Marina Smolevitskaya
email: msmolevitskaya@yandex.ru

Keywords: Polytechnic Museum, collection, electronic digital computing machines, documents, pictures, papers computer technology founders, Russian scientists

niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.

Introduction

During the long years of its existence the Polytechnic Museum tries to limelight events and people which many generations are obliged. One of the most important areas of the museum activity is the restoration in memory of the wider community the contribution of Russian engineers and scientists. The museum has implemented the project "History of Russian engineering thought", including research, exposition, collection and educational activities. One of the goals of this project is to create a database about the heritage of outstanding Russian scientists. Research results are reflected in a series of publications "Problems of cultural heritage in the field of engineering." In accordance with this project, the museum hosts exhibitions and events devoted to outstanding creators of science and technology that helps maintain a high level of public recognition of our scientists and engineers.

In the Polytechnic Museum more than 20 years the scientific exposition Information Technology Department collected exhibits related to the biography, scientific and professional activities creators of computer technology in the Soviet Union and Russia. We opened 13 personal documentary funds on "Domestic science and engineering schools in the field of Computing and Informatics," which includes more than 800 authentic merchandise, documentaries, printed and graphic materials. The Polytechnic museum holds documentary funds academician S.A. Lebedev, academician V.M. Glushkov, corresponding member of the USSR Academy of Sciences I.S. Brook, his disciples -M.A. Kartsev and N.Ya. Matyuhin, talented creators B.I. Rameev and Yu.Ya. Bazilevskiyi, the developer of the only ternary computer in the world N.P. Brusentsov, mathematician S.N. Mergelyan, Director of the Moscow factory accounting machines V.S. Petrov, founders of the national school of cybernetics A.A. Lyapunov and V.A. Kitov, academician V.S.Burtsev. All of them have made an invaluable contribution to the domestic computers park and the further development of the domestic computing.

The personal documentary funds stored in the Polytechnic Museum are presented amply in the collection of articles "Problems of cultural heritage in the field of engineering". This article describes only the four personal documentary funds: S.A. Lebedev, V.S. Burtsev I.S. Brook and M.A. Kartsev. In the future, the author expects to perform a description of all personal funds of the founders of the domestic computing.

Sergey Lebedev (1902 -1974)

Academician Sergey Lebedev -an outstanding scientist in electrical and power engineering and founder of the domestic computing [START_REF] Alekseevich | To the 100 anniversary from the birthday of the founder of the national computer technology / Burtsev V. (Responsible Editor), FIZMATLIT, Moscow[END_REF].

The name of Lebedev related major events in the history of national computing:

 creation of the first national computers with stored program -Small Electronic Calculating Machine (SECM, in Russian -MESM) in 1951 and in 1953 -Large and in the future High-speed Electronic Calculating Machine (HsECM, in Russian -BESM);  development of serial first-generation computer M -20 and then the secondgeneration computers, software-compatible with the M-20 ( 1958 , 1968);  creation of high-performance general-purpose computer BESM-6 with a capacity of 1 million operations per second, a record in the second half of the 60s to the computer park of the USSR and Europe (1966);  issue powerful computer systems for the missile defense system (since 1956);  organization of the engineering development school of universal high-performance machinessupercomputers.

Lebedev's personal fund № 44 was created and updated through the cooperation of the museum with his daughter Natalia Lebedeva. Currently the fund has 44 storage units. These are Lebedev's manuscripts, rough drafts in notebooks and notepads, inventors' certificates, scientific works in electrical engineering, electric power and computer technology, photos of this scientist alongside his computers, photos from family albums.

The Polytechnic Museum has a number of documents related to the biography of Sergei Lebedev and his professional activities. There are handwritten memories of his sister famous artist Tatyana Mavrina, a decision to impose Lebedev Director of The Institute of Precision Mechanics and Computer Technology (IPM CT) of USSR Academia of Science and the ruling on his election as a academician in 1953, business cards, letters with colleagues. The museum store personal items belonging to Lebedev, and even has a bookshelf made him.

The name of Lebedev was awarded The Institute of Precision Mechanics and Computer Technology, which has a small museum.

Since 1994 Department of Informatics, Computer Science and Automation of Russian Academy of Sciences annually awards a prize named after Lebedev for the best work in the development of computing systems.

The international scientific community in the face of IEEE Computer Society recognized the merits Lebedev in 1996, giving him the title «Computer Pioneer».

In the same year Victor Glushkov and Alexei Lyapunov have got this title too. Lebedev followers created their own scientific schools and groups.

Vsevolod Burtsev (1927 -2005)

Academician Vsevolod Burcev was one of the Lebedev's disciples. Before graduating from the Moscow Energy Institute Bourtsev began his scientific and engineering activity under the guidance of S. Lebedev in IPM and CT [START_REF] Burtsev | Parallelism of Computational Processes and Development of Supercomputing Architecture / Torchigin[END_REF]. Already at the stage of graduate design V.Burtsev became one of the leading developers of domestic electronic computing machines.

