Charles-Jones Huw, Latimer Joanna, May Carl
School of Primary Care, University of Manchester, Manchester.
Sociol Health Illn. 2003 Jan;25(1):71-92. doi: 10.1111/1467-9566.t01-1-00325.
The paper focuses on the redistribution of medical work within primary health care teams. It reports the results of the analysis of interviews with general practitioners, practice nurses and managers, undertaken as part of an ethnographic study of primary care organisation and practice during a period of rapid organisational change. By examining the ways in which the respondents account for how work is being redefined and redistributed, we explore how current government policy and professional discourses combine to reconfigure both the identities of those who work in primary care and the nature of patienthood. In particular, we show how general practitioners are being reconfigured as medical specialists or consultants in ways that seem to depart radically from earlier claims that general practice is a distinctive field of social or biographical medicine. Within this new discourse medical work is distributed between doctors, nurses and unqualified staff in ways which make explicit the reduction of general practice work to sets of biomedical problems or tasks. At the same time, the devolution of much general practice work to less qualified and cheaper personnel is justified by drawing on a discourse of person-centred medicine.
本文聚焦于基层医疗团队内部医疗工作的重新分配。它报告了对全科医生、执业护士和管理人员访谈的分析结果，这些访谈是在基层医疗组织和实践的快速组织变革时期进行的一项人种志研究的一部分。通过考察受访者对工作如何重新定义和分配的解释方式，我们探讨了当前政府政策和专业话语如何结合起来，重新塑造基层医疗工作者的身份以及患者身份的本质。特别是，我们展示了全科医生如何被重新塑造为医学专家或顾问，这似乎与早期关于全科医疗是社会或传记医学独特领域的说法大相径庭。在这种新话语中，医疗工作在医生、护士和非专业人员之间的分配方式，明确了将全科医疗工作简化为一系列生物医学问题或任务。与此同时，通过借鉴以患者为中心的医学话语，将许多全科医疗工作下放给资质较低、成本较低的人员是合理的。
