that patient or 'consumer' views should be taken into account as part of a comprehensive assessment of quality of care. This paper reports a study carried out in four European countries about consumer satisfaction with primary care. The results showed that higher levels of general satisfaction with general practitioner services were found in Canterbury (95%) and Ioannina (87%) than Belgrade (85%) and Moscow (62%). Further analysis of the data showed that in all four cities the key dimensions of satisfaction with general practitioner care are both the nature in quality of the doctor-patient relationship and the GP's professional skills. The implications of these findings are discussed.

Adolescent↗
PubMed1994

Involvement of the primary health care team in coronary heart disease prevention.

BACKGROUND: Recent years have seen a vast increase in the amount of health promotion activity undertaken in general practice. AIM: This study set out to identify the level of general practitioner and nurse involvement in activities aimed at coronary heart disease prevention and to examine variations in involvement. METHOD: A questionnaire survey was undertaken of a sample of general practitioners across England and the nurses who worked in their practices. RESULTS: Of 1696 randomly selected general practitioners 64% completed a questionnaire, of 928 practice nurses 71% responded and of 682 health visitors and 679 district nurses 52% and 40% responded, respectively. Of the general practitioners 94% reported that they were involved in assessing lifestyle risk factors in the routine consultation and regular assessments most commonly involved blood pressure testing and inquiry about smoking status. Eighty six per cent of practices were reported by the practice nurse as having well person clinics; these clinics were usually run by the practice nurse. Clinics for the management of specific lifestyle risk factors were also usually run by practice nurses, although many doctors were involved in hypertension clinics and cholesterol clinics. Health visitors and district nurses had a low level of involvement in this practice based clinic activity. Involvement of general practitioners and practice nurses in coronary heart disease prevention was associated with training in health promotion and positive attitudes towards prevention and health promotion. The level of involvement of practice nurses in health promotion was associated with the support received from primary health care facilitators, family health services authorities and district health authorities. CONCLUSION: Members of the primary health care team appeared to have their own distinct area of preventive activity. However, this division did not appear to be a result of organized teamwork and deployment of skills and expertise according to a clearly defined management protocol. Instead it seemed to be a product of general practitioner contract and management arrangements which tended to encourage an approach to general practice health promotion which revolved around the practice nurse and which hindered the development of a broader team based approach to planning and delivery of health promotion in relation to the needs of the practice population.

Coronary Disease↗
PubMed1993

Coronary heart disease prevention: the role of the general practitioner.

The objectives of the study were to identify the level of general practitioner (GP) involvement in activities aimed at coronary heart disease prevention and to explain variations in involvement. These questions were explored through a postal survey of a random sample (n = 1696) of GPs in England of whom 64% completed questionnaires. Ninety-four per cent of GPs reported that they were involved in risk factor assessment in the consultation although these assessments most commonly involved blood pressure testing and identification of smoking. Ninety-one per cent of practices were reported by the GP to have a lifestyle risk assessment clinic where there was more evidence of systematic risk assessment. These clinics were usually run by a practice nurse as were lifestyle risk factor management clinics although GPs were more involved in hypertension and cholesterol clinics. Positive attitudes to prevention and training in health promotion were associated with higher GP involvement, and higher practice involvement was associated primarily with the number of practice nurses employed. The implication of these findings are discussed.

Adult↗
PubMed1993

Breast cancer screening services in three areas: uptake and satisfaction.

The objective of our study was to test whether attendance for breast cancer screening and satisfaction with the service could be predicted from a knowledge of the woman's social and psychological characteristics. In a prospective design, demographic characteristics, self-reported health status and behaviour, expectations and attitudes were examined through postal questionnaires sent out shortly before the invitation to screening, and the measures were used to predict subsequent attendance and satisfaction. The sample was taken from three areas in the South-East Thames Regional Health Authority providing a Forrest service--one rural, one provincial and one inner city--and consisted of 3160 women aged 50-64 invited routinely for screening. The main predictors of attendance were the woman's attitude to being screened and her belief that 'salient others' wanted her to attend. The main predictors of satisfaction with the service were the behaviour of the staff and the facilities at the centre. Three implications of the findings are discussed: (a) health education should include partners, relatives and friends of the target women, as their views had as much effect on attendance as did the women's attitudes; (b) staff training and development should focus on communication with the patient; (c) further research should examine the precursors of reported discomfort and pain.

