title: Self-treatment and its discussion in medical consultations: how is medical pluralism managed in practice?
abstract: Recent policy changes in the UK such as deregulation of prescribed medicines and the introduction of telephone helpline services are intended to promote self-treatment. Drawing on interviews with, and consultations between, 35 patients and 20 general practitioners, we use Kleinman's (Patients and Healers in the context of culture: an exploration of the Borderland between Anthropology, Medicine and Psychiatry, University of California Press Ltd., London) model of the three sectors of health care in order to examine the range of self-treatments people use and the discussion of these treatments in medical consultations. We argue that despite the availability of a range of treatment options and policy changes advocating greater use of self-treatment, patients are inhibited from disclosing prior self-treatment, and disclosure is affected by patients' perceptions of the legitimacy of self-treatment. The findings are in keeping with Cant and Sharma's (A New Medical Pluralism, Alternative Medicines, Doctors, Patients and the State, UCL Press, London) contention that although there has been a pluralisation of "legitimate" providers of health care and a restructuring of expertise, biomedicine itself remains dominant.
authors.affiliation: Department of General Practice and Primary Care, Guy's, King's, and St Thomas' School of Medicine, Kings College, London SE11 6SP, UK. f.stevenson@pcps.ucl.ac.uk
authors.forename: Fiona A
authors.initials: FA
authors.lastname: Stevenson
authors.forename: Nicky
authors.initials: N
authors.lastname: Britten
authors.forename: Christine A
authors.initials: CA
authors.lastname: Barry
authors.forename: Colin P
authors.initials: CP
authors.lastname: Bradley
authors.forename: Nick
authors.initials: N
authors.lastname: Barber
mesh_terms: D001291:Attitude of Health Personnel; D000529:Complementary Therapies / Q000523:psychology / Q000706:statistics & numerical data; D003469:Culture; D004739:England; D005194:Family Practice; D019981:Health Care Sector / Q000145:classification; D006801:Humans; D004366:Nonprescription Drugs / Q000627:therapeutic use; D010342:Patient Acceptance of Health Care / Q000523:psychology; D010817:Physician-Patient Relations; D012017:Referral and Consultation; D012648:Self Care / Q000523:psychology* / Q000706:statistics & numerical data*; D012650:Self Disclosure; D012651:Self Medication / Q000523:psychology / Q000706:statistics & numerical data; D012962:Sociology, Medical; D013222:State Medicine
chemical_list: D004366:Nonprescription Drugs