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De positie van de burger als patiënt en consument is de laatste decennia aan grote veranderingen onderhevig. Tot in de jaren tachtig werden de belangen van patiënten door anderen verwoord: door beleidsmakers, medici en managers van instellingen. Op het moment dat patiënten en consumenten voor hun eigen belangen opkwamen, zijn de beleidsprioriteiten gaan schuiven. Dat uit zich onder andere in het feit dat de rol en de verantwoordelijkheid van de burger een expliciet beleidsthema wordt. Dit is ook terug te zien in de adviezen van de commissie Dekker, de commissie Dunning en de Wetenschappelijke Raad voor het Regeringsbeleid. In deze invloedrijke adviezen is het begrip burgerschap in de gezondheidszorg geïntroduceerd, waarbij de verantwoordelijkheid en de rechten van de burger zijn benadrukt. Het begrip burgerschap wordt daarbij vanuit verschillende opvattingen belicht.Ondanks deze ontwikkelingen is de positie van de burger in de gezondheidszorg nog steeds zwak; hij moet opboksen tegen machtige partijen (zorgverzekeraars en zorgaanbieders). In deze publicatie staat de vraag centraal hoe burgerschap in de gezondheidszorg vorm kan krijgen, zodat de burger uitgangspunt van beleid kan worden. Als casus is de actieve rol van patiënten en consumenten bij de beoordeling van de kwaliteit van de huisartsenzorg geanalyseerd. Volgens de auteur is het bedrijfskundig paradigma, dat in de kwaliteitsdiscussie in de gezondheidszorg overheerst, te beperkt om recht te doen aan de positie van de patiënt en consument als burger. Zij gaat voorbij aan het feit dat de gezondheidszorg niet als markt functioneert en de patiënt zich niet als consument gedraagt; de keuzemogelijkheden in de gezondheidszorg zijn beperkt en de relatie tussen arts en patiënt is gebaseerd op vertrouwen. De betrokkenheid van de burger bij de kwaliteitsbeoordeling en -bevordering is bovendien van een verstrekkender betekenis: het gaat om het ontwikkelen van nieuwe verhoudingen tussen de overheid, de burger en het maatschappelijk middenveld. In deze nieuwe verhoudingen wordt de competentie van de burger erkend en is ruimte voor leerprocessen tussen burgers als patiënt en consument en burgers als professional. De auteur gaat nader in op de vraag onder welke voorwaarden de patiënt en consument burger kunnen zijn, welke instrumenten hieraan een bijdrage leveren en hoe andere partijen in de zorg burgerschap van patiënten en consumenten kunnen bevorderen.
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In this provocative book, the authors debunk the medical model of the psychotherapist as a healer who merely applies the proper nostrum to make the client well. Instead, they see the therapist as a coach, collaborator, and teacher who frees up the client's innate tendency to heal.
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Il n'y a pas selon l'auteur, de théorie possible du masochisme sans la pulsion de mort et, d'autre part, le masochisme est le témoin ou l'expression par excellence de la pulsion de mort. Le masochisme "érotise" et lie la destructivité issue de la pulsion de mort, la rendant ainsi supportable et, dans certaines conditions, limitant sa dangerosité. C'est ainsi que le masochisme devient le "gardien de la vie psychique".
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