Author Archives: Dr Zowie Davy

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To be or not to be LGBT in Primary Health Care

An analysis and commentary paper on lesbian, gay, bisexual and transgender primary care has been published in the British Journal of General Practice.

Lesbian, Gay, Bisexual and Transgender (LGBT) primary healthcare will, increasingly, be a feature of the primary care repertoire. Pride in Practice, which is supported by the RCGP, provides a rating system that judges primary care surgeries on a welcoming environment, access, the general practitioner (GP) – patient consultation, staff awareness and training and health promotion for LGBT people. For those surgeries signed up to the initiative, plans to address shortfalls will be developed in consultation with the Lesbian and Gay Foundation.

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School of Health and Social Care Seminar Series 2010-11

Professor Nancy Harding

NHS Management: Living on the boundary between the self as unitary manager and the self as intersectional ‘me’.  Professor Nancy Harding (University of Bradford)

According to Prof Harding the notion of management was formally introduced into the NHS in the 1980s, following publication of the Griffiths Report.  The instigation of New Public Management, as this came to be known, was interpreted variously. A more confusing term also appeared in the discourse around management practices, namely “talent management”.  The succeeding quarter of a century has seen a legitimisation of the role of management in the NHS, an increase in the numbers of managers employed, and numerous attempts to improve the quality of managerial work. In all of this, the manager has been imagined to be a rational, logical, non-emotional, powerful and one-dimensional person.  Intersectionality theory would warn against such a presumption.

However, two interview-based studies of NHS managers suggest they move fluidly and unquestioningly between an identity or sense of self of a rational manager working within an organizational structure, and an identity or sense of self as fluid, emergent, irrational and with multiple identities. It seems that their position(s) as managers, colleagues, friends and workers all coincide with the various intersecting aspects of being a manager that does not always fit the often ‘faceless’ aspects of management theory.

The paper drew on these studies looking at the the aesthetics of leadership and the introduction of talent management into the NHS, to explore how managers can move between a subject position (‘the rational manager’) and a living, embodied sense of self that is not only separate and distinct from the self as manager, but also contradicts that managerial self.  Harding suggested that intersectionality theory challenges the presumption of theories of control and resistance that are highly influential in critical approaches to NHS management. Control and resistance are shown to require theories of categorisation that are confounded by the lived experience of working as a manager in the NHS.

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School of Health and Social Care Seminar Series 2010/11 Jo Gilmartin (University of Leeds): A critical review of the impact of reconstructive surgery following massive weight loss on patient QoL: a pilot study plan

Jo Gilmartin argued that there is a growing number of morbidly obese patients who are seeking surgical solutions to there problems, such as bariatric surgery. Significant weight loss often leads to excessive skin, which leads to QoL problems, such as problems with pychosocial and physical functioning. This coupled with the immense pressures of being slender and beautiful for women and slender and healthy for men add to a complex context for people who have recieved surgical interventions. Even though more and more people are accessing what is known in the literature as ‘body contouring’, little is known about the QoL aspects of life after this surgery in the UK.

Whilst some literature report good outcomes in relation to a number of aspects of QoL, Gilmartin argued that these were often drawn from case notes, and questionnaires administered that may not capture the complexity of this particular patient group. This reporting may also have a asymmetrical power balnce going on, which distorts the actual picture of the actual outcomes.

Jo Gilmartin and her colleagues call for a more patient centred approach to this patient group in which more psychosocial apsects are captured in the QoL studies alongside a clearer healthcare pathway.

In order to do this, Gilmartin and colleagues are conducting a pilot study to

1. identify tools & procedures to inform a large scale multicentre study.

2. to identify QoL outcomes from body contouring following massive weight loss.

to find out more about this study please refer to the presentation slides attached:A Pilot Study-Body Contouring Jo Gilmartin

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School of Health and Social Care Seminar Series 2010-11 Prof. Margrit Shildrick

This presentation looked at heart transplantation as an exemplary process that potentially disturbs all aspects of modernist bioethics as well as raising concerns about prostheses and human hybridity in general (Shildrick, 2010). .

