Sylvie Fortin

The paediatric clinic as negotiated social space

Contemporary urban diversity combined with increasing specialisation in tertiary care, technological innovations, and complexity of pathologies, render patient–physician relations challenging for both patients and practitioners. Based on ongoing research in a university paediatric hospital in Montreal, this paper examines how patient–physician relations are played out in the space of the clinic in which a set of social, cultural, structural and asymmetrical relations intertwine. Through an ethnographic approach, which includes the observation of multi-disciplinary clinical settings as well as interviews with clinicians and families (migrants and non-migrants), the paper examines how the ‘images’ of both the patient (his family) and the physician play an active role in the clinical encounter. Interpretations of parental attitudes by practitioners are linked to their perceived background within the local and institutional configuration of norms and values, including the notion of a ‘good parent’. This research problematises the concept of culture as it is engaged by clinicians (by excluding their own) and promotes reflection on an anthropologically informed clinical practice.

Diversity, Conflict, and Recognition in Hospital Medical Practice.

Abstract The hospital is a place of encounter between health care providers, patients and family members, the healthy and the suffering, migrants and non-migrants, as well as social and cultural minorities, and majorities of various backgrounds. It is also a space where multiple conceptions of care, life, quality of life, and death are enacted, sometimes inhibiting mutual understanding between caregivers and the cared for, a scenario that in turn may provoke conflict. Through the lens of conflict, we explore in this article the theme of Otherness within the clinic, basing analysis on an ethnographic study conducted in recent years in three cosmopolitan Canadian cities. Daily practices and—on a larger scale—the social space of the clinic become material here for reflecting on recognition (and non-recognition) of the Other as actors in the clinical encounter. The examination of structural and situational conditions that contribute to the emergence of conflict offers an understanding of the diversity of values that pervade the clinic. By way of conclusion, we argue that recognition of diversity, at least on the part of practitioners, is a key condition for the emergence of a pluralist normativity in the social space of the clinic.

Survey highlights the need for specific interventions to reduce frequent conflicts between healthcare professionals providing paediatric end-of-life care

This study explored how paediatric healthcare professionals experienced and coped with end‐of‐life conflicts and identified how to improve coping strategies.

Functional Gastrointestinal Disorders: An Anthropological Perspective

This chapter suggests a number of ways that anthropology can contribute to the study of functional gastrointestinal disorders (FGIDs), in a spirit of interdisciplinary cooperation. FGIDs are a complex clinical entity, involving a number of possible signs (e.g., constipation, abdominal pain, nausea), as well as a variety of care strategies, ranging from occasional rest to sustained medical follow-up, against a backdrop of diagnostic and therapeutic uncertainty. In this chapter, we focus on the originality of what an anthropological approach and method has to offer for the understanding of FGIDs, opening up avenues of research, such as expert and lay explanations of disorders, family dynamics in a context of illness, use of medical services, and relationships of care. Grounded in the narratives of the people affected by FGIDs (patients, families, professionals) in a context of urban diversity, anthropology seeks to produce knowledge that is sensitive and appropriate to contemporary settings of life and practice. It provides an opportunity to share thoughts with clinicians about the complexity of clinical processes that incorporate the biological, cultural, and social dimensions of these disorders, which affect many children and adults.

Uncertainty, culture and pathways to care in paediatric functional gastrointestinal disorders

This paper examines how children and families of diverse ethnic backgrounds perceive, understand and treat symptoms related to functional gastrointestinal disorders (FGIDs). It is questioned how different ways of dealing with medical uncertainty (symptoms, diagnosis) may influence treatment pathways. Semi-structured interviews were conducted with 43 children of 38 family groups of immigrant and non-immigrant backgrounds. The analysis takes into account (a) the perceived symptoms; (b) the meaning attributed to them; and (c) the actions taken to relieve them. The social and cultural contexts that permeate these symptoms, meanings and actions were also examined. It is found that, in light of diagnostic and therapeutic uncertainty, non-immigrant families are more likely to consult health professionals. Immigrant families more readily rely upon home remedies, family support and, for some, religious beliefs to temper the uncertainty linked to abdominal pain. Furthermore, non-immigrant children lead a greater quest for legitimacy of their pain at home while most immigrant families place stomach aches in the range of normality. Intracultural variations nuance these findings, as well as family dynamics. It is concluded that different courses of action and family dynamics reveal that uncertainty is dealt with in multiple ways. Family support, the network, and trust in a childs expression of distress are key elements in order to tolerate uncertainty. Lastly, the medical encounter is described as a space permeated with relational uncertainty given the different registers of expression inherent within a cosmopolitan milieu. Narrative practices being an essential dynamic of this encounter, it is questioned whether families’ voices are equally heard in these clinical spaces.

La práctica pediátrica en un medio cultural plural: una experiencia en curso

El ejercicio de la medicina se basa fundamentalmente en el establecimiento de una relacion humana entre el paciente y los miembros del equipo de salud. En el caso particular de la pediatria, esta relacion siempre incluye a la familia. Los factores que intervienen en una relacion humana y que permiten comprenderla son estudiados por las ciencias humanas y sociales; y aunque parezca increible para un profano, las ciencias humanas y sociales no son por lo general parte de los programas que las facultades de medicina han elaborado para formar a los futuros medicos. La educacion medica se basa y hasta podriamos decir, se limita, a los aspectos biologicos. Cabe preguntarse: ?como aprender “todo” sobre el hombre, si la ensenanza se restringe a los aspectos biologicos? Indudablemente, una vision holistica en la formacion de los profesionales de la salud mejoraria la calidad de la practica medica. Vale recordar que nuestra razon de ser como profesionales de la salud es la ayuda que podemos brindar a nuestros pacientes y para ello dependemos de nuestra preparacion humana, cientifica y etica. Las limitaciones que existen en la formacion de los medicos no son nuevas, ya que parecen hallarse desde la creacion de las facultades de medicina tal como las conocemos hoy. Por el contrario, cabria preguntarse si alguna vez en la historia la formacion estructurada de los profesionales de la medicina se pudo librar de la influencia de la cultura “biomedica”. En 1910, Abraham Flexner presento su evaluacion de los estudios medicos en America del Norte. Sus conclusiones se basaron en la visita a 155 facultades de medicina en Estados Unidos y Canada. Unos anos mas tarde, resumiendo su experiencia, Flexner expreso: “el programa de es* Departamento de Pediatria. CHU-Sainte Justine. Universidad de Montreal. # Departamento de Antropologia. Universidad de Montreal. ◊ Unidad de Pediatria Intercultural. ∆ Instituto Nacional de la Investigacion Cientifica, Universidad de Quebec.

Blood transfusion in acute and chronic pediatric settings: beliefs and practices

Blood has been imbued with powerful connotations through history and across cultures. Currently bestowed with scientific meaning, blood nevertheless carries symbolic resonance. This study examines these representations among practitioners and sheds light on the clinical and nonclinical factors that guide blood transfusion (BT) decision‐making in Quebec, Canada.