Magten i sundhed: Om sundhedsprofessionalisme i kommunale sundhedshuse

Abstract

Artiklen undersøger, hvordan det ændrede fokus på sundhed (afstedkommet af strukturreformen i 2007) har haft betydning for udviklingen af sundhedsprofessionalisme i kommunale sundhedshuse og for de sundhedsprofessionelles kamp for status. Hvordan udøves sundhedsprofessionalisme i fraværet af læger og deres bio-medicinske forståelsesramme, i fraværet af hospitalets kliniske rammer og ikke mindst i fraværet af ”diagnosen” som klassificerende og statusgivende redskab? Artiklens teoretiske afsæt er professionel udvikling og status. Teori peger her på at professionalisme får sin endelige form i mødet med individet og de administrative, sociale og fysiske rammer, der betinger udøvelsen af aktiviteter og graden af formalisering. Artiklen undersøger hvilken status, der knytter sig til de sundhedsrelaterede aktiviteter udøvet under de lokale administrative og forvaltningsmæssige rammer i sundhedshusene, ligesom det undersøges, hvilken status sundhedshuset ser ud til at have for de borgere, der kommer der.The power of health: Health professionalism in municipal health housesThe article examines how the altered focus on health (brought about by structural reform in 2007) has had an impact on the development of health professionalism in municipal health houses and health professionals’ struggle for status? How is the health professionalism exercised in the absence of doctors and their bio-medical framework of understanding, in the absence of hospital clinical setting and not least in the absence of »the diagnosis« as a classifying and status-giving tool? The article’s theoretical basis is professional development and status. Theory suggests that professionalism gets its final form in the meeting with the individual and in the meeting with the administrative, social and physical environment that determines the performance of activities and the degree of formalization. The article examines the status related to the health-related activities pursued under the local administrative and governance structures in health houses, just as it is examined what status the health house seems to have for the citizens who come there.

Diagnostic fluidity: working with uncertainty and mutability

“…However, if we look at the diagnoses and the contexts most often studied in this field in social science, we find that quite often it is the chronic diseases rather than the acute ones that are in focus (Barker, 2011;Brown, Lyson, & Jenkins, 2011;Olafsdottir & Pescosolido, 2011;Salter, Howe, McDaid et alii, 2011;Singh, 2011;Trundle, 2011). These conditions are mostly studied in the very young and the very old (Prior, Evans, & Prout, 2011;Salter et alii, 2011;Singh, 2011;Trundle, 2011), and rather than internal medicine and surgery, the context of the studies is predominantly gynaecology, psychiatry and primary care Barker, 2011;Berger & Johansen, 2016;Brown et alii, 2011;Dahl, 2016;Møller, 2016;Olafsdottir & Pescosolido, 2011;Ringø, 2016;Singh, 2011;Trundle, 2011;Ulrich, 2016). There are important studies on how powers and drivers from outside the clinical context -notably pharmaceutical industry, new technology and national politics-may impact the classification system of diagnoses (Barker, 2011;Bourret, Keating, & Cambrosio, 2011;Danholt, Bossen, & Klausen, 2016;Schubert, 2011), but these are described as outside influences on classification rather than part of diagnostic work itself.…”

Challenges to cross-sectoral care experienced by professionals working with patients living with low back pain: a qualitative interview study

“…Moeller's study showed that-parallel to a biopsychosocial approach-municipal professionals also use a medical discourse to oppose the dominant medical group, e.g., by underlining other professionals' lack of human perspective. This view enhances the rehabilitation centres as a constructive and forward-looking alternative [28]. Neglecting and/or talking negatively about the work performed by former professionals are examples of such a discourse.…”

“…It is not always easy to make an exact diagnosis for patients with LBP. Back pain cannot always be explained from a biomedical perspective, and the health care professional may need to work from a biopsychosocial approach, namely by incorporating knowledge of several aspects of the patient's daily life to the assessment of the back pain situation [6,28]. Buch et al showed that implementation of LBP guidelines in hospitals and municipalities focuses on the professional core output [27].…”

“…Buch et al showed that implementation of LBP guidelines in hospitals and municipalities focuses on the professional core output [27]. Moeller explored health professionalism in Danish municipal rehabilitation centres and found that the core output differs greatly among health care professionals, depending on whether they work within a biomedical or biopsychosocial paradigm [28]. This discrepancy may explain why professionals do not immediately incorporate knowledge generated by others who may differ in their approach to pain and function.…”