Academic journal article Health Sociology Review

Knowledge Matters: Producing and Using Knowledge to Navigate Healthcare Systems

Academic journal article Health Sociology Review

Knowledge Matters: Producing and Using Knowledge to Navigate Healthcare Systems

Article excerpt

Introduction

In recent years, the discourse of 'patient choice' has grown in popularity in several of the world's healthcare systems, particularly in countries such as Australia, the United Kingdom, and Sweden, where governments have actively encouraged the expansion of a private healthcare industry amidst the network of publicly owned and managed healthcare services. The discourse of choice has, in these countries, been taken up by neo-liberal governments as the solution to system failure problems, and indeed become an imperative for all citizens. Citizens are urged to take individual responsibility for their health and become 'expert patients' (Taylor & Bury, 2007). These developments have taken place in concert with a proliferation of knowledge about health matters, particularly from the news media and the Internet (Hesse et al., 2005). These various sources of knowledge offer new sites for contestations over healthcare knowledge (Hardey, 1999), but have nevertheless become increasingly common and 'unremarkable' (Chapple, Evans, & Ziebland, 2012). For example, when people make healthcare decisions, they use the Internet to find information and support not provided through more orthodox healthcare channels about such matters as second opinions or alternative treatments, the experiences of others, the backgrounds of treating doctors, and the interpretation of diagnosis (Ziebland et al., 2004). Some research suggests that the healthcare information gleaned from the Internet can improve the decision-making process (Gerber & Eiser, 2001). For example, in the face of serious illness, patients may use knowledge acquired through the Internet to 'display competence' (Ziebland et al., 2004) not only in becoming familiar with technical or medical terms, but also meeting the changing definitions of being a 'good patient'.

The increasing range of information about healthcare, and the imperative to gain knowledge about, and choose between, an array of services and treatments is an area that requires the close attention of researchers. In focusing on the notion of healthcare knowledge, it becomes immediately apparent that there are a number of problems with the idea of the knowledgeable, expert patient. To begin, examination of prevailing discourses about 'choice' in healthcare and the accompanying policy context reveals that the notion of choice is based on a view of decision-making as a process of cost-benefit assessment. Such discourses and policies take a rational choice approach to human behaviour and do not accord well with sociological understandings of social action (Collyer, Willis, Franklin, Harley, & Short, 2015; Greener, 2003). Three assumptions about human behaviour are well captured within rational choice theory. First, this theory of human behaviour presumes choice to be an inherent good, with humans desirous and capable of managing unlimited choice (Iyengar & Lepper, 2000); second, people always act rationally and with intention; and third, a given individual will repeat the same choices, regardless of their social circumstances and context (Levin & Milgrom, 2004). This perspective also resonates with contemporary societal values, such that it 'is much more than a working hypothesis; it is an article of faith grounded in a deep commitment to the value of liberty' (Etzioni in Pescosolido, 1992, p. 1101). The sociological literature, however, proffers a wealth of evidence to counter this view. Individual experiences are shown to be limited and constrained by the operation of various social structures, and choices in the healthcare field are rarely based on rational calculation but guided and managed in the interactive context. Thus, in situations where they are at their most vulnerable, individuals rely heavily on the generally greater medical knowledge of their healthcare practitioners, their own experiences, and experiences of their friends and family (Dixon et al., 2010; Frank & Zeckhauser, 2009). …

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