Background During a period of continuing changes in society and increasing availability of medical information, publication of patients’ views on experiences of health and illness have gained greater prominence. By contrast, studies of medical perspectives have tended to concentrate on reported discontent and implications for workforce planning while leaving broader insights and concerns under-investigated. Since the applied skills of highly trained and publicly funded clinicians are vital for safe and effective delivery of the nation’s health care, it seemed important to explore new ways to consider components of medical professionalism and to set these in current NHS contexts. Rationale and fieldwork Focussing attention on the individual perspectives of NHS doctors in order to hear and understand their experiences of work was central to development of this thesis. An interpretive epistemological approach to biographical narratives as told by a group of 12 doctors drawing on 25 years of NHS experience included use of Situational Analysis Mapping to support detailed analysis of their richly informative, first-hand accounts. As knowledgeable and reflective informants with stories from diverse clinical specialties and differing personal viewpoints, their narratives produced a range of views and observations shaped by their lived experiences as clinicians. Poetic representation of sociologically-informative narrative extracts provided an effective vehicle for engaging mixed audiences and has evoked emotionally resonant reactions from doctors. Findings Strong connections between individuals’ core principles and enacted responses were evident; doctors identified preferred working practices which they believed supportive of delivery of high quality health care. Key aspects of professionalism, including professional autonomy, self-regulation and application of clinical knowledge, were challenged by progressive introduction of new working processes and regulatory mechanisms. Increased recording of clinical and administrative data for performance monitoring and achievement of targets produced reactive strategies in individuals and teams while challenging their sense of professional position or developed medical identity. Poorly performing colleagues and difficult team interactions caused much disruption while blurred ethical boundaries exposed contestable decision-making and demonstrated the limited effectiveness of external regulatory monitoring. Conclusions This research indicates that contemporary NHS doctors may experience conflict between what is expected in managed medical practice and their interpretation of best professional performance. Better understanding of these fundamental relationships could constructively contribute to reconsideration of contemporary medical professionalism and assist with progressive workforce preparation for an effective future NHS.

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This thesis will deal what is the impact on the life of a young woman with breast cancer disease who is take care of at least one child. More specifically, it will focus on the area of motherhood, partnerships and financial security at a time during treatment. The author will try to uncover how the effects of the disease affecting these areas were perceived by women. Keywords Disease, breast cancer, social support, motherhood, partnership, financial security.

The thesis explores priority setting in the National Health Service. It focuses on the changing way in which rationing issues are dealt with in the wake of the Health Service reforms and the separation of function between purchasing and providing health care. It examines how managers within sample District Health Authorities justify their priority-setting agenda. Two connected themes are also analysed. One is how health needs assessment and the call for a 'primary care led NHS' presage a more dominant role for Public Health medicine in informing purchasing. Secondly, how evidence based medicine together with the use of clinical protocols/guidelines, measurement of outcomes and the use of clinical/medical audit, become factors in the decision making process. Theoretically, the thesis attempts to demonstrate a practical use for the Foucauldian concept of 'governmentality' as a framework with which to analyse contemporary changes in health policy. The principal concern is the role experts play within the problematisation of government associated with liberalism. This includes their role within the institutions and technologies of governance that reflect the notion that the strength of the liberal state is derived from securing the well being of the population. In turn this reflects the self-critical dynamic within liberal problematisations of defining the legitimate boundaries of government responsibility in a society made up of autonomous individuals. The PhD is based on semi-structured interviews (32 in total), conducted with the Chief Executives and principal directors of six English District Health Authorities, together with the Chief Officers of their associated CHCs. The District Health Authorities were selected - after a general review of Health Authority Purchasing Plans for 1996/97 - from those Authorities that acknowledged the rationing debate in their purchasing intentions and represented a cross-section of gainers and losers with respect to the new funding formula.

