Doctors, academically educated and authorized, assert that there is more to being a real doctor than having fulfilled the formal criteria. It has been said that there is a particular doctor's ethos, which is based not only on thorough medical education but also on traditional know-how, internalized ethics and good character. This paper contains several studies of the efforts of Swedish physicians to define themselves as doctors, individually and collectively, during the period 1890-1960 and to identify the ethos of their profession. The empirical material consists mainly of texts written by doctors for doctors on different social and political questions pertaining to the profession's interests. Studying the identities, interests and ideals that have been expressed by Swedish doctors in society and on the professional and individual level made it possible to distinguish and describe different aspects of their particular ethos. The starting point for these studies was the discussions during the inter-war period – held above all in Germany but also in Sweden – about the crisis of medicine and of the medical profession (chapter 1). Developments in legislation concerning the authorization of doctors show the ambiguity of the Swedish doctor's legal identity (chapter 2). The Swedish medical profession's efforts to hold on to the concept of internalized ethics meant that formal ethical rules were not accepted until 1951 (chapter 3). A study of medical obituaries revealed that the ideal doctor was seen as a man and a good colleague with his ethics rooted in antiquity (chapter 4). The heterogeneous medical profession has not been able to reach a consensus as to a common identity or common interests and ideals. The efforts of leading men amongst Swedish doctors gain charismatic, traditional and legal legitimacy for the profession have been opposed. After 1960, however, doctor's legitimacy in the scientific field has gained ground (chapter 5). Debate concerning the ethos of the doctors served as a strategy to unite the profession and to draw boundaries against those considered to be unqualified actors in the field of the healing arts. This, in itself, is part of this ethos.

Made available in DSpace on 2015-05-14T13:27:01Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 906138 bytes, checksum: aacd50591a661d30407334b65b918e7c (MD5) Previous issue date: 2012-05-22 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This study is dedicated to discussion and understanding of social processes that are part of the training and professional identity in medicine in connection with the reformulation in the context of undergraduate courses. The objectives were to identify the concepts of medical students about being a doctor and the medical practice, to identify, at different stages of medical school, the students' perceptions about the professional identity, understanding if the processes of change in curricula of medical schools are related to professional identity formation and to identify the concepts of medicine and the medical profession to students at different stages of the course. For this, was developed an exploratory and qualitative methodological approach, using various techniques of field work, such as participant observation, interviews, discussion groups and use of information from social networks. It was noticed, with the research that medical students bring representations about the profession from before entering the university, many of them responsible for choosing a career, such as social status and the possibility of acquiring economic capital. Students go through processes of socialization during the course to acquire medical knowledge and the normative precepts of medicine. In the beginning of the course, neophytes maintains an idealist position, which is changing towards the acquisition of strong technical expertise focused on the diagnosis and treatment of diseases. To change the focus of training from the disease to care about people the curricula of medical schools are becoming, in the midst of processes of resistance due to professional power. Constructing new identities in the context of curriculum change is extremely difficult, because the training is crystallized in the maintenance of professional power and the closing of the profession towards people and other professions. / Este estudo se dedica à discussão e compreensão dos processos sociais que fazem parte da formação e identidade profissional no campo da medicina a partir das reformulações no âmbito dos cursos de graduação. Os objetivos foram: conhecer as concepções dos estudantes de medicina sobre o ser médico e sobre o exercício da profissão médica; identificar, em diferentes etapas do curso de medicina, as percepções dos estudantes sobre a identidade profissional; compreender se os processos de mudança nos currículos das escolas médicas estão relacionados com a formação identitária profissional e conhecer as concepções de medicina e da profissão médica de estudantes em diferentes fases do curso. Para isso, desenvolveu-se um percurso metodológico qualitativo e exploratório, com a utilização de diversas técnicas de trabalho de campo, como observação participante, entrevistas, discussão em grupos e utilização de informação proveniente de redes sociais. Percebeu-se, com a realização da pesquisa, que os estudantes de medicina trazem representações sobre a profissão desde antes do ingresso na universidade, muitas delas responsáveis pela escolha pela carreira, como o status social e a possibilidade de aquisição de capital econômico. Os alunos passam por processos de socialização durante o curso para adquirirem o saber médico e os preceitos normativos da medicina. Inicialmente no curso, os neófitos mantém uma posição idealista, que vai se modificando no sentido da aquisição de forte competência técnica voltada para o diagnóstico e tratamento das doenças. Para se modificar o foco da formação da doença para o cuidado, os currículos das escolas médicas vêm se transformando, em meio a processos de resistências devido ao poder profissional. Construir novas identidades nesse âmbito de mudança curricular é extremamente difícil, pois a formação está cristalizada na manutenção do poder profissional e no fechamento da profissão em relação às pessoas e as demais profissões.