Attitude to Health↗
PubMed1992

Discomfort and pain during mammography: description, prediction, and prevention.

OBJECTIVE: To identify the nature of pain and discomfort experienced during mammography and how it can be ameliorated. DESIGN: Questionnaire survey before invitation for mammography and immediately after mammography. Responses before screening were related to experience of discomfort. SETTING: Health district in South East Thames region. SUBJECTS: 1160 women aged 50-64 invited routinely for screening; 774 completed first questionnaire, of whom 617 had mammography. 597 completed the second questionnaire. MAIN OUTCOME MEASURES: Reported discomfort and pain, comparisons of discomfort with that experienced during other medical procedures, qualitative description of pain with adjective checklist. RESULTS: 35% (206/597) of the women reported discomfort and 6% (37/595) pain. 10 minutes after mammography these figures were 4% (24/595) and 0.7% (4/595) respectively. More than two thirds of women ranked having a tooth drilled, having a smear test, and giving blood as more uncomfortable than mammography. The most important predictor of discomfort was previous expectation of pain (discomfort was reported by 21/32 (66%) women who expected pain and 186/531 (35%) who did not). Discomfort had little effect on satisfaction or intention to reattend. CONCLUSIONS: The low levels of reported pain and discomfort shortly after mammography and the favourable comparisons with other investigations suggest that current procedures are acceptable. Since two thirds of the women experienced less pain than expected health education and promotion must ensure that accurate information is made available and publicized.

Female↗
PubMed1992

Professional reimbursement and management of time in general practice. An international comparison.

A hypothetical model was proposed for explaining the relationship between general practitioners' system of payment and the amount of time spent in patient and non-patient work. It was hypothesized that GPs reactions to higher workload vary according to the payment system. In this paper we compare two health care systems which have both mixed systems of payment of GPs. In England and Wales up until April 1990 GPs are partly paid by capitation (approx 45% of their income), partly by allowance (38% of their income) and for a much smaller part fee for service (18% of their income). In the Netherlands GPs are paid by capitation for the publicly insured patients (63% of the average practice list) and fee for service for the privately insured patients. We expect (among other things) a stronger, positive relationship between list size and hours worked in the Netherlands and a comparably strong, negative relationship between list size and booking intervals in the Netherlands and in England and Wales. Drawing on data collected from national surveys of GP workload in the Netherlands and England and Wales these propositions were examined. The results of this comparative analysis showed some support for the propositions in that the relation between list size and number of hours worked in patient related activities is stronger in the Dutch setting than in England and Wales, and about the same strength for the relationship between list size and booking intervals.

Appointments and Schedules↗
PubMed1991

Convergence and divergence: assessing criteria of consumer satisfaction across general practice, dental and hospital care settings.

This paper describes the results of the first-stage of a study carried out in the spring of 1988 in the South East of England. The study looked at general and specific aspects of consumer satisfaction with general practitioner services, general dental care services and hospital in-patients care. It also examined which specific consumer criteria were the key predictors of overall satisfaction within each of these particular medical care settings. A related aim was to assess the degree of congruence or divergence of consumer criteria across these differing medical care settings. The evidence suggests that whilst general levels of consumer satisfaction are high (i.e. 83-97%), questions of a more detailed and specific nature revealed greater levels of expressed dissatisfaction (e.g. 38% of the sample felt that they could not discuss personal problems with their GP, 51% felt their dentist was not easy to reach at weekends/holidays, whilst 35% felt hospital doctors did not give sufficient information). Whilst different areas of dissatisfaction were found in each specific medical care setting examined, what was particularly striking was the degree of convergence of the key predictors of overall consumer satisfaction across the medical care settings. That is to say, our findings clearly suggest that issues concerning 'professional competence', together with the nature and quality of the patient-professional relationship, are the key predictors of overall consumer satisfaction with general practice, dental and hospital care [e.g. GP giving sufficient information correlated 0.64 (P less than 0.001) with overall GP satisfaction scores; competent dentist 0.52 (P less than 0.001) with overall dental satisfaction scores; and full confidence in hospital doctors 0.49 (P less than 0.001) with overall hospital satisfaction scores]. The theoretical importance and policy implications of these findings, particularly in the light of the recent NHS reforms, are discussed.

