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Introduction: The COVID-19 pandemic was a tremendous challenge to the practice of modern medicine. In this study, we use neo-institutional theory to gain an in-depth understanding of how physicians in Sweden narrate how they position themselves as physicians when practicing modern medicine during the first wave of the pandemic. At focus is medical logic, which integrates rules and routines based on medical evidence, practical experience, and patient perspectives in clinical decision-making.

Methods: To understand how physicians construct their versions of the pandemic and how it impacted the medical logic in which they practice, we analyzed the interviews from 28 physicians in Sweden by discursive psychology.

Results: The interpretative repertoires showed how COVID-19 created an experience of knowledge vacuum in medical logic and how physicians dealt with clinical patient dilemmas. They had to find unorthodox ways to rebuild a sense of medical evidence while still being responsible for clinical decision-making for patients with critical care needs.

Discussion: In the knowledge vacuum occurring during the first wave of COVID-19, physicians could not use their common medical knowledge nor rely on published evidence or their clinical judgment. They were thus challenged in their norm of being the “good doctor”. One practical implication of this research is that it provides a rich empirical account where physicians are allowed to mirror, make sense, and normalize their own individual and sometimes painful struggle to uphold the professional role and related medical responsibility in the early phases of the COVID-19 pandemic. It will be important to follow how the tremendous challenge of COVID-19 to medical logic plays out over time in the community of physicians. There are many dimensions to study, with sick leave, burnout, and attrition being some interesting areas.

The aim of this paper is to analyse how Swedish grade three children are discursively positioned as pupils when they are taking national tests in mathematics and when they reflect on the testing situation afterwards. With support from theories about affective-discursive assemblages, we explore children's body language, emotions, and talk in light of the two overarching discourses that we believe frame the classroom: the 'testing discourse' and the 'development discourse'. Through the disciplinary power of these main discourses children struggle to conduct themselves in order to become recognized as intelligible subjects and 'ideal pupils'. The analysis, when taking into account how affects and discourses intertwine, shows that children can be in 'untroubled', 'troubled', or ambivalent subject positions.

I denna artikel diskuterar vi vad som avses med begreppet humanjuridik, dess innehåll och avgränsning och hur det i övrigt kan förstås. Syftet är att utveckla en teoretisk ram kring begreppet. Vår slutsats är att humanjuridiken inte betecknar något nytt rättsområde i traditionell mening, utan att det används som ett samlingsbegrepp för ett antal, inte enhetligt angivna, rättsområden som kännetecknas av en särskild problematik och som därför anses kräva annan kunskap än den strikt juridiska. Att jurister är i behov av annan kunskap än enbart juridisk sådan är en uppfattning som humanjuridiken delar med andra rättsfilosofiska strömningar. I den meningen representerar humanjuridiken inte heller någon ny kunskap. De perspektiv som dessa strömningar representerar kan ses som en reaktion på förändringar i samhället men väcker frågor om rättssäkerheten stärks eller försvagas genom dessa perspektiv, om vilken annan kompetens jurister behöver och om juristrollen i relation till andra professionsgrupper.

In Sweden, the government has invested considerable resources to implement victim offender mediation (VOM) for young people (under the age of 21). Despite this, the number of mediations is decreasing. What appears to be a gap between the legislator’s intentions and practical applications raises questions about the reasons for this gap and the premises for mediation in penal matters in Sweden today. Our purpose in this article is to highlight and discuss some circumstances that can explain this decrease and the future of VOM in Sweden. We start by discussing the development of VOM in Sweden and continue by analysing possible reasons for why mediation is declining. The conclusion is that the decrease can be explained by problems related to legal and organisational structures as well as mediation practice. The conclusion is also that if the state and municipalities do not show more interest in VOM and restorative justice, then this activity will probably disappear.

Independent experts serve a vital role in how the human rights of patients are protected in mental health law. This article investigates the contribution of court-appointed psychiatrists (APs) in civil commitment court hearings. Analysis is based on 12 court hearings that were audiotaped. Supplementary informal interviews with participants were also conducted. Data were analysed through a combination of rhetoric analysis and discourse analysis. Analysis of the hearings reveals that APs do not fulfil their function to critically investigate treating psychiatrists’ (CPs) recommendations that patients meet commitment criteria. They typically do not ask any questions from CPs, and the few questions that are asked do not cast light on the legal issues at stake. To further understand the role of APs, their communication has been analyzed in terms of four interpretative repertoires: collegial, disclosing, therapeutic and mediating. In conclusion, the human rights of patients subjected to involuntary commitment might be at risk when therapeutic concerns are built into the process. The specific Swedish model where APs deliver their own assessment about whether commitment criteria are met may be counterproductive. This argument possibly extends to the role of medical members in mental health tribunals in the United Kingdom, Australia and New Zealand.

The alcohol consumption of female rape victims is often discussed during rape trials. This has been regarded as an emblematic example of victim blaming and the failures of the legal system in relation to rape. From a feminist perspective it can be seen as an expression of the structural subordination of women in society in general.

This article investigates the meanings attached to alcohol in written court decisions in Swedish rape trials (2008-2012). Rape trials are contrasted with assault trials, where the complainants are men. Thirty court decisions from each type of trial are compared, with the same number of guilty and not-guilty verdicts.