This is a study based on a qualitative method about how medical doctors perceives themselves compared to cancerpatients. The study shows how gender and power can be understood in the analysis based on the doctors narratives and understandings of cultural beliefs. By using habitus, cultural and symbolic capital can make social practices visible through use of language, knowledge and social position the doctors have towards patients. Therefore it is possible to illustrate gender and power structures in society and healthcare.

The American medical profession has publicly pondered its roles and duties since its inception in the 18th century. Recently, that discussion has included whether or not advocacy by physicians is a responsibility of the profession. The following work is an argument and plan to support the ethical, professional imperative of physician advocacy. The historical underpinnings of the American medical profession suggest a responsibility to patients and interactions with society. In addition, there is a strong bioethical argument in favor of physician advocacy as an essential duty. Although there is a well-recognized set of barriers to physician advocacy, this article details solutions to help implement advocacy as a daily practice in the lives of all physicians. This piece will describe a way forward for physicians to take on their professional responsibility to advocate. / Urban Bioethics

La France est caractérisée par un bon état de santé global et d'importantes inégalités sociales de santé. Le renouveau d'intérêt pour ces dernières est l'occasion de questionner une définition univoque centrée sur les résultats au détriment des procédures, dans un pays qui a axé ses politiques de lutte sur le système de soins. La médecine générale y a une place particulière par son apparition récente en tant que spécialité universitaire et la nécessité de se définir qui s'ensuit. Elle est décrite tout à la fois comme pivot du système de soins, agent de santé publique ou chantre d'une relation inter-individuelle et d'une prise en charge globale. Si la médecine est fondée sur les données de la science, elle est aussi une profession prudentielle en ce qu'elle prend en compte des situations singulières, générant de l'incertitude dans la pratique. Parmi les sources de singularité, l'aspect social, tant du patient que du médecin, est à considérer. Dans sa pratique, ce dernier éprouve cependant une diversité de social. Tantôt obstacle à son activité professionnelle et vu comme extérieur au médical, tantôt élément apparenté aux données de la science par l'épidémiologie, il peut aussi être une brique de la construction individuelle du patient sur laquelle s'appuyer, conduisant parfois à une moralisation des conduites et des identités. Les caractéristiques sociales du médecin sont quant à elles souvent oubliées, comme s'il était neutre ou simple représentant de la science. C'est pourtant dans l'interaction entre ces deux mondes que se jouent aussi les inégalités sociales de santé et tout se passe comme si le médecin ne pouvait bien soigner que ses semblables. / France is characterized by a good overall health status and high social inequalities in the health sector. The renewed interest in health inequalities is the opportunity to question a unique definition focused on results at the expense of processes, in a country where policies on tackling inequalities are based on the health care system. General practice has a particular position in this system, as a new academic speciality, which still needs to figure out how to define itself. It is described simultaneously as a heath care system gatekeeper, a public health officer or an advocate for inter-individual relationship and holistic care. While medicine is based on scientific evidence, it is also a prudential profession as it considers singular situations, generating uncertainty in practice. Among singular sources, social characteristics of both patients and doctors have to be considered. However, in their practice, physicians experience a diversity of social. Sometimes a barrier to the professional activity and considered external to the medical world, sometimes considered as part of scientific evidences by epidemiology, it could also be considered as a component of the individual construction of the patient on which the physician can rely, with the potential to lead to a moralization of behaviours and identities. The physician's social characteristics are often omitted, as if doctors were neutral or mere representatives of science. It is however in the interaction between these two worlds that social determinants of health inequalities can be found, and it seems that a physician could only provide good care to patients sharing the same similarities.

