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The provision of gender affirming hormone therapy for transgender and non-binary people is a rapidly developing area of gender affirming healthcare. While research indicates the benefits of providing gender affirming hormone therapy through interdisciplinary primary care-based models, less is known about how service users and providers construct their understandings of affirmative approaches. In this paper, we present findings from a discourse analysis of four service users' and four healthcare professionals' talk about a primary care-based pilot clinic providing gender affirming hormone therapy in Aotearoa New Zealand. Participants employed notions of pathologisation, time, and agency in their talk to construct the clinic as a personal setting which gave service users time to make their own health decisions, while constructing hospitals as impersonal with lengthy wait times. The assessment-driven nature of best practice guidelines that governed clinicians' decision-making was constructed as constraining users' agency. Findings highlight the ongoing importance of aligning gender affirming hormone therapy with other non-disease types of healthcare, and suggest new ways for achieving this through affirmative approaches to healthcare. [ABSTRACT FROM AUTHOR]

The large number of international medical graduates (IMGs) working in Australia, and many other countries around the world, has received significant attention from the media, governments and academia. These institutions utilise a number of classificatory schemes in order to categorise IMGs. Such classification is often stigmatising, yet goes largely unquestioned. In this paper I show that the 'official naming' of IMGs in Australia, as well as the naming of IMGs by staff in hospitals, is historically, politically and socially produced. Following Bourdieu's call to also study how the classified classify, the paper goes on to examine ways in which IMGs name and categorise each other, drawing on ethnographic research. I argue that IMGs use classification themselves, strategically, in order to modify their marginalised position within the 'social space' of the hospital. The article questions taken-for-granted assumptions about classified groups such as IMGs and leaves an opening for change. [ABSTRACT FROM AUTHOR]

The broadening of access to HIV pre-exposure prophylaxis (PrEP) in Australia has rekindled debates about which types of clinicians are best suited to deliver HIV prevention innovations: specialist HIV services or primary care physicians and general practitioners (GPs). We conducted 21 semi-structured qualitative interviews in 2017 with Australian HIV sector experts working across policy, advocacy, clinical service provision, research, and health promotion. These interviews took place before a national policy commitment to subsidising access to PrEP was achieved. We explored how participants conceptualised PrEP, patients and GPs at this key turning point in the history of HIV prevention. Participants expressed varied views regarding GPs' anticipated ability to successfully navigate the potential complexities associated with PrEP roll-out. While participants were supportive of greater patient access to PrEP, they expressed concerns about non-specialist GPs' cultural competence and expertise regarding sexuality and clinical practice, and the potential for patients to experience discrimination and homophobia from non-expert GPs. This study has broad implications for thinking about experts and expertise, the implementation of previously specialised medicine into mainstream settings, and the anticipated challenges of LGBTIQ+ inclusive healthcare. [ABSTRACT FROM AUTHOR]

Interprofessional conflict has largely been understood in terms of jurisdictional disputes centred on contested task domains and role boundaries, with less attention paid to the symbolic value associated with specific professional titles. Bourdieu's concepts of symbolic power and capital help to shed light on the opposition of the medical profession in the UK to the adoption of the title "podiatric surgeon" by non-medically qualified podiatrists undertaking foot surgery. Focusing on the medical discourse evident in press and media coverage of the dispute over a 12-year period gives insights into the use of strategies of symbolic violence aimed at retaining control over the exclusive use of prestigious forms of professional title. Titles, as symbolic capital, are understood as central to professions' struggle for legitimacy and recognition. [ABSTRACT FROM AUTHOR]

I give an account of disquieting experiences in relation to my treatment and those with chronic illness in the acute system during my 5 years' experience as an informal caregiver. People with chronic illness (and their caregivers), particularly stroke survivors face a biased, frustrating and even dangerous acute care hospital system where they are second class. Well-being and stability from rehabilitation and self-management can be undermined. Dow and McDonald's (2007) concept: 'disenfranchised care contractors' within early discharge and 'hospital in the home' programs is generalised more broadly. The studies that initiated Hospital at Home programs are scrutinised. The Australian medical system relies on informal carers in a fundamental way but still does not identify or acknowledge them despite the presence of laws such as the Carers Recognition Act (2005). A new concept argues informal caregivers 'do social bonds' at a deep level, weaving the social fabric into a denser structure. But as part of the private world, the formal system treats them routinely with disrespect and they can be manipulated to obtain their participation in early discharge programs and long term care. [ABSTRACT FROM AUTHOR]

Little has been done to consider how practitioners from different mental health sectors relate to each other, with even fewer studies examining this relationship through referral practices. Among religiously affiliated populations, clergy continue to be an important source of mental health care although they are unlikely to make referrals to mental health professionals. This study examines the case of clergy referral intentions to mental health professionals for several scenarios of mental health concern in Singapore and attempts to identify possible barriers to such referrals. Using a self-administered, mailed survey to a representative sample of clergy, it was found that explanatory models associated with mental disorder as well as professional role identity, professional competence and professional networks were important in predicting referral intentions. Several education-related variables as well as religious conservatism were also useful in the statistical analysis. [ABSTRACT FROM AUTHOR]