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X Negotiate a length of time for the interview and stick to it levitra soft 20mg low price, unless the interviewee is happy to continue levitra soft 20 mg line. X Check recording equipment is working without draw- ing attention to it levitra soft 20mg low cost. X Achieve closure purchase 20 mg levitra soft with mastercard, thank them and leave a contact num- berincasetheywishtogetintouchwithyouabout anything that has arisen purchase 20 mg levitra soft visa. HOW TO CONDUCT INTERVIEWS / 75 X Respect their confidentiality – do not pass on what has been said to third parties unless you have requested permission to do so. They are popular within the fields of market research, political research and educational research. The focus group is facilitated by a moderator who asks questions, probes for more detail, makes sure the discussion does not digress and tries to ensure that everyone has an input and that no one person dominates the discussion. If you are interested in running focus groups for your re- search you will need to acquire a basic understanding of how people interact in a group setting and learn how to deal with awkward situations (see Table 8). However, the best way to become a successful moderator is through experience and practice. If possible, try to sit in on a focus group run by an experienced moderator. Once you have done this, hold your own pilot focus group, either with friends or ac- tual research participants. You might find it useful to video tape this focus group so that you can assess your body lan- guage, see how you deal with awkward situations, analyse how you ask questions, and so on. Don’t be disappointed if your first few groups do not go according to plan. In all focus groups you need to explain the purpose of the group, what is expected of participants andwhatwillhappentotheresults. Negotiatealength for the discussion and ask that everyone respects this as it can be very disruptive having people come in late, or leave early. Usually one and a half hours is an ideal length, although some focus groups may last a lot longer. Assure the participants about anonymity and confidenti- ality, asking also that they respect this and do not pass on what has been said in the group to third parties. You may find it useful to produce and distribute a Code of Ethics (see Chapter 13). Asking questions General, easy to answer questions should be asked first. As moderator, listen carefully to everything people say, acknowledging that you are listening by mak- ing good eye contact and taking notes regarding issues to which you may return later. Make sure that no one person dominates the discussion as this will influence your data. Some moderators prefer to use a list of questions as their interview schedule, whereas others prefer to use a list of topics (see Chapter 7 for more information on developing an interview schedule). The overall aim is a free-flowing discussion within the subject area, and once this happens the input from the moderator may be considerably less than it would be in a one-to-one interview. You will find that in most focus groups, most people will talk some of the time, although to varying de- grees. In some groups, some people may need gentle per- suasion to make a contribution. You have to use your discretion about how much you do this as there might be occasions when somebody is unwilling or too nervous to contribute. You often find that, even though you have negotiated a time, people enjoy the discussion and want to continue, although at this stage you must make it clear that people can leave, if they wish. Often, some of the most useful and pertinent information is given once the ‘official’ time is over. Also, you will find that people talk to you on an individual basis after the group has finished, especially those who might have been nervous contribut- ing in a group setting. It is useful to take a notepad and jot down these conversations as soon as possible after the contact as the information might be relevant to your re- search. Finishing the focus group When you have finished your focus group, thank the par- ticipants for taking part and leave a contact name and number in case they wish to follow up any of the issues that have been raised during the discussion. It’s good practice to offer a copy of the report to anybody who wants one.

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In the aftermath of the Shipman case buy levitra soft 20 mg on-line, more radical critics of the GMC proposed that it should have a lay majority buy levitra soft 20 mg cheap, thus effectively bringing professional self-regulation to an end discount 20 mg levitra soft with amex. Lay members were first introduced onto the GMC in 1950 and their numbers have increased substantially in recent years purchase levitra soft 20 mg visa. Though reformers seem to assume that lay members provide some sort of representation of the public safe levitra soft 20mg, the mode of selection—by appointment by the Privy Council—means that they are more an instrument of state control than a mechanism of democratic accountability. Leading figures in the RCGP assert that the ‘input of lay people is critical to ensure coverage of areas to do with communication and attitudes to patients’ (Southgate, Pringle 166 CONCLUSION 1999). Yet they do not explain why lay people should be better judges of these matters than doctors who have both professional and personal experience of doctor-patient interactions. Nor do they indicate the nature and scale of the lay input, or how such people would be selected, trained or paid. Following the pattern of such appointments to diverse quangos, they could be expected to be selected according to their loyalty to New Labour and its leadership. The willingness of doctors to concede the right to judge their fitness to practise to those who include such cronies and toadies reflects an alarming loss of professional self-respect. The independent general practitioner, competent on qualifica- tion, symbolised the confidence of the medical profession in the nineteenth century. By contrast, the ‘never quite competent’ GP, one who requires continuous formal instruction and regulation, mentoring and monitoring, support and counselling, symbolises the abject state of the profession at the start of the new millennium. But, while some GPs are drawn into the process of assessing their colleagues’ fitness and many more are continuously collecting evidence to justify their fitness to practise, who will see the patients? And what will patients think of doctors who have so little faith in themselves that they put their trust in formal procedures of assessment and regulation? Far from restoring public confidence in medicine, the proposed system of revalidation is destined to damage it still further. The immediate response to any criticism of the drive to revalidation is the demand for a superior alternative. But revalidation is the answer to the wrong question: it is not a matter of proposing an alternative response, but of reposing the question—what is the real problem of contemporary medicine? It is not underperforming and unacceptable GPs or inadequate regulatory procedures—these are old and familiar problems. The real problem lies with the style of practice deemed excellent by the leaders of the profession, a style which is destined to be promoted still further by the revalidation procedures. This approach is characterised by a shift of medical practice away from the care and treatment of patients towards the regulation of behaviour and the rationing of resources. It results in individual GPs devoting less time to their own patients and spending more time in activities remote from the patients. It also has the effect of making doctor-patient relations more conflictual and instrumental, as doctors try to persuade their patients to adopt healthy lifestyles and undergo screening tests (partly in the cause of making targets) and patients see doctors as the front line of the 167 CONCLUSION government’s drive to curtail NHS spending on drugs and hospital treatment. If doctors are concerned about restoring public trust, we should first recall what created public trust in the medical profession in the first place. This should lead to a renewed commitment to medical science and a determination to defend it against the anti-scientific prejudices which have recently become influential, not only in society as a whole, but more damagingly within medicine itself. It should also lead to a recognition of the importance of sustaining the personal doctor-patient relationship which has always been the bedrock of general practice, but is threatened by recent bureaucratic trends, not least by the drive towards revalidation. The autonomy of the patient According to GP philosopher Peter Toon, ‘autonomy has become a buzzword in medical ethics’ (Toon 1999:16). This concept ‘has been at the centre of the attack led by a recent generation of non-physician medical ethicists and patient representatives on the arrogance of medical paternalism’. But this narrow focus on doctors as the major threat to the autonomy of the patient underestimates both the impact of wider social and political forces on the doctor-patient relationship and the potential for doctors and patients to work together to combat the oppressive consequences of these influences. We have considered two interlinked trends which have the effect of diminishing individual autonomy: the medicalisation of life and the politicisation of medicine. The first involves the proliferation of categories of disease to cover wider and wider areas of human experience and a growing proportion of the population. It also involves extending medical jurisdiction over diverse areas of personal and social life in the cause of preventing disease.

