e-book Inside Chronic Pain: An Intimate and Critical Account (The Culture and Politics of Health Care Work)

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Second, they forget that the types of practices they advocate as legitimate and normal are not absolute truths, but are locally produced, reflecting the viewpoints of those in positions of cultural and institutional authority that can change over time or across places. These conceptual shortcomings can easily result in attaching moral value to particular cultures and devaluing others. Awareness of these shortcomings can lead to more effective interventions from public health professionals and better care from health care professionals.

In the following, we illustrate several promising avenues for action.

Cultural Reflexivity in Health Research and Practice

Health practitioners have limited time and usually only see patients in one context, typically a health care setting. By suspending their own cultural conceptions of right and wrong, these researchers found that seemingly pathological cultural practices made sense in the context of local social structures and illuminated the broader systems of inequality that created such structures. Such work can have concrete benefits for health practitioners.

For example, Bourgois and Schonberg discovered that the heroin in San Francisco generated soft-tissue infections, and the resulting abscesses were the main reasons for admissions to local emergency departments which were unaware of this because they did not tabulate data on such infections.

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There was no national standard of care for infections caused by injection drug use, and the patients complained of extremely invasive procedures that led them to treat their own abscesses and delay seeking medical attention, ultimately resulting in long and expensive hospital stays. Health researchers should consider formal qualitative components to their research projects. Qualitative research projects can serve as pilot studies that inform larger quantitative studies; they can occur concurrently to explain quantitative findings as they unfold, or they can occur as standalone endeavors.

One challenge to such qualitative research designs is obtaining funding. Health researchers and professionals should advocate higher funding priorities for qualitative and other culturally sensitive research. Certain nonprofit funders, such as the Robert Wood Johnson Foundation, have started to do so. Progress has been made on this front among some funding organizations; for example, the National Science Foundation has developed standards for evaluating qualitative research and included more qualitative researchers on review panels. Although traditional biomedical perspectives tend to treat diseases as distinct, there is growing recognition that certain diseases tend to cluster, and to interact with one another, within particular populations.

For example, Singer et al. They found that respondents were pessimistic about the long-term commitment of their romantic relationships because of multiple overlapping economic and personal disadvantages. Furthermore, the use of contraception was seen as a sign of mistrust; sexual partners signaled commitment to their relationships by desisting contraceptive use. Although sexually transmitted disease and pregnancy prevention efforts have successfully taught participants about condom use, 53 the research by Singer et al.

This example illustrates how a cultural lens can explain why health conditions coexist and why behaviors may not change in response to informational campaigns or to increased access to health-promoting resources. A more nuanced understanding of structural conditions and social relations also raises the possibility that behavioral change may not be desirable: If health conditions are rooted in broader social systems, another way to expand the context of health delivery is to build connections with other institutions that are intertwined with the patient population.

For example, the Camden Coalition of Healthcare Providers identified that a small number of patients used a disproportionate amount of health care. This intervention is currently being evaluated in a randomized control trial and being expanded to additional cities. The authority to classify certain cultural practices as legitimate is linked to institutional power, and health care practitioners have the unique power to classify illness, disease, and health. A culturally reflective perspective acknowledges that our understandings of patients reflect the current cultural practices of those in authority positions, and potentially misrecognizes the reasons why some social groups do not adopt practices that we perceive to be healthy.

No institutional review board approval was needed for this article because the research performed for this article did not directly involve human participants. National Center for Biotechnology Information , U. Am J Public Health. Published online July. Author information Article notes Copyright and License information Disclaimer. Reprints can be ordered at http: Contributors All authors contributed ideas for relevant literature, wrote significant portions of the article, and reviewed drafts of the article. Accepted January 5, This article has been cited by other articles in PMC.

Abstract Recent public health movements have invoked cultural change to improve health and reduce health disparities. Culture and Health Just as the culture of poverty literature emphasized enmeshed beliefs that reproduced poverty, public health campaigns have also emphasized beliefs in efforts to reduce health disparities. Kleinman reflected that what was meant to humanize care by providing room for lay voices and practices appeared instead to be reducing complex lives to limiting, biased stereotypes.