A segunda metade do século XX é marcada pela manifestação de uma nova maneira de perceber o corpo humano. A consolidação da biologia celular e molecular permitiu ao ser humano investigar as particularidades microscópicas que formam seu organismo, potencializando a criação de novas práticas terapêuticas. Essas tecnologias de inovação no campo da saúde, contudo, são acompanhadas por questionamentos de ordem ética e moral, visto que a sua prática investigativa abre espaço para a polêmica em torno do estatuto jurídico do embrião humano e das possíveis consequências sociais e naturais decorrentes de sua incorporação ao cotidiano social. Se a ciência e a racionalidade que lhe é própria constituem-se como elementos centrais na organização da sociedade moderna, seus desdobramentos tecnológicos não necessariamente são percebidos e apreendidos da mesma forma pelos membros que compõem uma determinada sociedade, independentemente de esses indivíduos constituírem-se como agentes técnicos ou leigos. A receptividade de uma inovação tecnológica depende tanto de um processo de ajustamento sucessivo de confrontação, negociação e redução de incertezas, quanto das experiências que caracterizam a trajetória de cada agente social, visto ser ela um produto da aproximação de culturas paralelas. Nesse sentido, o objetivo deste estudo é compreender a relação existente entre a biotecnologia, configurada pelos estudos de manipulação de células-tronco, e as trajetórias sócio-profissionais de um setor da comunidade médica do Rio Grande do Sul. Tomando como base a medicina regenerativa de manipulação de células-tronco, este estudo propõe-se a compreender como essa relação interfere na receptividade desse setor a este tipo de investigação científica, por meio de uma análise das instâncias da vida social na qual se inserem as trajetórias de vida desses profissionais, bem como do modo como elas operam, pela via de valores que as caracterizam nas tomadas de decisões ético-morais em relação às novas tecnologias. / The 20th century is marked by the manifestation of a new way of perceiving the human body. The consolidation of Molecular and Cellular Biology allowed the individual to investigate microscopic particularities of the structures which form the human organism, potentializing the creation of new therapeutic practices. However, these innovating technologies in the field of Health are accompanied by ethical and moral questionings, for their investigative practices favor the polemic around the juridical status of the human embryo and their possible social and natural consequences regarding the incorporation of these technologies in people's routine. Even though science and rationality are central in the organization of modern society, technological advancement has not necessarily been perceived and apprehended in the same way by the members that compose society, either technicians or laymen. The acceptance of a technological innovation depends on both a process of successive adjustment of confrontation, negotiation and understanding and the experiences which characterize the trajectory of each social agent. This technological acceptance results from the approximation of parallel cultures. Thus, the objective of this study is to comprehend the relation between Biotechnology - studies on stem cell manipulation - and socio-professional trajectories in a sector of medical community in Rio Grande do Sul. Based on the regenerative medicine of stem cell manipulation, this study is an attempt to understand how this relation interferes in the acceptance of such sector towards this type of scientific investigation by analyzing instances of social life in which these professionals are inserted as well as the way they operate, their values, their ethical and moral attitude regarding new technologies.

