IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v57y2003i6p1031-1044.html
   My bibliography  Save this article

ORS is never enough: physician rationales for altering standard treatment guidelines when managing childhood diarrhoea in Thailand

Author

Listed:
  • Howteerakul, Nopporn
  • Higginbotham, Nick
  • Freeman, Sonia
  • Dibley, Michael J.

Abstract

This study explores Thai physicians' rationales about their prescribing practices for treating childhood diarrhoea within the public hospital system in central Thailand. Presented first are findings of a prospective clinical audit and observations of 424 cases treated by 38 physicians used to estimate the prevalence of sub-optimal prescribing practices according to Thai government and WHO treatment guidelines. Second, qualitative interview data are used to identify individual, inter-personal, socio-cultural and organisational factors influencing physicians' case management practices. Importantly, we illustrate how physicians negotiate between competing priorities, such as perceived pressure by caretakers to over-prescribe for their child and the requirement of health authorities that physicians in the public health system act as health resource gatekeepers. The rationales offered by Thai physicians for adhering or not adhering to standard treatment guidelines for childhood diarrhoea are contextualised in the light of current clinical, ethical and philosophical debates about evidence-based guidelines. We argue that differing views about clinical autonomy, definitions of optimal care and optimal efficiency, and tensions between patient-oriented and community-wide health objectives determine how standard practice guidelines for childhood diarrhoea in Thailand are implemented.

Suggested Citation

  • Howteerakul, Nopporn & Higginbotham, Nick & Freeman, Sonia & Dibley, Michael J., 2003. "ORS is never enough: physician rationales for altering standard treatment guidelines when managing childhood diarrhoea in Thailand," Social Science & Medicine, Elsevier, vol. 57(6), pages 1031-1044, September.
  • Handle: RePEc:eee:socmed:v:57:y:2003:i:6:p:1031-1044
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277-9536(02)00478-1
    Download Restriction: Full text for ScienceDirect subscribers only
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Gouws, Eleanor & Bryce, Jennifer & Pariyo, George & Armstrong Schellenberg, Joanna & Amaral, João & Habicht, Jean-Pierre, 2005. "Measuring the quality of child health care at first-level facilities," Social Science & Medicine, Elsevier, vol. 61(3), pages 613-625, August.
    2. Sheikh, Kabir & Porter, John, 2010. "Discursive gaps in the implementation of public health policy guidelines in India: The case of HIV testing," Social Science & Medicine, Elsevier, vol. 71(11), pages 2005-2013, December.
    3. Biswas, Debashish & Hossin, Raduan & Rahman, Mahbubur & Bardosh, Kevin Louis & Watt, Melissa H. & Zion, Mazharul Islam & Sujon, Hasnat & Rashid, Md Mahbubur & Salimuzzaman, M. & Flora, Meerjady S. & Q, 2020. "An ethnographic exploration of diarrheal disease management in public hospitals in Bangladesh: From problems to solutions," Social Science & Medicine, Elsevier, vol. 260(C).

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:57:y:2003:i:6:p:1031-1044. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    We have no bibliographic references for this item. You can help adding them by using this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.