Michael Hardey

Doctor in the house : the Internet as a source of lay health knowledge and the challenge to expertise

This paper investigates the new and unique medium of the Internet as a source of information about health. The Internet is an inherently interactive environment that transcends established national boundaries, regulations and distinctions between professions and expertise. The paper reports findings from a qualitative study of households who routinely used the Internet to access health information and examines how it affected their health beliefs and behaviours. The public use of previously obscure and inaccessible medical information is placed in the context of the debate about deprofessionalisation. It is shown that it is the users of Internet information rather than authors or professional experts who decided what and how material is accessed and used. It is concluded that the Internet forms the site of a new struggle over expertise in health that will transform the relationship between the health professions and their clients.

Appraising the Evidence: Reviewing Disparate Data Systematically

The authors describe a method of systematically reviewing research from different paradigms. They draw on the methods adapted, developed, and designed during a study concerned with the delivery of care across professional boundaries. Informed by the established method of systematic review, the authors undertook the review in distinct stages. They describe the methods developed for each stage and outline the difficulties encountered, the solutions devised, and the appraisal tools developed. Although many of the problems encountered were related to the critical assessment of qualitative research, the authors argue that the method of systematic review can be adapted for use with different data and across disciplines.

Life beyond the screen: embodiment and identity through the internet

This paper explores on-line and off-line identities and how relationship are formed and negotiated within internet environments that offer opportunities to meet people on-line and move into relationship off-line. To do this it draws on an analysis of users experiences of internet dating sites that are designed for those who wish meet others in the hope of forming an intimate relationship. Locating analyses in the context of the individualized sociability of late modernity, it is argued that virtual interactions may be shaped by and grounded in the social, bodily and cultural experiences of users. It is shown that disembodied anonymity that characterizes the internet acts as a foundation for the building of trust and establishing real world relationship rather than the construction of fantasy selves. The paper concludes with a discussion of the wider significance of this for understanding disembodied identities and interactions and the impact of cyberspace on off-line sociability.

‘The Story of My Illness’: Personal Accounts of Illness on the Internet

Narratives about health have an established place in the study of the nature of illness and lay encounters with medical expertise. This article is based on research in the electronic realm of the Internet. Within this new and unique space, people have constructed ‘home pages’ that contain accounts of their health and illness. The interactive and dynamic nature of the Internet means that these web pages represent far more than conventional illness narratives. Based on an analysis of home pages a four-fold typology is presented. This framework is used to map the transformation of people from consumers of health information and care to producers of information and care. It is suggested that home pages constitute the emergence of a new genre that forms part of a broader reconfiguration of the relationship between lay and medical expertise.

Professional territories and the fragmented landscape of elderly care.

This paper examines the problems and dilem mas involved in delivering care to older people. In particular it seeks to identify the processes that facilitate or hinder communication and collaboration between those involved in care that has to be both reliable and expeditious to ensure that high quality care is provided. To do this the paper draws on a recent international systematic review of the relevant research lit erature which is briefly described. A geo graphical analogy is employed to help map dif ferent organisational and professional territo ries of care. It will be argued that these territo ries have their own priorities, patterns of working and perceptions of older people. The paper concludes by considering a potential way to merge territorial interests by reconfig uring the map of care around the older per son.