更年期婦女之骨質疏鬆篩檢政策－－風險與規訓

Osteoporosis Screening Policy for Menopausal Women: Risk and Discipline

以更年期婦女為目標而積極推展的社區骨質疏鬆篩檢，是公共衛生護理人員重要工作項目。本文討論骨質篩檢成為正常化技術（technology of normalization），規訓（discipline）更年期婦女執行合乎常態（norms）如避免骨質流失的行為。並分析骨質篩檢政策之推展創造了更年期婦女骨質疏鬆疾病身體之知識。現代社會規訓權力之展現基於預防論述鼓吹的健康意識，在新自由主義強調個人自主與決定權的推波助瀾之下，台灣更年期婦女實踐自我監控（self-surveillance），配合廠商推廣可信度存疑之定量超音波儀，踴躍參與政府衛生單位主導之社區複合式篩檢，更年期婦女進一步改變日常生活型態包括飲食、運動、生活作息、甚至穿著，預防骨質流失及避免造成醫療資源耗損之骨折發生。臨床上護理人員應深刻反省，聆聽婦女篩檢經驗及討論篩檢結果之意義。並轉換個人管理為環境改造，避免跌倒及骨折。

The community-based osteoporosis screening program for menopausal women is an important service provided by community health nurses. This paper discusses how normalization technologies such as bone density screening help to discipline menopausal women conformed to normative behavior as to reduce bone loss risk. An analysis of osteoporosis screening policies found that mass surveillance technology perpetuates the knowledge of diseased menopausal body with osteoporosis. In addition, voluntary practices of self-surveillance represent the governmental strategy of disciplinary power by which menopausal women are monitored in the framework of neo-liberalism emphasizing individual choice and freedom. Although unreliable, the Quantitative Ultrasound promoted by pharmaceutical companies has been participated eagerly by women in community osteoporosis screening activities. Self-surveillance measures further involve modifications in lifestyle (e.g., diet, exercise, daily activity, garments) to prevent bone loss and to lessen the risks of facing costly medical care bills. This paper suggests that health care professionals pay greater attention to menopausal women's opinions about their screening experiences and to the results of discussions on screening results. Better assessing screening policies should help facilitate a transformation in policy focus from self regulation to environmental modification.