Beard Renée L
Institute for Health Research and Policy, Center for Research on Health and Aging, University of Illinois Chicago, 1747 W. Roosevelt Road, M/C 275, Chicago, IL 60608, USA.
Cult Med Psychiatry. 2008 Mar;32(1):11-30. doi: 10.1007/s11013-007-9073-z.
Clinicians aim to establish trust during medical encounters because, without it, health consumers may not seek medical care, consider their diagnoses legitimate, or adhere to treatment regimens. This paper examines the identification and treatment of memory loss within two specialty clinics to understand how cultural dynamics, such as organizational ethos and work practices, influence the social fabric of cognitive evaluations. Ethnographic data suggest important historical and cultural differences in the approaches to Alzheimer's disease (AD). Organizational routines, however, support a common goal, that of moving individuals from "potential patients" to patients, and ultimately research subjects, through establishing trust. Although the processes through which trust is potentially achieved, or the social conditions of trust, were similar at the sites, the object of trust was different. Whereas one clinic encouraged trust in collective medical expertise, the other focused on trust in specific clinicians. These conditions affect the clinical consequences of trust, particularly how and when the diagnosis is delivered, use of the AD label and other terminology, and the level of standardization. The individual consequences include perceptions of patients and depictions of the prognosis. Whether cognitive impairment is viewed as a scientific puzzle to be solved or is seen as a chronic illness significantly shapes the organizational processes of clinical evaluation. Alzheimer's disease, as a cultural object, is a particularly salient exemplar of the clinical negotiation of ambiguous diagnostic categorizations and the unpredictable patient in daily biomedical practice.
临床医生在医疗过程中致力于建立信任，因为没有信任，医疗消费者可能不会寻求医疗服务，认为他们的诊断不合理，或坚持治疗方案。本文考察了两个专科诊所对记忆丧失的识别和治疗，以了解文化动态，如组织风气和工作实践，如何影响认知评估的社会结构。人种志数据表明，在治疗阿尔茨海默病（AD）的方法上存在重要的历史和文化差异。然而，组织常规支持一个共同目标，即通过建立信任，将个体从“潜在患者”转变为患者，并最终成为研究对象。尽管在这些场所实现信任的潜在过程或信任的社会条件相似，但信任的对象却不同。一个诊所鼓励对集体医学专业知识的信任，另一个则侧重于对特定临床医生的信任。这些情况会影响信任的临床后果，特别是诊断的方式和时间、AD标签及其他术语的使用，以及标准化程度。个体后果包括患者的认知和对预后的描述。认知障碍被视为一个有待解决的科学难题还是被视为一种慢性病，这极大地塑造了临床评估的组织过程。作为一种文化对象，阿尔茨海默病是日常生物医学实践中模糊诊断分类的临床协商和不可预测患者的一个特别突出的例子。
