Wednesday, 18 November 2009

A Social Model of Health Management

Firstly an apology—I have ignored several comments for almost a fortnight. Part of the problem is that I gained access to Google Wave and have been distracted by that, more on that later. Secondly, the weather and domestic duties have been getting me down and I have not had spare capacity to blog. However, I can reward myself with some blogging time today.

Secondly, welcome to Dr Anne Marie Cunningham as joint author of this blog. Thanks for your thoughtful post.

Let's take Anne Marieapos;s comments on my last post first.

but what are other examples where a traditional model of disability and a social model would take different actions? I'm trying to understand where the two models are in conflict with each other.

There was a perfect example on BBC Wales last night, in their documentary about the people affected by the thalidomide tragedy (Week in Week out—We're Still Here). The whole programme is a really good commentary on changing attitudes to disability but if you are pressed for time watch a segment about six minutes in when one of the people talks about the doctors' attitudes to them as small children: "They tried to replace the parts that were missing because of their perception that society would only accept them if they were as normal as possible". The old film has horrendous images of children fitted with ugly and poorly functioning prosthetics. Contrast this with the attitude of the mother of another of the children who sent her daughter to ballet lessons to improve her balance. That child is now a beautiful woman who keeps herself fit by swimming and runs her own business giving foot massage. I have to admit that in some cases the prosthetics were useful and gave the recipient a new lease of life. The point is that the medics assumed that all the children would need them and find them useful. The reality is that each differs and decisions need to be taken collaboratively.

I would also say that with regards to the cochlear implants, it is not universally accepted that having them is a bad thing.

With regards to Bobath therapy I can't see that anyone would have any objections to this.

I don't think I said that cochlear implants were always a bad thing, just that some deaf people feel sufficiently empowered to reject such a medical intervention. Similarly, I do know one empowered disabled person who rejects Bobath Therapy. However, in this case I am certain that this is a knee-jerk reaction to the word therapy. I would love to get her to visit the Centre and see what goes on there. I guess that the downside of empowerment is that it can produce stroppy people and mis-informed attitudes (I'll return to the importance of information later).

Most people in health related areas would say that we have moved beyond the very paternalistic model that you ascribe to current medicine.... as a model at least. In reality there may still be problems.

I agree! I'm trying to define the point from which we are moving. So this extremely paternalistic model is out-moded but not gone and leads to bad outcomes.

You give the example of your mother-in-law's death and state that you are sure 'in another context' her condition would have been resisted by the professionals or family. What kind of other context? If the existing model allows this to happen- and I don't think that there is any chance this is a one-off, then what is added by the new model?

The sorts of things I was thinking of here were: people who demand drugs which are not generally available and spend huge amounts of money to gain a few more months of perhaps poor quality life; where family members or members of the medical team have difficulty accepting the person's decision. I suppose too that I'm trying to contrast the old assumed omnipotence of the medical profession where it would perhaps have been anathema for a patient to withdraw from major treatment.

Anyway, perhaps I exaggerate to make a point. People are able, if they choose, to take a more active part in managing their health but this empowerment is not universal an we need to make it so. So I'm trying to define an ideal and using its antithesis to point up what we need to change.

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