O foco deste estudo está nas possíveis transformações na relação de poder estabelecida entre médico e paciente representada em três comunidades virtuais com tema em saúde-doença. Trata-se de uma pesquisa qualiquantitativa com uso da técnica do Discurso do Sujeito Coletivo (DSC), o que possibilita a construção de discursos coletivos distintos que expressam as representações sociais de uma coletividade. Como resultado é possível verificar: (i) porque as pessoas participam de comunidades virtuais; (ii) como as pessoas participam; (iii) como se organizam essas comunidades; (iv) quais tipos de informações são mais buscados; (v) quais conteúdos informacionais existem nos fóruns de discussão (vi) como se dá a interação entre integrantes da comunidade; (vii) como as relações de poder estabelecidas entre médico e paciente são tratadas nas comunidades; (viii) identificação de possíveis transformações na relação de poder estabelecida entre médico e paciente. Conclui-se que a maior parte dos integrantes das comunidades analisadas está em um nível associativo-participativo de compartilhamento das informações e experiências. Esse nível, apesar de não se constituir em ação de cooperação e prática de produção coletiva, permite aos integrantes se tornarem pacientes mais ativos em seus processos de saúde e doença. Os resultados sugerem que o princípio ético da autonomia está, legalmente e na prática, mais fortalecido, contribuindo com a constituição de um indivíduo integrante, interativo, mais autônomo / Possible changes in the power relationship established between doctor and patient represented in three online communities which address the subject of health and illness is the focus of this study. This is a qualitative and quantitative research using the Collective Subject Discourse (DSC), which allows the construction of separate collective discourse, which expresses the social representations of a collectivity. As a result, it is possible to verify: (i) why people participate in such virtual communities , (ii) how people participate, (iii) how those communities are organized, (iv) what types of information are most searched, (v) which information exist in those discussion forums (vi) how community members interact, (vii) how the power relations established between doctor and patient are treated in these communities, (viii) identification of possible changes in the relationship established power between doctor and patient. We conclude that most members of the communities studied are in an associative-participatory level regarding information and experiences sharing. This level, though is not considered as an action of mutual cooperation and collective production practice, allows members of such communities to become more active as patients in their processes of health and disease. The results suggest that the principle of autonomy is, legally and in practice, more energized, contributing to the constitution of an individual, integral, interactive, and increasingly autonomous

There are numerous empirically described problems of communication in healthcare. The doctor/patient relationship is fundamental to many such problems. The changing nature of healthcare and the doctor/patient relationship is explored in this thesis. An increasing evidence base demonstrates that patient outcomes in healthcarea re directly relatedt o clinical communication. However, more fundamental than patient outcomes is the very nature of personhood and the effects illness has on individual autonomy. A theory of human need provides the foundation for discussion. Autonomy in healthcare is discussed in these terms and is argued as a basic human need. Moreover, human communication is argued as a basic human need using the same theoretic approach. It therefore follows logically that health professionals have the same duties and responsibilities to meet basic human communication needs on the same terms as those for autonomy. The relationship between autonomy and communication is shown to be a reflexive one. A theory of democratic communication is drawn on to describe the type of communication that will meet autonomy and communication needs. This is set in the context of healthcare. Consent in healthcare is used to show how far we have come in meeting communication and autonomy needs. Given the arguments o far it is reasonable to expect medical education to respond to the changing and recognised needs of the users of healthcare. The role of effective communication in medical education programmes is explored. Finally, a strategic approach to organising and delivering a communication curriculum is proffered which tries to meet both the philosophically and democratically argued basic needs. The resulting communication curriculum combines theoretic foundations with a pragmatic approach to the problems of clinical practice. If the approaches in this thesis are followed then communication can no longer be perceived as something doctors do after they have completed other medical tasks. Effective doctors have to be effective communicators in order to meet patients' needs.