Adolescent↗
PubMed1991

Key determinants of consumer satisfaction with general practice.

Consumer satisfaction is an increasingly important issue, both in the evaluation and the shaping of health care, yet the relationship between specific criteria of health care and overall levels of consumer satisfaction with primary care is rarely addressed. The study reported here, based upon the results of a postal questionnaire of a random sample of adults in the south east of England (response rate 62%, n = 454), attempts to address this issue. Whilst general levels of satisfaction were high (95%), questions of a more detailed and specific nature revealed greater levels of dissatisfaction (e.g. 38% felt unable to discuss personal problems with their GP, 26% expressed dissatisfaction with the level of information they received, and 25% were dissatisfied with the length of time spent in consultation). Key dimensions such as communication (0.64; p less than 0.001), the nature and quality of the doctor-patient relationship (0.61; p less than 0.001) and the GP's professional skills (0.58; p less than 0.001)--vis-a-vis issues such as access, availability and type of service provision--were found to be the criteria which were most strongly associated with overall levels of satisfaction with general practice. The policy implications of these findings in the light of the recent Government White Papers, Promoting Better Health and Working for Patients, are discussed.

Adolescent↗
PubMed1989

Control over health and patterns of health-related behaviour.

This paper empirically examines the relationship between position in the social structure, beliefs about control over health and three different types of health-related behaviour. The data are drawn from two large scale community surveys (N = 4224) carried out in southern England. The results show that the relationship between the Multi-dimensional Health Locus of Control (MHLC) and exercise, cigarette smoking and use of alcohol was never more than modest even within different social and economic contexts. Doubts are cast upon the value of the MHLC for explaining variations in health-related behaviour and more fruitful areas for research are suggested.

Alcohol Drinking↗
PubMed1989

The limits of medicine: women's perception of medical technology.

This paper develops an analysis of women's perceptions of medical technology and the elements which shape them, and then draws out the implications for medicine and the and the medicalization thesis. In the first part of the paper we outline the macro-theoretical debates about medicalization and the role of medical technology in this process, and the consequences for those who use health care. The implications for women are given particular attention as they have a higher level of contact with health care than men. We then evaluate the arguments of these macro-theorists against evidence from two ethnographic studies, concerning women patients' and their doctors' attitudes to the use of minor tranquillizers and women's evaluations of medicine and medical practice. This provides a basis for questioning some of the assumptions of the macro-theorists regarding the social relations of medical technology and the medicalization thesis.

Anti-Anxiety Agents↗
PubMed1988

Images of general practice: the perceptions of the doctor.

During the post second world war period there has been considerable discussion both within and outside the medical profession about what the role of the general practitioner should be. This study, drawing on data gathered from a national representative sample of general practitioners in England and Wales, explores general practitioners' own perceptions of their work role. The evidence shows that general practitioners might be divided into those who see a broad role for the general practitioner and place emphasis on the social aspects of care, and those who see a more traditional role for the general practitioner focusing specifically on organic illness. Those with a social orientation were also more likely to doubt the value of financial incentives, whereas the medical oriented doctors were more likely to say that their behaviour was influenced by financial incentives. The analysis also showed that the medically oriented were distinctly different to those with a social orientation in terms of personal characteristics and the setting in which they worked. The implications of these findings are discussed in full.

Attitude of Health Personnel↗
PubMed1988

Towards a conceptual framework of lay evaluation of health care.

It is argued in this paper that much of the empirical research into the public's and patients' perceptions of the adequacy of health care has suffered from conceptual weaknesses. In addition, and maybe as a result of these weaknesses, a contradictory pattern of findings has emerged from this research. To overcome some of these problems it is suggested that an investigation of lay evaluation of health care should be carried out within a conceptual framework which incorporates the following elements. (i) The goals of those seeking health care in each specific instance. (ii) The level of experience of use of health care. (iii) The socio-political values upon which the particular health care system is based. (iv) The images of health held by the lay population. Each of these elements interrelates with the others and their influence will be mediated through socio-demographic characteristics of the service users.

Consumer Behavior↗