Veterinary Medicine does not have a history in the social sciences and is therefore a fascinating field of study. Despite the growth of education research in the veterinary schools, the social and relational aspects of veterinary training and practice are under-examined, and could have profound effects on the ability of students to make a successful transition into qualified work. This thesis explored the development of occupational identity in veterinary students and newly-qualified veterinary surgeons, using narrative interview techniques and organisational policy analysis. From interviewees’ stories, a clear distinction could be drawn between the majority, who were vocationally-motivated, and a smaller group who were drawn to a veterinary career by the high academic standards required. All identified several influences on their own professional identity development: role models, the need to perform as competent and confident, and presenting an approved personality type in order to gain access to the practical experience required during training. The predominant story arc is that of becoming increasingly ‘vetlike’ as they progress through the course. Animal welfare is a substantial silence in the organisational discourse of veterinary medicine. The discourse analysis revealed the overwhelming presentation of the elite academic nature of the profession, at the expense of any mention of animal care or welfare, or acknowledgement of vocational motivation. A compelling collective responsibility was also identifiable in terms of upholding a professional reputation and its high standards. A strong occupational history contributes to this, leading to a very bonded occupational group. The idea of veterinary medicine not being a nine-to-five job is expressed in policy and resonated very strongly with interview participants. However, there exists a very clear, organisationally-sanctioned, officially-approved attitude towards veterinary life and work, allowing very little deviation. This has the subsequent effect that tolerance of weakness, unhappiness, or complaint is low; so that members are forced to either internalise their unhappiness or leave the profession entirely. Veterinary medicine is perceived as a career with high job satisfaction and a positive public image. However, awareness is increasing of worryingly high levels of mental illness, stress, unhappiness and dissatisfaction with their work among the veterinary workforce. This thesis suggests that one factor that could underlie this is a mismatch between a new entrant’s ideas of what a vet is and does, and the reality of a working life in veterinary practice. From the conclusions presented in this thesis - in particular the finding that, as a profession, veterinary medicine strives to distance itself from an animal care or animal welfare focus - I suggest that it is the confused messages received as part of the process of socialisation during training that could connect to many of the problems facing the modern entrant to the veterinary profession. This research specifically focused on the development of occupational identity in veterinary students and newly-qualified veterinary surgeons in the UK and is the only current work to examine the processes, presentation and experiences of veterinary training in this comparative manner. As a relatively new, and very interdisciplinary, field of study, the capacity for future work in veterinary social sciences is considerable, with much to be learnt from allied fields as well as further explorations of just what makes veterinary medicine unique, and such a valuable source of social inquiry given the significance of pets and livestock to the lives of a nation of animal lovers. This is potentially a very rich field.

1 Abstract: The diploma thesis applies sociological perspective on interrelationships of pharmaceutical industry, physicians and patients. Its main focus is on the role of pharmaceutical industry in context of relationships with the two other actors. The first part of the work summarizes available Czech and mainly foreign social science literature referring to the broad network of relations. The transformation of medical profession in current society and the development of international pharmaceutical industry in the Czech Republic are also discussed. The empirical part of the thesis reports the findings of a qualitative interview study undertaken with ambulatory physicians concerning their relationships with pharmaceutical companies. The goal of the research was to explore how and why Czech physicians interact with the pharmaceutical companies, gain insight into their ethical evaluation and assessment of consequences and detect the strategies and rationalizations they use to cope with these relationships. Keywords: pharmaceutical industry, physician, patient, conflict of interest, sociology of medicine

How can marginalised communities organise a project to yield significant social change? This thesis theorises the resources which enable such community organisation to work. Participation, empowerment and conscientisation are understood, not through a logic of quantity which creates linear dimensions, but through a logic of concrete qualities. A pragmatist approach is taken, to define our constructs in terms of the actions being undertaken by participants, within specific, qualitatively distinctive domains. Activity theory is used to theorise participation as a process of collective activity, which is supported by shared rules, a division of labour and shared goals, and which is challenged by divergences of interest. A community case study of the Sonagachi Project, a successful HIV prevention project run by sex workers in Kolkata (India), is used to investigate participation. The case study is based on interviews and group discussions with sex workers and Project workers (sex workers employed by the Project), and observation of the daily activities of the Project. Sex workers relate to the Project as a source of support in solving their individual problems, gaining new powers, but not acting as collectivity members. Project workers are constituted as collectivity members, whose action interlocks with that of their colleagues, through participating in the politicising discourse of the Project, which states that sex workers should be granted “workers’ rights”, and through learning the rules of participation in meetings and the hierarchical division of labour. To be allowed to operate, the Project has to carefully adjust to local power relations, with madams, political parties, and funding agencies, in collaborative-adversarial relationships. In conclusion, the scope of participation is defined as producing significant, yet circumscribed, local change. To intervene in a fractured community is a political process in which the provision of new resources is both necessary and potentially divisive.

ABSTRACT /ENG/ Sociology of Health Health and media in the social context Until the middle of the twentieth century, modern scientific medicine had an excellent reputation as a universally effective institution. In recent decades, however, this idea has been called into question, because the public has realised that the idealised image of medicine promised more than it could fulfil. The image of medicine over the past 50 years has changed significantly and today it is closely associated with other areas, including the environment, politics and the economy. The thesis is therefore devoted to current issues of health systems, health information and mass media as a mediator of health information. One reason why we will criticise modern medicine is that the Czech Republic can not cover all the costs associated with caring for patients; others will include lobbies in the health sector, and the general difficulty of comparing the country's quality of health care and research to other countries. For the public, the media, playing a major role in the process of the "secularisation" of medicine, has become the main source of information on health and health care. But the media also has another function: to direct our attention to health issues and...

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