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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

Medicalisation at the start of life

Justin Allen

18th International Bled Course

health
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

disease
Disease
  • An interruption, cessation or disorder of bodily functions, systems or organs

Dorland’s Medical Dictionary

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illness
Illness
  • A patient's personal experience of his or her disease

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medicalisation 1
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

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medicalisation 2
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

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start of life
Start of life

Conception

Pregnancy

Childbirth

Infancy

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start of life1
Start of life

Conception

Pregnancy

Childbirth

Infancy

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quick questions
Quick questions:
  • Where should women give birth?
  • Why?
  • Who should decide?

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change factors
Professional

Better anaesthesia

Epidurals

24 hour issue

Litigation

Patient led

Consumer choice

Birthing pools

Birthing posts

Birthing friends

Change factors

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buzz groups
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.

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my list
My list

Lawyers

Media

Pressure Groups

Politicians

Mother

Family/Friends

Healthcare managers

Obstetric Specialist

Maternity nurse

GP

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it should be two way communication
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

but may be
But may be -

Media

Lawyers

Pressure Groups

Politicians

Mother

Family/Friends

Healthcare managers

Obstetric Specialist

Maternity nurse

GP

18th International Bled Course

issues
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

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adverse events
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

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defensive medicine
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

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when things go wrong
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

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can medicalisation be reversed
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

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what should we teach our trainees
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?

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questions or comments
Questions or comments?

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