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So, thanks to the creators for actually giving good definitions. Though not commonly used by most contemporary play wrights, an epilogue makes the reader to grasp the insight of a play. Notify me of follow-up comments by email. Notify me of new posts by email.

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Skip to content. In the twenty years following the mids managerial trends have intensified, and the regulation of medicine has become less individually focused. The rise of Evidence-Based Medicine and its hierarchy of evidence has, for instance, placed greater stress on codification of norms and standardisation of practice. Similarly, the deputation of responsibility for purchasing and budgeting decisions to consortia boards established new forms of oversight and administrative relationships between primary care staff.

Performance data, practice norms, peer review, and delegate visits for practices were used to encourage adherence, supported by accountability agreements and practice reviews of referral and prescribing. In traditional sociological terms, therefore, it might be said that the relative power of the state has increased at the expense of the profession over the past twenty years.

Given present trends, such dynamics are unlikely to change in the near future. However, though insightful, such a framing perhaps underplays the continued role of medical professionals themselves in creating managerial structures. Whilst undoubtedly aligned with projects to reduce state expenditure and ensure resource efficiency, healthcare governance also continues to be the product of negotiation between visions of how to manage the medical profession.

Into the present century, doctors appealed to traditional forms of therapeutic individualism — the idea that familiarity with individual patients and drugs should inform prescribing — and integrated protocols with personal knowledge. Historical perspective may provide useful context and points of departure for prognostication, but drawing definitive conclusions from history is something of a fool's errand.

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Nonetheless, if asked what the future might hold for diabetes care — in the absence of radical breakthroughs to cure or prevent the condition — I would say it is likely that structures for professional management will be central to whatever innovations are to come. Many of the features that fostered structured care and professional oversight in the post-war period remain in the present.

The NHS continues to be subject to financial constraints. There are, moreover, considerable political pressures to reform the service's structures in pursuit of integrated and more efficient care. Such concern has even found cultural outlets in popular prime-time television dramas, and is reinforced by those audits and reviews that highlight divergence from agreed standards of care.

In the absence of significant structural, political, or cultural change, it is safe to assume that managerial approaches to diabetes care and British medicine more broadly are here to stay for the foreseeable future. Modern historians are not generally used to passing explicit moral comment on their subjects. I have legitimated such work in terms of historiographical benefit — opening vistas onto the dynamics of post-war British medicine and government, as well as providing useful insight into the histories and character of professionalism. Moreover, I have tried to explain the emergence and maintenance of such systems in relation to political, cultural, institutional, technological, and epistemological factors, and thus without recourse to appeals of their self-evident or universal benefit.

However, historians are often closer to their work than they usually admit, and in producing this book I have found it difficult to completely disentangle myself from normative questions. The research for this work coincided with diagnoses of diabetes in my family, and as part of writing the manuscript I have been fortunate enough to interview actors involved with structures for managing the health service and its professionals.

As a result of these experiences, I have come to appreciate the potential value of managerial technologies. Depending on one's political position, moreover, data on the performance of welfare services can help to improve policy and hold governments as well as medical teams and institutions to account. Yet an overwhelming focus on management systems can also have negative consequences.

On a macro-level, it can divert attention away from the factors underpinning inequalities. We may be aware of the connections between economic and social marginalisation on the one hand and higher rates of diabetes prevalence and morbidity on the other because of the surveillance and analytic systems at the heart of managerialism. If certain structures of employment or discrimination are simultaneously subjecting populations to increased risks and excluding them from mainstream institutions, then they will not come under the care of health services in the first place.

A political emphasis on management to the exclusion of broader thinking can, therefore, be dangerous in itself. This is to say little about how intensive emphasis on performing routine tasks can result in simple bureaucratic fatigue as discussed in Chapter 3 , or how undue stress on targets and performance can result in serious problems of anxiety, depression, and physical ill-health in professionals.

As this book has tried to highlight, those persons experimenting with, or promoting the use of, professional management tools have never intended these outcomes. In terms of diabetes care, prominent figures in policy creation see managerial systems as part of broader solutions, even if large-scale economic change remains outside the purview of acceptable policy, as during the post-war decades.

Although by no means providing a guide to what we should do, this work and the historical and sociological materials on which it draws do suggest that emphasis on singular policy fixes is unlikely to be successful. In reflecting further on the past, or at least our framings of it in the form of history, this work has contributed to a growing body of literature on diabetes care, chronic disease management, and medical governance.

