Evaluating a pilot community stroke service using insights from medical anthropology

This paper focuses on the evaluation of a pilot community stroke service. Its aim is to illustrate how the insights gained from the research of two medical anthropologists, Kaufman and Pinder, provided an understanding of the experience of chronic illness in the community. Two linked themes identified in the literature, which also emerged from the exploratory phase of the evaluation, are discussed: the tension between the patient's goal of recovery and the professional's goal of rehabilitation; and the management of uncertainty. It is argued that it may be very difficult, if not impossible, to reconcile these divergent goals of recovery and rehabilitation, and that this problem is exacerbated for patients and professionals alike by the challenge of how to manage the uncertainty of a chronic illness such as stroke. The empirical findings of the first phase evaluation corroborate Kaufman and Pinder's findings. Furthermore, the present research suggests that the mismatch between the goals of recovery and rehabilitation, and the management of uncertainty are integrally related. The implications for practice are that there is a need for professionals to find ways of recognizing and taking account of the possible tensions between their goals and those of patients and families, and related to this, for the development of strategies which enable professionals to explain clearly the nature of stroke to patients and their carers.