Caught up in Care: Crafting Moral Subjects of Chronic Fatigue

Patients with chronic fatigue receive advice to improve symptom management and well-being. This advice is based on ideas of self-management and is conveyed during clinical assessment as “activity regulation.” Based on ethnographic fieldwork in a hospital clinic in Norway, we show how these patients attempt to demonstrate their competences and everyday concerns, and how the ideology of self-management frames the hope for recovery and crafts a subject with the ability to improve. Patients, however, linger between everyday social predicaments and ideals of healthy living, and are caught up in cultural models of care that deflect everyday concerns and agency

Den praktiserende læge - eksistentiel søgen efter professionel identitet

I gamle dage kunne enhver læge blive praktiserende læge. I løbet af de sidste 50 år har de prakti-serende læger skabt et speciale  – almen medicin – på linie med andre lægelige specialer. Men  i den samme periode er det blevet tiltagende vanskeligt at definere, hvad faget er – og hvad der  udgør den praktiserende læges roller  og identitet. I denne artikel undersøges, hvordan et kur‑ sus i kommunikation og eksistentialisme danner rammen om konstruktionen af en søgen efter  professionel identitet. Ved hjælp af narrativ teori indkredses flere mulige fortællinger, der både  relaterer sig til den enkelte læges personlige situation og fagets samfundsmæssige kontekst: et  personligt eksistentielt narrativ, et relationelt narrativ og et somatisk narrativ

Self-treatment of acute exacerbations of chronic obstructive pulmonary disease requires more than symptom recognition – a qualitative study of COPD patients’ perspectives on self-treatment

Source at http://dx.doi.org/10.1186/s12875-017-0582-8 Background: Self-treatment of acute exacerbations of COPD with antibiotics and/or oral corticosteroids has emerged as a promising strategy to reduce hospitalization rates, mortality and health costs. However, for reasons little understood, the effect of self-treatment, particularly when not part of comprehensive self-management programs, remains unclear. Therefore, this study aims to get insight into the patients’ perspective on self-treatment of acute exacerbations of COPD, focusing specifically on how patients decide for the right moment to start treatment with antibiotics and/or oral corticosteroids, what they consider important when making this decision and aspects which might interfere with successful implementation. Methods: We interviewed 19 patients with chronic obstructive pulmonary disease using qualitative semi-structured interviews, and applied thematic analysis for data analysis. Results: Patients were well equipped with experiential knowledge to recognize and promptly respond to worsening COPD symptoms. Worries regarding potential adverse effects of antibiotics and oral corticosteroids played an important role in the decision to start treatment and could result in hesitation to start treatment. Although selftreatment represented a practical and appreciated option for some patients with predictable symptom patterns and treatment effect, all patients favoured assistance from a medical professional when their perceived competence reached its limits. However, a feeling of obligation to succeed with self-treatment or distrust in their doctors or the health care system could keep patients from timely help seeking. Conclusion: COPD patients regard self-treatment of exacerbations with antibiotics and/or oral corticosteroids as a valuable alternative. How they engage in self-treatment depends on their concerns regarding the medications’ adverse effects as well as on their understanding of and preferences for self-treatment as a means of health care. Caregivers should address these perspectives in a collaborative approach when offering COPD patients the opportunity for self-treatment of exacerbations

Introduction: Sensations, Symptoms and Healthcare Seeking

This is a post-peer-review, pre-copyedited version of an article published in Anthropology in Action. The definitive publisher-authenticated version Andersen, R.S., Nichter, M. & Risør, M.B. (2017). Introduction. Sensations, Symptoms and Healthcare Seeking. Anthropology in Action. 24(1), 1-5 is available online at: https://doi.org/10.3167/aia.2017.240101.Inspired by the sensory turn in the humanities, anthropologists have coined the term ‘an anthropology of the senses’ to describe the study of the perceptual construction and output of bodily sensations and sense-modalities (cf. Howes 2006; Nichter 2008). Starting from the premise that different cultures and social settings configure, elaborate and extend the senses in different directions, key proponents have argued for a greater empirical and analytical attention to the cultural embeddedness and socio-biological basis of bodily perception and experience. This follows a rethinking of a series of theoretical (cf. Hinton et al. 2008; Ingold 2011) and methodological commitments in anthropology (cf. Pink 2009; Stoller 2004) that also holds relevance for anthropological studies of health and illness, which is the focus of this special issue on sensations, symptoms and healthcare seeking

Vi har efterhånden fundet vores egne ben som forældre: Forældreskab og sundhedspleje i spændingsfeltet mellem velfærdsstat og privatsfære