A segunda metade do século XX é marcada pela manifestação de uma nova maneira de perceber o corpo humano. A consolidação da biologia celular e molecular permitiu ao ser humano investigar as particularidades microscópicas que formam seu organismo, potencializando a criação de novas práticas terapêuticas. Essas tecnologias de inovação no campo da saúde, contudo, são acompanhadas por questionamentos de ordem ética e moral, visto que a sua prática investigativa abre espaço para a polêmica em torno do estatuto jurídico do embrião humano e das possíveis consequências sociais e naturais decorrentes de sua incorporação ao cotidiano social. Se a ciência e a racionalidade que lhe é própria constituem-se como elementos centrais na organização da sociedade moderna, seus desdobramentos tecnológicos não necessariamente são percebidos e apreendidos da mesma forma pelos membros que compõem uma determinada sociedade, independentemente de esses indivíduos constituírem-se como agentes técnicos ou leigos. A receptividade de uma inovação tecnológica depende tanto de um processo de ajustamento sucessivo de confrontação, negociação e redução de incertezas, quanto das experiências que caracterizam a trajetória de cada agente social, visto ser ela um produto da aproximação de culturas paralelas. Nesse sentido, o objetivo deste estudo é compreender a relação existente entre a biotecnologia, configurada pelos estudos de manipulação de células-tronco, e as trajetórias sócio-profissionais de um setor da comunidade médica do Rio Grande do Sul. Tomando como base a medicina regenerativa de manipulação de células-tronco, este estudo propõe-se a compreender como essa relação interfere na receptividade desse setor a este tipo de investigação científica, por meio de uma análise das instâncias da vida social na qual se inserem as trajetórias de vida desses profissionais, bem como do modo como elas operam, pela via de valores que as caracterizam nas tomadas de decisões ético-morais em relação às novas tecnologias. / The 20th century is marked by the manifestation of a new way of perceiving the human body. The consolidation of Molecular and Cellular Biology allowed the individual to investigate microscopic particularities of the structures which form the human organism, potentializing the creation of new therapeutic practices. However, these innovating technologies in the field of Health are accompanied by ethical and moral questionings, for their investigative practices favor the polemic around the juridical status of the human embryo and their possible social and natural consequences regarding the incorporation of these technologies in people's routine. Even though science and rationality are central in the organization of modern society, technological advancement has not necessarily been perceived and apprehended in the same way by the members that compose society, either technicians or laymen. The acceptance of a technological innovation depends on both a process of successive adjustment of confrontation, negotiation and understanding and the experiences which characterize the trajectory of each social agent. This technological acceptance results from the approximation of parallel cultures. Thus, the objective of this study is to comprehend the relation between Biotechnology - studies on stem cell manipulation - and socio-professional trajectories in a sector of medical community in Rio Grande do Sul. Based on the regenerative medicine of stem cell manipulation, this study is an attempt to understand how this relation interferes in the acceptance of such sector towards this type of scientific investigation by analyzing instances of social life in which these professionals are inserted as well as the way they operate, their values, their ethical and moral attitude regarding new technologies.

A segunda metade do século XX é marcada pela manifestação de uma nova maneira de perceber o corpo humano. A consolidação da biologia celular e molecular permitiu ao ser humano investigar as particularidades microscópicas que formam seu organismo, potencializando a criação de novas práticas terapêuticas. Essas tecnologias de inovação no campo da saúde, contudo, são acompanhadas por questionamentos de ordem ética e moral, visto que a sua prática investigativa abre espaço para a polêmica em torno do estatuto jurídico do embrião humano e das possíveis consequências sociais e naturais decorrentes de sua incorporação ao cotidiano social. Se a ciência e a racionalidade que lhe é própria constituem-se como elementos centrais na organização da sociedade moderna, seus desdobramentos tecnológicos não necessariamente são percebidos e apreendidos da mesma forma pelos membros que compõem uma determinada sociedade, independentemente de esses indivíduos constituírem-se como agentes técnicos ou leigos. A receptividade de uma inovação tecnológica depende tanto de um processo de ajustamento sucessivo de confrontação, negociação e redução de incertezas, quanto das experiências que caracterizam a trajetória de cada agente social, visto ser ela um produto da aproximação de culturas paralelas. Nesse sentido, o objetivo deste estudo é compreender a relação existente entre a biotecnologia, configurada pelos estudos de