ABSTRACT
Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'IX: people and places-diverse populations and locations of care', authors address the following themes: 'LGBTQIA+health in family medicine', 'A family medicine approach to substance use disorders', 'Shameless medicine for people experiencing homelessness', '''Difficult" encounters-finding the person behind the patient', 'Attending to patients with medically unexplained symptoms', 'Making house calls and home visits', 'Family physicians in the procedure room', 'Robust rural family medicine' and 'Full-spectrum family medicine'. May readers appreciate the breadth of family medicine in these essays.
Subject(s)
Medically Unexplained Symptoms , Sexual and Gender Minorities , Humans , Family Practice , Physicians, Family , House CallsABSTRACT
Given the expansion of genetics in medicine, there is a growing need to develop approaches to engage patients in understanding how genetics affects their health. Various qualitative methods have been applied to gain a deeper understanding of patient perspectives in topics related to genetics. Community dialogues (CD) are a bi-directional research method that invites community members to discuss a pertinent, challenging topic over the course of a multi-week period and the community members openly discuss their positions on the topic. Authors discuss the first application of the CD method to the topic of pharmacogenetics testing. Additional CD are needed to engage diverse participant populations on this topic to improve genetics literacy, enhance physician engagement and drive policy change.
Subject(s)
Health Literacy/ethics , Pharmacogenetics/ethics , Pharmacogenomic Testing/ethics , Precision Medicine/ethics , Bioethical Issues/standards , Focus Groups/standards , Health Literacy/standards , Humans , Pharmacogenetics/standards , Pharmacogenomic Testing/standards , Precision Medicine/standardsABSTRACT
This article reviews our experience and observations from conducting six Community Bioethics Dialogues (CBD) with elderly residents in diverse communities in Galveston, Texas, from 2014 through 2016. CBD is a mixed method that combines focus groups, instruction, ethnography, and community-based research. CBD brings together select community members for 3 hours once a week for 6 weeks to identify values. We employed CBD to investigate how participants think about and react to issues surrounding Patient-Centered Outcomes Research (PCOR), Comparative Effectiveness Research (CER), and mental health. We offer a methodological approach for conducting and optimizing meaningful dialogues with community groups.
Subject(s)
Bioethics , Community-Based Participatory Research/methods , Community-Based Participatory Research/organization & administration , Focus Groups , Program Development/methods , Aged , Aging , Comparative Effectiveness Research , Cooperative Behavior , Empowerment , Humans , Mental Health , Patient Outcome Assessment , TexasABSTRACT
Images function as sources of data and influence our thinking about fieldwork, representation, and intersubjectivity. In this article, I show how both the ethnographic relationships and the working method of photography lead to a more nuanced understanding of a healing event. I systematically analyze 33 photographs made over a 15-minute period during the preparation and application of a poultice (topical cure) in a rural Andean home. The images chronicle the event, revealing my initial reaction and the decisions I made when tripping the shutter. By unpacking the relationship between ethnographer and subject, I reveal the constant negotiation of positions, assumptions, and expectations that make up intersubjectivity. For transparency, I provide thumbnails of all images, including metadata, so that readers may consider alternative interpretations of the images and event.
Subject(s)
Medicine, Traditional , Photography , Rural Population , Anthropology, Medical/methods , Bolivia/ethnology , HumansABSTRACT
Community bioethics dialogues were held on the topic of patient-centered outcomes research (PCOR) and comparative effectiveness research (CER). Participants were 65 and older and represented either a lower income, African American group (A) or a higher income White group (B). Participants were presented with a variety of background reading and study materials. Meetings were held 2 hr per week for 6 weeks. The groups showed both independence in judgment from the investigators and diversity of opinion between the two groups. Group B addressed more topics than Group A and in some instances explored additional policy nuances. Members of Group A appeared more cognizant of issues of social justice that affect vulnerable populations and appeared leery of approaches that suggested possible disrespect for their own personal experiences. Future plans call for both repeating the dialogue with additional, diverse community groups and repeating community bioethics dialogues on new topics with the same groups.
Subject(s)
Awareness , Communication , Community-Institutional Relations , Comparative Effectiveness Research/ethics , Patient Outcome Assessment , Social Justice , Vulnerable Populations , Black or African American , Aged , Attitude , Ethics , Ethics, Research , Female , Humans , Income , Male , Pilot Projects , Poverty , Residence Characteristics , White PeopleABSTRACT
Recent research indicates that asthma is more complicated than already recognized, requiring a multilateral approach of study in order to better understand its many facets. Apart from being a health problem, asthma is seen as a knowledge problem, and as we argue here, a cultural problem. Employing cultural analysis we outline ways to challenge conventional ideas and practices about asthma by considering how culture shapes asthma experience, diagnosis, management, research, and politics. Finally, we discuss the value of viewing asthma through multiple lenses, and how such "explanatory pluralism" advances transdisciplinary approaches to asthma.
Subject(s)
Asthma/ethnology , Asthma/psychology , Asthma/physiopathology , Cross-Cultural Comparison , Cultural Characteristics , Ethnicity , Humans , Inflammation/ethnology , Inflammation/physiopathology , Inflammation/psychology , Politics , Prejudice/ethnology , Prejudice/psychology , Severity of Illness IndexABSTRACT
The importance of community in primary health care (PHC) is evident in the role of community participation and in the types of programs that are routinely implemented (community health-worker [CHW] programs, community clinics, community-based disease-control programs). Few health care providers and program administrators, however, have considered the meaning of community. Instead, they frequently impose their own definition of community and assume that it corresponds to local realities. This is problematic because target populations may have different ideas about what a community is and how it functions. When disparate ideas of community exist, they can affect the implementation of PHC programs, leading to low rates of acceptance, participation, and utilization. Using two examples, a community clinic in El Alto, Bolivia, and a CHW program in Rio Branco, Brazil, this article discusses some of the problems that arise when local definitions of community do not correspond to programmatic definitions.
