Revisiting "patient career"

Almost a decade ago I posted:

Medical Sociology: The Importance of 1894....2015 patient career - health career

- which was prompted by:

McKinlay, J.B. (1971) The concept “patient career” as a heuristic device for making medical sociology relevant to medical students. Social Science and Medicine, 5(5), 441-460.

https://pubmed.ncbi.nlm.nih.gov/5160599/

McKinlay's abstract reads:

Abstract

Increasingly it is being suggested that the behavioural sciences can contribute to medical education and should be incorporated into the medical curriculum. Evidence for the development of this view in Great Britain can be found in the recommendations of the recent Royal Commission on Medical Education and the submissions of various bodies to it. Given that the behavioural sciences in general and medical sociology in particular, can contribute in a positive way to the medical curriculum this paper attempts to: (a) draw together and crystallize some of the major problems inherent in past attempts to organize and include the behavioural sciences in the medical curriculum; (b) devise some criteria for determining the behavioural science content of the medical curriculum; (c) outline and discuss one possible course in medical sociology utilizing, as an organizing framework, the concept “patient career”.

Brian Hodges created his eponymous model with curriculum planning, design and development as a key purpose. In the early-mid 1980s nursing was looking forward to becoming a degree, undergraduate course of study.

McKinlay's use of 'patient career' (and others) can obviously be associated with the impact of life chances upon a person's health career. 

Individual

|

      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

'While discussing the relationship between the medical and social sciences, and the role of the social scientist in teaching and research in medicine, Butler groups the range of medical topics which have been studied sociologically into four main categories [l4]. These are, the sociology of illness, the sociology of health, the sociology of medical care and the sociology of healing.' p.443.^

McKinlay sees these categories as too comprehensive. Although within the SOCIOLOGICAL domain of Hodges' model this is a 'start'? McKinlay proceeds to identify specific difficulties presented to educators, which include (in summary and with my emphasis):

'(a) The failure to identify needs, specify objectives and devise criteria

(b) The failure to distinguish between perspectives

'Very generally, the behavioural sciences can be said to be conccrned with the description and explanation of the health and illness behaviour of groups and social categories, whilst medicine (especially clinical medicine) aims at the understanding and successful treatment of individual patient cases. By working exclusively on the basis of (or failing to take account of) these separate perspectives, meaningful dialogue between behavioural scientists and medical students has been made extremely difficult.'

(c) The failure to distinguish the audience

(d) The failure to take account of temporal location

(e) The failure to provide a conceptual framework

Most courses in the behavioural sciences either offered or proposed, to a greater or lesser extent, tend to ressemble a sort of shopping list. For example, the courses offered by Badgley, Martin et al., and those proposed by the Society for Social Medicine and the Royal Commission all reflect this "'shopping list" charactcristic. After working down the list it is assumed that students will have the technical goods required. It is, of course, difficult for students undertaking these "shopping list" courses to reflect on where they have been, appraise their current position, or consider where they may be going.

Two further general problems seem to be inherent in many of the attempts to systematize the field of medical sociology, and to some extent are associated with some of the problems already outlined. 

(f) The problem of trying to cover too much [Which lists 18 topics for 2nd year students.]
 (g) The problem of omitting important areas' pp.443-445.

McKinlay then, is similarly preoccupied with the curriculum (for medical students):

'This section is concerned primarily with devising criteria which, given the finite amount of teaching time available, will offer some guidance in determining what aspects or areas of medical sociology should be given priority for teaching in the medical curriculum.' p.445.

This work from the 1970s surely invites reflection upon the meaning of 'progress'? 

^My formatting.

More to follow...?