Quantitative analysis reveals that alcohol consumption is mentioned more often in rape trials, where it also appears more relevant to decision-making. The complainants' consumption is mentioned four times more often than the defendants' consumption. In assault decisions, the mentioning of alcohol consumption is distributed roughly equally between the parties.  

The analysis shows how a large proportion of the alcohol references in both rape trials and assault trials can be regarded as largely irrelevant noise. The remaining alcohol references are understood in terms of five interpretative repertoires: 1) the accuracy of memory on part of witnesses; 2) explanations of seemingly irrational behaviors; 3) vulnerability, 4) getting the victim drunk, and 5) moral character. The latter three interpretive repertoires are more common in rape decisions. As a conclusion, part of the preoccupation with rape victims’ alcohol consumption can be attributed to protectionary strategies, and should thus not be regarded as victim-blaming. However, some assessments appear to build on assumptions that information about alcohol consumption is indicative to moral character that is relevant to court decisions. 

Hur våldtäktsmål och våldtäktsoffer hanteras är en ständigt aktuell fråga, som nyligen föranledde ytterligare en statlig offentlig utredning (SOU 2016:60). I denna artikel har Maritha Jacobsson och Stefan Sjöström undersökt hur alkohol relateras till i våldtäktsdomar, och jämfört detta med misshandelsdomar. De konstaterar att alkoholkonsumtion ibland kan hjälpa till att få en fällande dom, medan det i andra fall blir till en nackdel för den målsägande.

BACKGROUND: There is widespread consensus on the importance of safe and secure communication in healthcare, especially in trauma care where time is a limiting factor. Although non-verbal communication has an impact on communication between individuals, there is only limited knowledge of how trauma team leaders communicate. The purpose of this study was to investigate how trauma team members are positioned in the emergency room, and how leaders communicate in terms of gaze direction, vocal nuances, and gestures during trauma team training.

METHODS: Eighteen trauma teams were audio and video recorded during trauma team training in the emergency department of a hospital in northern Sweden. Quantitative content analysis was used to categorize the team members' positions and the leaders' non-verbal communication: gaze direction, vocal nuances, and gestures. The quantitative data were interpreted in relation to the specific context. Time sequences of the leaders' gaze direction, speech time, and gestures were identified separately and registered as time (seconds) and proportions (%) of the total training time.

RESULTS: The team leaders who gained control over the most important area in the emergency room, the "inner circle", positioned themselves as heads over the team, using gaze direction, gestures, vocal nuances, and verbal commands that solidified their verbal message. Changes in position required both attention and collaboration. Leaders who spoke in a hesitant voice, or were silent, expressed ambiguity in their non-verbal communication: and other team members took over the leader's tasks.

DISCUSSION:

In teams where the leader had control over the inner circle, the members seemed to have an awareness of each other's roles and tasks, knowing when in time and where in space these tasks needed to be executed. Deviations in the leaders' communication increased the ambiguity in the communication, which had consequences for the teamwork. Communication cannot be taken for granted; it needs to be practiced regularly just as technical skills need to be trained. Simulation training provides healthcare professionals the opportunity to put both verbal and non-verbal communication in focus, in order to improve patient safety.

CONCLUSIONS: Non-verbal communication plays a decisive role in the interaction between the trauma team members, and so both verbal and non-verbal communication should be in focus in trauma team training. This is even more important for inexperienced leaders, since vague non-verbal communication reinforces ambiguity and can lead to errors.

OBJECTIVES: To investigate the association between the time taken to make a decision to go to surgery and gender, ethnicity, years in profession, experience of trauma team training, experience of structured trauma courses and trauma in the trauma team, as well as use of closed-loop communication and leadership styles during trauma team training.

DESIGN: In situ trauma team training. The patient simulator was preprogrammed to represent a severely injured patient (injury severity score: 25) suffering from hypovolemia due to external trauma.

SETTING: An emergency room in an urban Scandinavian level one trauma centre.

PARTICIPANTS: A total of 96 participants were divided into 16 trauma teams. Each team consisted of six team members: one surgeon/emergency physician (designated team leader), one anaesthesiologist, one registered nurse anaesthetist, one registered nurse from the emergency department, one enrolled nurse from the emergency department and one enrolled nurse from the operating theatre.

PRIMARY OUTCOME: HRs with CIs (95% CI) for the time taken to make a decision to go to surgery was computed from a Cox proportional hazards model.

RESULTS: Three variables remained significant in the final model. Closed-loop communication initiated by the team leader increased the chance of a decision to go to surgery (HR: 3.88; CI 1.02 to 14.69). Only 8 of the 16 teams made the decision to go to surgery within the timeframe of the trauma team training. Conversely, call-outs and closed-loop communication initiated by the team members significantly decreased the chance of a decision to go to surgery, (HR: 0.82; CI 0.71 to 0.96, and HR: 0.23; CI 0.08 to 0.71, respectively).

CONCLUSIONS: Closed-loop communication initiated by the leader appears to be beneficial for teamwork. In contrast, a high number of call-outs and closed-loop communication initiated by team members might lead to a communication overload.