Suchergebnisse

Doctors are among the healthiest segments of the population in western countries. Nevertheless, they complain strongly of stress and burnout. Their own explanation is deprofessionalisation: The honourable art of doctoring has been replaced by standardised interventions and production lines; professional autonomy has withered. This view is shared by many medical sociologists who have identified a "golden age of medicine," or "golden age of doctoring," starting after World War II and declining around 1970. This article looks at some of the central sociological literature on deprofessionalisation, particularly in a perspective of countervailing powers. It also looks into another rise-and-fall model, proposed by the medical profession itself, where the fall in professional power was generated by the notion that there are no more white spots to explore on the map of medicine. Contemporary doctoring is a case of cognitive dissonance, where the traditional doctor role seems incompatible with modern health care.
Keywords: deprofessionalisation, professional autonomy, cognitive dissonance, golden age of doctoring

More knowledge is needed on how to reduce the prevalence of formal and informal coercion in Norwegian mental health care. To explore possible reasons for the widespread differences in coercive practice in psychiatry and drug addiction treatment in Norway, and the poor compliance to change initiatives, we performed a nationwide survey. Six vignettes from concrete and realistic clinical situations where coercive measures were among the alternative courses of action, and where the difference between authoritarian (paternalistic) and dialogical (user participation) practices was explicitly delineated, were presented in an electronic questionnaire distributed to five groups of professionals: psychiatrists, psychologists, nurses, other professionals and auxiliary treatment staff. Non-coercive dialogical resolutions were more likely than coercive authoritative. However, there is a clear professional hierarchy with regard to authoritarian approaches, with the psychiatrists on top, followed by nurses and other professionals, and with psychologists as the least authoritarian. The majority of the respondents sometimes prefer actions that are illegal, which suggests that individual opinions about coercion often overrule legislation. The variation between and within professional groups in attitudes and opinions on coercion is extensive, and may account for some of the hitherto meagre results of two ministerial action plans for coercion reduction.

<i>Aim:</i> The study's aim was to determine whether medical doctors' expectancy that alcohol use reduces tension predicts the extent of their hazardous drinking and whether this effect is mediated by drinking to cope. <i>Methods:</i> A group of Norwegian medical doctors' (n = 288) alcohol use was followed for 6 years. The expectancy that alcohol reduces tension and the use of alcohol to cope with tension were measured 3.5 years after graduation (T1), and hazardous drinking was evaluated at T1 and 9.5 years after graduation (T2). <i>Results:</i> At T1, 15% of men and 3% of women reported hazardous drinking. At T2, these proportions were 16 and 2%, respectively. Men reported a higher expectancy than women that alcohol reduces tension (p = 0.03), whereas there was no sex difference in drinking to cope. Adjusted predictors of hazardous drinking at T2 were male sex (p < 0.01), alcohol expectancy (p < 0.01) and hazardous drinking at T1 (p < 0.001). The effect of alcohol expectancy on hazardous drinking at T2 was not mediated by drinking to cope. Hazardous drinking at T1 mediated the effect of drinking to cope on hazardous drinking at T2. <i>Conclusion:</i> Efforts to reduce drinking among medical students and doctors should target both alcohol expectancies (beliefs) and hazardous drinking (behavior).

"Background: Ethics reflection groups (ERG) or moral case deliberations (MCD) are increasingly used in health care as a form of clinical ethics support (CES). ERGs are often evaluated with a focus on evaluating ERG itself yet not on the impact of or change due to ERGs. Within a larger study implementation and impact of ERG was studied with use of various qualitative and qualitative research methodologies. In this presentation we present findings of the quantitative research. Research question: Are there changes over time after two years of ERG regarding employees' normative attitudes with respect to the use of coercion, user involvement during the use of coercion, team cooperation and the handling of disagreement? Research methods: Repeated cross-sectional survey at seven wards within three different Norwegian mental health care institutions (T0-T1-T2). Results: In total, 817 surveys were included in the analyses. Of these, only 7.6 % (N= 62) have responded at all three points in time, while 76.8 % (N= 628) responded only once. Over time, adjusted for ward and profession, respondents agreed less that coercion is a form of care or security. Furthermore, respondents thought they involved patients and their family significantly more often in situations of coercion and they reported that the constructive of disagreement within the team significantly improved. More frequent ERG participation seemed associated with a more critical attitude towards the use of coercion and higher scores for user involvement, team cooperation and the constructive handling of disagreement, yet differences between ERG participation were generally small in absolute terms. Conclusion: Structural participation in ERG seems to contribute to changes in attitudes, user involvement and team cooperation. Studying changes over time and trying to find a relationship between CES interventions and outcome is difficult yet important and need to be further developed in future CES evaluation research. "