A presente tese tem por objetivo estudar alguns aspectos semióticos de paixão e persuação na relação médico-paciente, uma relação sempre marcada pela verticalização e pela complexidade - de um lado, o poder de persuasão de quem detém o conhecimento; de outro, a fragilidade de quem está doente e precisa da cura. Para esse estudo, será apresentado, em uma primeira parte, um panorama da história da Medicina ocidental, bem como comparações entre os médicos atuais e os xamãs e feiticeiros de antigas civilizações. Verificar-se-á que o prestígio do profissional da Medicina atual assemelha-se ao respeito de que gozava o xamã naquelas sociedades: tanto um quanto o outro, ao estabelecer a cura de um doente, possibilitam sua reintegração ao grupo social a que pertencia e do qual foi separado em razão de sua enfermidade. Em seguida, serão apresentados os modelos teóricos presentes nos escritos de A. J. Greimas e C. T. Pais para que se estudem três casos narrados por médicos de três diferentes especialidades - um ortopedista, um cirurgião de cabeça e pescoço e uma cardiologista. Com a análise semiótica das narrativas, chegar-se-á ao estudo da \"visão de mundo\" subjacente aos citados casos e seus desdobramentos, bem como a análise do comportamento dos sujeitos envolvidos na busca do objeto de valor: o restabelecimento da saúde. De um lado, o profissional da Medicina, que deve seguir os preceitos de sua profissão, bem como os mandamentos da chamada Bioética, para que seja sancionado positivamente pela sociedade da qual faz parte; de outro, o paciente, que freqüentemente deposita no médico mais expectativas de cura do que esse profissional pode alcançar. Serão levadas em conta, também, as teorias de J. Campbell sobre o \"mito do herói\", bem como a teoria dos \"arquétipos\" de C. Jung. Em suma, este trabalho procurou analisar, sob o ponto de vista da semiótica e da bioética, as condições em que se pode desenvolver a relação entre médico e paciente. Assim, esperamos poder contribuir, de alguma forma, para estudos posteriores que se proponham a investigar o universo da Medicina / This thesis intends to study some semiotics aspects of passion and persuasion in the doctor-patient relationship, a relationship marked by verticalization and complexity - on the one hand, the power of persuasion of a doctor who has the know-how; on the other hand, the fragility of someone who is ill and needs to be cured. On this study, a synthetic history of Western Medicine will be shown, including a comparison between the modern doctors and old witch doctors from primitive tribes. It´ll be clear that the status of the modern doctors has not changed from that time because both of them, when they get to cure a person, can bring back the patient to his social group, since any ill person is separated from his family and friends due to the ilness. After that, the theoric patterns of Greimas and Pais will be shown in order to study three cases told by three different doctors from three different areas of Medicine: Orthopedics, Head and Neck Surgery and Cardiology. With the semiotic analysis of the cases, the \"interpretation of the world\" will be identified according to the relationship studied, as well as the analysis of the behavior of the characters searching their goals: the recovering from the illness. We will find the doctor who must obey the laws of his profession, as well the commandments of Bioethics, to be approved by the social group in which he lives; but we will find, too, the patient who often expects more than he should from his doctor. J. Campbell´s theories about \"The mith of the hero\" and Jung´s \"Theory of the Archetypes\" will be important to this work too. In short, this work tried to study, considering Semiotic and Bioethic, the conditions and problems envolving the relationship between doctor and patient. We hope we can give some contribuiton to future works that may intend to investigate the Medicine world.