In 1952-1955 the result of joint work with the staff of Radio Research Institute was the creation of two specialized computer "Diana-1" and "Diana-2" for the automatic removal of data from radar and automatic tracking of air targets. Being responsible executor, V.Burtsev proposed the principle of selection and digitization of the radar signal. Based on this principle removal of target data from radar and putting them into the computer were done, an experiment for simultaneous tracking of multiple targets computing machine was successfully conducted. Further development of this work was the creation of a series of computers designed for ballistic missile defense (BMD).

The creators of the first missile defense system G.Kisunko, S.Lebedev and V.Burtsev received the Lenin Prize. The Notice of the Committee on Lenin Prizes in science and technology, which is also stored in the museum, evidenced.

Multicomputer complex of MDS (the eight machines 5E92b with automatic backup) has been tested in a real work in 1967. Later serial machines 5E92b became the basis of the country's missile defense system, ensured parity with the U.S. in the "cold war" and played an important political role in the conclusion of agreement to limit missile defense in 1972.

Thru selfless work V.Burtsev got the full confidence of academician Lebedev and became his assistant in creation of a reliable high-performance control and information systems for anti-missile and space monitoring centers.

In 1969-1972 V.Burtsev, as chief designer, created the first onboard computer of the third generation for ammunition combat anti-missile system C-300. Now these computers are on alert and are sold to other countries.

When S.Lebedev died, V.Burtsev was appointed director IPMCT. Continuing the work of his teacher, Bourtsev put a lot of effort to create a family of super-computers "Elbrus" and further development works in the field of missile defense.

In 1973-1985 Vsevolod Bourtsev led the development of multiprocessor computing systems "Elbrus-1", "Elbrus-2", as the chief designer. The fundamental construction questions of universal processors with marginal productivity were resolved when creating complex "Elbrus".

In 1986-1993 the architecture of supercomputers based on the new, not the von Neumann principle, providing parallelized computational process at the hardware level was developed under the leadership V.Burtsev. This architecture uses the principles of optical data processing, has highly regular structure and achieves performance 10 10 -10 12 op/s. The principal feature of the proposed architecture is automatic dynamic allocation of computing resources between the individual processes.

In 1992 V.S. Bourtsev was elected a member of the RAS in the Department of Informatics, Computing and Automation (specialty "Computing and Electronic Components").

Until his death (14.06.2005) academician V.Burtsev was the supervisor of fundamental research on the development of various unconventional architectural solutions HPC machines using new physical principles, as well as the system software to create data-processing systems at peak performance 10 12 -10 14 op/s.

The fund of academician Vsevolod Burcev was formed by his wife Tamara Burtseva. This fund № 42 is one of the most rewarding interesting evidence of scientific thought and evidence of the practical implementation of his ideas in the domestic computers, which function reliably now.

Burtsev's documentary fund has over 70 storage units. There are manuscripts (rough notes in notebooks and notepads) diploma project dedicated random access memory of the famous BESM, inventors' certificates, the photos of scientist at work, the publishing of his scientific works.

The Polytechnic Museum has a number of documents related to the Burcev's biography and his professional activities. There are a brief autobiography, characterization of production and social activities, dated November 17, 1976, schedule debugging MVK "Elbrus-2", documents related to the preparation of receiving the title of academician of the Russian Academy of Sciences, correspondence and personal items belonging to V.Burtsev.

Bourtsev, like some of the other students of Moscow Energy Institute, participated in the preparation of preliminary design documentation of BESM. This material formed the basis of his diploma project, also stored in the documentary fund.

The materials associated with the creation of two specialized computer "Diana-1" and "Diana-2" and a series of computers designed for ballistic missile defense (BMD) are an extremely important part of the personal documentary fund of V.Burtsev in the Polytechnic Museum. «With our sites Rockets go flying start» -so Chief Designer missile defense system (MDS) Georgiyi Kisunko wrote in the book of his poems, donated Burtsev and now also stored in the documentary fund. This book complements the pencil drawing of a polygon with a launcher made G.Kisunko.

Many of the documents of his personal fund are evidenced by the creation of the family of super-computers "Elbrus".

The works of V.Burtsev dedicated parallelism of computational processes and the development of supercomputer architecture, including multiprocessor computing system "Elbrus" were included in section of fund publications.

Vsevolod Sergeevich Bourtsev awarded the Lenin and State prizes, awarded many orders and medals. He was awarded the Lebedev's prize of the Russian Science Academy for his series of works "Theory and practice of high-performance multiprocessor computers".

Isaak Bruk (1902 -1974)

Biography of I.Brook is known from the memoirs of his sister, Mira Brook, the reports and the papers of his colleagues and disciples (Yu.Rogachev, N.Prohorov, A.Zalkind), thier manuscripts and typescripts are stored in the museum.

The museum fund № 213 of corresponding member of the USSR Academy of Sciences I.S. Brook is not the most extensive and there are 45 items of documentary and pictorial materials. Besides the documents related to the creation of electronic computers in our country, it contains not less interesting materials Brook's work in the field of electricity and mechanical devices for the solution of differential and integral equations.

