Olaug S Lian

Olaug S Lian
UiT The Arctic University of Norway · Department of Community Medicine

Professor Dr. Polit.
Clinical Interaction in Context: "One in a Million"

About

103
Publications
8,668
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438
Citations
Introduction
Professor in medical sociology and head of the Medical Humanities research group at the University of Tromsø. Part-time research advisor at the clinical research department at the University Hospital in Tromsø. Among her current research projects, clinical interaction and medical uncertainty is a top priority. Most of her research is based on qualitative data and methods (narrative analysis of clinical dialogues and illness narratives mainly) and conducted with international collaborators.
Additional affiliations
December 2018 - present
University of Oslo, Institute of health and society
Position
  • Researcher
September 2012 - present
UiT The Arctic University of Norway
Position
  • Professor (Full)
Description
  • Professor of medical sociology
December 2003 - present
University Hospital of North Norway
Position
  • Research Officer
Description
  • Supervision Qualitative Research
Education
August 1987 - June 1999
UiT The Arctic University of Norway
Field of study
  • Sociology and philosophy

Publications

Publications (103)
Article
Full-text available
Culture and history affect the ways in which medical knowledge is shaped, sustained and changed. The less knowledge we have, the larger the space for the cultural imprint becomes. Based on these assumptions, we ask: how have medical constructions of long-term exhaustion changed over time, and how are changing constructions related to societal chang...
Article
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In this article, we explore relations between health, being, belonging and place through an interpretive thematic analysis of autobiographic text and photographs about the everyday lives of 10 women and men living with medically unexplained long-term fatigue in Norway. While interpreting their place-related illness experiences, we ask: How do they...
Article
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In this article we qualitatively explore the manner and style in which medical encounters between patients and general practitioners (GPs) are mutually conducted, as exhibited in situ in 10 consultations sourced from the One in a Million: Primary Care Consultations Archive in England. Our main objectives are to identify interactional modes; to deve...
Article
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Based on a narrative analysis of 20 naturally occurring clinical consultations between general practitioners and patients in England, sourced from the One in a million data archive, we explore how they conceptualize and negotiate medical and existential uncertainty. To capture the interactional element, which is often overlooked, three consultation...
Article
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Background: National surveys have identified major geographical inequalities in offers of secondary healthcare for children and adolescents in Norway. Inequalities vary from three-fold to five-fold for different illness categories. These inequalities cannot be explained by differences in morbidity. Health policy objectives of geographical equality...
Article
Nasjonale kartlegginger har påvist til dels store geografiske ulikheter i tilbudet av spesialisthelsetjenester til barn og unge i Norge. Tilbudsulikhetene varierer fra tre til fem ganger for enkelte sykdomskategorier. Disse ulikhetene kan ikke forklares med forskjeller i sykelighet. Helsepolitiske målsettinger om geografisk likeverdige tjenestetilb...
Article
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Nasjonale kartlegginger har påvist til dels store geografiske ulikheter i tilbudet av spesialisthelsetjenester til barn og unge i Norge. Tilbudsulikhetene varierer fra tre til fem ganger for enkelte sykdomskategorier. Disse ulikhetene kan ikke forklares med forskjeller i sykelighet. Helsepolitiske målsettinger om geografisk likeverdige tjenestetilb...
Article
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Following a “visual turn” in qualitative methods, photographs and other forms of visual expression are increasingly used in conjunction with verbal data in social science research. According equal status to visual and verbal artifacts, however, poses significant methodological challenges. “Photo elicitation” methods, which typically privilege parti...
Article
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National Institute for Health and Care Excellence (NICE) har nylig publisert nye retningslinjer for behandling av langvarige medisinsk uforklarte utmattelsestilstander som myalgisk encefalopati (ME) og kronisk utmattelsessyndrom (CFS). Retningslinjene innebærer en relativt stor kursendring, blant annet er den tidligere vektleggingen av fysisk treni...
Article
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Objectives: To explore interactional processes in which clinical decisions are made in situ during medical consultations, particularly the ways in which patients show agency in decision-making processes by proposing and opposing actions, and which normative dimensions and role-expectations their engagement entail. Methods: Narrative analysis of ve...
Chapter
Medical knowledge and cultural influence on definitions of health and illness are inversely related in the sense that the less knowledge we have, the greater the latitude for cultural influence becomes. Conditions that are poorly understood medically get their acceptance and credibility mainly from cultural norms and values. Some conditions receive...