A presente tese tem por objetivo estudar alguns aspectos semióticos de paixão e persuação na relação médico-paciente, uma relação sempre marcada pela verticalização e pela complexidade - de um lado, o poder de persuasão de quem detém o conhecimento; de outro, a fragilidade de quem está doente e precisa da cura. Para esse estudo, será apresentado, em uma primeira parte, um panorama da história da Medicina ocidental, bem como comparações entre os médicos atuais e os xamãs e feiticeiros de antigas civilizações. Verificar-se-á que o prestígio do profissional da Medicina atual assemelha-se ao respeito de que gozava o xamã naquelas sociedades: tanto um quanto o outro, ao estabelecer a cura de um doente, possibilitam sua reintegração ao grupo social a que pertencia e do qual foi separado em razão de sua enfermidade. Em seguida, serão apresentados os modelos teóricos presentes nos escritos de A. J. Greimas e C. T. Pais para que se estudem três casos narrados por médicos de três diferentes especialidades - um ortopedista, um cirurgião de cabeça e pescoço e uma cardiologista. Com a análise semiótica das narrativas, chegar-se-á ao estudo da \"visão de mundo\" subjacente aos citados casos e seus desdobramentos, bem como a análise do comportamento dos sujeitos envolvidos na busca do objeto de valor: o restabelecimento da saúde. De um lado, o profissional da Medicina, que deve seguir os preceitos de sua profissão, bem como os mandamentos da chamada Bioética, para que seja sancionado positivamente pela sociedade da qual faz parte; de outro, o paciente, que freqüentemente deposita no médico mais expectativas de cura do que esse profissional pode alcançar. Serão levadas em conta, também, as teorias de J. Campbell sobre o \"mito do herói\", bem como a teoria dos \"arquétipos\" de C. Jung. Em suma, este trabalho procurou analisar, sob o ponto de vista da semiótica e da bioética, as condições em que se pode desenvolver a relação entre médico e paciente. Assim, esperamos poder contribuir, de alguma forma, para estudos posteriores que se proponham a investigar o universo da Medicina / This thesis intends to study some semiotics aspects of passion and persuasion in the doctor-patient relationship, a relationship marked by verticalization and complexity - on the one hand, the power of persuasion of a doctor who has the know-how; on the other hand, the fragility of someone who is ill and needs to be cured. On this study, a synthetic history of Western Medicine will be shown, including a comparison between the modern doctors and old witch doctors from primitive tribes. It´ll be clear that the status of the modern doctors has not changed from that time because both of them, when they get to cure a person, can bring back the patient to his social group, since any ill person is separated from his family and friends due to the ilness. After that, the theoric patterns of Greimas and Pais will be shown in order to study three cases told by three different doctors from three different areas of Medicine: Orthopedics, Head and Neck Surgery and Cardiology. With the semiotic analysis of the cases, the \"interpretation of the world\" will be identified according to the relationship studied, as well as the analysis of the behavior of the characters searching their goals: the recovering from the illness. We will find the doctor who must obey the laws of his profession, as well the commandments of Bioethics, to be approved by the social group in which he lives; but we will find, too, the patient who often expects more than he should from his doctor. J. Campbell´s theories about \"The mith of the hero\" and Jung´s \"Theory of the Archetypes\" will be important to this work too. In short, this work tried to study, considering Semiotic and Bioethic, the conditions and problems envolving the relationship between doctor and patient. We hope we can give some contribuiton to future works that may intend to investigate the Medicine world.

O foco deste estudo está nas possíveis transformações na relação de poder estabelecida entre médico e paciente representada em três comunidades virtuais com tema em saúde-doença. Trata-se de uma pesquisa qualiquantitativa com uso da técnica do Discurso do Sujeito Coletivo (DSC), o que possibilita a construção de discursos coletivos distintos que expressam as representações sociais de uma coletividade. Como resultado é possível verificar: (i) porque as pessoas participam de comunidades virtuais; (ii) como as pessoas participam; (iii) como se organizam essas comunidades; (iv) quais tipos de informações são mais buscados; (v) quais conteúdos informacionais existem nos fóruns de discussão (vi) como se dá a interação entre integrantes da comunidade; (vii) como as relações de poder estabelecidas entre médico e paciente são tratadas nas comunidades; (viii) identificação de possíveis transformações na relação de poder estabelecida entre médico e paciente. Conclui-se que a maior parte dos integrantes das comunidades analisadas está em um nível associativo-participativo de compartilhamento das informações e experiências. Esse nível, apesar de não se constituir em ação de cooperação e prática de produção coletiva, permite aos integrantes se tornarem pacientes mais ativos em seus processos de saúde e doença. Os resultados sugerem que o princípio ético da autonomia está, legalmente e na prática, mais fortalecido, contribuindo com a constituição de um indivíduo integrante, interativo, mais autônomo / Possible changes in the power relationship established between doctor and patient represented in three online communities which address the subject of health and illness is the focus of this study. This is a qualitative and quantitative research using the Collective Subject Discourse (DSC), which allows the construction of separate collective discourse, which expresses the social representations of a collectivity. As a result, it is possible to verify: (i) why people participate in such virtual communities , (ii) how people participate, (iii) how those communities are organized, (iv) what types of information are most searched, (v) which information exist in those discussion forums (vi) how community members interact, (vii) how the power relations established between doctor and patient are treated in these communities, (viii) identification of possible changes in the relationship established power between doctor and patient. We conclude that most members of the communities studied are in an associative-participatory level regarding information and experiences sharing. This level, though is not considered as an action of mutual cooperation and collective production practice, allows members of such communities to become more active as patients in their processes of health and disease. The results suggest that the principle of autonomy is, legally and in practice, more energized, contributing to the constitution of an individual, integral, interactive, and increasingly autonomous