It has suggested that historical perspectives can give new meaning to contemporary analysis, and proposed that histories of disease and technologies of management can provide new and important insight into twentieth-century Britain. Such work is by no means complete, and further research remains.

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Perhaps in years to come, broader comparative perspectives will reveal different avenues for investigation and interpretation. At the very least, however, it is hoped that this close analysis of managing diabetes has provided new light in which to view the history of managed medicine. The Washington summit was useful to Lyndon B.

Johnson mainly because it allowed him to impress upon the British the need for them to retain their traditional 'great power' role and also to allow him to bring the multilateral force MLF to a conclusion. Harold Wilson accepted the American view that Britain should preserve its current position in defence, telling the Cabinet on 11 December that 'the most encouraging fact about the conference was America's emphasis on Britain's world wide role'.

Johnson not only wanted Wilson to maintain Britain's defence commitments, but to extend them into South Vietnam. After Wilson's visit to Washington, most observers, including the President, anticipated that he would face a serious challenge in explaining what he had agreed to in Washington to the House of Commons in the foreign affairs debate scheduled for December.

Johnson relationship traversed the spectrum from discord to cordiality. Discord erupted over the Vietnam War when Wilson telephoned Washington in the early hours of 11 February to suggest to Johnson an urgent visit to the White House.


Wilson agreed to the US initiative, even though the visit might have caused a political storm in Britain had it become public knowledge - it would appear that the United States was dictating British economic measures. Wilson noted that unlike the December summit and the telephone conversation in February, Johnson did not make 'any suggestion of our committing troops to Vietnam nor even any reference to police, medical teams, or teams to handle the flow of refugees'.

User Account Individual sign in Create Profile. Search Close search all content. Advanced Search Help. Martin D. Epilogue in Managing diabetes, managing medicine. Open Access free. Download PDF. Diabetes and chronic disease in the twentieth century In the five decades after the Second World War, health systems in Europe and North America gradually adjusted their approaches to the challenges of long-term disease. Chronic disease and the management of medical professionals Shifts in diabetes management, therefore, formed part of a broader change in approach to chronic diseases, and often served as an exemplar in some respects.

Collective regulation of standards for qualification and discipline may have been essential features of professional status, but, as one distinguished physician proudly declared in There is no voice to which you must … give heed that can inscribe on tables of stone a series of medical commandments, or that can compel your subscription to thirty-nine or some other number of articles. On the use and limitations of death certification for such assessments: A. Porter and G. Jackson ed. Sturdy and R. Domenech and C. Timmermann and E. Toon eds. Bridgen and J. Contemporary discussions explicitly noted the differences between specific conditions: C.

Bucknall, C. Robertson, F. Moran, and R. Nonetheless, for similarities in approach see chapters on diabetes, hypertension, anaemia, and asthma in J. Fry and G. Foulkes, A. Kinmouth, S.

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Frost, and D. Osbourne and D. Wear ed. Timmermann and J. Anderson eds. Snowden, T. Sheldon, and G. Weisz and J. In its most basic form, transition has been taken to refer to the shifting fertility and mortality profiles of given societies, in which a high birth rates and high mortality rates give way to low birth rates and low mortality rates, and b acute infectious diseases of childhood give way to non-communicable, chronic, and degenerative diseases of middle and old age as predominant causes of death.

References in classic literature? It might have been expected that when the play was done, both players and audience would have dispersed; but the epilogue was as bad as the play, for no sooner was the Devil dead, than the manager of the puppets and his partner were summoned by the single gentleman to his chamber, where they were regaled with strong waters from his private store, and where they held with him long conversations, the purport of which no human being could fathom.

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From the first casting of the parts to the epilogue it was all bewitching, and there were few who did not wish to have been a party concerned, or would have hesitated to try their skill. One can only imagine what goes on in the kitchen of Epilogue. Epilogue at Conrad Manila-what 'kodawari' and 5 Japanese chefs can do. Fifteen chapters and epilogue are divided into three parts: reform in two worlds; the age of crises; reform in transition; epilogue : Reform Judaism after However, there has to be an epilogue to this and if this is it--let it be, says Goran Rafajlovski, President of the Economic Chamber of Skopje.

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