Annemarie Jutel

Sociology of diagnosis: a preliminary review

Diagnoses are the classification tools of medicine, and are pivotal in the ways medicine exerts its role in society. Their sociological study is commonly subsumed under the rubrics of medicalisation, history of medicine and theory of disease. Diagnosis is, however, a powerful social tool, with unique features and impacts which deserve their own specific analysis. The process of diagnosis provides the framework within which medicine operates, punctuates the values which medicine espouses, and underlines the authoritative role of both medicine and the doctor. Diagnosis takes place at a salient juncture between illness and disease, patient and doctor, complaint and explanation. Despite calls for its establishment, almost two decades ago (Brown 1990), there is not yet a clear sociology of diagnosis. This paper argues that there should be, and, as a first step, draws together a number of threads of medical sociology that potentially contribute to this proposed sociology of diagnosis, including the place of diagnosis in the institution of medicine, the social framing of disease definitions, the means by which diagnosis confers authority to medicine, and how that authority is challenged. Through this preliminary review, I encourage sociology to consider the specific role of diagnosis in view of establishing a specific sub-disciplinary field.

Towards a sociology of diagnosis: Reflections and opportunities

The North East Medical Sociology Group is pleased to announce details of the next half day seminar to be held on the afternoon of Wednesday 26 March 2014 at Teesside University, Darlington Campus. There will be a keynote presentation by Professor Sarah Nettleton from the Department of Sociology at University of York. There will additionally be three presentations from local speakers, together with a participatory session exploring a current topic of interest. A draft programme is set out overleaf.

Weighing Health: The Moral Burden of Obesity

This article explores how a contemporary fixation with body fat and its containment takes its origins in historical sources. Despite the fact that the thin body has not always been the coveted norm, strong cultural beliefs about the significance of appearance provide a foundation for the preoccupation with calorie-counting, body sculpting, exercise and diets. These practices are based on three important premises. First, in the range of senses, vision ranks highest. What we see is somehow more reliable than what we hear, taste or feel. Second, from this follows the notion that appearance mirrors the “true” inner self, and reflects a supreme order. And finally, food contains and conveys moral value to the person who eats it, a value that may be witnessed in physical appearance. This article briefly reviews how these beliefs have, over many centuries, merged into an aesthetic of health, setting the standards that lead our contemporary society to an over-reliance on weight as an indicator of health.

Does Size Really Matter? Weight and Values in Public Health

The medical community has long regarded obesity and overweight as serious health risks, and popular culture reflects these concerns. A focus on body weight reduction motivates many contemporary exercise and diet practices, especially among women. Yet, there is significant evidence that those risks have been exaggerated, that weight loss regimens may be more detrimental to health than moderate obesity, and that pressure to be thin leads to disordered eating and unhealthy lifestyle choices. This paper examines the problematic manners in which some national health policies regard the problems of overweight and obesity. It contends that concepts of aesthetics, grounded in 19th-century beliefs about the body, guide clinicians to emphasize measurement of the body in health assessment at potential cost to individual wellness.

Soft Targets: Nurses and the Pharmaceutical Industry

The nursing literature has yet to pay much attention to the expansive reach of the pharmaceutical industry into the nursing profession.

Framing disease: The example of female hypoactive sexual desire disorder

Disease classification is an important part in the process of medicalisation and one important tool by which medical authority is exerted. The demand for, or proposal of a diagnosis may be the first step in casting lifes experiences as medical in nature. Aronowitz has written about how diagnoses result from social framing mechanisms (2008) and consensus (2001), while Brown (1995) has demonstrated a complex range of interactions between lay and professionals, institutions and industries which underpin disease discovery. In any case, there are numerous social factors which shape the diagnosis, and in turn, provide a mechanism by which medicalisation can be enacted. Focussing on diagnostic classification provides an important perspective on the human condition and its relationship to medicine. To illustrate how layers of social meaning may be concealed in a diagnosis, this paper uses as heuristic the relatively obscure diagnosis of Female Hyposexual Desire Disorder which is currently surfacing in medical and marketing literature as a frequent disorder worthy of concern. I describe how this diagnosis embodies long-standing fascination with female libido, a contemporary focus on female hypersexuality, and commercial interest of the pharmaceutical industry and its medical allies to reify low sexual urge as a pathological disorder in women.

