Search results

This chapter delves into the specific heuristics, biases, and cognitive errors that often arise during decision-making processes in healthcare. It explores how specific mental shortcuts can lead to inconsistencies and irrationalities. Key concepts include statistical evaluation errors, such as the base rate fallacy and the law of large numbers, and causal inference issues like regression to the mean and omitted variables. This chapter also covers common cognitive biases, such as confirmation bias, optimism bias, action bias, halo effect, overdiagnosis, etc., which influence medical professionals and patients in interpreting information and deciding. Recognition of such biases can enhance medical decision outcomes as well as improving the communication between stakeholders.

The biomedical paradigm enjoys growing importance in our society. Biomedicine (e.g., Genetics) seems to occupy the position once held by religion and politics. In this context, every trivial problem of daily life is thought to require an appropriate remedy, and perfect health becomes a paramount value, especially within the upper class.

Medicalization is not only promoted by doctors. Today, other engines of medicalization are also available. These include pharmaceutical companies through marketing, advertising, and disease mongering; active consumers who seek a pharmacological solution – a magic bullet – to solve non-organic problems; technology, because highly sensitive diagnostic tools can now detect potential abnormalities even in very low quantities; and the culture of risk, which is connected to the evolution of diagnostic tools, because it is now always possible to be at risk of something.

The parts of life today considered pathological or quasi-pathological are ever increasing shyness, sadness, imperfect blood pressure, or glucose levels. Progressing editions of the Diagnostic and Statistical Manual (DSM) – the text from which diagnoses of mental illnesses are made – reveal a growing number of syndromes. These “diseases” are diagnosed on the grounds of certain symptoms and the number of weeks they last (quantification). Smartphones, with their tremendous capacity for data collection, contribute to a growth in self-diagnoses. For example, invited to log our every moment of sadness through a “trustworthy” avatar from our app (gamification), we can easily make too much of normal moments of discomfort, immediately seeing them – with a simple computation – transformed into something pathological in need of a cure.

The aim of this article is an analysis of the links between race and psychotic illness, psychiatric diagnosis and treatment, as well as psychiatric, police and prison violence against people with mental health problems. The analysis focuses on Black men who are more frequently diagnosed with schizophrenia and other psychotic disorders and who face more brutal treatment than other people with such diagnoses. We have adopted a multidisciplinary approach which draws insights from psychiatry, psychology, and sociology and challenges the biologistic interpretation of “mental illness.” We take into account the United States and Britain – two countries with large Black minorities and an established tradition of research on these groups. Among the crucial findings of this study are the facts that racial bias and stereotypes heavily influence the way Black men with a diagnosis of psychotic illness are treated by the psychiatric system, police and prison staff, and that the dominant approach to psychosis masks the connections between racism and mental health.

According to The Ethics Centre (2018) ‘[T]he social license to operate (SLO) is made up of three components: legitimacy, credibility, and trust’. These three components serve to frame the relationship that has emerged and continues to evolve, its root arguably dating back to the Enlightenment and Post-industrial ages, between the worlds of capitalist commercial and industrial operations, and the liberal-democratic citizenry/consumers of society. The ‘SLO’, it will be shown, has historical grounding that indicate the SLO is a broader translatable concept not limited to the business realm. The SLO, the evidence will show, is a multifaceted concept not least, a unifying vehicle utilized for the purpose of acceptance, to advance normative concerns, and resistance, against questionable and harmful practices. Evidently, many domains of human services operate sub-optimally with less than favourable outcomes. In effect, this translates to structural injustices as characterized by poor understanding, insufficient standards of practice, ineffective safeguard, and governance institutions, perpetuated by entrenched practices, allowing the rise of mediocre service providers no less enabled by deficient regulation. Accordingly, the ethical focus of this paper is on the healthcare system, the evident and unnecessary deficiencies, and the failings of the central governance institutions involved. The underlying characteristics of what constitutes a SLO arguably, whether in name or not, have been engaged to expose, challenge, and repel, unethical conduct that gave rise to multiple health care-related Royal Commissions across Australia; predominantly, impacting the Disability, Aged Care, and Mental Health (DAM) sectors to name a few of recent times.

Since its first appearance in policy, the diagnostic construct of learning disability (LD) has struggled to demonstrate its validity. Any diagnostic construct requires the operationalization of a “true positive” diagnosis to permit strong analyses of diagnostic accuracy and associated intervention outcomes. Because there is no “true positive” definition for LD, diagnostic accuracy and outcome research are disparate and difficult to translate into meaningful actions for diagnosticians and intervention teams in schools. In this chapter, a new framework of decision making centered on consequential validity, evidence-based education, and shared decision making is proposed for evaluating the relative costs and benefits of alternative actions when making decisions about whether to conduct assessment or intervention, and what assessments or interventions to implement.

The main purpose of this paper is to document the first author's experience of using institutional ethnography (IE) to “take sides” in healthcare research. The authors illustrate the points with data and key findings from a study of cardiovascular disease prevention.

The authors use Dorothy E Smith's IE approach, and particularly the theoretical tool of “standpoint”.

Starting with the development of the study, the authors trouble the researcher's positionality, highlighting tensions between institutional knowledge of “prevention” and other locations where knowledge about patients' health needs materialises. The authors outline how IE's theoretically and methodologically integrated toolkit became a framework for “taking sides” with patients. They describe how the researcher used IE to take a standpoint and map institutional relations from that standpoint. They argue that IE enabled an innovative analysis but also reflect on the challenges of conducting an IE – the conceptual unpicking and (re)thinking, and demarcating boundaries of investigation within an expansive dataset.

This paper illustrates IE's relevance for organisational ethnographers wishing to find a theoretically robust approach to taking sides, and suggests ways in which the IE approach might contribute to improving services, particularly healthcare. It provides an illustration of how taking a patient standpoint was accomplished in practice, and reflects on the challenges involved.