Thyroid disease, a chronic illness, affects nearly 200 million people worldwide and is more common among women than in men. Numerous factors make diagnosing and treating thyroid disease in women challenging. The standard blood test for diagnosing thyroid disease and determining treatment effectiveness is inconsistent in its accuracy. Many women with thyroid disease are misdiagnosed or struggle with symptoms even once receiving treatment. Although thyroid disease is highly prevalent among women and the doctor-patient relationship is known to influence treatment outcomes, there is a gap in the literature regarding the treatment experiences of women with thyroid disease and the doctor-patient relationship. The purpose of this phenomenological study was to explore female thyroid patients' experiences of treatment and the doctor-patient relationship. Sixteen female thyroid patients, ages 18 and older and members of an international online support group, were individually interviewed via online chat. Data interpretation was guided by social constructionism and feminist theory and was accomplished via Moustakas's analytic method. Themes related to the doctor-patient relationship were identified, including the culture of the medical profession, diagnostic bias, and gender differences in communication. Emergent themes included patient education level, patient self-advocacy behaviors, and the use of natural thyroid medication. The results of this study may contribute to positive social change by enhancing doctors' understanding of thyroid disease in women and the influence of the doctor-patient relationship in determining positive treatment outcomes, thus equipping doctors with enriched knowledge for providing their female thyroid patients with the highest quality of care.

Uterine Fibroids, medically termed uterine leiomyoma, are benign tumors of smooth muscle cells that grow in the uterus. While they are the most common pelvic neoplasm in women and fewer than 1 percent of fibroids develop into cancer, uterine fibroids can cause infertility, adverse pregnancy outcomes, and greatly affect one’s quality of life. Black women have been disproportionately affected by fibroids; when compared to white women, Black women are: 2-3 times more likely to have fibroids, diagnosed at a younger age, more likely to have 7 or more fibroids, more likely to have more severe and more troublesome symptoms (anemia, severe pelvic pain, constipation, and stomach aches), and have twice as many hysterectomies due to fibroids. Black women’s disproportionate affliction with uterine fibroids is particularly concerning given the historical medical injustices associated with Black women’s bodies and reproductive rights from slavery to present day. By placing Black women at the center of analysis and using a Black feminist epistemological framework, this study aims to make a unique contribution to medical sociology as well as literature on the theoretical and practical management of sickness and wellness among Black women in the United States. Using qualitative interviews and grounded theory methodology, the study examined how Black women frame the condition of having uterine fibroids. Specifically, the study investigated a) how Black women conceptualize having fibroids, b) how Black women’s conceptualizations of fibroids affect their feelings about selves or their lifestyles, c) the mechanisms, if any, by which Black women deal with uterine fibroids, d) how their multiple race, class, and gender identities affect their illness experiences and types of treatment that they seek, and e) how conventional and complementary/alternative medicine shapes Black women’s experiences with fibroids. Conceptualizations about fibroids are rooted in the race-gendered histories of Black women and the unique stressors that they face. Through interactions with doctors and among peers, Black women resist the unbearable burden of uterine fibroids through various coping strategies, but generally “keep it moving”. They avoid invasive surgeries through patient agency by being advocates for their medical treatment, self-researching, dialoguing with others, and directing doctor-patient interactions.

The recent expansion of general practitioner (GP) out of hours cooperatives indicates that many British GPs see this as the solution to managing out of hours work, particularly the 'problem' of 'inappropriate' demand. This thesis investigates the highly contentious subject of 'inappropriateness' of demand for out of hours GP services for children under five, and develops a methodology that allows for a reconceptualisation of the issues involved based on the beliefs, assumptions and practices of all those concerned, rather than locating the 'problem' within the province of parents alone, or within the doctor-patient relationship as a bounded system. Using a predominantly sociological and anthropological conceptual framework, the thesis draws on a synthesis of views and practice, bringing those of professionals and parents together with fieldwork observations based in the primary care centre setting. It suggests that contrary to talk about management of the 'problem' in technical, bureaucratic and medical terms, this becomes a moral issue in practice. Scientific or organisational imperatives disguise largely moral proscriptions and examples illustrate ways in which moral and emotional dimensions embedded within these social relations can conflict with particular forms of rationality. The analysis shows how organisational initiatives that fail to take account of such moral frameworks can produce unexpected and unintended consequences. The thesis illustrates the value of what is described as a dialogic process, taking account of the fluidity between voices, layers of time and space, and interchange between researcher, participants, and future audiences. The play of these issues in the rapid and extensive growth of cooperatives is discussed in the wider context of the rhetoric of consumerism and shifts in interprofessional practices and relationships. Negotiation of 'appropriate' supply of and demand for out of hours services has had a major impact on government initiatives for primary care as a whole. Thus key elements in the formation of cooperatives, originally targeted at a more narrow conceptualisation of problems, can be seen as expressing a deeper impetus for change, and serving as vehicles for more fundamental and rapid development.

