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Medicalisation at the start of life

Medicalisation at the start of life. Justin Allen. Health. "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity". WHO 1948. Disease. An interruption, cessation or disorder of bodily functions, systems or organs

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Medicalisation at the start of life

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  1. Medicalisation at the start of life Justin Allen 18th International Bled Course

  2. Health • "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity". WHO 1948 18th International Bled Course

  3. Disease • An interruption, cessation or disorder of bodily functions, systems or organs Dorland’s Medical Dictionary 18th International Bled Course

  4. Illness • A patient's personal experience of his or her disease 18th International Bled Course

  5. Medicalisation (1) • the process by which certain events or characteristics of everyday life become medical issues, and thus come within the purview of doctors. Wikipedia 18th International Bled Course

  6. Medicalisation (2) • Illich argues that the medical establishment poses a "threat to health" through the production of clinical, social, and cultural “iatrogenesis” and medicalises human life. Ivan Illich 1975 18th International Bled Course

  7. Start of life Conception Pregnancy Childbirth Infancy 18th International Bled Course

  8. Start of life Conception Pregnancy Childbirth Infancy 18th International Bled Course

  9. Quick questions: • Where should women give birth? • Why? • Who should decide? 18th International Bled Course

  10. Some facts and figures – changes in care delivery in UK

  11. Some facts and figures – changes in care delivery in UK

  12. What about abroad?

  13. Professional Better anaesthesia Epidurals 24 hour issue Litigation Patient led Consumer choice Birthing pools Birthing posts Birthing friends Change factors 18th International Bled Course

  14. Buzz groups Who are the key stakeholders in bringing about changed patterns of care in childbirth? List as many as you can in 2 minutes. 18th International Bled Course

  15. My list Lawyers Media Pressure Groups Politicians Mother Family/Friends Healthcare managers Obstetric Specialist Maternity nurse GP 18th International Bled Course

  16. It should be two-way communication- Media Lawyers Pressure Groups Politicians Mother Family/Friends Healthcare managers Obstetric Specialist Maternity nurse GP 18th International Bled Course

  17. But may be - Media Lawyers Pressure Groups Politicians Mother Family/Friends Healthcare managers Obstetric Specialist Maternity nurse GP 18th International Bled Course

  18. Issues • Societal expectations • A normal child is my right • Inter-professional warfare • Obstetric specialists and nurses • Intra-professional warfare • Obstetric specialists and GPs • Compensation culture • If something goes wrong somebody is to blame • No win/no fee lawyers • Poor communication • People forgive most things if they are explained to them 18th International Bled Course

  19. Adverse events • Many patients suffer increased pain, disability and psychological trauma and may regard failures in their treatment as a terrible betrayal of trust. • Staff may experience shame, guilt and depression after making a mistake, especially if they face complaints, inquiries or litigation. • Doctors and nurses whose confidence has been impaired will work less effectively and efficiently; at worst they may abandon medicine as a career. Safe births: everybody’s business 18th International Bled Course

  20. Defensive medicine • 70% of all negligence claims are for childbirth (£2.6bn in 2007 in UK) • >90% relate to “failure to intervene” • Movement of low-risk deliveries into specialist units • Unnecessary and inappropriate monitoring leading to interventions • Fear of lawsuits is a significant factor in lack of maternity provision 18th International Bled Course

  21. When things go wrong: • Patients are grieving, confused, guilty, angry, frightened. • Health professionals are guilty, angry, confused, frightened. • Health care systems change structures (again) and lawyers prosper • The wrong problem is solved 18th International Bled Course

  22. Can medicalisation be reversed? • Return to regarding birth as a normal physiological process and valuing low intervention rates. • Provide women and their families consistent and evidence based information. • Develop a genuine “no-fault” culture • Act as patients ADVOCATE, in PARTNERSHIP 18th International Bled Course

  23. It’s all in the Educational Agenda! Primary Care management 1.5 & 1.6 Person Centred Care 2.1, 2.2 & 2.4 Community orientation 5.1 Holistic approach 6.1 Attitudinal Approach 7.2 Scientific approach 7.3 What should we teach our trainees? 18th International Bled Course

  24. Questions or comments? 18th International Bled Course

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