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O’Reilley does worry about his patients generic 20 mg levitra soft overnight delivery, who are poor trusted levitra soft 20mg, being sent large bills by providers because their in- surer denies coverage and he didn’t follow rules cheap levitra soft 20mg fast delivery. Of the insured people with various disabilities cheap 20 mg levitra soft with amex, including mobility problems buy levitra soft 20 mg low cost, 28 percent report they have special needs that are not covered—for particular therapies, equipment, medications—compared to 7 percent of those without disabilities. Among those with very severe disabilities, 40 percent note un- covered special needs (Harris Interactive 2000, 56, 57). Overall, 19 percent of disabled persons report that they needed medical care within the last year but didn’t get it, compared to 6 percent of nondisabled persons (Harris In- teractive 2000, 60). Disabled people attribute these failures to lack of insur- ance coverage (35 percent), high cost (31 percent), difficulties or disagree- ments with physicians (8 percent), problems getting to physicians’ offices or clinics (7 percent), and inadequate transportation (4 percent). Department of Health and Human Services (2000, 6-5) recognizes that, “As a potentially underserved group, people with disabilities would be expected to experience disadvan- tages in health and well-being compared with the general population. When the canaries keeled over, the miners knew the air wasn’t good—they’d better get out. People with disabilities tend to be the most vulnerable persons in the health care system. Unless there’s a lot of advocacy, their needs tend to be put on the back burner and dealt with as an afterthought. Problems in the health care system hit people with disabilities first, but ultimately almost everyone is affected. Basic restructuring of our health-care sys- tem is essential, but intractable societal forces and cost concerns have, thus far, blocked fundamental reforms. While often maligned, public and private health insurance has protected much of the public from the full brunt of acute health-care costs, although uninsured and chronically ill people might tell different tales. As a country, we have not yet explicitly con- fronted what the health-care system should pay for and why. Even Christopher Reeve had trouble getting his private insurance com- pany to extend his stay in a rehabilitation facility and to purchase equip- ment. She lives in a low-income apartment, one of those little places like a motel room. Some friends raised the money and gave her an electric wheelchair—a real cheap one, but it allowed her to get out the door and up to a small park. On a nice spring day, she can go out and sit under a tree and come back in. So the wheelchair has now been folded up and is gathering dust in the corner. It’s been retired from use, and every time a home-health aide comes, she tries not to see it. What happens—and nobody from home health sees this—is that this team at her church comes and gets her on Sunday and packs her up and takes her over and then brings her home af- terward. Her friends rightly assumed that Medicare would refuse to purchase her power wheelchair since she does not need it within her tiny apartment—as for Erna Dodd, it would not have been deemed “medically necessary. The independence and ease conveyed by the power wheelchair, however, could put at risk her eligibility for home-based nursing care for her remaining leg ulcerated by diabetes: if Mary Jo leaves her apartment without considerable and taxing effort to sit under a tree in her power wheelchair, she might lose home-health care. Going to church is permitted, but neither Mary Jo nor her friends wish to risk a strict interpretation of Medicare’s rules, and so her power wheelchair sits unused. Remaining homebound when she could venture out diminishes Mary Jo’s quality of life and could compromise her overall health. To commemorate the twelfth anniversary of the ADA on 26 July 2002, President George W. Bush addressed one concern raised by Medicare’s homebound definition: that home-care coverage ceases if people go out for reasons other than health care or church services. It’s too soon to tell how Medicare will interpret President Bush’s pronouncement. Insurance covers health-care costs at premiums that governments, em- ployers, and individuals are willing to pay. Therefore, controlling costs is completely reasonable and even essential to keeping premiums affordable, presumably allowing more people to remain insured.

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