Der er særligt gennem de sidste 50 år sket en intensivering af et børnecentreret forældreskab, som i stigende omfang er orienteret mod børns sundhed og udvikling, hvor brug af ekspertråd er centralt. Præmature børn befinder sig i en forhøjet risiko for komplikationer relateret til sundhed, trivsel og udvikling, og de er ved fødslen oftest med forældrene indlagt gennem en periode på en hospitalsafdeling med specialiseret biomedicinsk ekspertise. Sundhedspleje er en universel velfærdsydelse som næsten alle forældre i Danmark tager imod, hvor Sundhedsstyrelsens medicinsk videnskabeligt informerede anbefalinger angående børns sundhed og udvikling formidles som samtidig støtte og kontrol. Støtten består i at vejlede og informere forældre, og kontrol udøves som en skærpet pligt til underretning ved forhold som sundhedsplejersken finder bekymrende. Brug af sundhedspleje indgår således som ekspertinstans i forældres liv med deres børn. Dette studie tager afsæt i et etnografisk feltarbejde i og omkring danske familier med præmature børn. Det følger familierne i barnets første år, og for enkelte hovedinformanter op til to et halvt år, og det ser på, hvordan forældreskab forhandles i forældres møde med velfærdsstat eksemplificeret gennem sundhedspleje og sundhedspleje-ekspertviden. Vi diskuterer i artiklen, hvordan sundhedsplejensråd tilpasses, omsættes eller forkastes af præmaturforældre, og hvilken indflydelse dette har på konstitueringen af forældreskab. Vi argumenterer for, at mange danske forældre til præmature børn benytter ´hverdags-modstand´ (Scott 1989) som en strategi og en reaktion på ekspertråd med tilpasninger. Dette bliver en måde at agere i det felt, der konstituerer børns liv i den danske velfærdsstat

Diagnoser: Organisation, kultur og mennesker

Der er rav i den. I skrivende stund (medio september 2016) er det i Dagbladet In- formation kommet frem, at psykiatriske diagnoser til børn nogle gange stilles på et meget løst grundlag. I en kronik underskrevet af 50 psykologer, sygeplejersker, læger og psykiatere står der blandt andet: »Som læger og psykologer har vi stillet diagnoser på børn på baggrund af andres vur- deringer beskrevet kort i patientens journal, og andre gange har barnet mødt mange forskellige behandlere på sin vej til en diagnose. Mange af disse børn er i forvejen sårbare i forhold til at danne nye relationer, og de bliver mødt af en psykiatri, hvor der ikke længere er mulighed for at skabe den relation, der skal til for at forstå barnet.« Nogle børn har, med andre ord, fået stillet en diagnose, uden at de har mødt en læge, psykolog eller psykiater. Det får naturligt nok debatten til at rase. I relation til den verserende debat er fokus for dette nummer særligt rettet imod tre forhold: Den politisk fastsatte udrednings- og behandlingsgaranti. Den organisatoriske ramme skal kunne håndtere denne garanti, og selve den måde hvorpå diagnoser- ne stilles. Baggrunden for behandlingsgarantien er først og fremmest et politisk ønske om hurtigt at stille diagnoser, så patienten kan indgå i et behandlingsforløb - i sig selv et sympatisk ønske, der dog løber ind i en række problemer og utilsig- tede konsekvenser, når den skal eksekveres i praksis, som det fremgår af lægernes debatindlæg. Et centralt omdrejningspunkt for de ophedede diskussioner, som avisindlæggene har medført – og som allerede nu har fået politiske konsekven- ser – er samtidens omgang med, forståelse- og brug af diagnoser. Diagnoser er på alles læber for tiden. Diagnoser har, som den amerikanske medicinhistoriker Charles Rosenberg skriver, ”altid spillet en væsentlig rolle i den medicinske prak- sis” (Rosenberg 2002: 237) som et værktøj/model, der sammenfatter symptomer og fund og angiver behandling. I vores samtid er diagnoserne imidlertid rejst ud af den medicinske praksis, og de har indlejret sig i alle mulige andre sammenhænge: Sociale, politiske, økonomiske, kulturelle og så videre. Et væsentligt spørgsmål i denne sammenhæng er, hvordan vi skal forstå diagnosernes nuværende status, hvordan de tillægges mening, udvikles, defineres, anvendes, og hvordan diag- noser får indflydelse på konkrete sygdomsforhold og på processer generelt, som spiller ind på, hvordan vi opfatter sundhed, krop og behandling

Exploring the potential of a standardized test in physiotherapy: making emotion, embodiment, and therapeutic alliance count for women with chronic pelvic pain