In their decade-long study of homeless heroin addicts in San Francisco, Bourgois and Schonberg described their own efforts to strategically suspend moral judgment in order to understand and appreciate the diverse logics of social and cultural practices that, at first sight, often evoke righteous responses and prevent analytical self-reflection. Foster Research—Practitioner Partnerships Health practitioners have limited time and usually only see patients in one context, typically a health care setting. Promote Cultural Health Research Health researchers should consider formal qualitative components to their research projects.

Look for Syndemics Although traditional biomedical perspectives tend to treat diseases as distinct, there is growing recognition that certain diseases tend to cluster, and to interact with one another, within particular populations. Build Connections Across Institutions If health conditions are rooted in broader social systems, another way to expand the context of health delivery is to build connections with other institutions that are intertwined with the patient population.

Empower Patients and Communities The authority to classify certain cultural practices as legitimate is linked to institutional power, and health care practitioners have the unique power to classify illness, disease, and health. Human Participant Protection No institutional review board approval was needed for this article because the research performed for this article did not directly involve human participants. Investigating neighborhood and area effects on health. Social capital, income inequality, and mortality.

Berkman LF, Kawachi I, editors. Oxford University Press; Health Behavior and Health Education: Theory, Research, and Practice. Reconsidering culture and poverty. Medical Talk and Medical Work. Robert Wood Johnson Foundation. Accessed July 25, Outline of a Theory of Practice. Cambridge University Press; Parker R, Aggleton P. Princeton University Press; Damned if you do: The Case for National Action.

Small ML, Newman K. Urban poverty after The Truly Disadvantaged: Teenage childbearing as cultural prism. The Moynihan Report and its aftermaths. Nestle M, Jacobson MF. Halting the obesity epidemic: Airhihenbuwa CO, Obregon R. Health literacy as a public health goal: Disparities and access to health food in the United States: Geronimus AT, Korenman S. The socioeconomic consequences of teen childbearing reconsidered. Reevaluating the costs of teenage childbearing. From illness as culture to caregiving as moral experience.

The Keys to Private HEALTHCARE in SINGAPORE - VisualPolitik EN

N Engl J Med. Eliasoph N, Lichterman P. A Theory of Group Action and Culture. Russell Sage Foundation; The Violence of Everyday Life in Brazil.

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University of California Press; Bourgois PI, Schonberg J. Auyero J, Swistun DA. Environmental Suffering in an Argentine Shantytown. The good-enough science-and-politics of anthropological collaboration with evidence-based clinical research: Care of injection drug users with soft tissue infections in San Francisco, California. King T, Wheeler MB, editors. Medical Management of Vulnerable and Underserved Patients: Principles, Practice, and Populations.

Curry L, Nunez-Smith M. Mixed Methods in Health Sciences Research: Chronic pain -- Treatment. Summary "Chronic pain, which affects 70 million people in the United States alone - more than diabetes, cancer, and heart disease combined - is a major public health issue that remains poorly understood both within the health care system and by those closest to the people it afflicts. This book examines the experience of pain in ways that could significantly improve how patients and practitioners deal with pain.

Inside Chronic Pain, based in part on the pain journal Heshusius keeps, is a memoir of a life lived in constant pain as well as an insightful and often critical account of the inadequacies of the health care system - from physicians to hospitals and health insurance companies - to understand chronic pain and treat those who suffer from it.

Inside Chronic Pain: An Intimate and Critical Account (The Culture and Politics | eBay

Through her own frequently frustrating experiences, she shows how health care providers often ignore, deny, or incorrectly treat chronic pain at immense cost to both the patient and the health care system. She also offers cogent suggestions on improving the quality and outcome of chronic pain care and management, using her encounters with exceptional medical professionals as models.


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It chronicles the chaos that takes place, the paralyzing impact of severe pain, the changes in personality that ensue, and the corrosion of the ability to attend to day-to-day tasks. It describes how one's social life falls apart and isolation takes over. It also relates moments of happiness and beauty and describes how rooting the self in the present is crucial in managing pain. Contents A life altered That which has no words, that which cannot be seen Pain and the self Pain and the world of pain management Pain medicine On science and time Pain and others Where are we with chronic pain?


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