300 likes | 411 Views
Medicalisation at the start of life. Justin Allen. Health. "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity". WHO 1948. Disease. An interruption, cessation or disorder of bodily functions, systems or organs
E N D
Medicalisation at the start of life Justin Allen 18th International Bled Course
Health • "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity". WHO 1948 18th International Bled Course
Disease • An interruption, cessation or disorder of bodily functions, systems or organs Dorland’s Medical Dictionary 18th International Bled Course
Illness • A patient's personal experience of his or her disease 18th International Bled Course
Medicalisation (1) • the process by which certain events or characteristics of everyday life become medical issues, and thus come within the purview of doctors. Wikipedia 18th International Bled Course
Medicalisation (2) • Illich argues that the medical establishment poses a "threat to health" through the production of clinical, social, and cultural “iatrogenesis” and medicalises human life. Ivan Illich 1975 18th International Bled Course
Start of life Conception Pregnancy Childbirth Infancy 18th International Bled Course
Start of life Conception Pregnancy Childbirth Infancy 18th International Bled Course
Quick questions: • Where should women give birth? • Why? • Who should decide? 18th International Bled Course
Professional Better anaesthesia Epidurals 24 hour issue Litigation Patient led Consumer choice Birthing pools Birthing posts Birthing friends Change factors 18th International Bled Course
Buzz groups Who are the key stakeholders in bringing about changed patterns of care in childbirth? List as many as you can in 2 minutes. 18th International Bled Course
My list Lawyers Media Pressure Groups Politicians Mother Family/Friends Healthcare managers Obstetric Specialist Maternity nurse GP 18th International Bled Course
It should be two-way communication- Media Lawyers Pressure Groups Politicians Mother Family/Friends Healthcare managers Obstetric Specialist Maternity nurse GP 18th International Bled Course
But may be - Media Lawyers Pressure Groups Politicians Mother Family/Friends Healthcare managers Obstetric Specialist Maternity nurse GP 18th International Bled Course
Issues • Societal expectations • A normal child is my right • Inter-professional warfare • Obstetric specialists and nurses • Intra-professional warfare • Obstetric specialists and GPs • Compensation culture • If something goes wrong somebody is to blame • No win/no fee lawyers • Poor communication • People forgive most things if they are explained to them 18th International Bled Course
Adverse events • Many patients suffer increased pain, disability and psychological trauma and may regard failures in their treatment as a terrible betrayal of trust. • Staff may experience shame, guilt and depression after making a mistake, especially if they face complaints, inquiries or litigation. • Doctors and nurses whose confidence has been impaired will work less effectively and efficiently; at worst they may abandon medicine as a career. Safe births: everybody’s business 18th International Bled Course
Defensive medicine • 70% of all negligence claims are for childbirth (£2.6bn in 2007 in UK) • >90% relate to “failure to intervene” • Movement of low-risk deliveries into specialist units • Unnecessary and inappropriate monitoring leading to interventions • Fear of lawsuits is a significant factor in lack of maternity provision 18th International Bled Course
When things go wrong: • Patients are grieving, confused, guilty, angry, frightened. • Health professionals are guilty, angry, confused, frightened. • Health care systems change structures (again) and lawyers prosper • The wrong problem is solved 18th International Bled Course
Can medicalisation be reversed? • Return to regarding birth as a normal physiological process and valuing low intervention rates. • Provide women and their families consistent and evidence based information. • Develop a genuine “no-fault” culture • Act as patients ADVOCATE, in PARTNERSHIP 18th International Bled Course
It’s all in the Educational Agenda! Primary Care management 1.5 & 1.6 Person Centred Care 2.1, 2.2 & 2.4 Community orientation 5.1 Holistic approach 6.1 Attitudinal Approach 7.2 Scientific approach 7.3 What should we teach our trainees? 18th International Bled Course
Questions or comments? 18th International Bled Course