Article
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In territories of medical uncertainty, clinical encounters are highly contentious. To uncover maintaining mechanisms behind persistent conflicts, we explore the interactional dynamics of clinical encounters fused with medical uncertainty. Based on a thematic qualitative analysis of experiential texts from 385 people living with medically unexplaine...
Chapter
The main theme of this essay is depictions of long-term exhaustion, a severe form of tiredness, in historical and contemporary fictional literature. Tiredness and exhaustion are real both in a biological and in an experiential sense: the phenomena entail experiences of biological processes that go on in the human body. In this paper, however, it is...
Article
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Purpose People with non-epileptic seizures (NES) consistently report poorer Health-Related Quality of Life (HRQoL) than people with epilepsy. Yet, unlike in epilepsy, knowledge of how social factors influence the HRQoL of adults with NES is limited. To add to the evidence base, this study explores the relationship between HRQoL and perceived stigma...
Article
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Purpose: Clinical encounters related to medically unexplained physical symptoms (MUPS) are associated with high levels of conflict between patients and doctors. Collaborative difficulties are fused by the medical uncertainty that dominates these consultations. The main aim of this study is to explore the interactional dynamics of clinical encounte...
Article
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Background: People with non-epileptic seizures (NES) describe challenging relationships with health professionals, and explain negative interactions as common and expected. Despite these difficulties, little is known about how people with NES experience difficult healthcare encounters. Methods: Using a thematic discourse analysis approach, we analy...
Chapter
Full-text available
The main theme of this essay is depictions of long-term exhaustion, a severe form of tiredness, in historical and contemporary fictional literature. Tiredness and exhaustion are real both in a biological and in an experiential sense: the phenomena entail experiences of biological processes that go on in the human body. In this paper, however, it is...
Article
Full-text available
Background: People with non-epileptic seizures (NES) describe difficult and challenging relationships with health professionals, and explain negative interactions as common and expected. Despite these difficulties, little is known about how people with NES experience healthcare encounters. Methods: Using a thematic discourse analysis approach, we a...
Article
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Online communities, created and sustained by people sharing and discussing texts on the internet, play an increasingly important role in social health movements. In this essay, we explore a collective mobilization in miniature through an in-depth analysis of two satiric texts from an online community for people with myalgic encephalomyelitis (ME)....
Book
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While modern biomedicine has improved doctors ability to diagnose, treat and cure a wide range of diseases, health services in the western world struggle to meet the needs of an increasing number of people with complex chronic illnesses in need of long-term coordinated care. Patients with chronic conditions imbued with high degree of medical uncert...
Article
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Background Due to a worldwide increase in overweight and obesity, weight-management through lifestyle changes has become an important public health issue. Adolescents and young adults comprise a vulnerable group. The transition into adulthood represents a stage in life when establishing good lifestyle habits for the future is important. The aim of...
Article
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Aims: The aim of this study was to explore the relationships between measured body size (body mass index (BMI)), perceived body size, weight change wishes and self-perceived health in young adults. Methods: The participants were recruited from a school-based population study in Norway, the Tromsø Study: Fit Futures 2, carried out in 2012-2013. A...
Article
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Background Continuity of care is important for patients with chronic illness in need of coordinated healthcare services from multiple providers. Little is known about how patients with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) experience continuity of GP care.This study explores how women with CFS/ME experience GP care across the...
Article
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In this article, we explore the role of 'place' in shaping people's illness experiences through a data-led inductive case-study based on experiential data from people living with myalgic encephalomyelitis (ME) in Norway. Our main aim is to understand how they experience, interpret and attach meaning to various places in which they reside, and how t...
Article
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Objective To test the association between self-rated health and self-rated degree of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), and CFS/ME patients' assessment of quality of primary care, specialist care and coordination of care. Design Cross-sectional study. Setting Self-reported questionnaire data from women members of The Norwe...
Article
Full-text available
Bodily phenomena that are difficult to identify, localize, explain and cure with the aid of modern biomedical knowledge and technology leave ample room for cultural influence. That makes them a perfect case for studying the cultural dimension of medical knowledge and practice. Building on this assumption we qualitatively explore the communication b...
