Social and Behavioral Sciences Commons^™

Co-Management In Healthcare: Negotiating Professional Boundaries, Catherine Schryer, Olga Gladkova, Marlee Spafford, Lorelei Lingard

Lorelei Lingard

This article investigates discursive practices associated with the co-management of patients between healthcare providers. Specifically, we focus on two genres (38 referral letters and 37 consultant reports) written by optometrists and ophthalmologists — two groups who are experiencing interprofessional tension over their scopes of practice. In our analysis we foreground four kinds of modality associated with verbs — epistemic, deontic, phatic and subjective. We found that these healthcare providers shared in the epistemic resources used to hedge their sense of clinical certainty, and that ophthalmologists used deontic resources to control future action. However, we also noted that both professions used …

Implementation Of The Intervention-Based Family Assessment Procedure: A Case Study, Jeanne Jenkins, Audrey Ellenwood

Jeanne E. Jenkins

Chronic illness is a worldwide phenomenon impacting the emotional stability and daily functioning of families across cultures. Families with a chronically ill member are in need of interventions and therapy, yet, time constraints and care-taking demands make it difficult for families to seek traditional family therapy services. The objectives of this article are to (1) overview the Intervention-Based Family Assessment Procedure (IBFA) and (2) present a case vignette demonstrating the implementation of the procedure. The IBFA is an effective diagnostic tool and intervention strategy to help family therapists alter the dysfunctional and rigid structural dynamics of families with a chronically …

Questioning Competence: A Discourse Analysis Of Attending Physicians' Use Of Questions To Assess Trainee Competence, Tara Kennedy, Lorelei Lingard

Lorelei Lingard

BACKGROUND: Attending physicians (APs) must constantly assess trainees' competence to act independently, to promote learning while ensuring quality of care. This study aimed to explore, through discourse analysis of case presentations, the process of competence assessment for case-specific clinical independence.

METHOD: Twenty-six case presentations in emergency medicine were observed and audiorecorded. A discourse analysis was conducted, focusing on APs' use of questioning strategies.

RESULTS: Questioning strategies involved clarifying questions (to ensure APs' understanding of the case), probing questions (to probe trainees' understanding of a case or their underlying knowledge), and challenging questions (to challenge presuppositions). Case-related probing questions and challenging …

Best Practices In Intercultural Health; Five Case Studies In Latin America, J. Mignone, J. Bartlett, J. O'Nwil, Treena Orchard

Dr. Treena Orchard

The practice of integrating western and traditional indigenous medicine is fast becoming an accepted and more widely used approach in health care systems throughout the world. However, debates about intercultural health approaches have raised significant concerns. This paper reports findings of five case studies on intercultural health in Chile, Colombia, Ecuador, Guatemala, and Suriname. It presents summary information on each case study, comparatively analyzes the initiatives following four main analytical themes, and examines the case studies against a series of the best practice criteria.

In This Life: The Impact Of Gender And Tradition On Sexuality And Relationships For Devadasi Sex Workers In Rural India, Treena Orchard

Dr. Treena Orchard

In the popular imagination and certain academic fields, sex workers' experiences of sexuality and intimate relationships are often "naturalized," to the point where they are assumed to be deviant or completely different than those of women in mainstream society. Researchers and sex worker organizations are challenging these reified constructions by examining more diverse and representative models of sexuality and relationships. However, the experiences of women selling sex in the "third world" are consistently portrayed as violent, non-pleasurable, and oppressive, characteristics often applied universally to "third world women". Using data from ethnographic fieldwork with girls and women who belong to the …

Girl, Woman, Lover, Mother: Towards A New Understanding Of Child Prostitution Among Young Devadasi Sex Workers In Rural Karnataka, India, Treena Orchard

Dr. Treena Orchard

The emotive issue of child prostitution is at the heart of international debates over ‘trafficking’ in women and girls, the “new slave trade”, and how these phenomena are linked with globalization, sex tourism, and expanding transnational economies. However, young sex workers, particularly those in the ‘third world’, are often represented through tropes of victimization, poverty, and “backwards” cultural traditions, constructions that rarely capture the complexity of the girls’ experiences and the role that prostitution plays in their lives. Based on ethnographic fieldwork with girls and young women who are part of the Devadasi (servant/slave of the God) system of sex …