Index
in Managing diabetes, managing medicine

Index

accountability 5, 9, 54, 181–3, 184–7, 201–3, 218–19, 220–4, 231–2, 246–7, 251–3, 255–6
Alberti, George, Professor of Medicine, former President of the Royal College of Physicians 209 n.61, 233
antenatal care 129, 244
appointment systems 10, 117–18
see also recall systems
asthma 22, 77 n.139, 99, 243–4
audit 2, 4, 5, 6, 7, 11, 18, 22, 24, 133–6, 137, 138–9, 182, 187, 192–3, 198–200, 201, 202–3, 207 n.39, 212 n.122, 219, 222–3, 224, 225–6, 227, 229, 231, 232, 247, 248–9, 250, 252, 254, 255–6, 261 n.43, 265 n. 87
autonomy
clinical 5, 54, 186–8, 193–4, 195, 203, 207 n.43
personal 182
professional 5, 11–13, 54, 217, 251
see also freedom
balance
economic 8
lifestyle 46
physiological 19, 49, 63
therapeutic 16–17, 48
borderline diabetes 61, 88, 95–6
British Diabetic Association (BDA) 10, 11, 15, 21–2, 24, 27, 50, 53–5, 60, 64, 91, 124–5, 133, 154, 155–7, 158, 159, 161, 167, 169, 176 n.97, 193, 196–8, 203, 211 n.96, 225–6, 229–30, 231, 247, 250
care team 3, 10, 22, 63–7, 91–2, 116–17, 121–2, 128, 131, 135–6, 188, 190–2
see also dietician; district nurse; general practitioners; health visitors; nurses
Chief Medical Officer 107–8 n.59, 201, 216, 233
chronic disease management 98–9, 224–6, 232–3, 241–7, 247–8, 250
chronic sick 55–8
civil service 3, 7–8, 9, 11, 52, 54, 56, 58, 88, 156–9, 161, 162–3, 164–7, 168, 186, 215–16, 220, 226, 229, 233
clinical governance 151, 181, 203
clinical skill 3, 4, 7, 16, 83
Clinical Standards Advisory Group 226–8, 229–31
clinical trials 14, 51, 122, 134, 137, 153, 183, 187
classification of disease and 95, 96, 97–8
treatment of diabetes and 17, 41 n.115, 59, 61, 95, 153–4, 156, 172 n.45
Cochrane, Archie, doctor and epidemiologist 183–4, 207 n.39
Cogwheel 89, 107–8 n.59, 184, 216
Cold War 59–60, 218
College of General Practitioners 74 n.91, 93, 250
see also Royal College of General Practitioners
community diabetes care 65–7, 243, 250
see also hospitals; shared care
community surveys 51, 58–9, 61, 73 n.82, 74 n.91, 88, 95–6, 246
complaints 182–3
computers 103–4, 119–20, 129, 131, 143 n.39
Conservative Party 7–8, 89, 160–1, 162, 164, 166, 217, 219, 232, 246
the NHS and 1, 9, 185, 215, 217, 219–23
consultants 52, 56, 89, 119, 123, 138, 139, 158, 183, 186, 201, 216, 230
relationships with GPs 12–13, 80, 82–3, 91–2, 103, 115, 129, 139, 249–50
continuity of care 66, 92, 94, 128
data
diabetes management and 10, 64, 96, 125, 129, 133, 189, 198, 199–200, 224, 228–9
health service management and 8–9, 89, 123, 133, 184, 215–17, 236 n.37, 252, 255
Department of Health 1–2, 199, 215–16, 221, 223, 224, 225, 226, 229, 231
Department of Health and Social Security 124, 150, 155–6, 156–9, 161, 162, 163, 164–7, 168, 182, 191–2
diabetes
complications 2, 17, 18, 39 n.95, 80, 90–1, 98, 244–5
costs of 11, 150, 163–4, 165–6
relationship with control of blood glucose and metabolism 18, 49, 61, 63, 86, 88, 95–6, 97, 151
definition 15–17, 19
diagnostic criteria 15–17, 60–1, 88, 95–6, 97, 189–90, 194
patient self-care 2–3, 17, 21–2, 49, 53, 65–6, 116–17, 129, 197, 211 n.96
prevalence 1, 10, 28 n.4, 59–61, 255
treatment see balance; diet; insulin; oral hypoglycaemic agents