manipulação de células-tronco, e as trajetórias sócio-profissionais de um setor da comunidade médica do Rio Grande do Sul. Tomando como base a medicina regenerativa de manipulação de células-tronco, este estudo propõe-se a compreender como essa relação interfere na receptividade desse setor a este tipo de investigação científica, por meio de uma análise das instâncias da vida social na qual se inserem as trajetórias de vida desses profissionais, bem como do modo como elas operam, pela via de valores que as caracterizam nas tomadas de decisões ético-morais em relação às novas tecnologias. / The 20th century is marked by the manifestation of a new way of perceiving the human body. The consolidation of Molecular and Cellular Biology allowed the individual to investigate microscopic particularities of the structures which form the human organism, potentializing the creation of new therapeutic practices. However, these innovating technologies in the field of Health are accompanied by ethical and moral questionings, for their investigative practices favor the polemic around the juridical status of the human embryo and their possible social and natural consequences regarding the incorporation of these technologies in people's routine. Even though science and rationality are central in the organization of modern society, technological advancement has not necessarily been perceived and apprehended in the same way by the members that compose society, either technicians or laymen. The acceptance of a technological innovation depends on both a process of successive adjustment of confrontation, negotiation and understanding and the experiences which characterize the trajectory of each social agent. This technological acceptance results from the approximation of parallel cultures. Thus, the objective of this study is to comprehend the relation between Biotechnology - studies on stem cell manipulation - and socio-professional trajectories in a sector of medical community in Rio Grande do Sul. Based on the regenerative medicine of stem cell manipulation, this study is an attempt to understand how this relation interferes in the acceptance of such sector towards this type of scientific investigation by analyzing instances of social life in which these professionals are inserted as well as the way they operate, their values, their ethical and moral attitude regarding new technologies.

Dans de nombreux états providences, les systèmes de santé subissent de nos jours d’importantes transformations en réponse aux pressions budgétaires et caractérisées par le rôle croissant du marché et des mesures de rationalisation. C’est dans ce contexte que la France et l’Allemagne ont mis en place des programmes de Disease Management (DM) dans le but de fournir des soins plus structurés et de paiement à la performance (P4P) pour inciter financièrement les fournisseurs à répondre à certains objectifs.Ces réformes, qui reflètent le rôle croissant de l’État dans les deux systèmes d’assurance maladie, se sont inspirées des modèles anglo-saxons mais se concrétisent de manière distincte en fonction des caractéristiques des systèmes des deux pays. En Allemagne, DM et P4P se sont basés sur la concurrence croissante entre les caisses d’assurance maladies et entre les hôpitaux tandis qu’en France, ces réformes ont reflété un changement du rôle de l’assurance maladie « de payeur à acteur ».Le positionnement de la profession médicale vis-à-vis de ces nouveaux instruments de gouvernance, qui sont de nature hiérarchique et qui imposent une logique comptable, est une question clef en France et en Allemagne. Dans les deux pays, les processus de négociations ont été lié à un écart grandissant entre les représentants des médecins et leurs membres, et ce malgré les différences dans la manière dont les médecins sont traditionnellement intégrés dans la régulation des systèmes de santé respectifs. / Health systems in many welfare states are undergoing important transformations, triggered by increasing budgetary pressures and characterized by the growing role of market and rationalization measures. In this context, France and Germany have introduced disease management (DM) programs to deliver more structured patient care and pay-for-performance (P4P) measures to provide financial incentives for providers meeting certain objectives.These reforms, which reflect the increasing role of the State in both statutory health insurance systems, were inspired by Anglo-Saxon models but translated in distinct ways, owing to differences in the two countries’ systems. In Germany, DM and P4P were based on increasing competition between sickness funds and between hospitals, while in France these reforms reflected a shift by its central insurance system “from payer to player”.The positioning of the medical profession vis-a-vis these new instruments of governance, which are hierarchical in nature and impose stronger public accountability, was a key issue in both France and Germany. The negotiation processes were accompanied by a growing disconnect between physician representatives and their memberships in both countries, despite significant differences in the way physicians are traditionally integrated into health system regulation.

