An ethnography of general practice in the north east of England

Abstract

This thesis is based on an eighteen-month period of fieldwork with a group of general practitioners in the North East of England. Changing patterns in the practice of primary health care are examined alongside a detailed discussion of the role of the practice nurse in order to set general practice in its cultural and historical context. The thesis takes issue with the positioning of primary health care practitioners squarely within Kleinman's 'professional' sector. Within this context, three major themes relating to the primary health care setting are identified as being of major relevance to the enquiry 1. the use of narratives by patients and practitioners, both clinical and therapeutic 2. The role of the general practitioner and practice nurse in mediation between the patient and the secondary health care sector and the role of the practice nurse in mediation between the general practitioner and the patient3. the similarities in practice between healers in primary health care settings and ethnomedicine in traditional and developed societies These themes are illustrated by the use of fieldwork material and are discussed with reference to current anthropological theory concerning narrative, mediation, dialogics, the placebo effect and the practice of shamanism, as an example of ethnomedicine. On the basis of an examination of the similarities between primary care practitioners and ethnomedical practitioners, namely: quality of practitioner-patient relationship based on narrative understanding, shared cultural explanatory models, and shared mediatory role, this thesis concludes that a shared philosophy underlines the two, and that general practice is in itself a system of ethnomedicine practised within the Western context.