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New doctoral thesis about grey zones in medical care

Photo of different pills.

The 24th of March Rui Liu defended her doctoral dissertation “Tinkered Care: Assembling Medicine Consumption in Grey Zones”. The thesis looks into two related domains: care seekers’ self-care and medicine consumption strategies on the one hand, and the provision of health services on the other.

The thesis explores how medical professionals and care seekers negotiate their perceptions of medicine access. It examines how such negotiations shift boundaries between professional and lay knowledge, and between healthcare as public services and as a market-oriented business. A central focus is the market of substandard and falsified medicine.

– The subject is topical, with the current attitude towards medical authority and authority in general, especially during covid. One of my ambitions was to focus on the grey zones and bring awareness to what counts as legal, says Liu.

The study was conducted with several different methods: two surveys with open-ended questions, one with Swedish physicians and one with Swedish residents; ethnographical observations of customs clearance points, digital spaces, pharmacies, and everyday life; interviews with pharmacy customers and data analysis with material from Folk Life Archive in Lund.

In the thesis Liu uses two concepts: Assembling and Tinkering. Assembling, or Assemblage, is used to conceptualize medicine consumption as a collection of relations between different entities. In this case, the key entities are medicines, care seekers and medical professionals. Together with the term tinkering, to adjust and experiment with the medical care and health services, the concepts are useful to explain how care seekers operate in the grey zones.

– I seek to inspire a curiosity in the medical profession to explore what happens in fields they can’t control.

The thesis provides an empirical account of health services as a multi-actor network. It adds knowledge to the spatial-temporal dimension of care practices and offers a conceptualization of care as tinkered practices. It argues for a need for alternative understandings of care and health services other than institutionally scripted ones. The thesis advocates to bring professionals back to the dialogue.

– It’s important to avoid victim discourse. Care seekers are reflexive. However, the individual agency is rarely taken into account from the professional perspective. I encourage medical practitioners to learn more about the art of communication. To establish a meaning and engaging physician-patient relationship, professionals need to be brought back to the picture. The professionals need other tools than simply medical technologies and medical knowledge to care for patients.