Health professionals and ethnic Pakistanis in Britain : risk, thalassaemia and audit culture
Abstract
The central theme or
`red-thread' that I
consider
in this thesis is the concept of risk as it is
perceived
by
and affects the two sides of
the medical encounter
-
in this instance
ethnic
Pakistanis
and
Health Professionals
-
in Britain. Each
side very often perceives risk quite
distinctively,
relating to the balance between the spiritual and temporal realms.
This is
particularly germane
in
matters to do
with possible congenital
defects
within the prenatal
realm
for the ethnic
Pakistani,
and predominantly
Muslim,
side of this encounter.
Thus
one
of the factors
considered
in this thesis is how
senses of
Islam impact
upon the two sides.
By
ethnic
Pakistanis Islam is
seen as central to all
life decisions,
whilst
Health Professionals
view
Islam
with some considerable trepidation, little
understanding
it
or
its
centrality to the
former's decision-making
processes. This is
particularly significant with regard to attitudes
to health
and
health
care.
In the initial
stages of the project
I had thought first
cousin
marriage
(FCM),
seen by
ethnic
Pakistanis
as desirable
and
by Health Professionals
as
putting ethnic
Pakistanis
at-risk to be
central to the argument,
but
concluded that concerns
around
FCM
were a
`red herring',
merely a trope for the tensions between the two sides -
at
once
both British
and at-risk
from
audit culture.
Although
no
longer
central,
FCM
remains a
viable touchstone in
consideration of the two sides' perceptions of genetic risk.
In this thesis
the medical encounter
between
ethnic
Pakistanis
and
Health Professionals is
performed
within the realm of the so called
New Genetics. Here the respective understandings of the
New Genetics
are
informed by the enculturation processes that shape the two sides' world
view.
Furthermore, I
will agree with
Lord Robert Winston's
and others' concern that any
attempt
to eradicate an adaptive genetic mutation,
in this instance, thalassaemia, from the
gene pool
is
not only undesirable
in the short term, but
also that such eradications may
have
an adverse, and
far
reaching, effect on whole population groups
in the future. The
main
thrust of my argument
is that audit culture not only compounds risk
for both
sides,
but
also
perpetuates institutional
racism within the National Health Service (NHS), by
promulgating
what
I have
called the language
myth.
That is to say that much
institutional
racism
is the
unwanted
by-product
of the NHS's
attempts to become
more patient centred and
its
continuing efforts to develop
systems of
best practice.
This
professionalisation process
within
the NHS
can
be
seen to impact
most strongly
in
relation to communication
-
particularly the claimed
language barrier between the two sides.
This `barrier' has worrying
policy
implications for
any meaningful communication
between the two sides, notably
relating to obtaining
informed
consent
from
ethnic
Pakistani
patients
-
with a resultant
increase in
risk
for
the two sides and clear economic consequences for the NHS.
Type
Thesis, PhD Doctor of Philosophy
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