Maps are increasingly understood as socio-cultural and political constructs, rather than mirrors of nature. Drawing on the insights of cultural cartographers, this paper presents a critical analysis of a specific instance of map-making in health policy, namely the growing use of care pathways in care planning and service delivery. Widely regarded to date as devices for ensuring quality of care, equity of treatment, optimal resource allocation and a rational division of labour between healthcare professionals, they have been seen as helpful -and technically neutral -tools for routing patients through the system. By contrast, we argue that the metaphors are misleading: lived experience and its objectification in pathway maps continually re-create one another, as we explore the slippage between map, map-making and mapping. This paper is based on interviews and observations with a variety of healthcare workers in three areas of south eastern England. We trace the development of a series of pathways-in-process, and show how they configure the patient, highlighting some aspects of their experiences, whilst silencing others. We also analyse the role of pathways in the carving up and surveillance of space round the emergence of the 'hybrid professional', particularly new practitioners such as GP specialists, specialist nurses, extended scope therapists and others. In considering the wider implications of care pathways as part of the contemporary discourse on policy, the paper critiques the rationalist, and sometimes evangelical assumptions underpinning their current popularity. In particular, we suggest that a critical and processual understanding of pathways might contribute to a more informed appreciation of
This paper tussles with the policy question, that of integrating people with arthritis into employment, in terms of a dialectic between trouble and trust. It suggests that disability theorists' emphasis on the 'social model of disability' as the definitive explanation for disabled people's unfavourable position in the labour market is limited without an understanding of the body as a set of relationships linking self and outer world together. For disabled people, longterm illness in a public domain such as work may profoundly disrupt expectations about biographical and social integrity, and normative order. Using an indepth qualitative approach, this paper focuses on the differing employment experiences of two informants disabled by rheumatoid arthritis. Their accounts illustrate some tensions between the breakdown of trust, its constitution as trouble, and attempts to restore 'business as usual' in the workplace. The wider social and cultural significance of illness in the workplace, and the need to adopt a more discriminating approach to 'discrimination' are discussed.
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