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Accounting and Washing

Good Care in Long-Term Psychiatry

Amsterdam Medical Centre, University of Amsterdam

This article analyzes how the recent call for accounting in health care interferes with daily care practice and raises the question of how accounting practices relate to the aim of good care. The most influential accounting methods in the Netherlands suggest ways for professionals to legitimize their activities. The analysis of washing patients in long-term mental health care shows that different styles of accounting evaluate and legitimize care while structuring notions of what good care is. A specific style of accounting enforces certain values but does not tell about the tragic or unexpected effects that come with it, nor does it provide a repertoire to deal with these. Thus, care practices incorporating specific styles of accounting remain dependent on forms of care that are not accountable or ask for new forms of reflexivity.

Key Words: accounting • justification • good care • ethnography • evidence-based medicine • ethics • long-term mental health care

Science, Technology & Human Values, Vol. 31, No. 4, 409-430 (2006)
DOI: 10.1177/0162243906287544


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