diabetic outpatient clinics 3, 13–14, 21–2, 49, 50–1, 53–4, 65, 67–8, 79, 82, 83, 84–5, 90, 91, 92, 94, 97, 99, 102–3, 117–18, 119, 121, 124–5, 151, 155, 188, 190–1, 224, 243–4
referral 50, 82, 83–4, 91, 92, 104, 131–2, 138, 191, 194
diet
cause of diabetes and 1, 28–9 n.4
challenges of 60, 64–5
classification of patients and 18, 90, 92
treatment programmes 16–17, 20, 39 n.95, 48–9, 152, 193
dietician 21, 63, 64, 65, 121, 128, 138, 190, 203
district nurse 47, 66, 92, 121, 190
economy 5, 8, 46, 57, 59, 88, 89, 99, 166, 167
elderly patients 55, 57, 64, 66, 67, 159, 173 n.58, 242
empire 51, 59
medical knowledge and 17, 58, 189
research networks and 44 n.157, 59, 208 n.55, 209 n.61
techniques of government and 13, 265 n. 89
epidemiological research see epidemiology
epidemiologists 14, 15, 19, 55, 57, 58, 60, 61–2, 140, 155, 183, 207 n.39
epidemiology 19, 51, 58, 60–1, 95–7, 122–3, 165, 184
see also community surveys
Evidence-Based Medicine 201–2, 232, 252
freedom
clinical 184, 220
economic 160, 217–18
personal 211 n.96, 217–18
professional 115, 132, 185, 201
Fry, John, general practitioner 185, 207 n.39
General Medical Council 11–12, 182, 205 n.10
general practice
financing 82, 112 n.139, 185, 220–2
ideologies of 93–4, 97–100, 128, 250
professional esteem 82–3, 109 n.86
research and 58, 74 n.91
general practitioners
construction of managed medicine 2, 6, 118–19, 120, 123, 125–8, 129–31, 132–3, 135, 137–40, 185, 187, 194–6, 202, 227, 244, 247, 249–50
diabetes care and 50, 82, 83–4, 85–8, 91–4, 97–9, 102–3, 106 n.34
see also care team; diabetic outpatient clinics; shared care
National Health Service and 1–2, 52–3, 81–2, 87, 128, 185, 186–7, 215–16, 220–1, 221–2, 224–5, 229, 232–3, 252
relationship to hospital 12, 81–2, 93–4, 100, 105 n.12, 186, 222, 249
Griffiths management review 220
guidelines 204 n.1, 208 n.53
criticisms of 7, 201–2, 207 n.39, 249
emergence of 5, 7, 11, 22, 23–4, 89, 187, 188–93, 208 n.50, 225–6, 229, 232, 247, 248, 252
health service reforms and 2, 223, 227, 229
managing care and 4, 5, 184, 193–8, 227, 230–1, 232–3, 249
see also protocols
Hart, Julian Tudor, general practitioner 98, 223–4
health economics 8, 11, 59–60, 90, 108 n.69, 164–6, 167, 183–5, 192, 201, 248
health economists see health economics
health service research 54, 135, 136, 163–4, 183, 249
health visitors 47, 65–6, 77 n.139, 92, 118, 121, 128, 190
Hospital Activity Analysis 184, 216, 224
hospitals
clinical management in 3, 13–14, 133–4, 185, 186
see also Cogwheel; Hospital Activity Analysis
integrated diabetes care and 22, 65–6, 85–6, 91–3, 94, 97–8, 102, 121, 128–33, 139–40, 169, 192, 247
National Health Service and 52, 53–4, 70 n.35, 87, 100–1, 207 n.46, 221–2
service integration and 6, 12, 15, 18, 23, 51, 52–3, 65, 66, 100–1, 102, 123, 200, 243, 244, 254
hyperglycaemia see diabetes
hypertension 15, 20, 58–9, 61, 87, 98, 99, 111 n.122, 123, 131, 243, 244
diabetes management and 95, 97, 98, 132
hypoglycaemia 17, 49, 66, 80, 88, 153, 195
impaired glucose tolerance 95
insulin 17, 22, 41 n.115, 48, 49, 50, 84, 116, 151, 243, 244
International Diabetes Federation 155, 200, 226
Joint Working Party on the Organisation of Medical Work see Cogwheel
