The impact of economic theory on the art of clinical practice : a study of science, meaning, and health
In being philosophically based this thesis is concerned with understanding the human condition with particular reference to matters of meaning and how these find expression in systems of government and social policy. This study is based on the premise that concepts determine how the world is viewed and people use a variety of conceptual schemes to answer different classes of questions. Scientific endeavour is based in a scheme that enables questions about the material world to be answered. It cannot however answer classes of questions related to many features of human lives as its methods necessitate the development and use of abstractions and generalisations that are ill-equipped by design to determine what is important to people and what motivates and satisfies them. Therefore, the reality of any particular individual or group cannot be adequately understood in scientific terms. The thesis examines the scientific conceptual framework and minimalist abstractions of the medical model and the quasi-scientific conceptual frameworks of economics and identifies their conceptual limits. It shows that if the medical model is assumed to provide a complete representation of realities in health and is uncritically used as the basis of medical practice it has the potential to overlook the patient as a person and distance medical practice from its social roots which can lead to adverse outcomes for both clinical practice and medicine itself. It also observes that the economic scheme has conceptual limits that create their own distorted representations of reality. A similar dislocation in the meaning of people's lives occurs when abstractions are made by adopting concepts from other schemes based in science, such as the medical model, without any awareness of their conceptual limits. Further distortions occur when these other accounts are turned into economic ones. Not only is the patient as a person overlooked, so is the patient as an entity. In light of these observations the thesis examines health reforms that have taken place in New Zealand, whereby the economic scheme has been given dominance in the development of public policy and set the parameters for rationality and what can acceptably be said. It shows that in not recognising features of meaning these parameters have led to health sector reforms that have had unintended and adverse consequences for clinical practice, as shown in the particular case of reforms of maternity services. Furthermore these reforms have severed the health sector from its social roots and moral frameworks and created barriers between it and government so that health sector problems that cannot be understood using economic parameters cannot be addressed in forums where public policy is developed.
Advisor: Gillet, Grant; Gauld, Robin; Devlin, Nancy
Degree Name: Doctor of Philosophy
Degree Discipline: Dunedin School of Medicine
Publisher: University of Otago
Keywords: clinical medicine; health care reform; medical policy; New Zealand; economic aspects
Research Type: Thesis