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At least 1,423 records · Page 79Linked to original sources
PubMed1998

[A conjoined birth: the emergence of kinesiotherapy in France and the establishment of physiotherapy in Quebec: trajectories in mirrors].

In France, the development of manual care was considerably conditioned by its popular origin, whereas in Quebec such treatments were put into practice in a country where nothing of the kind had ever existed. Although France had left its mark there, it was from England that the first qualified practitioners--already called physiotherapists--came. In those two countries, World War I had been a period of organization and recognition which had brought out the practice as a complement of military surgery. In Quebec, the medical issues at stake, which were important at first, were progressively reduced because of private activity exploiting physiotherapists. The profession's protection system showed its efficiency by having doctors' lack of competence in physiotherapy acknowledged. Such a situation led on the free access to physiotherapy for patients. But the sharing of medical acts with other professions remained a serious handicap. In France, the medical issues at stake remain significant. Physicians have always kept physiotherapists and physiotherapy under control through medical prescription, physiotherapists being perceived as considerably less threatening towards the autonomy of the profession. On the other hand, the organization of officially recognized health professions prevents them from encroaching upon one another's professional acts.

Canada↗
PubMed2000

Archie Cochrane and his legacy. An internal challenge to physicians' autonomy?

Archibald L. (Archie) Cochrane was born in 1909 into a wealthy Scottish family, from which he inherited the advantage of a private income and the disadvantage of porphyria. Though a brilliant student, his medical training was interrupted by a lengthy psychoanalysis in Europe, and by service in a field ambulance unit in the Spanish Civil War. Eventually Cochrane qualified in medicine in 1938 and joined the R.A.M.C. in 1939. He was taken prisoner in Crete in 1941 and served the rest of the war as medical officer in various POW camps. Cochrane's post-war career with the Medical Research Council as a field epidemiologist in South Wales earned him the respect and admiration of a generation of British epidemiologists. However, Cochrane's international reputation is not based on his achievements as an epidemiologist, but on his 1971 monograph "Effectiveness and Efficiency. Random Reflections on Health Services," a biting scientific critique of medical practice. Cochrane died in 1988, but his name lives on in the Cochrane Collaboration, a network of researchers devoted to clinical trials, and the torch which he lit had been carried forward by the groups promoting evidence-based medicine. Some have looked askance at these developments, regarding them as a threat to the autonomy of physicians.

Epidemiology↗
PubMed2003

Instrumental colonisation in modern medicine.

Stethoscopes, x-rays and other medical technologies are two-edged swords. They make medical treatment and diagnosis more accurate and effective, but do at the same time reveal our perceptual inadequacy. By transcending our senses, these technologies reveal that we can be seriously diseased without experiencing any symptoms at all. This situation has changed our attitude towards our relations and ourselves. The situation can be analysed using Jürgen Habermas' conception of "systems colonisation of the lifeworld." Medical technologies colonise our lifeworld. They change the way we think and act. They make us all accept that we can become patients almost any minute, even if we feel perfectly healthy. Sense transcending technologies turn us all into proto-patient.

Biomedical Technology↗
PubMed2005

Moral dilemmas of nursing in end-of-life care in Hungary: a personal perspective.

The authors' aim is to bring to the attention of readers the inadequacies of care for people in Hungary who are terminally ill. They believe that both objective and subjective factors cause these inadequacies. Most of these factors arise from moral dilemmas that could be eased or even solved if ethics education had a much more prominent place in the nursing curriculum. Even if nurses would not become automatically better persons morally, a much wider knowledge of medical/nursing ethics could significantly improve nursing care both before and at the end of life. Although the article is also critical of the nursing care provided, it is not its purpose to make any generalizations. The study utilized selected passages from essays written by 76 practicing nurses on their personal experience of ethical dilemmas in their work environment, and a questionnaire administered to 250 students (registered nurses and health care students) studying for a college degree. This article is written by two authors who have formed an unusual alliance: a registered nurse with 29 years' experience of bedside nursing, but who is currently a teacher of nursing ethics at a local health college, and a lawyer turned bioethicist.

Clinical Competence↗
PubMed1997

The normative constitution of professional power.

This article concerns the manner in which we think and talk about power in health care policy and regulation, and the political and social practices allied with that discourse. I assert that in health care policy and practice we speak of and live within the era of countervailing power. In this language and practice power is a force exercised by one actor to enforce its will against another actor against whom power is exerted. I contend that this language inculcates an individual and social passivity in which citizens rely upon various types of representatives to constitute health care for them in a manner in which they do not and cannot participate. However, this language of power and the political and social practice with which it is associated is merely a contingent, historical product. I claim that an alternative discourse of power is possible, in which power consists of the social interactions in which all of us mutually participate but no one of us can control. Power in this sense is participatory by nature, and because no one is in control, it makes no sense to relegate tasks to specialized, nonparticipatory domains. This alternative discourse of power, therefore, might call forth participatory practices in health care and a concomitant diminution of specialization and expansion of the public sphere. The result would be to blur the lines separating politics from everyday interaction, politics from economy, professionals from patients, and insurers from insureds. Participation would mean much more than casting a vote or writing a check but would also include the mutual sharing of time and energy in the tasks that need to be done: long-term and short-term care, practices of prevention, caring for the chronically ill, and monitoring bureaucratic and professional activities.

Budgets↗
PubMed1997

Assessing and balancing elder risk, safety and autonomy: decision-making practices of health care professionals.

Diverse professionals assess and manage risk with frail elderly yet no standard practice guidelines are used across the care continuum. This qualitative study provides new understanding of how eldercare workers conceptualize and assess risk with frail elderly clients. Fifteen professionals were interviewed using the Long-Interview Method of McCracken (1988) and Crabtree and Miller (1991). Respondents included home care case managers, visiting nurses and hospital discharge social workers. This paper reports on two key decision-making styles identified through multidisciplinary analysis of transcripts: the "snap decision-makers" and the "agonizers." Labeling strategies are identified that may assist eldercare workers with the dissonance between professional training and the realities of practice. Variable thresholds for risk tolerance among diverse professionals were found. These findings suggest that risk assessment often reflects the values of the individual practitioner's profession and agency culture. Standardized training and ethical practice guidelines are needed to reduce extreme variability in professionals' judgments; and to better assist staff with assessing and balancing elder risk, safety and autonomy.

Aged↗