The moral career of poor patients in free clinics

Abstract

AcknowledgementsThis research was supported by the INSERM Avenir programme, the Institut de l"Humanitaire and Médecins du Monde. Isabelle Parizot and Serge Paugam used the NGO data from an earlier analysis. Our thanks go to Jean-Marie Firdion and Julien Damon for helpful comments and suggestions with this. We also would like to thank the staff at the clinics and all the patients who answered our questions. 3 The Moral Career of Poor Patients in Free Clinics AbstractThis paper explores the lived experiences and the identity processes attached to attendance at free clinics. It draws on a qualitative study of 94 patients and 37 professionals that were interviewed at four free clinics in France. Since these facilities are for the poor and for people without health coverage, attendance reflects a medical experience as well as an experience of assistance, both of which have an impact on healthcare utilisation. Nevertheless, the meaning attached to the recourse to free clinics and the patients" lived experiences change over time and depend on interactions with clinic staff. This study proposes a typology of care recourse modes (occasional, regular and inconsistent attendance) crossed with different types of lived experiences. Occasional attendance and distant patient-professionals relationships, often due to the humiliation that some people feel when they have to ask for social assistance, characterise the first times people have recourse to care. Patients commit to regular followups only when they have come to terms with their position in the medical and assistance system, doing so by rationalising and adjusting their identity. When discussing our findings, our outlook is to gain greater insight into the utilisation of healthcare by different population groups and in different contexts. Abstract word count: 202 words

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“…Our descriptive results are comparable to those of most studies, particularly to Roelen’s, in which 88% of the respondents returned to work, indicating that a number of women choose to work following their BC diagnoses ( 1 , 3 , 8 , 24 ). Other studies reported a rate of work resumption between 64% and 88% ( 6 , 14 , 21 , 25 ). In 2006, Bouknight and colleagues reported an 82% RTW rate for women with BC at 12 months postdiagnosis and 83% at 18 months.…”

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“…The rationalization of certain aspects of care has been shown to be used elsewhere in healthcare. Rationalization as a protective mechanism has been shown to be a strategy used by patients to maintain dignity and personal identity (Baillie 2009, Parizot et al. 2005).…”

“…Parizot et al. (2005) discuss the role of rationalization in the maintenance of self‐image and identity in circumstances that challenge the individual’s understanding of self.…”

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“…D'une part parce que les médecins n'auraient pas conscience de l'écart entre accès théorique aux soins et accès effectif [43] et suivraient les consignes de prise en charge, qui préconisent le retour au système de soins ambulatoire classique dès l'ouverture de droits. D'autre part à cause d'un sentiment de gêne de la part de ces patients à profiter de soins gratuits [44] alors qu'ils pourraient se faire soigner dans le système de soins classique, qui conduirait à une autocensure et à un retard sinon à un renoncement aux dépistages [45,46]. Il est probable que l'orientation rapide des immigrés ayant une couverture sociale vers le système de soins crée des inégalités par construction [43] en défaveur de ces patients.…”