Health is everywhere: Unravelling the mystery of health
Health is everywhere: Unravelling the mystery of health

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Health is everywhere: Unravelling the mystery of health

4 The ‘lay/professional’ axis

4.1 Introduction

As we said at the beginning of the last section, much of the impetus in earlier work on lay perspectives was to examine how far they deviated from the ‘true’ knowledge of experts. Now the emphasis has changed and there is a move to try to understand lay knowledge in order to inform expert knowledge, and in the process the distinction is increasingly being questioned. As Bury notes, the ‘opposition between the world of patients and doctors has been a major theme in medical sociology’ (1997, p. 20).

Activity 7: Worlds apart?

0 hours 15 minutes

Listen to the audio clip, ‘The views of doctors’, where four doctors give their views on health. The first one Sir John Crofton, who is now retired but who used to work as a consultant chest physician at the Edinburgh Royal Infirmary. He has been very active in supporting community initiatives. He is optimistic that the rigid medical views on health held by his generation of doctors are less dominant among younger doctors. The next three doctors you hear represent more modern views. They are all currently working at the Birmingham Heartlands Hospital diabetes centre. First you hear Professor Tony Barnett, who is head of the diabetes centre. He is followed by Dr Sudhesh Kumar, who also works at Heartlands Hospital, and finally you hear Dr Philip Dyer, who is one of the specialist registrars at the diabetes centre.

Note down how far you think that Sudhesh Kumar, Tony Barnett and Philip Dyer are broadening their view of health as the first doctor, Sir John Crofton, suggests may be the case.

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Helen Mark (Presenter)
Four doctors put forward their views on health. First, Sir John Crofton, who is now retired, suggests that the traditional view of health is not so strongly held by young doctors.
Sir John Crofton
I used to say that, in the big teaching hospitals, the old fashioned physicians used to deal with ‘a body in a bed’ … and, if he was a surgeon, ‘an organ in a bed’. Then they began to realise that the background of the patient was of some importance, and have gradually moved out. So the medical profession is gradually moving out into this much more broader field. But they still obviously have a lot to learn.
Helen Mark
Now some views from three doctors currently in practice. First Tony Barnet, a consultant in diabetic medicine at Heartlands Hospital in Birmingham.
Tony Barnet
Health means to me both mental and physical wellbeing. And I think that the health profession in this country has, for too long, only considered the physical aspects - that's the symptoms and signs of disease, and so on - without considering the quality of life, the psychological aspects which are involved in this feeling of general wellbeing. So it's a total package. It's both mental and physical wellbeing.
Helen Mark
Sidhesh Kuma is a consultant in medicine, also at Heartlands.
Sidhesh Kuma
Well, not just the absence of disease, but I think it is a feeling of wellbeing … being able to work to one's fullest potential, enjoy life, you know … without fear of ill health. I think it would mean different things to different people. For a lot of people say … “If I look like Hugh Grant” … No, I think it's really … from my perspective as a health professional really, not just absence of disease, it’s being able to really live life to one's fullest potential.
Helen Mark
Sidhesh goes on to elaborate his views on workplace stress.
People take homework on their laptops, and things like that. And there's a price to be paid from all this, and that's a lot of psychological mobility, and so on. For example, the last patient I had … I believe all her problems were related to stress from all working - taking work home, work that she could not finish during the daytime. And, increasingly, you are seeing this not just among executives and, you know, people like that … you are seeing it in people who work in the manufacturing sector.
The work is generally getting more stressful. So there's a lot of mobility, I think, related to psychological problems these days … more so than we had seen maybe twenty years ago.
Helen Mark
Finally, Philip Dwyer, a specialist in diabetes.
Philip Dwyer
I think health means being happy actually. And I think health means being able to do all the things you want to do. I mean, one thing I thought about recently was actually being overweight and obese and etc. And, I saw one good programme about it … and this chap was talking about obesity, and he was saying, you know, we get wrapped up about people being overweight … and you actually can say to somebody “You've got to lose your weight … you've got to lose your weight … you've got to lose your weight”. And all you're doing eventually is actually making them depressed, you know.
And I thought myself, what are they losing their weight for? And the key is … you've got to say … I say to my patients, “Now you lose enough weight so you can do the things that you want to do”.
So being healthy is to be able to do the things you want to do. That's what matters. And all that matters is what you want to do, not what somebody else says that you should be doing. To be healthy is actually being able to do what you want to do, and there's no restriction on doing what you want to do. That's being healthy, and that's what I call being healthy is.
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Now listen to the audio clip, ‘Two community workers’, where two health professionals who work in the community link their views on health to policy and practice. First you hear Jane Jones, who is a community health worker and founder member of the Pliton Community Heatlh Project, and second you hear Dr Jill Meara who is a consultant in community medecine for Northampton Health Authority. Jill helped to establish the Right Angle Health Project which is concerned with health and lifestyles in rural and urban areas of Northampton.

Note down the implications this has for their practice.

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You will hear from two community workers, who link their views on health to policy in practice. First, Jane Jones, from the Pilton Project in Edinburgh.
Jane Jones
We don't take a very strict medical model of health. So we don't just work with illness or disease, though that's the obvious thing, I suppose. It means that we would take on board issues like housing … issues like what the local shops are like. If people are finding that they can't get an adequate diet because the local shops don't stock very good food, or it's poor quality, or it's very expensive, then, obviously, that limits the choices they've got in terms of keeping themselves healthy. Play space for children, we've looked at, as well as mental health … and maybe support groups for people with an illness. So it doesn't mean we ignore that, but we would have a very broad view of what health is.
Gill Meara - a community doctor, who works in Northampton.
Gill Meara
I suppose I've always been very concerned with the issue of powerlessness, you know, in all its forms as it were. So, particularly in the health field … how people have no say, very simply, in what goes on. And that's been quite a driving interest of mine … of how to get that profile raised higher in the health services field.
And then the way that the medical dominance of the health field has meant that people's own view of what's wrong with them, or view of what their own health is, has been squashed into the sidelines quite a lot. And I'm also quite interested in trying to get hold of that again, and give it a higher profile.
Health is wider than just treating disease. The role of the NHS is not only to treat disease, but also promote health. And a lot of studies have shown that it's quite fundamental things that affect people's health - fundamental things like whether they can get to where they want to be, whether they feel happy and secure, and whether they've got enough money. There's obviously not much that the NHS can do in some of those areas, but we feel that the Right-Angle Project is trying to address other areas that can be met through collaboration with local agencies and people.
We want to put some effort into helping the community to develop to a state where they can get things organised for themselves. The idea of the money that we're spending is not that it goes into a bottomless pit, but that, at the end of the project, there'll still be some of the things running and set up that we've begun through the project. And that's a very efficient use of money because then, if things have a momentum of their own, they'll be taken on and funded in other ways.
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Sudhesh Kumar, Tony Barnett and Phillip Dyer clearly see health as more than the absence of disease or a set of signs and symptoms, and they all talk about the importance of the social and economic background of their patients. So there is certainly a change from the old-fashioned way that physicians used to deal with a body in the bed, or an organ in a bed, as Sir John Crofton puts it. Jane Jones and Jill Meara go much further in applying their broad view of health and question the medical dominance of health. They try to address the issue of powerlessness and find ways to give people in the community a much greater say in the issues that concern them.


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