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Although health services in Australia have an aim to provide inclusive care for their patients/clients, this study highlights how barriers to care can lie at the centre of patient-provider interactions. Racial microaggression is a subtle form of racism that can occur in health settings, leading to further exclusion for First Nations Australians, immigrants and refugees. This paper is guided by Derrida's approach to deconstructionism by unpacking how language is used by health professionals – as holders of organisational power – and how they construct 'truths' or discourses about clients that historically have been marginalised by health services and system. Data comprise 21 interviews with staff from two rural health services. It identified three racial microaggressions were used to justify the challenges of providing care to people from First Nations, immigrant and refugee backgrounds: (1) Participants problematised culture(s) of service users; (2) participants implied cultural superiority in their conceptualisation of 'other' cultures; and (3) participants shared stories of inactions, discomfort and relegating of responsibility. The findings identified these discourses as forms of racial microaggression that can potentially lead to further exclusion of people seeking services and support. [ABSTRACT FROM AUTHOR]

Synopsis: In this article, we propose to understand the doctor- patient relationship (DPR) using a health communications perspective, as it is located in the sociohistorical framework of modernising processes. The paper analyses the academic literature about the doctor-patient relationship (DPR) during the period of 1980-2015, gathered from key words in digital collections and indexed magazines available in three electronic databases (SISBI, SciELO and DIALNET). Eighty-four articles were selected from the initial search. The results suggest three axes of thematisation of the DPR over the period analysed: patient satisfaction, models of relationship between professionals and patients, and eHealth. The latter, eHealth, demonstrates the current transformation of social and communication order and is the main axis of reflection and investigation. [ABSTRACT FROM AUTHOR]

In this study, we explored Swedish dietitians' experiences of a standardised Nutrition Care Process (NCP) and terminology from the perspective of Habermas' concepts of system and lifeworld. Seven focus group discussions were analysed thematically. In this paper, we argue that dietitians seem to mainly connect the NCP with a system perspective, highlighting aspects such as professionalism, measurability and clarity of the patient record as helpful outcomes from the NCP standardisation. We also see a tension between system and lifeworld, as dietitians emphasised the importance of the dietitian–patient relationship, stating that a patient's complex situation does not always fit into the pre-defined NCP terms and measurements. Several approaches were identified whereby dietitians tried to reach a balance between the system and lifeworld. We argue that strategies for achieving this balance need more attention in the education and implementation of standardised care processes and terminologies. [ABSTRACT FROM AUTHOR]

This paper starts from the premise that embodied knowledge is critical to understanding health policy implementation. We explore this notion through a qualitative investigation of the way that knowledge has functioned in the implementation of an Australian mental health policy, Partners in Recovery (PIR). Analysis uses the theoretical lens of interpretive policy analysis and the 'embodied, inscribed, enacted' knowledge schema developed by Freeman and Sturdy [(2014a). Introduction: Knowledge in policy – embodied, inscribed, enacted. In R. Freeman & S. Sturdy (Eds.), Knowledge in policy: Embodied, inscribed, enacted (pp. 1–19). Bristol: Policy Press]. Our analysis reveals a policy problem centred around difficulties of coordination where the inscribed solution lies in individuals who must implement the PIR program in local areas. Our interviews with PIR consortium members and stakeholders show that this implementation happens through the enactment of embodied knowledge. However this implementation is not straightforward and we point to difficulties arising from the centrality of embodied processes in implementation, related to the localisation of systems knowledge in individuals and structural devaluation of certain types of knowledge over others. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue including the health knowledge legitimisation, the management of the evidence-based medicine challenges, and the embodied knowledge in health care.

