Piyush Pushkar
The University of Manchester, Social Anthropology, Graduate Student
- PhD candidate in social anthropology - working on moral reasoning of activists in the NHS, and considering the implic... morePhD candidate in social anthropology - working on moral reasoning of activists in the NHS, and considering the implications of this for the social contract in the UK
Wellcome Trust fellow
Medical doctor. Psychiatry trainee, CT3, in North Western Deanery
Chair of Manchester Medactedit
MA Dissertation
Research Interests:
A blog post reporting on our reading's group's discussion of this text.
A blog post reporting on our reading group's discussion of this text.
A blog post reporting on our reading group's discussion of this text.
This textbook was written for an undergraduate course on global health at Harvard University, compulsory for those enrolled at Harvard Medical School. It aims to introduce ethical, social, economic, and political theories and methods to... more
This textbook was written for an undergraduate course on global health at Harvard University, compulsory for those enrolled at Harvard Medical School. It aims to introduce ethical, social, economic, and political theories and methods to medics in order to critically inform their analyses of the frameworks used to build and justify global health movements. As such, the emphasis is on giving the reader the capacity to do the analysis him/herself rather than laying out the full exegesis in the book, which focuses more on outlining theories with brief illustrative examples and case studies.
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Background: With the aim of decreasing immigration, the British government extended charging for healthcare in England for certain migrants in 2017. There is concern these policies amplify the barriers to healthcare already faced by... more
Background: With the aim of decreasing immigration, the British government extended charging for healthcare
in England for certain migrants in 2017. There is concern these policies amplify the barriers to healthcare already
faced by asylum seekers and refugees (ASRs). Awareness has been shown to be fundamental to access. This article
jointly explores (i) health care professionals’ (HCPs) awareness of migrants’ eligibility for healthcare, and (ii) ASRs’
awareness of health services. Methods: Mixed methods were used. Quantitative survey data explored HCPs’
awareness of migrants’ eligibility to healthcare after the extension of charging regulations. Qualitative data
from semi-structured interviews with ASRs were analyzed thematically using Saurman’s domains of awareness
as a framework. Results: In total 514 HCPs responded to the survey. Significant gaps in HCPs’ awareness of
definitions, entitlements and charging regulations were identified. 80% of HCP respondents were not confident
defining the immigration categories upon which eligibility for care rests. Only a small minority (6%) reported
both awareness and understanding of the charging regulations. In parallel, the 18 ASRs interviewed had poor
awareness of their eligibility for free National Health Service care and suitability for particular services. This was
compounded by language difficulties, social isolation, frequent asylum dispersal accommodation moves, and
poverty. Conclusion: This study identifies significant confusion amongst both HCP and ASR concerning eligibility
and healthcare access. The consequent negative impact on health is concerning given the contemporary political
climate, where eligibility for healthcare depends on immigration status.
in England for certain migrants in 2017. There is concern these policies amplify the barriers to healthcare already
faced by asylum seekers and refugees (ASRs). Awareness has been shown to be fundamental to access. This article
jointly explores (i) health care professionals’ (HCPs) awareness of migrants’ eligibility for healthcare, and (ii) ASRs’
awareness of health services. Methods: Mixed methods were used. Quantitative survey data explored HCPs’
awareness of migrants’ eligibility to healthcare after the extension of charging regulations. Qualitative data
from semi-structured interviews with ASRs were analyzed thematically using Saurman’s domains of awareness
as a framework. Results: In total 514 HCPs responded to the survey. Significant gaps in HCPs’ awareness of
definitions, entitlements and charging regulations were identified. 80% of HCP respondents were not confident
defining the immigration categories upon which eligibility for care rests. Only a small minority (6%) reported
both awareness and understanding of the charging regulations. In parallel, the 18 ASRs interviewed had poor
awareness of their eligibility for free National Health Service care and suitability for particular services. This was
compounded by language difficulties, social isolation, frequent asylum dispersal accommodation moves, and
poverty. Conclusion: This study identifies significant confusion amongst both HCP and ASR concerning eligibility
and healthcare access. The consequent negative impact on health is concerning given the contemporary political
climate, where eligibility for healthcare depends on immigration status.