Bakgrund: Flera aktörer anses vara förändringsledare respektive förändringsmottagare, såväl som att föremål för förändringsmotstånd kan tolkas olika. Detta kan i sin tur påverka hur de inblandade hanterar situationen. Primärvårdens situation under Covid-19 pandemin föranledde att tidigare konkurrerande aktörer, tvingades samarbeta för att uppnå ett gemensamt mål. Förevarande uppsats undersöker bland annat hur konkurrenter samspelar när det krävs och hur detta i sin tur kan påverka ledarskap och tidigare paradigm. Vidare utreds vilka utmaningar förändringsledare ställs inför under en omfattande förändring som orsakas av kris, i relation till den undersökta förändringens speciella förutsättningar. Uppsatsen har genomförts ur ett nyanserat perspektiv på förändringsmotstånd där alla dess orsaker och konsekvenser, positiva som negativa, belyses. Det nyanserade perspektivet på motstånd av vikt för att skapa en djupare förståelse kring förändringsledning genom fokus på hur förändringsledaren kan tolka förändringsmottagares intryck och reaktion på en förändring, samt använda förändringsmotstånd som en konstruktiv kraft.Syfte: Studiens syfte är att bidra med en ökad förståelse angående ledarskapets roll under förändringsprocesser som orsakas av kris i primärvården.Metod: Förevarande studie är en fallstudie med en kvalitativ forskningsstrategi, iterativ forskningsansats samt ett hermeneutiskt forskningsperspektiv. Studiens empiri utgörs av åtta semi-strukturerade intervjuer med klusterledare från Region Stockholm.Slutsats: Uppsatsen redogör för att krisen föranlett ett paradigmskifte inom primärvården som har lett till positiva och bestående konsekvenser för vårdgivare och vårdtagare. Vidare konstateras att kriser kräver att ledare hittar en balans mellan olika ledarskapsbeteenden. Uppsatsen redogör även för att en kris ställer krav på en ökad tillgänglighet hos ledaren och det är av vikt att ledare i en krissituation förmedlar ett lugn till medarbetarna. Uppsatsen visar att en ledares inställning till förändringsmottagares åsikter är avgörande i hanteringen av förändringsmotstånd. / Background: Several actors are considered change leaders and change recipients, as well as the subject of resistance can be interpreted differently. This can affect how those involved handle the situation. The situation within primary health care during the Covid-19 pandemic necessitated that previously competing actors were forced to collaborate in order to achieve a common goal. This essay examines how competitors interact when required and how this, in turn, can affect leadership and previous paradigms. Furthermore, it investigates the challenges faced by change leaders during a comprehensive change caused by a crisis, in relation to the specific conditions of the investigated change. The essay has been conducted from a nuanced perspective on resistance to change, where all its causes and consequences, both positive and negative, are illuminated. The nuanced perspective on resistance is important for creating a deeper understanding of change management by focusing on how the change leader can interpret the impressions and reactions of change recipients to a change, and use resistance to change as a constructive force.  Purpose: The purpose of the study is to contribute to an increased understanding of the role of leadership during change processes caused by crises in primary healthcare. Method: The present study is a case study with a qualitative research strategy, iterative research approach, and a hermeneutic research perspective. The empirical data of the study consists of eight semi-structured interviews with cluster leaders from Region Stockholm. Conclusion: The essay explains that the crisis has prompted a paradigm shift in primary care, which has led to positive and lasting consequences for healthcare providers and patients, as well as the emergence of new work methods. Furthermore, it is noted that crises require leaders to find a balance between different leadership behaviors and also explains that a crisis demands increased accessibility from leaders, and it is important for leaders in a crisis situation to convey calmness to their employees. The essay demonstrates that a leader's attitude towards the opinions of change recipients is crucial in managing resistance to change