Lutfey Karen
Department of Sociology, University of Minnesota, Minniapolis, Minnesota 55455, USA.
Sociol Health Illn. 2005 May;27(4):421-47. doi: 10.1111/j.1467-9566.2005.00450.x.
Questions pertaining to patient adherence and provider roles are part of the classical repertoires in sociological and health services research. While extensive research programmes consider why patients do not follow medical advice, less is known about how practitioners assess patient adherence. Similarly, there has been much work on provider roles changing with the organisation of healthcare, but less attention to the ways providers conceptualise, choose and strategically enact practices in the course of their work. Using data from a year-long ethnographic study of two diabetes clinics, I examine some of the stances medical practitioners actively choose and enact in their treatment of diabetes patients - educators, detectives, negotiators, salesmen, cheerleaders and policemen - and how they tailor their actions to specific patients in order to maximise their adherence to treatment regimens. Findings suggest that the notions of 'patient adherence' and 'physician roles' are conceptually broader and more fluid than what is captured in existing literature, and this rigidity potentially impairs our ability to learn more about the everyday practices of medical work.
与患者依从性及医疗服务提供者角色相关的问题，是社会学和卫生服务研究中的经典内容。尽管有大量研究项目探讨了患者不遵循医嘱的原因，但对于从业者如何评估患者依从性却知之甚少。同样，关于医疗服务提供者的角色如何随医疗保健组织的变化而改变，已有很多研究，但较少关注他们在工作过程中如何构思、选择并策略性地实施医疗行为。通过对两家糖尿病诊所进行为期一年的人种志研究获得的数据，我考察了医疗从业者在治疗糖尿病患者时积极选择并实施的一些立场——教育者、侦探、谈判者、推销员、啦啦队长和警察——以及他们如何针对特定患者调整自己的行为，以最大限度地提高患者对治疗方案的依从性。研究结果表明，“患者依从性”和“医生角色”的概念比现有文献中所描述的更为宽泛和灵活，这种僵化可能会削弱我们进一步了解医疗工作日常实践的能力。