The paper offered an insight into the way human heart recipients in a North American context are likely to experience psychic disruption to their sense of self as a result of their bodily transformation. Drawing on a mixed method approach of interview and visual methods (video), recipients were able to talk about their feelings about receiving a donor”s heart as well as offer more phenomenological understandings through their body language and affect. The empirical aspects offered often indicated that the emotional descriptions of their identity did not correspond with their body language and emotionality surrounding their heart transplants, which points to the existing bioethical implications of heart transplantation, in this instance, and perhaps other organ transplantation more generally. Margrit Shildrick (2010) argues that the implications have profound ethical implications on 2 levels. From a conventional perspective, results show a clear need to revamp clinic practice to enable recipients to give more open accounts of their actual bodily experiences following transplantation, and indeed to question the limits of what is seen as unproblematically therapeutic. On this level, it seems that the pressure to conform to the ‘grateful for life’ discourse, whilst grappling with, amongst other things, guilt that somebody died, which enabled them to live, obligations that come with receiving a ‘gift,’ the encouragement by clinicians to write letters of gratitude to donor’s families alongside visceral changes in their embodied self were more than the authorized narrative. The authorized  narrative situates the body as a Cartesian machine that is being restored to an originary self. However, the research confirmed that recipients are highly invested in speculating on the identity of donors precisely because they feel that some donor characteristics will carry over, and that almost 80% display distress, either in relation to the donor, to their own identities, or both (Shildrick, 2010). The authorised narrative insists that the replacement of a ‘failed’ organ restores the originary self, but the problem is that the post–transplant body is not only prostheticised, but becomes irreducibly hybrid for life: the originary self is irrecoverable (Shildrick, 2010). Throughout the seminar, Susan Stryker’s famous quotation in relation to transgender surgery kept springing to mind:

“As we rise up from the operating tables of our rebirth, we transsexuals are something more […] than the creatures our makers intended us to be. Though medical techniques for sex reassignment are capable of crafting bodies that satisfy the visual and morphological criteria that generate naturalness as their effect […] Transsexual embodiment, like the embodiment of the monster, places its subject in an unassimilable, antagonistic, queer relationship to a Nature in which it must necessarily exist” (Stryker, 2006: 248).

On the second level, Shildrick (2010) asks could a better understanding of what it means to incorporate an organic prosthesis mobilise a different approach to a range of biomedical interventions? This would require a move away from a number of ethical paradigms that insist on the Cartesian mind/body split and rethinking Utilitarianism. Both prostheses and transplants show us a destabilisation of the socio-political, legal and ethical categorisation of bodies according to normative epistemologies that create markers such as gender, sex and race (Shildrick, 2010). As the body makes novel connections and participates in assemblages of the organic and inorganic, it demands a reimagination of the ideologies of human identity, and a reconfiguration of bioethics (Shildrick, 2010).

References:

Shildrick, M. (2010). Hybrid bodies and prostheses: the bioethics of identity. Paper presented at the Intersectionality: Theory and Practice for Quality Improvement in Healthcare, School of Health and Social Care Seminar Series 2010-11, University of Lincoln.

Stryker, S. (2006). My Words to Victor Frankenstein above the Village of Chamounix: Performing Transgender Rage. In S. Stryker & S. Whittle (Eds.), The Transgender Studies Reader (pp. 244-256). New York: Routledge.

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School of Health and Social Care Seminar Series 2010-11

 Professor Janneke Vans Mens-Verhulst from the University of Utrecht kicked-off the 2010-11 seminar series on Wednesday 20th October. Her seminar entitled: “Improving Health and Social Care with an Intersectional Approach to Diversity” introduced the concept of ‘intersectionality’ as representative of the complex, varied, and variable effects which proceed when multiple axes of differentiation – economic, political, cultural, psychic, subjective and experiential – intersect in historically and geographically specific contexts. The concept emphasizes that what we call ‘identities’ – black, gay, mother, Muslim and so on – are not objects but social processes constituted in and through power relations. The concept also emphasizes that different dimensions of social life cannot be separated out into discrete and pure strands.

Multiplicity, representing consciousness as a “site of multiple voicings” does not necessarily originate with the subject but through discourses that are intersubjectively and structurally produced. According to Van Mens-Verhulst these multiplicities are part of everybodies existence. Therefore, in order to be more patient centered and improve quality in health and social care environments we must take heed to the ‘multiplicity’ and ‘hybridity’ of patients social positions as well as to their similarities. Thus, multiple axes need to be observed on order to instruct quality improvement projects within our respective healthcare systems. Lincoln-presentation -handout Prof Van Mens Verhulst

If you want to learn more about Intersectionality Theory and feminist ethics in health and social care join us at the next seminar where Professor Magrit Shildrick from Queen’s University Belfast and author of “Leaky Bodies and Boundaries: Feminism, Postmodernism and (Bio)ethics” (1997), “Embodying the Monster: Encounters with the Vulnerable Self” (2002) and “Dangerous Discourses of Disability, Subjectivity and Sexuality” (2009) will speak about heart transplants in her talk entitled: “Hybrid bodies and prostheses: the bioethics of identity.”