Doctor-patient interactions during medical consultations about obesity

The current “obesity epidemic” is a global concern for governments and healthcare organisations. Obesity is seen as a medical problem of excess body weight which can be resolved through interventions to encourage weight loss, most particularly diet and exercise regimes. Much existing sociological work focuses on moral understandings of obesity as a perceived symbol of individual greed and laziness in a culture that prioritises self-control and effort. This neglects the ways in which the condition is actively discussed and managed in relevant settings such as medical encounters. This thesis addresses this research gap by analysing talk during obesity-related medical consultations. Talk is central to all medical encounters and has particular resonance in treatments for obesity where most interventions are carried out by the patient away from the medical gaze. Patients must report on their treatment behaviours in ways that enable practitioners to evaluate them and offer further relevant advice. Talk is not only a means through which treatment is delivered but a form of treatment itself. Fieldwork took place in two UK NHS outpatient clinics specialising in weight loss treatment for obese patients. A sample of 18 patients and 1 doctor consented to have their consultations video-recorded over a period of 9 months. This resulted in 39 recorded interactions which were analysed according to the principles of Conversation Analysis (CA) to identify recurring patterns of interaction. The thesis describes how talk between doctor and patient functions to achieve certain tasks. In particular, it analyses how the specific institutional setting shapes and is shaped by talk. A dominant theme is that clinic interactions frequently invoke normative issues concerning knowledge, responsibility and effort. These issues are consistent with moral dynamics perceived to surround the condition of obesity and patient responsibilities. Doctor and patient collaboratively construct obesity as a moral issue. This has consequences for the conduct of the consultation. The findings extend existing CA knowledge on medical interactions and demonstrate the utility of an interactional approach to the sociological study of obesity. They also have relevance to healthcare policy and practice

“It becomes more of an abstract idea, this privacy”—Informing the design for communal privacy experiences in smart homes

In spite of research recognizing the home as a shared space and privacy as inherently social, privacy in smart homes has mainly been researched from an individual angle. Sometimes contrasting and comparing perspectives of multiple individuals, research has rarely focused on how household members might use devices communally to achieve common privacy goals. An investigation of communal use of smart home devices and its relationship with privacy in the home is lacking. The paper presents a grounded analysis based on a synergistic relationship between an ethnomethodologically-informed (EM-informed) study and a grounded theory (GT) approach. The study focuses on household members’ interactions to show that household members’ ability to coordinate the everyday use of their devices depends on appropriate conceptualizations of roles, rules, and privacy that are fundamentally different from those embodied by off-the-shelf products. Privacy is rarely an explicit, actionable, and practical consideration among household members, but rather a consideration wrapped up in everyday concerns. Roles and rules are not used to create social order, but to account for it. To sensitize to this everyday perspective and to reconcile privacy as wrapped up in everyday concerns with the design of smart home systems, the paper presents the social organization of communal use as a descriptive framework. The framework is descriptive in capturing how households navigate the ‘murky waters’ of communal use in practice, where prior research highlighted seemingly irreconcilable differences in interest, attitude, and aptitude between multiple individuals and with other stakeholders. Discussing how households’ use of roles, rules, and privacy in-practice differed from what off-the-shelf products afforded, the framework highlights critical challenges and opportunities for the design of communal privacy experiences

Further Exploring Communal Technology Use in Smart Homes: Social Expectations

Device use in smart homes is becoming increasingly communal, requiring cohabitants to navigate a complex social and technological context. In this paper, we report findings from an exploratory survey grounded in our prior work on communal technology use in the home [4]. The findings highlight the importance of considering qualities of social relationships and technology in understanding expectations and intentions of communal technology use. We propose a design perspective of social expectations, and we suggest existing designs can be expanded using already available information such as location, and considering additional information, such as levels of trust and reliability.Comment: to appear in CHI '20 Extended Abstracts, April 25--30, 2020, Honolulu, HI, US

Doctor-patient interactions during medical consultations about obesity

The current “obesity epidemic” is a global concern for governments and healthcare organisations. Obesity is seen as a medical problem of excess body weight which can be resolved through interventions to encourage weight loss, most particularly diet and exercise regimes. Much existing sociological work focuses on moral understandings of obesity as a perceived symbol of individual greed and laziness in a culture that prioritises self-control and effort. This neglects the ways in which the condition is actively discussed and managed in relevant settings such as medical encounters. This thesis addresses this research gap by analysing talk during obesity-related medical consultations. Talk is central to all medical encounters and has particular resonance in treatments for obesity where most interventions are carried out by the patient away from the medical gaze. Patients must report on their treatment behaviours in ways that enable practitioners to evaluate them and offer further relevant advice. Talk is not only a means through which treatment is delivered but a form of treatment itself. Fieldwork took place in two UK NHS outpatient clinics specialising in weight loss treatment for obese patients. A sample of 18 patients and 1 doctor consented to have their consultations video-recorded over a period of 9 months. This resulted in 39 recorded interactions which were analysed according to the principles of Conversation Analysis (CA) to identify recurring patterns of interaction. The thesis describes how talk between doctor and patient functions to achieve certain tasks. In particular, it analyses how the specific institutional setting shapes and is shaped by talk. A dominant theme is that clinic interactions frequently invoke normative issues concerning knowledge, responsibility and effort. These issues are consistent with moral dynamics perceived to surround the condition of obesity and patient responsibilities. Doctor and patient collaboratively construct obesity as a moral issue. This has consequences for the conduct of the consultation. The findings extend existing CA knowledge on medical interactions and demonstrate the utility of an interactional approach to the sociological study of obesity. They also have relevance to healthcare policy and practice

