Global Health Humanities

This collection of stories from two practising GPs describes the reality of working within a failing and highly bureaucratic system, where there is a balancing act: regulation versus relationships; autonomy versus standard practice; algorithm versus individual attention. We aren't suggesting a return to a 'better' time. We don't object to being bureaucrats, embedded within and accountable to the systems we are in. But we do want to consider how and with what the gap left by the old-fashioned GP has been filled. We use stories based on our experience to describe the effect of different facets of bureaucracy on our ability to maintain a nuanced, individualised approach to each patient and encounter; and to question the prominence and effect of protocol. We are interested in the way professional relationships are influenced by protocol: between and within organisations; and most importantly with patients/clients/service users.. We are accustomed nowadays to automated telephone lines, chatbots, website FAQs- the frustration of being unable to connect with another human being who will listen to our particular question and give us something other than a generic answer. The same issues that are facing society at large have changed the way in which we work as GPs and the care we give. Introduction – an analysis of the different aspects of bureaucracy and regulation which influence decision making in general practice. • Poppets and Parcels – healthcare systems are not designed to meet the needs of everyone. This chapter is about a fundamental but undocumented component of general practice - the 'holding work' required for patients whose problems can't be solved in the usual ways, the ones for whom there isn't a simple answer. • Waiting to Connect – In this chapter, the stories are about flow – the flow of patients through a turbulent, over-stretched system in which access and response are often controlled by algorithm. • Taking Liberties -this chapter examines the role of GPs as agents of social control in the restriction of civil liberties - in the context of the mental health act and of safeguarding. • Guidelines, Tramlines, Mindlines -how guidelines are developed and the difficulties of applying them in the messy world of general practice. • The Elephant in the Room -the stories in this chapter are about biography and biology; about medical categorisation and its effects and shortcomings. • The Bureaucracy of Death - In the realm of death, protocol -which has become the bedrock of clinical practice- is less useful, because the right decisions and the right timing are so individual and nuanced. These stories are about death and bureaucracy. Conclusion and Afterword A Labour of Love -a few stories to end, of healthcare enacted with love

Medical knowledge manifests in materials, and materials are integral to the reproduction of medical knowledge. From the novice student to the expert practitioner, those who study and work in and around medicine rely on material guidance in their everyday practice and as they seek to further their craft. Students, just as experts, pore over textbooks, photographs and films. They put up and copy down chalkboard illustrations, manipulate plastic models and inspect organic specimens fixed in formalin. They pass through grand university libraries and try not to contaminate anything in cramped surgical theatres. Students, just as experts, learn within an expansive material culture of medicine, they learn from explicitly educative materials, from the workaday tools used for diagnosis and in treatment, they learn in everyday spaces and as part of sprawling infrastructures. While the specific constellation of material varies across time and space, many materials have remained constant, key actors in the spread of medical practices and in the steady, global expansion of biomedical frameworks of health and disease. This collection focuses on the materials, objects, tools and technologies which facilitate the reproduction of medical knowledge and often reify understandings of medical science. The training of doctors is changing rapidly in response to technological development as well to the evolving needs and expectations of patients. Medical schools are beginning to respond to these challenges through curricula redesign and the purchase or endorsement of new teaching aids, simulations and pedagogies. Often, this means that medical schools are embracing the digital at the expense of older teaching materials. Medical education is at a critical juncture and there is momentum to radically rethink its approaches. This collection offers a reflection on these challenges by presenting an innovative and expansive overview of the role of materiality in the training of doctors and in the social reproduction of medicine in general. Experimental in form, and with ethnographic, museological and historical cases, and traces from around the world, this edited volume is the first to fully explore the matter of medical education in the modern world. Supported by the European Research Council under the European Union's Horizon 2020 research and innovation programme. An academic text, it will be most relevant to academics and graduate students in the fields of health and material culture, but will also have a wider readership with those working on medical education and knowledge and medical history