”What works” in rehabilitation? – Dominant patients’ strategies.

”What works” in rehabilitation? – Dominant patients’ strategies.
OBJECTIVES: In Denmark, as part of the Nordic welfare states equality in social, educational and health care are an ideal. But quantitative studies have shown that high positioned patients in the health care system achieve better treatment and more services e.g. time, examinations than low positioned patients. In this study there is a focus on inequality in healthcare and on how different positioned patients and their relatives act in public healthcare in rehabilitation. In this presentation one high positioned patient and relative is followed during interfaces and critical transitions with the healthcare professions, from time of accident to twelve month follow-up. It is questioned what kind of resources, strategies and negotiations they apply to promote own position and how it is perceived by healthcare professions. This is compared to low positioned patients/relatives. The overall Ph.d.-study aims to sociological investigate rehabilitation trajectories in different adult patients with traumatic brain injury (TBI) and stroke, and to describe mechanisms behind the institutionalized (health care) as part of inequality in health with emphasis on interfaces and critical transitions from time of accident to twelve month follow-up.
THEORY AND METHODS: The sociology of Pierre Bourdieu constitutes the theoretical framework and is central to theories structuring. Bourdieu’s concepts of economic, cultural, social, health and symbolic capital are used to analyze the patient positions and strategies in the field. The concept of strategy is used to understand how the agents perform to optimize their position in general and also as ‘good’ patients, relatives and professionals and how they have incorporated the structural conditions. Observation and qualitative interview has been conducted of one patient following the patients’ trajectories though different phases of the rehabilitation process during admission at Traumatic Brain Unit. Interdisciplinary meetings are regarded as key elements of the empirical attention.
RESULTS: The presented case is a 60 year old female (MK) admitted to rehabilitation after a major car accident. The patient suffers from severe physical and cognitive deficits. MK is married and has 3 grown-up children. MK is an academic and is acknowledged within the field, as well as her husband. They live in a house on three floors. At the admission interview, the husband argues for examinations using the biomedical concepts, classifications and logic and the examinations are accepted. Consequently, it seems like an active resource to act pro-active. As well as it seems like the patient and relative have the ability to use and convert capitals. That means that the couple’s knowledge is articulated and used in practice and furthermore that they have the ability to take advantage and make use of it in the rehabilitation process.
CONCLUSIONS: Denmark as part of the Nordic welfare states is relatively equal in access to treatment in health care, but inequality is increasing. The case study shows how one high status couple with many resources uses capitals. Especially cultural health capital, cultural capital (including health literacy and ability to use language) and social capital (including family and networks) when interacting with the health and welfare professions in the rehabilitation field. Twenty patients with different status and capitals will be followed during the next year to describe a broader picture of patient´s use of capital and of strategies used in Denmark.