Keen, Harry, diabetes specialist and epidemiologist 84, 85, 209 n.61, 228, 231, 233
ketonuria 16, 17, 18, 22, 48, 49, 125, 191, 197
Keynesianism 7, 160
King's Fund 90, 216
laboratories 3
GP access 92, 106 n.34
patient surveillance and 17, 18, 48, 50, 84, 119, 195
Labour Party 8, 52, 62, 76 n.120, 89–90, 99, 159, 162, 166, 169, 215, 217, 219, 232
Lawrence, Robin, diabetes specialist 19, 21, 53–4, 77 n.139
Local government 161
hospitals 13, 50, 55–6
public health departments 47, 53, 63, 65
social services 56
see also Medical Officer of Heath
Major, John, Prime Minister
governments of 215, 224, 229–30
Malins, John, diabetes specialist 91, 93, 94, 159, 190
media 134, 182, 223
medical individualism 3, 5, 7, 12–13, 14, 37 n.72, 93–4, 96, 122, 123, 133–4, 153, 183–4, 185, 186–7, 194, 195, 200–1, 202–3, 251–2, 253
Medical Officer of Health 46–7, 53, 58, 61, 62, 66–7, 85, 87, 100–2
see also local government
medical records 66, 139
emergence of 17–18, 121–3
managing care 3, 10, 63–4, 104, 124–31, 133–4, 137, 139, 250
shared care records 129–31, 244
Medical Research Council 41 n.115, 122, 150, 156, 190
middle age 55, 58
Ministry of Health 41 n.115, 52, 53–4, 57, 79, 88, 89, 122, 124, 186, 188–9, 192, 215–16
see also Department of Health; Department of Health and Social Security
Morris, Jerry, clinician and epidemiologist 60, 185, 206 n.32, 207 n.39
National Health Service
creation 50–3
National Insurance 13, 50, 52, 122, 123
neoliberalism 2, 9, 29 n.6, 89, 160–1, 217–19
health services and 6, 9, 169–70, 197, 211 n.96, 219–24, 224–5, 227–8, 231
New Right 5, 32 n.24, 169–70
Nuffield Provincial Hospitals Trust 90, 216
nurses 15, 18, 23, 64, 117
care team and 50, 63, 65, 121, 128, 188, 190
deputation 119, 126, 138, 191
general practice and 87, 92
specialists103, 119, 138
ophthalmologists 121, 153, 155, 156–7, 158, 159, 165, 167, 191
Oral Hypoglycaemic Agent 92, 156, 172 n.45
Parliament 150, 156, 161, 169, 182, 184, 215, 223, 227
legislation 6–7, 224
select committees 162, 217, 219
patient consumerism 8, 90, 182–3, 197, 227, 248
Patients’ Association 90, 108 n.69, 182
photocoagulation 97, 153–5, 156–7, 163
planning 9, 51, 88, 161, 223
economic 8, 76 n.120, 160, 217–18
post-war consensus 7–8, 160–1, 219, 222
preventive healthcare 1, 19–20, 46–7, 53, 57, 62–3, 86–7, 98–9, 100–1, 244–5
diabetes management and 1–2, 20–1, 27, 46, 60–1, 63, 86, 88, 94–8, 153–5, 158–9, 164, 165–6, 168–9, 224–5, 226, 241
see also risk
productivity 59–60, 220, 251
professionalism 5, 13, 134, 193, 194, 200–3, 251–3
identity 11, 12, 93, 201
inter-professional conflict 12, 102–3, 183, 249–50
professional regulation 4, 11–12, 14, 135, 183, 197, 198, 200–1, 202, 203, 217, 245–6, 248, 251
protocols 10, 136, 153, 198, 204 n.1
emergence of 14, 91, 122–3, 131–2, 247, 250
health service reforms and 2, 225–6
managing care 104, 121, 132–3, 134, 138–9, 184, 187, 194, 195–6, 197, 199, 202–3, 244, 250, 253
see also guidelines
public health see chronic disease management; local government; Medical Officers of Health; preventive health care; risk
quality of care 2–4, 6, 115–16, 133–4, 186–7, 202–3, 220, 221–2, 224–5, 230–1, 261 n.43
criticisms of 116, 134, 181–5, 187–8, 247
