Lisbeth Sachs

The meaning of 6.8: Numeracy and normality in health information talks

The ambiguities of risk which stem from its translation from epidemiological findings into clinical knowledge and practice and thus to lay experiences of health and illness is a clear dilemma. How are risks expressed statistically, or otherwise mathematically, to be interpreted and communicated within the discourse of medico-science, and how within the discourse of an individuals everyday life? An important tool in all risk discourses and in preventive practices such as health information is testing and test results. Test results--presented in mathematical terms as points on a scale, or as a number--are in fact fundamental to preventive practice. But what do we know about how people involved in these tests understand them and how the results are used in the construction of ideas about risk and normalcy? This article attempts to answer part of that question by drawing on an empirical study of the use of numbers as metaphors in talks between a nurse and her potential patients in a directed health survey.

'I got a letter ...' a qualitative study of women's reasoning about attendance in a cervical cancer screening programme in urban Sweden

This explorative study aims at investigating how ‘healthy’ women describe and reason about participation in a cervical cancer screening programme in Sweden. The study is part of a multidisciplinary research project studying a population‐based cervical cancer‐screening programme from the perspective of different actors.

Is there a pathology of prevention? the implications of visualizing the invisible in screening programs

The preventive orientation that has been gaining ground in Sweden is indicative of ways in which our society is organized to sustain values like “a healthy life,” “a healthy body,” and “a healthy society.” Search for health dangers and risks shows how medical technology has been integrated with our thinking about health. Preventive language, like all language of medicine, besides describing a pre-existing biological reality, creates in the process its own objects of analysis. This also has an impact and influences how lay people experience their bodies. The study presented focuses on one form of prevention in an attempt to describe how the ambition to secure a healthy society, through the detection of early disease, may have the opposite effect. Medical health-care ambitions in screening for cholesterolaemia will be related to implications for a group of men in whom cholesterol was found to be elevated. The men feel healthy yet are in some sense diseased. This raises the issue of visualizing the invisible in health care and the implications of such a process for the patients concermed.

Expert Talk in Medical Contexts: Explicit and Implicit Orientation to Risks

In medical contexts, parties often have reasons to focus on risks: risks of developing diseases or of having children with congenital diseases, risks involved in taking drugs or in using a particular type of therapy, and so forth. In such risk-implicative contexts, doctors and nurses deal with the risk topics sometimes directly, at other times quite indirectly. In this article, we discuss results from studying 5 different health care contexts. We discuss contextual factors that might account for some of the considerable differences in risk talk. Our claim is that the different explicit versus implicit orientations are linked to where and how the different health care experts position themselvesvis-á-vis scientific risk formulations and everyday risk perceptions. Our data on the implicit orientations to risk cast doubt on theories of discourse that would hold that all relevant understandings in discourse are made verbally manifest.

Suffering, Hope and Diagnosis : On the Negotiation of Chronic Fatigue Syndrome

The medical interview has a central place in the transformation of suffering into disease. The focus in this article is on patients with suspected chronic fatigue syndrome (CFS). Central to the diagnosis of CFS is the absence of a clear medical pathology causing symptoms. To patients it is of central importance to present themselves in the medical interview in a way that makes a diagnosis of CFS possible, which provides both hope for a cure and a social legitimization of their suffering. To doctors it is important that they maintain their position as a medical authority and gatekeeper. This means that in a medical examination the doctor and the patient together must explore the patients suffering to define symptoms enabling a diagnosis of CFS. The central issue in this article is how doctors and patients in medical interviews negotiate symptoms and diagnostic criteria in search of a legitimate diagnosis and illness, and how this constitutes the central concern in the patients and doctors collaborative diagnosis work in the medical encounter.

Research on Risk and Risk in Research: Theoretical and Practical Experiences from a Multidisciplinary Study on Cervical Cancer Screening in Urban Sweden:

This article describes a qualitative research project on secondary cancer prevention that was conducted using a multidisciplinary team and that was inspired by perspectives from feminist research and fourth-generation evaluation. A screening program for cervical cancer was investigated from the perspective of different stakeholders through a series of substudies using a variety of qualitative approaches, in order to have a broad basis for consideration and negotiation of improvements. The first sections of this article describe the theoretical and methodological basis for the project, which triangulates a variety of qualitative and quantitative research strategies, whereas the latter sections describe some of our experiences, positive and negative, as a research team (and thus also as stakeholders) in actually conducting the studies.

Drug use and the role of patients and prescribers.

In order to move towards rational drug use in any national or local setting the methods of inquiry have to be expanded. Both the public and private sector have to be addressed. In the latter the pharmacists might be studied using a tracer, fictitious client. One important factor influencing prescribing, drug information, has rarely been assessed scientifically. Experimental studies using group randomization are, however feasible even in developing countries. The individual human being must be in the focus of drug studies and health care and health in the foreground. The combination of qualitative and quantitative methods will assist us to achieve rational drug use that is culturally acceptable, economically feasible and pharmacologically sound.

Practice-knowledge-attitudes-practice: An explorative study of information in primary care

Contemporary information programmes for health staff fail to give thorough consideration to the influence of situational factors on information transfer within health institutions. To study information transfer in Swedish primary care health centres, we have therefore used the participant observation method, to explore the influences of practice on knowledge and attitude formation, in turn giving rise to new practice. Management of hyperlipidaemia was used as an example. Our study suggests that the practice generates new information, which is added to or counteracts the acquisition and use of already existing information and is subsequently used in practice. Ongoing discussions between staff members give an opportunity to share practice experiences. Profession, professional hierarchy and gender are some of the factors influencing the use of information in this context. To improve the effectiveness of information programmes these factors and the professional roles of the health staff should be taken into consideration.

A nurse in preventive work--dilemmas of health information talks.

The possibility of making scientifically objective statements about health risks is part of a new complex of ideas pervading our Western social institutions. The concept of prevention includes an assessment of risk and dangers which lay persons have difficulties in comprehending. Advances in medical technology have made it possible to detect a growing number of anomalies in the human body and thereby to define more and more people as being at risk of various diseases. Even if it seems desirable for society to be able to detect the risks menacing its members, it calls for delicate management of the test procedures and of the preventive intervention. This article presents some perspectives on preventive work in connection with a directed health survey. The primary aim of the survey in question was to diagnose particular risk factors, for instance a high level of blood cholesterol, and inform the patient about how to prevent or reduce the risk of cardiovascular disease. The preventive measures are commonly undertaken by a nurse; her encounters with the patients—to obtain test samples, communicate the results and provide information about health risks—raise complex issues. These and other dilemmas in preventive work are discussed and analyzed

The messenger's dilemmas: giving and getting information in genealogical mapping for hereditary cancer

Recent advances in genetic research can provide constructive preventive possibilities for individuals and society but also provide physicians and laypersons with new problems. For instance, in consultations dealing with the risk of getting hereditary cancer, physicians have to balance between the role of clinician, attending to the needs of a certain individual, and the role of researcher, collecting vital data for important research. Individuals taking part in these consultations not only have to interpret the information provided by the physicians. They might also be faced with the problem of informing others, often close kin, in a similar risk situation, or on the physicians behalf obtain information from them. They do not only receive bad news about themselves but are placed in a messengers dilemma. The study is based on discourse data from 31 audio-taped talks between a physician and a person seeking information. Analyses of the consultations reveal how individuals seeking information about possible future diseases find themselves in a position where not only informing unknowing relatives, but also obtaining information from them, is experienced as giving them bad news.