Nurses' reported influence on the prescription and use of medication

AIM To identify the activities senior nurses report undertaking that may influence the prescription and use of medicines. BACKGROUND While much attention has focused on the role of nurse prescribing, little is known about the extent to which non-prescribing nurses influence medication decision making. The pharmaceutical industry recognizes this influence in its marketing strategies, and courts nurses by provision of promotional material and sponsorship of nursing professional development. METHODS We undertook parallel web- and paper-based surveys of 100 senior registered nurses employed by government-funded health boards in two distinct New Zealand regions. FINDINGS Only 2/96 (2%) of nurses had prescribing rights, yet 74/94 (79%) reported recommending treatments to the prescribing doctor, 74/95 (79%) stated they provided advice to patients about over-the-counter medications and 71/92 (77%) participated in the development of guidelines or policies that include the use of medications. All nurses in this sample reported influencing the prescription of medicines in one way or another. DISCUSSION From actually writing prescriptions to providing feedback on treatment outcomes, there are many opportunities for nurses to influence the decision making of medical and other prescribers, which open nurses to exploitation from commercial forces. Policy and education regarding prescriber relationships with the pharmaceutical industry should also recognize the role of non-prescribing nurses.

Shrinking social space in the doctor–modern patient relationship: A review of forces for, and implications of, homologisation

OBJECTIVE Forces for modernisation appear to have led to role convergence and reduced social distances between doctors and modern patients. This review aims to document and understand this process in theory and practice, and to consider the implications for modern patients in particular but also non-modern patients and doctors. METHOD Narrative review of published and grey literature identified from sources including electronic databases, the Internet and reference lists of retrieved works. RESULTS Forces for role convergence between doctors and modern patients include consumerism and increased patient literacy; socio-technological changes; values convergence; increased licence for doctors to use their emotions in patient care; and structural changes in the social organisation of health care. As a result, modern patients appear to have gained more in health care than they have lost and more than have the non-modern (or less modern) patients. Doctors have lost authority and autonomy in patient care. CONCLUSION The net impulse toward role convergence is, on balance, a positive development. The differential uptake of modernisation by patients has increased health inequalities between modern and non-modern patients. The need of doctors to accommodate these changes has contributed to a form of reprofessonalisation. PRACTICE IMPLICATIONS A key challenge is to make available the benefits of modernisation, for example through patient education, to as many patients as possible while minimising the risk of harm. It is important therefore to elucidate and be responsive to patient preferences for modernisation, for example by enlisting the support of the modern patients in overcoming barriers to the modernisation of non-modern patients. There is also a need to support doctors as they redefine their own professional role identity.

Too Few, Too Weak: Conflict of Interest Policies at Canadian Medical Schools

Introduction The education of medical students should be based on the best clinical information available, rather than on commercial interests. Previous research looking at university-wide conflict of interest (COI) policies used in Canadian medical schools has shown very poor regulation. An analysis of COI policies was undertaken to document the current policy environment in all 17 Canadian medical schools. Methods A web search was used to initially locate COI policies supplemented by additional information from the deans of each medical school. Strength of policies was rated on a scale of 0 to 2 in 12 categories and also on the presence of enforcement measures. For each school, we report scores for all 12 categories, enforcement measures, and summative scores. Results COI policies received summative scores that ranged from 0 to 19, with 0 the lowest possible score obtainable and 24 the maximum. The highest mean scores per category were for disclosure and ghostwriting (0.9) and for gifts and scholarships (0.8). Discussion This study provides the first comprehensive evaluation of all 17 Canadian medical school-specific COI policies. Our results suggest that the COI policy environment at Canadian medical schools is generally permissive. Policy development is a dynamic process. We therefore encourage all Canadian medical schools to develop restrictive COI policies to ensure that their medical students are educated based on the best clinical evidence available, free of industry biases and COI relationships that may influence the future medical thinking and prescribing practices of medical students in Canada once they graduate.

Digitizing diagnosis: a review of mobile applications in the diagnostic process

Abstract An increasing number of smartphone and software applications (“apps”) have been developed and marketed to assist in the process of diagnosis, yet little attention has been paid to their content, claims, potential risks, limitations or benefits of their use. This study sought to describe and catalogue available diagnosis apps and explore their impact on the diagnostic process. We undertook a content analysis of the app descriptions and developers’ websites using the descriptions provided for 131 medical diagnosis smartphone apps that were available in the Google Play and Apple App stores. Each app was reviewed for its content and approach, and its claims to medical authority. Four major categories of apps were identified: 1. apps for diagnosing; 2. diagnosis coding apps; 3. books, journals, or other publications in app format; 4. apps for medical education. Our analysis found that while these apps provide access to medical information previously widely not available to lay users and offered a convenient diagnostic tool for practitioners, many failed to describe the evidence base underpinning, or any other credential supporting, their design and use. These apps potentially shift how diagnosis operates, reconfiguring disease concepts and lay-professional relations. However they also raise the risk of conflict of interest and presenting inaccurate information. Further research is required into how these apps are used, the implications for medical practice and the impact on doctor-patient relationship.