Digitizing Sacks? Approaching social media as data

During the course of this article, we explore ethnomethodological principles in relation to approaching social media as data. More specifically, we consider the extent to which the work of Harvey Sacks and his rich intellectual legacy might inform this nascent field of empirical inquiry. This exploration is realised in the context of interdisciplinary research at the interface of social and computational science. Drawing from an extensive range of empirical projects into social media we reflect on the efficacy and limitations of these principles (Sacks, 1992) for understanding social media interaction as open data and practical action in the digital age

Developmentally regulated instability of the GPI-PLC mRNA is dependent on a short-lived protein factor.

The expression of the vast majority of protein coding genes in trypanosomes is regulated exclusively at the post-transcriptional level. Developmentally regulated mRNAs that vary in levels of expression have provided an insight into one mechanism of regulation; a decrease in abundance is due to a shortened mRNA half-life. The decrease in half-life involves cis-acting elements in the 3' untranslated region of the mRNA. The trans-acting factors necessary for the increased rate of degradation remain uncharacterized. The GPI-PLC gene in Trypanosoma brucei encodes a phospholipase C expressed in mammalian bloodstream form, but not in the insect procyclic form. Here, it is reported that the differential expression of the GPI-PLC mRNA also results from a 10-fold difference in half-life. Second, the instability of the GPI-PLC mRNA in procyclic forms can be reversed by the inhibition of protein synthesis. Third, specifically blocking the translation of the GPI-PLC mRNA in procyclic forms by the inclusion of a hairpin in the 5' untranslated region does not result in stabilization of the mRNA. Thus, the effect of protein synthesis inhibitors in stabilizing the GPI-PLC mRNA operates in trans through a short-lived factor dependent on protein synthesis

A governance framework for algorithmic accountability and transparency

Algorithmic systems are increasingly being used as part of decision-making processes in both the public and private sectors, with potentially significant consequences for individuals, organisations and societies as a whole. Algorithmic systems in this context refer to the combination of algorithms, data and the interface process that together determine the outcomes that affect end users. Many types of decisions can be made faster and more efficiently using algorithms. A significant factor in the adoption of algorithmic systems for decision-making is their capacity to process large amounts of varied data sets (i.e. big data), which can be paired with machine learning methods in order to infer statistical models directly from the data. The same properties of scale, complexity and autonomous model inference however are linked to increasing concerns that many of these systems are opaque to the people affected by their use and lack clear explanations for the decisions they make. This lack of transparency risks undermining meaningful scrutiny and accountability, which is a significant concern when these systems are applied as part of decision-making processes that can have a considerable impact on people's human rights (e.g. critical safety decisions in autonomous vehicles; allocation of health and social service resources, etc.). This study develops policy options for the governance of algorithmic transparency and accountability, based on an analysis of the social, technical and regulatory challenges posed by algorithmic systems. Based on a review and analysis of existing proposals for governance of algorithmic systems, a set of four policy options are proposed, each of which addresses a different aspect of algorithmic transparency and accountability: 1. awareness raising: education, watchdogs and whistleblowers; 2. accountability in public-sector use of algorithmic decision-making; 3. regulatory oversight and legal liability; and 4. global coordination for algorithmic governance

Communication: part 1 - soliciting information from the patient

Soliciting information from the patient is a key part of the consultation. Successful clinical outcomes are reliant on the practitioner asking questions to gather relevant information regarding, for instance, the patient’s history and symptoms and their responses to examination tests. This information needs to be gathered in a time efficient manner and in a way that encourages the patient to feel relaxed and fully engage with the eye examination. Practitioners often report that soliciting relevant information can be made difficult by over-talkative patients who take up valuable time giving lengthy, perhaps irrelevant, answers. Alternatively, patients may provide insufficient detail due to discomfort, anxiety or a lack of understanding. Finally, patients can at times appear overly concerned with providing the ‘correct’ answer to certain questions. This article describes some ways to optimise the complex process of soliciting information from the patient focusing on selection of question type, question wording and the role of eye contact. Examples given are based upon research analysis of video-recorded optometric consultations