Article
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In this article, we report on a study that seeks to explore how the contested chronic condition myalgic encephalomyelitis (ME), one of the current medical diagnoses for medically unexplained long-term exhaustion, is negotiated within the context of Norwegian internet sites. From an analysis of discussions on 14 internet forums sustained by and for...
Article
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With the increasing number of overweight and obese people, there is a growing public health concern and focus on body size and lifestyle issues, especially in the media. Young adult women comprise a vulnerable group regarding issues of weight balance and appearance. The aim of the study was to examine the experiences of young women on how this focu...
Article
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Bodily conditions that are difficult to identify, explain and treat with the aid of medical knowledge and technology appear to be particularly challenging to medical encounters. Patients are often dissatisfied with the help they receive, and they often experience that their medical needs are not met. To explore factors facilitating patient satisfac...
Article
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Bokanmeldelse av Aksel Fugelli: "Per. Glimt av min far" Oslo: Cappelen Damm, ISBN 978-82-02-42298-1
Article
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Background Continuity of general practitioner (GP) care is associated with reduced use of emergency departments, hospitalisation, and outpatient specialist services. Evidence about the relationship between continuity and use of complementary and alternative medical (CAM) providers has so far been lacking. The aim of this study was to test the assoc...
Article
In this article we report on a study that seeks to explore how the contested chronic condition myalgic encephalomyelitis (ME), one of the current medical diagnoses for medically unexplained long-term exhaustion, is negotiated within the context of Norwegian internet sites. From an analysis of discussions on 14 internet forums sustained by and for p...
Article
KARAKTERTREKKDIAGNOSER Ingress: I vår kultur er psykiske lidelser assosiert med svakhet og manglende mestringsevne, og dermed betraktet som en form for karakterbrist. Abstract: En dominerende trend i dagens vestlige samfunn er at vi omdefinerer stadig flere menneskelige egenskaper og kjennetegn fra karaktertrekk til sykdom med diagnostiske merkela...
Article
Full-text available
English: What’s in a name? The sociology of psychiatric diagnoses Psychiatric diagnoses are man-made creations founded on culturally defined normative evaluations of different ways of acting, feeling and thinking, and therefore historically and culturally contingent. In the latest diagnostic manuals (especially DSM-5), a wide range of human charact...
Article
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Bokanmeldelse: Petersson, Christer: Kunskap och läkekonst. Tankar om allmännmedicin. Lund: Studentlitteratur, 2014. Det handler om det kliniske blikket og medisinens kunnskapsgrunnlag, med utgangspunkt i forfatterens erfaringer fra 39 år som praktiserende lege. Hans hovedmål er å drøfte noe av mangfoldet i medisinens kunnskaps- og praksisformer....
Article
(English below) Praktiseringen av moderne biomedisin skal være basert på vitenskapelig kunnskap og teknologi, men medisinskfaglige forståelser av helse og sykdom preges også av tid og sted. For kroppslige plager som vanskelig lar seg entydig identifisere, forklare og kurere ved hjelp av medisinsk kunnskap og teknologi, kan den kulturelle pregningen...
Article
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Bokanmeldelse
Article
Increasing socio-economic inequalities in health, within a country as well as internationally, give rise to a timely question: Are there any systematic differences between people from differing social backgrounds with regard to their attitude to seeking professional medical assistance when experiencing physical problems of varying kinds? The data m...
Article
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Chapter
Tema for denne artikkelen er helsetjenestens bidrag til en mest mulig rettferdig fordeling av helse i befolkningen. Bidrar helsetjenesten til å utjevne allerede eksisterende helseulikheter, slik idealet tilsier, eller kan den også bidra til å ¢ke dem? Artikkelen sammenfatter og dr¢fter en del litteratur som har relevans for sp¢rsmålet om helsetjene...
Article
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Tid og sted setter tydelige spor etter seg i utviklingen av helseprofesjonenes virke. Dette gjelder både i forhold til hvilke typer utfordringer de m¢ter, hvordan de tolker dem, og hvordan de l¢ser dem. N¢kkelen til å forstå drivkreftene bak disse endringene ligger i helsetjenestens omgivelser, i kultur, politikk, ¢konomi og teknologi. Med utgangsp...
Chapter
For at et marked skal fungere noe i nærheten av hva teorien tilsier, må kundene vite hva de trenger, ha god informasjon om varen, ha oversikt over hva som tilbys, og ha reelle valgmuligheter. Videre må relasjonen mellom kunde og selger være upersonlig, og samhandlingen må være preget av at partene handler strategisk og med sikte på å maksimere egen...