This study examines the way people use online resources within their personal healthcare practices to better understand how individuals manage their health issues in the age of the Internet. It specifically addresses the extent to which the Internet is used as an information database and associated patterns of use, whether the Internet represents a source of support or enables a supportive encounter and the implications of using the Internet as part of the health management across relationships with medical professionals and oneself. Using a sequential mixed methods design, the data was gathered within a larger multidisciplinary research project conducted in East York, Ontario. An initial quantitative analysis of 350 surveys describes Internet usage. The qualitative analysis of the 86 follow-up interviews of people recounting their personal health management processes demonstrated the importance of social networks, subjective health status and Internet user-style. The facile ability to engage with health information is transforming definitions and experiences of health and relationships with medical professionals. Examining medical encounters mindful of the aspects of trust, power, knowledge and privilege reveals an evolution to the doctor-patient relationship brought about by both information and personal empowerment. Using the Internet reinforces primary relationships and points to the development of new relationships that are sought at moments of meaningful life events or circumstances. New types of connections are being built across the Internet based on shared experiences, health concerns and health identities. Applying Actor Network Theory furthers an understanding of how search engines and online resources can emerge as actors in health information seeking and health management processes. Internet use is now a part of everyday life and is no longer limited to affluent early adopters as the gaps between those with access diminish in urban Canada. While its use is becoming intrinsically linked to health management it is not a panacea for improving health outcomes. As the populations’ collective health knowledge increases, so does the presumption that health management is a personal imperative. This notion that the achievement of good health is an individual responsibility or the theory of Healthism, frames the interpretation of the large percentage of the sample indicating they are striving to become healthier. Social workers need to acknowledge the place of the Internet within its practice and to balance the emphasis on individualized health management with the perspective that health outcomes reflect community mores. It is important for social workers to treat the Internet as a medium of relationships and for social workers to become knowledgeable about what these connections can provide in terms of support and information and what the limitations and risks of these relationships can be.

This study examines the way people use online resources within their personal healthcare practices to better understand how individuals manage their health issues in the age of the Internet. It specifically addresses the extent to which the Internet is used as an information database and associated patterns of use, whether the Internet represents a source of support or enables a supportive encounter and the implications of using the Internet as part of the health management across relationships with medical professionals and oneself. Using a sequential mixed methods design, the data was gathered within a larger multidisciplinary research project conducted in East York, Ontario. An initial quantitative analysis of 350 surveys describes Internet usage. The qualitative analysis of the 86 follow-up interviews of people recounting their personal health management processes demonstrated the importance of social networks, subjective health status and Internet user-style. The facile ability to engage with health information is transforming definitions and experiences of health and relationships with medical professionals. Examining medical encounters mindful of the aspects of trust, power, knowledge and privilege reveals an evolution to the doctor-patient relationship brought about by both information and personal empowerment. Using the Internet reinforces primary relationships and points to the development of new relationships that are sought at moments of meaningful life events or circumstances. New types of connections are being built across the Internet based on shared experiences, health concerns and health identities. Applying Actor Network Theory furthers an understanding of how search engines and online resources can emerge as actors in health information seeking and health management processes. Internet use is now a part of everyday life and is no longer limited to affluent early adopters as the gaps between those with access diminish in urban Canada. While its use is becoming intrinsically linked to health management it is not a panacea for improving health outcomes. As the populations’ collective health knowledge increases, so does the presumption that health management is a personal imperative. This notion that the achievement of good health is an individual responsibility or the theory of Healthism, frames the interpretation of the large percentage of the sample indicating they are striving to become healthier. Social workers need to acknowledge the place of the Internet within its practice and to balance the emphasis on individualized health management with the perspective that health outcomes reflect community mores. It is important for social workers to treat the Internet as a medium of relationships and for social workers to become knowledgeable about what these connections can provide in terms of support and information and what the limitations and risks of these relationships can be.