Monday, 30 August 2010

The NHS Direct helpline is dead. Long live NHS 111!

www.bbc.co.uk/news/uk-11120853. A shame - NHSD provided a reason to think about Freidson’s "lay referral system" again, this time in connection with ICTs (Freidson 1988).


No, you’re not.

Freidson made the point that we need to think about the temporal trajectory of sickness. This meant considering seriously what happens before we opt for a consultation with a medical expert. He noted decisions about whether to access professional healthcare are conventionally first made in our immediate kin/community context, looking at both social relationships and cultural themes as factors.

If ICTs, now a “mundane reality” (Nettleton 2005) for many in seeking out health-related information and advice, have impacted that context then the lay referral system and its two components (the extent to which lay culture is congruent with professional health culture and the cohesiveness and extension of the lay referral structure) may have to be amended.

For example, has the effect of more information availability through dominant providers such as NHS Direct aligned lay health culture more closely with the knowledge base underpinning professional health culture (an especially relevant question for those identified by Freidson as not sharing in that culture, namely the 'lower classes')? Secondly, with the option of finding condition-specific social networks online, those identified as relying on a loose and truncated lay referral structure to help make decisions (identified by Freidson as the 'middle classes'), may find such structures extended, if not more cohesive.

Ultimately, how will digital ICTs interact with other factors, such as the Government's aim to encourage more healthcare to take place in home settings, to change the proportion of referrals to professional medics, if at all?

Thursday, 26 August 2010

The opinions of Professor Field are not the same as evidence from the field

Healthy living is commonly seen as a rational choice on the part of individuals. Indeed, Prof Fields' outlook (click his name for a summary from the Herd blog) seems to be grounded in theories about the rational actor/self regarding individual.

Durkheim initiated a long tradition of sociological and anthropological opposition to the kind of assumptions underpinning Prof Fields’ views, with his examination of the social origins of individual thought.

We need to think about the influence of socio-cultural factors on perceptions, i.e. the norms and values associated with culture and reference groups. We also need to think about the organisation of social relationships, using social network analysis for example, to determine the effect that family and friends can have on decisionmaking.



If we do so, and as any parent can tell you, we will realise that behaviour is infrequently changed by more information or persuasive arguments in isolation (e.g. see Lewis way back in 1945: ‘Conduct, knowledge and acceptance of new values,’ in Journal of Social Issues).

Finally, here's the video referred to in the Herd blog for a great counter to Professor Field's outlook, focusing on social processes:

Saturday, 14 August 2010

Is remote healthcare remotely healthcare?

New fangled approaches in healthcare will always get some peoples’ backs up and the idea of a virtual medic is about as new fangled as it gets: http://www.express.co.uk/posts/view/190756/Web-Would-you-trust-a-virtual-medic-  Both patients and practitioners (http://www.bbc.co.uk/news/10285950) and somewhat inevitably insurance companies with competing premium member services have raised objections to mediated interactions where the purpose is diagnosis or advice. Nevertheless, NHS Direct (a bit of a misnomer given its callcentre and website operations essentially mediate the healthcare experience) has proven enormously popular in England – with 18 million visits to its website in 2009 and 5 million calls to its call centre.

Anecdotally, some of the strongest objections to the ‘re-mediation’ of healthcare come from Northern Ireland where NHS Direct isn’t available. The primary concern there isn’t necessarily about mediation, after all doctors there allocate time in the day to take phonecalls and even emails from patients, a situation also common in the US. It’s the idea that advice should be given by anonymous practitioners who have no idea of your medical history (moreover they are nurses, complain the doctors).

I have been speaking to some of those within the NHS who would like to get to the bottom of ‘resistance’ on the part of both patients and practitioners to more technology-enabled services. Many share a vision where interactions with health services ultimately become like interactions with banks: the 2020 Public Services Trust is doing some thinktank work on this front.

With the Northern Ireland example alone, it’s clear that a patchwork of values concerning healthcare exist and that’s before considering constituencies such as the poor where issues of access also come into play. Clearly, more work needs to be done to understand what lies behind those values and what the information needs and access issues of patients are. Ethnography can help on these fronts. 

Friday, 11 December 2009

danah boyd interview

Interesting interview with digital anthropologist and social media expert danah boyd here today. I like the insight that kids are just as concerned with privacy as before (and as concerned as adults are). Privacy is linked to control and kids are only able to control spaces such as those online whilst adults have control over homes, which they see as the locus of privacy. Cue much confusion about whether kids actually value privacy any more.

danah boyd also deconstructs the uncritically accepted notion of 'digital native'. Children are no more natives than adults, it's just that the imperative to learn to use technology may be so much stronger when it has become an essential way to negotiate the conventional processes of growing up.

In short, plus ca change.

Wednesday, 9 December 2009

The Utah Teapot

Only time for a quick entry today by virtue of needing to deliver three essays next week...

One of the essays is actually a project to explore issues in digital anthropology. I'm looking at an iconic object in the world of 3D graphics - the Utah Teapot - to help me explore various issues such as open source sharing, the preservation of digital heritage, the validity of virtual anthropology and remediation. More anon...

video

Part of my presentation

Friday, 13 November 2009

Social media gurus get a kicking

Spotted this on Gabriella Coleman's blog Interprete today (see blog list). Very, very, (very) funny for anyone who has experienced the patter of a certain kind of social media guru.

There I was a few posts ago almost cutting such people some slack ('Not all sell, sell, sell') but I think it was a case of absence making the heart grow fonder...

Thursday, 12 November 2009

The BBC stripped bare (and paying for strippers)



Went to an interesting talk today by anthropologist Professor Georgina Born who wrote 'Uncertain Vision', based on ethnographic research at the BBC. She said that the BBC was an excellent place to witness the impact of neoliberal marketing thinking applied to the public sector in the 1990's (bringing in terms like accountability and a whole set of practices which are now accepted as part of the landscape).

She was critical about this impact, which for example saw the introduction of short term contracts which in her opinion squeezed the space available autonomous creative thinking, betraying the democratic Reithian vision.

There are pockets of hope and creativity for her, one being the BBC's determination to keep its finger on the pulse by exploring the possibilities of digital technology, leading to excellent services such as the BBC Asian Network which manages to be universalist and cater for a 'minority' (though this didn't square with her criticism of investment by public sector broadcasters in consultancies to project which platforms were going to be key in the future - how else are they supposed to know...?)

The answer came soon enough. Unsurprisingly perhaps for an anthropologist she also saw hope in the BBC's concerted efforts to carry out its own market research to ostensibly find out how to reach its audiences (I thought much like a PR professional might applaud an organisation which decides to do PR ect., but that's me being cynical). In the last decade this research has also included ethnography and she relished in the irony of the BBC employing commercial ethnography practices to "slap them in the face" when she had to tread so warily in her dealings with the upper echelons.

Anyway - two things to add. Firstly, the BBC isn't keen to shout about all the research it does. I am aware of its employment of a consultancy which conducted ethnographic research into nudist camps on its behalf (imagine the headlines...!). Secondly, for all her travails trying to get access to various departments such as news at the BBC, I spent a lot of time on the other side of the equation, trying to get journalists access to anthropologists going about their daily work. It wasn't easy and I think points to the difficulties outsiders have in gaining access to the internal processes of any institution as well as the similar incomprehension felt when facing rejection: "but why wouldn't they want to speak to me, my motives are pure..."