Article
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Are current health policy changes leading to a greater degree of convergence in the health systems of European nations, or to a pattern of divergence? How can the degree of convergence/divergence be explained, and what can it tell us about local versus global impulses of change? The most common answer to these questions is that because the process...
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Article
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En fornyet satsing på kjøp av helsetjenester til yrkesaktive sykmeldte utfordrer helsetjenestens verdigrunnlag og står i motsetning til arbeidet for å redusere sosiale ulikheter i helse Da striden om sykelønnsordningen høsten 2006 fikk sin løsning uten at selve ordningen ble endret, var det få som kommenterte at kjøp av helsetjenester inngikk i en...
Article
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In an age of globalization, do places matter for medical practices? Rural doctors throughout the world seem to think so, as they strive to understand the nature of rural practice as something different from urban practice. This essay presents some sociological reflections on this subject. Based on a discussion of theories of local communities in mo...
Article
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Eos-myten i den greske mytologien er en symbolsk fortelling om en vakker gudinne som forelsker seg i en alminnelig d¢delig mann, og som ber til guden Zeus om å gj¢re han ud¢delig. I en moderne versjon av denne myten er guden byttet ut med legen. Den moderne Eos jakter på et langt liv, god helse, ungdommelighet og lykke gjennom medisinsk ekspertise...
Article
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Studier av bruker- og pasienterfaringer blir stadig vanligere, men hvor godt kvalitetsmål er denne typen data? Sp¢rsmålet dr¢ftes med utgangspunkt i en komparativ studie av pasientopplevd kvalitet i primærlegetjenesten f¢r og etter fastlegereformen. Ved å identifisere de faktorene som er sterkest assosiert med tilfredshet, er målet å dr¢fte hva til...
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Article
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The main objective was to compare patient satisfaction in general practice before and after the introduction of a list patient system for general practitioners (GPs) in Norway in 2001. Postal survey sent to a random sample of inhabitants in Northern and Eastern Norway. A total of 1133 questionnaires from 2000 and 1141 from 2003 were included in the...
Article
Medieomtale: http://www.aftenposten.no/forbruker/helse/article744936.ece; http://www.dagsavisen.no/innenriks/article938783.ece; http://www.lofotposten.no/Innenriks/article897004.ece; http://www.hardanger-folkeblad.no/Innenriks/article897004.ece; http://www.austagderblad.no/Innenriks/article897004.ece; http://www.opdalingen.no/Innenriks/article89700...
Article
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Background and methods. New medical technology is in great demand. In order to understand the rising demand and its implications, we will take a closer look at its driving forces, from a position within the social sciences. Results. The development of new technology may easily be perceived as following the laws of nature, leading to a predetermined...
Article
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Background. Once created, new medical technology almost demands to be used. Still, numerous economic and ethical issues limit its use and expansion. Hence, someone has to decide whether, when and how new technology ought to be used, and under what conditions. Material and methods. In this article, the ethical issues underlying these decisions are d...
Article
Many countries are currently reorganizing their health services in response to cultural, economic, and technological changes. Because the changes are global, different countries are drawn toward similar reform programs. But countries' cultural, economic, and political differences also may lead to divergent responses. This article examines the conve...
Book
Forskere arbeider for tiden med å finne ut hva som skjer i kroppen når vi forelsker oss. Målet er å framstille en pille mot forelskelse, som visstnok skal være beregnet på gifte menn. Dette er ett av mange eksempler på hvordan medisinens ansvarsområde utvides og infiltrerer stadig flere av våre livsområder. Et resultat av denne medikaliseringen er...
Article
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Bakgrunn. Ny medisinsk teknologi kan oppfattes som at den bærer i seg et krav om at den b¢r tas i bruk når den f¢rst er der. Det er imidlertid en rekke ¢konomiske og etiske faktorer som legger, og som b¢r legge, sterke begrensninger både på anvendelse og utbredelse. Dermed er det noen som må avgj¢re om, når og hvordan den skal tas i bruk. Materiale...
Article
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Bakgrunn. Ettersp¢rselen etter ny medisinsk teknologi er ¢kende. For å forstå den voksende ettersp¢rselen og implikasjonene av den, ser vi nærmere på drivkreftene bak ettersp¢rselen etter ny teknologi. Materiale og metode. Drivkreftene bak ettersp¢rselen etter ny medisinsk teknologi belyses ut fra en samfunnsvitenskapelig synsvinkel. Resultater. Te...
