Health professionals and ethnic Pakistanis in Britain : risk, thalassaemia and audit culture

Transcultural medical care--Great Britain;Discrimination in medical care--Great Britain;Race discrimination--Great Britain;Medical audit--Great Britain;Pakistanis--Medical care--Great Britain;Pakistanis--Health and hygiene--Great Britain;Risk perception;Risk--Sociological aspects;Medicine--Religious aspects--Islam;Racism;Thalassemia;RA418.5T73M8

Murphy, Richard ; Riches, David ; Riches, David

University:University of St Andrews

Department:Philosophical, Anthropological & Film Studies (School of)

关键词: Transcultural medical care--Great Britain;    Discrimination in medical care--Great Britain;    Race discrimination--Great Britain;    Medical audit--Great Britain;    Pakistanis--Medical care--Great Britain;    Pakistanis--Health and hygiene--Great Britain;    Risk perception;    Risk--Sociological aspects;    Medicine--Religious aspects--Islam;    Racism;    Thalassemia;    RA418.5T73M8;   

Others  :  https://research-repository.st-andrews.ac.uk/bitstream/handle/10023/1714/RichardMurphyPhDThesis.pdf?sequence=3&isAllowed=y

来源: DR-NTU

【 摘 要 】

The central theme or`red-thread' that Iconsiderin this thesis is the concept of risk as it isperceivedbyand affects the two sides ofthe medical encounter-in this instanceethnicPakistanisandHealth Professionals-in Britain. Eachside very often perceives risk quitedistinctively,relating to the balance between the spiritual and temporal realms.This isparticularly germaneinmatters to dowith possible congenitaldefectswithin the prenatalrealmfor the ethnicPakistani,and predominantlyMuslim,side of this encounter.Thusoneof the factorsconsideredin this thesis is howsenses ofIslam impactupon the two sides.ByethnicPakistanis Islam isseen as central to alllife decisions,whilstHealth ProfessionalsviewIslamwith some considerable trepidation, littleunderstandingitoritscentrality to theformer's decision-makingprocesses. This isparticularly significant with regard to attitudesto healthandhealthcare.In the initialstages of the projectI had thought firstcousinmarriage(FCM),seen byethnicPakistanisas desirableandby Health Professionalsasputting ethnicPakistanisat-risk to becentral to the argument,butconcluded that concernsaroundFCMwere a`red herring',merely a trope for the tensions between the two sides -atonceboth Britishand at-riskfromaudit culture.Althoughnolongercentral,FCMremains aviable touchstone inconsideration of the two sides' perceptions of genetic risk.In this thesisthe medical encounterbetweenethnicPakistanisandHealth Professionals isperformedwithin the realm of the so calledNew Genetics. Here the respective understandings of theNew Geneticsareinformed by the enculturation processes that shape the two sides' worldview.Furthermore, Iwill agree withLord Robert Winston'sand others' concern that anyattemptto eradicate an adaptive genetic mutation,in this instance, thalassaemia, from thegene poolisnot only undesirablein the short term, butalso that such eradications mayhavean adverse, andfarreaching, effect on whole population groupsin the future. Themainthrust of my argumentis that audit culture not only compounds riskfor bothsides,butalsoperpetuates institutionalracism within the National Health Service (NHS), bypromulgatingwhatI havecalled the languagemyth.That is to say that muchinstitutionalracismis theunwantedby-productof the NHS'sattempts to becomemore patient centred anditscontinuing efforts to developsystems ofbest practice.Thisprofessionalisation processwithinthe NHScanbeseen to impactmost stronglyinrelation to communication-particularly the claimedlanguage barrier between the two sides.This `barrier' has worryingpolicyimplications forany meaningful communicationbetween the two sides, notablyrelating to obtaininginformedconsentfromethnicPakistanipatients-with a resultantincrease inriskforthe two sides and clear economic consequences for the NHS.