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"Over-medicalisation"
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Ordinary defensive medicine: in the shadows of general practitioners’ postures toward (over-)medicalisation
by
Ouvrard, Patrick
,
Herzig, Lilli
,
Cordey, Michaël
in
Adult
,
Attitude of Health Personnel
,
Decision-making
2024
This paper draws on qualitative research using focus groups involving 38 general practitioners (GPs). It explores their attitudes and feelings about (over-)medicalisation. Our main findings were that GPs had a complex representation of (over-)medicalisation, composed of many professional, social, technological, economic and relational issues. This representation led GPs to feel uncomfortable. They felt pressure from all sides, which led them to question their social roles and responsibilities. We identified four main GP-driven proposals to deal with (over-)medicalisation: (1) focusing on the communication in doctor–patient relationships; (2) grounding practices in evidence-based medicine; (3) relying on clinical skills, experience and intuition; and (4) promoting training, leadership bodies and social movements. Drawing on these proposals, we identify and discuss five paradigms that underpin GPs’ attitudes toward (over-)medicalisation: underlying social factors, preventing medicalisation, managing uncertainties, sharing medical decision-making and thinking about care as a rationale. We suggest that these paradigms constitute a defensive posture against GPs’ uncomfortable feelings. All five defensive paradigms were identified in our focus groups, echoing contemporary political debates on public health. This non-exhaustive framework forms the outline of what we call
ordinary defensive medicine
. GPs’ uncomfortable feelings are the origin of their defensive solutions and the manifestation of their vulnerability. This professional vulnerability can be shared with the patient’s vulnerability. In our view, this creates an opportunity to rediscover patient–doctor relationships and examine patients’ and doctors’ vulnerabilities together.
“There are many cases in which—though the signs of a confusion of tongues between the patient and his doctor are painfully present—there is apparently no open controversy. Some of these cases demonstrate the working of two other, often interlinked, factors. One is the patient’s increasing anxiety and despair, resulting in more and more fervently clamouring demands for help. Often the doctor’s response is guilt feelings and despair that his most conscientious, most carefully devised examinations do not seem to throw real light on the patient’s “illness”, that his most erudite, most modern, most circumspect therapy does not bring real relief.” (Balint M. The Doctor, His Patient and the Illness. New York: International Universities; 2005. [1957].)
“Theories about care put an unprecedented emphasis on vulnerability—taking up that challenge to transform what really counts in today’s hospitals implies letting colleagues inside previously closely guarded professional boundaries” (2, our translation).
Journal Article
The Definition of Health and Illness between Juridification and Medicalisation: A Private/Public Interest Perspective
2018
Abstract
This article addresses the interactions between medicalisation and juridification and their impact on the concepts of health and illness. Juridification, de-juridification, medicalisation and de-medicalisation are defined in many different ways and it is particularly interesting to see how they affect each other, impinging on individual freedom and contributing to shaping the definition of health and illness and their public understanding. Juridification and medicalisation are particularly affected by the shifting perceptions of the public and private interests at stake, even if the identification of the public or private interest is not an easy task, especially when ethically controversial issues come into play. Nevertheless, the private/public interest analysis is a crucial issue in the understanding of the interactions between these two concepts and in the identification of the boundary lines between them, giving an important key to the understanding of their influence on the rights and liberties at stake.
Journal Article