quality assurance 137, 228–9, 230, 234, 241, 248
see also standards of care
recall systems 3, 10, 104, 118–21, 125, 126, 134, 137, 231
Reid, J. R. R., Medical Officer of Health 46–7, 61, 63
risk 1, 4, 11, 97–9, 217, 244, 245, 255
diabetes management and 20–1, 27, 61, 62–3, 85–6, 95–8, 132, 150, 154
medical concepts of 19–20, 62, 86–8, 95
routinisation 104, 138, 246
Royal Colleges 2, 6, 131, 133, 169, 192, 200, 201, 203, 225, 226, 232, 247, 250, 252
Royal College of General Practitioners 97–8, 99, 123, 128, 131, 132–3, 194–6, 202, 244, 250
Royal College of Physicians
Edinburgh43 n.145, 123
London 22, 43 n.145, 83, 196, 199, 210 n.78, 225, 227
Standing Committee on Endocrinology and Diabetes Mellitus 190–2, 198
scientific medicine 7, 13, 122, 242, 247
laboratory practices 16–17, 252
statistics 14, 96, 97, 153, 183, 189
Scotland
British medicine and 23–4, 162–3, 168, 198–9, 226, 257
health services in52, 70 n.35, 72 n.67, 100–1, 198–9
medical culture and politics of 23–4, 100–1, 192
Scottish Home and Health Department
National Medical Consultative Committee 192–3, 198–9
social medicine 14–15, 35 n.56, 58, 60
social security 4, 8, 59–60, 160, 161, 162, 164, 165, 166, 218, 219
specialisation 12–13, 37 n.71, 56, 83–4, 122
clinics see diabetic outpatient clinics
diabetes specialists 11, 15, 21, 23–4, 51, 64, 90, 152, 157, 161, 168, 188, 190–1, 197, 209 n.61
construction of professional management 2, 3, 6, 23–4, 139, 180–1, 192–3, 198–9, 200, 224, 225–8, 228–32, 247, 250
relationships with GPs 17, 82, 85, 123, 139, 243, 244
standardisation 24, 38 n.87, 200
care and 5, 18, 123, 125, 232, 248, 252
categories and 154, 184, 189
medical records and 122–3, 124–5
units of medical work and 13, 14, 41 n.115, 184, 189
standards of care 1, 10, 13, 22, 50, 64, 68, 132, 135–6, 192, 196, 200–1, 202, 226
concerns about 80, 93, 128–9, 246, 250
published standards see guidelines; protocols
see also quality of care
St Vincent Declaration 200, 226, 228–9, 231, 233
surveillance
diabetes care and
disease 3, 21, 22, 48–9, 58, 63, 97, 154, 169, 245
health service and professionals and 128, 131, 197, 198–200, 207 n.39, 222, 226, 245–6, 252
shared care see community diabetes care; hospitals
Thatcher, Margaret, Prime Minister 160
governments of 8, 9, 44 n.159, 103, 160, 162, 168, 215, 219, 221, 224
time
economies of professional time 82, 87–8, 117
management in medicine 10, 64, 92, 96, 117–19, 135
waiting 80, 82, 90, 117, 119
United States of America 199
health service reform 35 n.57, 60, 73 n.82
management of medicine5, 24, 36 n.65, 247–9
Wales
British medicine and 23–4
health services in 52, 70 n.35, 101
welfare state 4, 5, 7, 8, 55–6, 58, 59–60, 160–1
expenditure 8, 58, 168, 203
professionals 5, 13, 134, 217, 218
services 57, 155, 161, 219, 255
social security see social security
see also post-war consensus
Whitehall 9, 216
see also civil service; post-war consensus
World Health Organization 99, 189–90, 192, 226, 228, 247
see also St Vincent Declaration

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Managing diabetes, managing medicine

Chronic disease and clinical bureaucracy in post-war Britain

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