Search results

Purpose – This chapter presents a case for reframing medical sociology to focus on diagnosis as a pivotal category of analysis via an extended literature review of the diagnosis as a tool of medicine.

Methodology/approach – Conceptual overview.

Practical implications – By reviewing the range of social functions served by diagnosis, and the similarly wide assortment of social forces that shape diagnostic categories, this chapter pushes social scientists and theorists to consider diagnosis as a cornerstone to the understanding of health, illness, and disease.

Originality/value of paper – Building on Brown's earlier call for a sociology of diagnosis, this chapter sets forth potential parameters for this field. It defines how the study of diagnosis is dissipated across myriad areas of scholarship, including medicalization, disease theory, ethics, classification theory, and history of medicine. Extirpating diagnosis and revealing it for specific discussion provides an opportunity to study topics such as illness experiences, health social movements, and disease recognition from a different and rich perspective.

The chapters PJ McGann and David J. Hutson have assembled for this volume are not only timely, coinciding with the appearance of DSM-V, but mark a defining moment in which a new subfield of medical sociology has emerged. Diagnosis, which refers both to diagnostic categories and the process of creating and applying them, is a central feature (Blaxter, 1978) – if not the central feature of medical work. Annemarie Jutel, who has done much to build the sociology of diagnosis, has described the wide array of “work” diagnosis performs in the medical world:Diagnosis is integral to medicine and the way it creates social order. It organizes illness: identifying treatment options, predicting outcomes, and providing an explanatory framework. Diagnosis also serves an administrative purpose as it enables access to services and status, from insurance reimbursement to restricted-access medication, sick leave and support group membership and so on… (Jutel, 2009, p. 278)

Purpose – To examine debates within the transgender rights movement over the GID diagnosis in order to demonstrate how diagnosis can be resisted as a source of stigma and social control at the same time that it is embraced as a means of legitimating experience and gaining access to resources, including medical services.

Methodology/approach – This chapter draws on qualitative data from: in-depth interviews with transgender rights activists and advocates, participant observation in transgender health care and activism settings, and content analysis of print and web-based materials on transgender health.

Findings – Transgender rights activists and advocates overwhelmingly reject the pathologization of gender variance. However, some actors advocate complete demedicalization, while others advocate diagnostic reform. Actors' advocacy for each position is influenced by the perceived costs versus benefits of diagnosis.

Social implications – The findings of this research shed light on the multiple and often contradictory effects of diagnosis. Diagnoses can both normalize and stigmatize. They can function to allow or deny access to medical services and they can support or act as barriers to legal rights and protections. Understanding these contradictory effects is essential to understanding contests over diagnosis, including the contemporary debate over GID.

Originality/value of paper – Through examination of an intra-constituent contest over diagnosis, this research demonstrates the need to distinguish medicalization from pathologization and illustrates the importance of examining the multiple and contradictory effects of diagnosis, both in and outside of medical settings.

Purpose – To explore the ideological effects and social control potential of diagnostic biopsychiatry and encourage the sociology of diagnosis to retain key insights of early medicalization scholarship.

Methodology – As the sociology of diagnosis emerges from medicalization, it is imperative that the new sub-specialty retains the critical edge of the early scholarship. With this in mind the paper reviews key aspects of the medicalization thesis, emphasizing the links between medical definitions and social control processes (e.g. Conrad, 1992; Conrad & Schneider, 1992; Zola, 1972). Based on this review scholars are urged to be mindful of the “diagnostic imaginary” -- a way of thinking that conceals the presence of the social in diagnoses, and which closes off critical analysis of the existential-connectedness and political nature of diagnoses.

Findings – The paradigm shift from dynamic to diagnostic psychiatry in DSM-III opened the door to a new biomedical model that has enhanced American psychiatry's scientific aura and prestige. With the increased presence and ordinariness of diagnoses in everyday life, an illusory view of diagnoses as scientific entities free of cultural ties has emerged, intensifying the dangers of medical social control.

Social implications – By illustrating that diagnoses are cultural objects imbued with political meaning, the ideological effects and social control potential of diagnostic biopsychiatry may be mitigated.

Historically, it has been common practice for doctors and parents to withhold the diagnosis from their minor intersex patients. This study seeks to integrate intersex youth experiences into the growing body of literature on diagnosis disclosure for intersex patients.

Using gender structure theory as a model, 16 intersex youth were given in-depth surveys regarding their experiences with their intersex identity in individual, interactional, and institutional contexts.

Participants more positively experience intersex than the earlier generations of intersex people. They were not deeply troubled by their diagnosis as doctors have historically feared, and they are open about their diagnosis with their non-intersex peers and teachers. They also find peer support valuable.

Data was collected from a single event and cannot represent all intersex youth. Future research must continue to engage with intersex youth experiences both inside of and beyond activist and support group networks.

These findings are strong exploratory evidence for the importance of diagnosis disclosure for intersex youth. Policies of withholding intersex diagnoses in clinical and familial contexts should be reevaluated in light of the experiences of intersex youth.

Diagnosis disclosure for intersex youth creates the potential for increased medical decision-making participation and increased capacity for activism and community building around intersex issues.

Our results encourage future studies that center the experiences of intersex youth, for we conclude that theorizing the lived experiences of intersex people is incomplete without their perspectives.