Article
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Different ways of organising and funding health services are based on certain assumptions about social action. Choice of theories affects the definition of the situation, policy content, goal fulfilment, as well as unintended effects. Here we discuss the role of the physician. How is it to be understood, and what implications do different theories...
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Bakgrunn. Ulike måter å styre, organisere og finansiere helsetjenestene på bygger på utematiserte forutsetninger om hva som motiverer akt¢rene i dette systemet til å handle slik de gj¢r. Valg av akt¢rmodell påvirker situasjonsdefinisjon og politikkutforming og kan være avgj¢rende for i hvilken grad tiltakene virker etter sin hensikt og hvilke utils...
Article
Which patients should be treated, and who should be treated first? In this paper, the attitudes of health professionals towards setting priorities are examined through an analysis of interview and questionnaire data answered by senior physicians and senior nurses in Norwegian hospitals. The data indicate that patients’ needs remain the most importa...
Article
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E�tterspørselen e�er helsetjenester øker raskt, langt raskere enn hva som synes mulig å tilby innenfor et offentlig finansiert helsevesen. Men e�tterspørsel er ikke nødvendigvis et u�rykk for legitime behov med krav på ytelser fra fellesskapet. Helsetjenestens utvikling aktualiserer en videre gjennomdrøfting av ”behov”. Hva er behov? Er det noe vi...
Article
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Etterspørselen etter helsetjenester øker raskt, langt raskere enn hva som synes mulig å tilby innenfor et offentlig finansiert helsevesen. Men etterspørsel er ikke nødvendigvis et uttrykk for legitime behov med krav på ytelser fra fellesskapet. Helsetjenestens utvikling aktualiserer en videre gjennomdrøfting av "behov". Hva er behov? Er det noe vi...
Article
The traditional autonomy of the health professions is being eroded by external bureaucratic regulations of health care services, implemented to control costs and secure equitable access to services. This is an international trend. The guaranteed maximum waiting time in Norway is an example of such regulations. Introduced in 1990 and revised in 1997...
Chapter
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Projects

Projects (8)
Project
Doctor-patient interaction is enmeshed in – and inseparable from – its cultural context. Although our empirical exploration focuses on consultations between patients and doctors as they unfold in naturally occurring clinical consultations, we situate their interaction in the cultural context in which it is embedded. Exploring their actions in relation to their institutionalized positions and roles illuminates how structural forces shape tacitly claimed rules of conduct for both parties. How are these constraints played out in the consultation room, and how do they influence on their interaction? These are some of the questions we ask. Our empirical data are sourced from the One in a Million: Primary care consultations archive, UK.
Project
To explore how patients and general practitioners negotiate medical uncertainties in naturally occurring clinical consultations performed in five different UK clinics. The study is based on a thematic and narrative analysis of verbatim transcripts and film-recordings of complete consultations, supported by pre-and post-consultation surveys, demographic data, practice and GP data and patient records. The research is conducted by an international and interdisciplinary research. Main international collaborators: professor Sarah Nettleton (University of York) and professor Christopher Dowrick (University of Liverpool).
Project
The gender perspective is an integral part of the sociological perspective on health and illness in the sense that gender is a cultural category. A gender perspective takes gender-based differences into account when looking at health and illness as a sociocultural phenomenon. This is particularly relevant in the case of contested chronic conditions because of the high proportion of women diagnosed (for many conditions, for instance myalgic encephalomyelitis, fibromyalgia, non-epileptic seizures and electromagnetic hypersensitivity, the gender-ratio is between 1 to 3 and 1 to 4). Also, the contestation itself might be gender-related. The gendered connotations of these ailments are likely to have an impact on the ways in which both patients and health professionals perceive and respond to uncertainties that cannot be eliminated through scientific biomedical knowledge and technology. The stereotyped representative of contested chronic conditions is a middle-aged woman, sometimes described as “middle- or upper class, well-educated, previously successful, and often perfectionistic women” (Hart & Grace 2000:189). To reveal the cultural and historical contingency of medical constructions of medically unexplained illnesses, we must contextualise them. In this project, cultural influences on these constructions are explored on the basis of gendered perspectives on health and illness.