Connective and Tactfully Tactical: Connective Tactics and Professional Authority in Doctor-Patient Relationships.

Medical authority is often thought to be threatened by lay access to information, but how does professional authority work when citizens have more knowledge and choices? We seek to understand how professional authority works in doctor-patient relationships and what each side does to navigate medical encounters. Our abductive study is relational as it builds on qualitative interviews with both doctors and patients. While doctors and patients each try to steer the encounter towards their desired outcomes, they also employ a series of 'connective tactics' to maintain a good, professional relationship. These connective tactics are often draped in a 'tactful' and informal manner so as not to threaten the continuous authority relationship between professionals and citizens. Both sides have a repertoire of how to act on authority relations, often supported by courteous attempts to not insist on formal superiority or patient rights. Each side shifts between what may seem like traditional and connective ways to perform medical authority. Doctors can continue to act as knowledge authorities if they also at least appear to be equals with patients; and patients can use internet findings to get involved in medical decisions as long as they pretend to still respect medical authority.

Trajectories of Professional Authority: A Comparative Study of Medical Associations and Professional Authority Claims.

Medical associations not only organize their members' interests but also exercise professional authority within the field of health policy. An important aspect of professional authority is the medical profession's ability to position itself in relation to national health policy and whether its command of professional knowledge enables the profession to claim exclusive authority for reflecting on health policy. This article analyzes and compares how medical associations claim authority over health policy and how they reposition their claims in light of perceived contestations to medical authority in public debates or from the political system. The study is based on a qualitative, descriptive analysis of 975 editorials in the medical associations' lead journals in the United States, the United Kingdom, and Denmark over a period of 60 years. The analysis explores the trajectories of authority claims in the three countries and how professional authority claims may be reconfigured to reflect external changes in health policy institutions. Whereas all the medical associations were highly critical of state-organized health systems in the 1950s and early 1960s, the British and Danish associations seem to shift positions entirely after national health systems are gradually implemented and the associations begin to present themselves as these public institutions' strongest supporters.

Governing Health Care through Free Choice: Neoliberal Reforms in Denmark and the United States.

We compare free choice reforms in Denmark and the United States to understand what ideas and political forces could generate such similar policy reforms in radically different political contexts. We analyze the two cases using our own interpretation of neoliberalism as having "two faces." The first face seeks to expand private markets and shrink the public sector; the second face seeks to strengthen the public sector's capacity to govern through incentives and competition. First, we show why these two most-different cases offer a useful comparison to understand similar policy tools. Second, we develop our theoretical framework of the two faces of neoliberalism. Third, we examine Denmark's introduction of a free choice of hospitals in 2002, a policy that for the first time allowed some patients to receive care either in a public hospital outside their local area or in a private hospital. Fourth, we examine the introduction of free choice among private managed care plans into the US Medicare program in 1997. We show how policy makers in both countries used neoliberal reform as a mechanism to make their public health care sectors governable. Fifth, on the basis of our analysis, we draw five lessons about neoliberal policy reforms.

The leap of faith from disease treatment to lifestyle prevention: the genealogy of a policy idea.

Since the 1970s public health policy has attempted to counter the rise of chronic diseases by getting individuals to make healthy choices about smoking, alcohol, diet, and physical exercise. Inspired by the so-called new perspective of the 1974 Lalonde report, this shift from disease treatment to prevention has been a key focus of public health policy to this day. Every generation of public health reports presents prevention as the answer to past failures, but the continuous experience of failure is strangely coexistent with a fundamental belief in the ability of lifestyle prevention to produce large health improvements. The article tracks the genealogy of lifestyle prevention as policy idea across three generations of U.S. and Danish public health reports and finds a systematic interpretation of lifestyle prevention as being more successful and promising than acute medical treatment.