The purpose of this paper is to present an automatic Medical Knowledge Elicitation System (MediKES), which is designed to improve elicitation and sharing of tacit knowledge acquired by physicians. The system leverages the clinical information stored in electronic medical record systems, by representing the acquired information in a series of knowledge maps.

The system architecture of the proposed MediKES is first discussed, and then a case study on an application of the proposed system in a Hong Kong medical organization is presented to illustrate the adoption process and highlight the benefits that can be realized from deployment of the MediKES.

The results of the case study show that the proposed solution is more reliable and powerful than traditional knowledge elicitation approaches in capturing physicians' tacit knowledge, transforming it into a machine‐readable form, as well as enhancing the quality of the medical judgment made by physicians.

A prototype system has been constructed and implemented on a trial basis in a medical organization. It has proven to be of benefit to healthcare professionals through its automatic functions in representing and visualizing physicians' diagnostic decisions.

Knowledge is key to improving the quality of the medical judgment of physicians. However, researchers and practitioners are still striving for more effective ways of capturing tacit knowledge and transforming it into a machine‐readable form so as to enhance knowledge sharing. In this paper, the authors reveal that the knowledge retrieval and the visual knowledge representation functions of the proposed system are able to facilitate knowledge sharing among physicians. Thus, junior physicians can use it as a decision support tool in making better diagnostic decisions.

Throughout the late 19th and early 20th centuries, one of the many techniques used by physicians and psychiatrists to diagnose patients involved external and highly public examination. Typically conducted as a lecture to other medical experts and students, the patient was placed in the center of a round room with onlookers arranged in tiered seating to guarantee an unobstructed view. As the lead physician detailed the list of symptoms, using the patient's body as an illustration, observers witnessed the behavioral signs for themselves and discussed the possible underlying conditions or pathologies. This process of consultation and naming worked to increase the relative reliability among experts and bolster the professional reputations of medicine and psychiatry alike (Conrad & Schneider, 1992; Gillis, 2006; Grob & Horwitz, 2010). As researchers have noted (Aronowitz, 2001; Foucault, 1973), this change from focusing on disparate, idiosyncratic symptoms as expressions of individual illness to a system that recognized disease states comprised of symptom clusters marks a historical turning point in the history of medicine. The shift toward a classification scheme that linked medicine with science and technology bolstered medical authority and the power of physicians. In addition to professional credentials, accumulated knowledge, and institutional legitimacy, the authority of modern medicine both rests on and is expressed by medicine's decisive power to name and categorize through diagnosis (Jutel, 2009). Even as medical prestige has eroded, ceding some of its power to other entities,¹ physicians remain the final arbiter of official medical categories (Pescosolido, 2006), judges of what is, and what is not, a “real” diagnosis. In the diagnostic process, one looks within to reveal the nature of disease from without – empirical observation becomes immutable fact. Of course, as critical perspectives on medicine have long pointed out (Conrad & Schneider, 1992; Zola, 1972), the scientific “fact” of one time and place is the mythology or ignorance of another. Diagnosis, as both category and process (Blaxter, 1978), is infused with all manner of things social, historical, and cultural. This volume explores some of these infusions. In so doing, it aims to clarify and contribute to the emerging sociology of diagnosis – an endeavor first called for by Brown (1990), but more recently revived by Jutel (2009).

Medical uncertainty is recognized as a critical issue in the sociology of diagnosis and medical sociology more generally, but a neglected focus of this concern is the question of patient decision making. Using a mixed methods approach that draws upon autoethnographic accounts and third-party interviews, we aim to illuminate the dilemmas of patient decision making in the face of uncertainty. How do patients and supportive caregivers go about navigating this state of affairs? What types of patient–doctor/healthcare professional relationships hinder or enhance effective patient decision making? These are the themes we explore in this study by following patients through the sequence of experiencing symptoms, seeking a diagnosis, evaluating treatment protocols, and receiving treatments. In general, three genres of culturally available narratives are revealed in the data: strategic, technoluxe, and unbearable health narratives.

Medical diagnosis and treatment constitute a network of inter‐related processes. The conventional method of medical diagnosis and treatment of diseases involves a state space search of the medical knowledge of diseases and patient history, which could be combinatorially explosive. This paper presents a report on the experimental study of an intelligent, interactive, user‐friendly, knowledge‐based system which performs a stepwise analysis of a patient's complaints, filtering cognitive and emotional elements to be able to make inferences. It applies both forward and backward chaining in making inferences concerning the management of disease. A case study of the system is carried out using some tropical diseases. It is believed that the system will serve as a useful contribution towards tropical medical informatics.

The purpose of this paper is to evaluate the contribution of medical information systems (IS) to efficient use of information when diagnosing chest pain complaints with suspected acute myocardial infarction (AMI) as regards ordering of tests and accuracy of diagnosis.

In total, 102 physicians were asked to diagnose three cases of chest pain in patients consulting an emergency department (ED) in a simulation study. Half of the participants had access to a medical IS with complete patient information and the other half of the physicians did not.

It was found that participants who viewed the medical IS ordered fewer clinical examinations. Participants who viewed the medical histories made a more accurate main differential diagnosis (DD) of AMI. Physicians with access to the medical history reported significantly higher levels of confidence in their decisions, regardless of seniority.

The findings suggest that IS leads to better utilization of medical services, greater efficiency and lower costs and thus has implications for other healthcare sectors.