Access to medical care is significant for many transgender young people and their families, which involves interactions with healthcare professionals. While a trans affirming model is used across Australian paediatric gender clinics, this does not automatically mean that all transgender young people and their parents experience the care they receive as affirming. This article considers the experiences and views of transgender young people (aged 11–17) and their parents in relation to healthcare professionals inside and outside of gender clinics in Australia. Ten qualitative interviews were conducted with parent–child dyads in two Australian states. Key themes relating to healthcare professionals were: differing levels of healthcare professional knowledge and affirmation, quality of service is dependent on individual healthcare professionals, and lack of connected services and referral pathways. The discussion explores specific issues arising from the findings that suggest implications for training for healthcare professionals so as to be better equipped to provide trans affirming clinical care. [ABSTRACT FROM AUTHOR]

Clinical practice guidelines (CPGs) are a central technique within the evidence-based medicine (EBM) movement. General practice is an area of medicine that seems to be particularly resistant to the use of CPGs. This article contributes to the debates about GPs and CPGs by reflecting on three different Australian studies conducted by the authors in an attempt to better understand variations between GPs' practices and the recommendations found in relevant CPGs. These projects focused on dementia, chronic obstructive pulmonary disease and hypertension (high blood pressure). A common finding across the three studies was that GPs described how their focus on the whole person and their patients' priorities and needs meant that the recommendations found in CPGs were not always appropriate or easy to apply. In doing this, our study participants were describing tensions between the holistic/whole person and patient-centred approach of GPs and the narrow disease-specific focus of guidelines. Our work provides insight into the rationality of GPs and illustrates some of the ways that whole person care and patient-centred care create operational challenges to the application of EBM in the form of CPGs. [ABSTRACT FROM AUTHOR]

In many contemporary healthcare systems, individuals are expected to be rational actors – weighing up available knowledge and making choices about their healthcare needs. In the policy context, this has been most explicitly applied to the financing of healthcare where there is encouragement for the purchase of private health insurance. However, perceptions of public and private healthcare provision, knowledge about healthcare needs, and the types of services people choose, are far from straightforward. Drawing on Bourdieu's concepts of habitus, field, and capital, and a study of individual experiences of choice in Australian healthcare, we explore the knowledges used by people as they navigate through the healthcare system. Such navigation takes place in a milieu where authoritative medical knowledge intersects with knowledge from other sources, including the Internet and lived experience. However, our study reveals that navigation of healthcare is assisted most of all by the capacity to draw on 'system knowledge'. System knowledge takes two, sometimes overlapping, forms. First, acquired system knowledge is produced through drawing on experience, formal knowledge and the capacity to undertake research (primarily cultural capital). Second, assumed system knowledge enables navigation of the healthcare system through accessing and utilising networks of privilege (primarily economic and social capital). [ABSTRACT FROM AUTHOR]

This article explores processes of legitimising health knowledge in three different spaces: the clinic, the home and the multidisciplinary meeting. It considers the ways in which categorisation work, health understandings and therapeutic actions are intertwined. The analysis draws on ethnomethodology and actor-network theory to suggest that in the clinic consultation room, a number of interactional elements in talk about side effects and talk about unorthodox interventions attempt to stabilise the categories used by health experts. In contrast, the household is a centre of knowledge production that may subvert, manipulate or align with expert systems. Fixed and stable expert knowledge becomes flexible and hybridised inside the home. In the multidisciplinary team meeting different forms of authority are called upon in hospital-based cancer care meetings, where health professionals mix scientific understandings with other ways of knowing in determining treatment options. From these empirical observations it is argued that therapeutic actions are not subject in any simplistic way to a dominant mode of understanding, but there are many means of understanding that selectively come into play in relation to the specifics of the interaction that is occurring between patients, health professionals and therapeutic spaces. [ABSTRACT FROM AUTHOR]

Living kidney donation is an alternative treatment option for end-stage renal failure. Prospective donors are protected from risk by counselling and assessment processes, to ensure they are fully informed about all the stages of donation. Drawing on in-depth interviews with 25 living kidney donors from across New Zealand, this article discusses donors' experience of the pre-donation screening process, donation workup coordination, psychological preparation, and post-operative follow-up care and support. In particular, the article examines donor perceptions of the informed consent process. The findings indicate that donors' experience of the consent process may be at odds with the New Zealand Code of Health and Disability Services Consumers' Rights 1996. Instead of a primary healthcare focus on the threshold elements of informed consent, this study indicates that more effort should be made to adequately inform donors and to clearly spell out each stage of the donation process to better meet donors' needs. [ABSTRACT FROM AUTHOR]