Centre for Public Policy Research, King's College London, Franklin-Wilkins Building Waterloo Rd, London SE1 9NN, UK.
Health Care Anal. 2012 Sep;20(3):268-80. doi: 10.1007/s10728-011-0186-8.
This paper considers proposals for developing 'co-productive' medical partnerships, within the UK National Health Service (NHS), concentrating in particular on the potential problem involved in combining professional and lay conceptions of health. Much of the literature that advocates the introduction of co-productive healthcare partnerships assumes that medical professionals and patients share, or can easily come to share, a common set of beliefs about what is valuable with regard to health interventions and outcomes. However, a substantial literature documents the contestability of the concept of health, particular across professional and lay divides. We suggest that this potential disagreement ought to be taken seriously, and suggest that the prospect of a co-productive NHS in which patients and professionals act in partnership is threatened by the existence of unresolved epistemic differences. We suggest that part of the solution may lie in re-framing this potential disagreement in the terms provided by Engel's bio-psycho-social account of health, and demonstrate how support for this account can be grounded upon a critical realist foundation. What we call a 'stratified conception of health' reveals the potential complementarity between health beliefs which may have at first seemed to be essentially contradictory. We consider some of the practical implications this idea has for conceiving and creating co-productive medical partnerships.
本文考虑了在英国国民医疗服务体系（NHS）内发展“协作性”医疗伙伴关系的建议，特别关注在将专业和非专业人士对健康的概念结合起来时可能涉及的潜在问题。许多提倡引入协作性医疗保健伙伴关系的文献都假设，医疗专业人员和患者对于健康干预和结果的价值，拥有或可以轻易达成共同的信念。然而，大量文献记录了健康概念的可争议性，特别是在专业和非专业人士之间。我们认为，应该认真对待这种潜在的分歧，并认为在 NHS 中存在尚未解决的认知差异，这使得患者和专业人员能够以协作的方式进行合作的前景受到威胁。我们认为，解决问题的部分方法可能在于用恩格尔（Engel）关于健康的生物-心理-社会理论来重新构建这种潜在的分歧，并展示如何在批判实在论的基础上为这种观点提供支持。我们称之为“健康分层概念”，揭示了最初看似本质上相互矛盾的健康信念之间的潜在互补性。我们考虑了这一观点对于构思和创建协作性医疗伙伴关系的一些实际影响。