Introduction: There has been an increased use of standardized measurements in health care meant to provide objective information to enhance the quality and effectivity of care. Patient performance tests are based on standardized predefined criteria with a limited focus. When facing multifaceted health conditions, information expanding the predefined criteria in a standardized test may be required to understand the patient’s complex symptoms. Relying on test information based on measurements according to functional biology, one risks missing information communicated by the sensitive and expressive body of the individual patient. The aim of this article is to investigate how body, self and illness perception is constituted as a co-construction between a physiotherapist and a patient with complex symptoms, expanding the use of a standard physiotherapy test. Methods: This qualitative study is based on video-recordings and in-depth interviews of seven women with the complex health condition chronic pelvic pain. The video recordings consist of the patients performing the Standard Mensendieck test pre- and post-treatment with Norwegian psychomotor physiotherapy. The interviews are based on the patients` and the physiotherapists` conversations while watching and elaborating on these video recordings. Empirical data is analyzed within the theoretical perspectives of phenomenology and enactive theory, especially focusing on the concepts of embodiment and intersubjectivity. Results: Taking an embodied approach, considering the body as expressive, communicative, and vulnerable to the environment and context, the results show that through bodily expressions the patients experienced the test situation as demanding, thus providing information beyond what the test was intended to measure. Additionally, when administering a standardized test, the interaction between the therapist and the patient had an impact on the results. Sensitive attention towards the patients bodily expressive emotions as a vital part of the interaction, reinforced therapeutic alliance by ensuring the integrity and autonomy of the patient. Discussion: Mutual communication, gave new insights regarding the patients’ complex symptoms and reinforced their belief in themselves and their recovery processes. Applying the patient’s expertise on herself and her life together with the professional expertise may make health care an interdependent practice where sensemaking is a co-construction of meaning between the patient and the health personnel

Symptoms of respiratory tract infection and associated care-seeking in subjects with and without obstructive lung disease; The Tromso Study: Tromso 6.

Respiratory tract infections (RTIs) may be more severe in those with asthma or COPD and these patients are more frequently in need of health care. The aim of the study was to describe the frequency of RTI symptoms in a general adult population and how care-seeking is associated with the presence of obstructive lung disease. Cross-sectional data including spirometry and self-reported chronic diseases were collected among middle-aged and elderly subjects in the Tromso population survey (Tromso 6). Self- reported RTI symptoms, consultations and antibiotic use were the main outcome variables. Possible predictors of RTI symptoms were evaluated by multivariable logistic regression. Of the 6414 subjects included, 798 (12.4 %) reported RTI symptoms in the previous week. RTI symptoms were reported less frequently by subjects aged 75 years or above, than by those younger than 55 years (OR 0.5). Winter season (OR 1.28), current smoking (OR 1.60), low self-rated health (OR 1.26) and moderate to severe bronchial obstruction (OR 1.51), were also statistically significant independent predictors of RTI symptoms, but these variables did not predict RTI symptoms that had started within the previous seven days. Among subjects with RTI symptoms, 5.1 % also reported a consultation with a doctor. In those with bronchial obstruction by spirometry, who did not report asthma or COPD, this frequency was 2.4 %. Antibiotic treatment was reported by 7.4 % of the participants, among whom one third had consulted a doctor. Antibiotics were taken more frequently when asthma or COPD was reported (13.7 %), but not in subjects with bronchial obstruction who did not report these diseases (7.2 %). RTI symptoms seldom led to consultation with a doctor and not even in subjects with obstructive lung disease. This was in particular the case in subject who did not know about their obstructive lung disease. Strategies for early diagnosis of COPD and providing health care to subjects with such disease cannot rely on their doctor visits due to respiratory symptoms

Chronic pelvic pain sufferers’ experiences of Norwegian psychomotor physiotherapy: a qualitative study on an embodied approach to pain.

Purpose - Chronic pelvic pain (CPP) is a multifaceted condition, and many women live with CPP without receiving any explanation for their complex symptoms. A multimodal approach including physiotherapy is the recommended treatment. To increase the limited knowledge of what is beneficial in physiotherapy, this article aims to explore women’s experiences of Norwegian psychomotor physiotherapy (NPMP) as treatment for CPP. Method - This qualitative study is based on in-depth interviews with eight women undergoing CPP. The concept of embodiment underpins the entire research project, and the analysis of the participants’ experiences builds on a phenomenological approach. Results and conclusion - Three final themes embrace the participants’ experiences of change after NPMP treatment: experiencing their body in new ways, letting go of tension, and understanding their symptoms. Through treatment, the participants moved from keeping bodily sensations at a distance towards increased bodily self-awareness. They realised that their state of tension was linked to their emotional life and stress was revealed as a trigger of bodily reactions they related to their symptoms. Positive bodily sensations were essential for the participants to let signals from their body guide their actions in a change process