title: Health 'care' interventions: making health inequalities worse, not better?
abstract: OBJECTIVE
  The aim of this paper is to present a model, the 'Effect of the Professional Ego', which provides a psychodynamically informed analytical framework for examining professional practice in arenas where issues of inequalities need to be addressed.
  
  
  BACKGROUND
  There is a great deal of literature on the psychosocial aspects of inequalities in health care provision. However, the impact of intrapsychic and professional cultural elements has not been explored in this context. Moreover, the body of work which does explore these elements in relation to health care workers does not address how they might impact on health inequalities.
  
  
  CONCLUSIONS
  Drawing on empirical work, we discuss ways in which intrapsychic and professional cultural elements feed into the dynamic between clients and health care professionals in a way which can subvert espoused, positive client health outcomes. Based on this discussion, we propose the Effect of the Professional Ego model, which identifies two main aspects of the professional ego - the grandiose self and self-preservation - and how they influence the professional/client dynamic.
  
  
  CONCLUSIONS
  Systematic self-reflection on the part of professionals would be a valuable contribution to the development of professional practice. This applies particularly to conceptualizing the links between the actions of service providers and the adverse health of clients.
authors.affiliation: Centre for Nursing and Midwifery Research, University of Brighton, Brighton, UK. a.hart@brighton.ac.uk
authors.forename: Angie
authors.initials: A
authors.lastname: Hart
authors.forename: Marnie
authors.initials: M
authors.lastname: Freeman
mesh_terms: D001291:Attitude of Health Personnel; D003469:Culture; D004506:Education, Nursing; D006282:Health Personnel / Q000193:education / Q000523:psychology; D006297:Health Services Accessibility; D006801:Humans; D008960:Models, Psychological; D009723:Nurse-Patient Relations; D009726:Nurses / Q000523:psychology; D009732:Nursing Care / Q000379:methods / Q000523:psychology*; D011369:Professional-Patient Relations