We introduce and critique a previously unexamined form of evidencebased activism (EBA): clinician-led evidence-based activism (CLEBA). In recent years funding of, and access to, the UK's National Health Service (NHS) have been depleted... more
We introduce and critique a previously unexamined form of evidencebased activism (EBA): clinician-led evidence-based activism (CLEBA). In recent years funding of, and access to, the UK's National Health Service (NHS) have been depleted through cuts, privatisation, and the reduction of universal healthcare. In these austere and hostile times, the legitimacy of those drawing attention to resultant health inequalities is eroded. One tactic that doctors have adopted while advocating for the delegitimized has been CLEBA: strategic use of clinical authority in the production and mobilization of knowledge for the governance of health issues. To illustrate the concept, we analyse two cases of CLEBA in the NHS in which we have participated. The first resisting cuts and privatisation of the NHS, the second resisting the charging of forced migrants for healthcare. By analysing CLEBA as a tactic, we show how doctors work to effect progressive goals by lending legitimacy to their allies, who are delegitimised by opponents as 'loony-left', 'shroud-waving' 'health tourists'. This approach to the problem of legitimacy separates CLEBA from EBA. Whereas EBA seeks to rebalance unequal social relations within a doctor-patient collective, CLEBA capitalizes on the symbolic power of doctors to contest unequal social relations out with the collective. By lending clinical authority to activist discourses, CLEBA consolidates forms of collective agency in which certain actors remain illegitimate. In contrast with EBA, where the rebalancing of legitimacy itself is prioritized, CLEBA reinforces a hierarchy of legitimacy that places clinicians on top.
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This article is based on ethnographic fieldwork carried out with managers, politicians and political activists in the English public healthcare system. Rather than a dominance of financial accountability, I found a mish-mash of... more
This article is based on ethnographic fieldwork carried out with managers, politicians and political activists in the English public healthcare system. Rather than a dominance of financial accountability, I found a mish-mash of accountabilities, in which the duty to 'balance the books' was a key driver but one that relied on other forms of coercion. Campaigners mobilised the concept of political accountability against cuts and privatisation. While bureaucrats were often sympathetic to activists' point of view, they felt constrained by 'the reality' of limited funds. Their conceptualisations of what was possible were enclosed. Debate regarding those limits was foreclosed. I sketch these limits on bureaucrats' ethical imagination, theorising them as ideological closure. But at times, managers did imagine alternative possibilities. Mostly, they kept quiet regarding alternatives due to a fear of losing their jobs. Thus, corporate accountability-to one's employer-enforced service retrenchment in the name of financial accountability.
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Using Thompson’s conceptualization of the moral economy, I describe how NHS activists in the UK utilize moral arguments to form alliances between different occupational groups, in a political battle against health care privatization,... more
Using Thompson’s conceptualization of the moral economy, I describe how NHS activists in the UK utilize moral arguments to form alliances between different occupational groups, in a political battle against health care privatization, reflecting how a consciousness is being built upon solidarity and shared interests. In this context, professional duties of health care professionals are linked to the interests of all citizens. I explore how the deployment of professional ethics elides a moral hierarchy that may hinder the movement’s egalitarian potential.
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The organisation, administration and running of a successful OSCE programme need considerable knowledge, experience and planning. Different teams looking after various aspects of OSCE need to work collaboratively for an effective question... more
The organisation, administration and running of a successful OSCE programme need considerable knowledge, experience and planning. Different teams looking after various aspects of OSCE need to work collaboratively for an effective question bank development, examiner training and standardised patients' training. Quality assurance is an ongoing process taking place throughout the OSCE cycle. In order for the OSCE to generate reliable results it is essential to pay attention to each and every element of quality assurance, as poorly standardised patients, untrained examiners, poor quality questions and inappropriate scoring rubrics each will affect the reliability of the OSCE. The validity will also be influenced if the questions are not realistic and mapped against the learning outcomes of the teaching programme. This part of the Guide addresses all these important issues in order to help the reader setup and quality assure their new or existing OSCE programmes.
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The Objective Structured Clinical Examination (OSCE) was first described by Harden in 1975 as an alternative to the existing methods of assessing clinical performance (Harden et al. 1975). The OSCE was designed to improve the validity and... more
The Objective Structured Clinical Examination (OSCE) was first described by Harden in 1975 as an alternative to the existing methods of assessing clinical performance (Harden et al. 1975). The OSCE was designed to improve the validity and reliability of assessment of performance, which was previously assessed using the long case and short case examinations. Since then the use of the OSCE has become widespread within both undergraduate and postgraduate clinical education. We recognise that the introduction of the OSCE into an existing assessment programme is a challenging process requiring a considerable amount of theoretical and practical knowledge. The two parts of this Guide are designed to assist all those who intend implementing the OSCE into their assessment systems. Part I addresses the theoretical aspects of the OSCE, exploring its historical development, its place within the range of assessment tools and its core applications. Part II offers more practical information on the process of implementing an OSCE, including guidance on developing OSCE stations, choosing scoring rubrics, training examiners and standardised patients and managing quality assurance processes. Together we hope these two parts will act as a useful resource both for those choosing to implement the OSCE for the first time and also those wishing to quality assure their existing OSCE programme.