The very interesting photo of Brook on the background of his mechanical integrator, which he had built in 1939, is in his personal fund besides his wonderful portraits and others pictures. Integrator allowed to solve differential equations of order 6.

The articles of I.Brook "The mechanical device for the approximate solution of differential equations of Laplace-Poisson" (1946), "The unexcited turbo generator asynchronously" (1947) and others, stored in the museum fund, demonstrate his works in the field of electrical engineering and the development of new computing devices.

Prior to digital technology I.Brook engaged in the development of analog computers [START_REF] Malinovskiy | История вычислительной техники в лицах. Киев: фирма «КИТ[END_REF]. In August 1948, together with a young engineer B.Rameev, he presented a project of automatic electronic computer. A little later, the State Committee of the USSR Council of Ministers on the implementation of advanced technology in the national economy gave I.Brook and B.Rameev Copyright Certificate for number 10475 for the invention of the digital computer with a priority date of December 4, 1948, which is also stored in the Polytechnic Museum. This is the first official document concerning the development of computer technology in the USSR. Professionals in the field of computing technology were not in our country, and I.Brook hired graduates and undergraduates N.Matyuhin, T.Aleksandridi, M.Kartsev. All of them became prominent scientists, computing designers. Isaak Brook photographed surrounded by his colleagues and students on one of the photos stored in his museum fund.

In April 1950 the decree of the Presidium of the USSR Academy of Sciences was issued on the development of electronic digital computing machine M-1 in Electrical laboratory, headed I.Brook, of Energy Institute of the USSR Academy in Moscow. December 15, 1951 Director of the Energy Institute of the USSR Academy G.Krzhizhanovskiyi puts his signature on the statement of completion of the establishment of the automatic computer M-1.

Automatic computer M-1 was the first in Russia small digital electronic computer with stored program. The script report for work "Automatic digital computer [M-1]" is stored in personal Brook's fund.

In April 1952 Brook launches new project: designing computer M-2. Nuclear research calculations for Atomic Energy Institute, calculations on the strength of dams constructing Kuibyshev's and Volga's hydroelectric power plants, calculations of thermodynamic and gas dynamic parameters of air for problems related to the launch of missiles were done on this machine.

Almost simultaneously with the construction of the M-2 I.Brook began development of the machine M-3. Based on it, the computer was started in Armenia, Belarus, Hungary and China. The books and the articles on these machines are presented in the Brook's fund.

I.Brook formulated possibilities and principles of controlling machines; their differences from mainframes and put immediate tasks of their application in automatic control in his articles of 1955-1957's.

In 1956 I.Brook made the presentation, which outlined the main directions of industrial applications of computers, at the session of the USSR Academy of Sciences. Two years later the note "Development of the theory, principles of construction and use of specialized and control machines" was prepared under his guidance. These documents were the impetus for the formation a number of research organizations and design offices to control machines and systems in the Soviet Union. In particular, the Institute of Electronic Control Machines of the USSR Academy of Sciences was created. The first director was appointed I.Brook .

The several major events in the history of domestic computer technology related to the name I.Brook: development the first national automatic digital computer with a stored program M1 in 1951; conception of small computers for massive engineering and scientific calculations in research institutes and design offices, alternative to the concept of highperformance super-computers; formulation of a scientific problem "Development of the theory, principles of construction and use of specialized and control machines"; creation of the Engineering School of development and application control machines.

Pioneering works of I.Brook had the strongest influence on the development of computer technology in our country in the 40-60s of the last century.

I.Brook published more than 100 scientific papers. Scientist I.Brook had the talent of the inventor and the experimenter. He received more than 50 invention certificates, 16 of them in the last 5 years of life, when he was already at an advanced age.

The followers and the colleagues I.Brook (B.Rameev, N.Matyuhin, M.Kartsev, G.Lopato, B.Naumov), continuing the tradition of his school, have created themselves teams and scientific schools, played a significant role in the development of domestic computing. Also the Institute of Electronic Control Machines continues the tradition of the school I.Brook. Since 2008 it bears his name.

Mikhail Kartsev (1923 -1983)

Michael Kartsev, one of the disciples of I.Brook, was born on May 10, 1923 in teachers' family in Kiev [START_REF] Malinovskiy | История вычислительной техники в лицах. Киев: фирма «КИТ[END_REF][START_REF] Aleksandrovich | TECHNOSFERA, Moscow (2013) Михаил Александрович Карцев. Созидатели отечественной электроники[END_REF]. All the Great Patriotic War he fought on the tank and participated in the liberation of Romania, Hungary, Czechoslovakia and Austria. This is evidenced by photos of M.Kartsev in those years, Diploma "Participant of fights for liberation from Nazi invaders ..." and the other fund documents.

After demobilization in 1947 M.Kartsev began to study on the radio department of the Moscow Power Engineering Institute. Being a fifth year student, he began to work in Energy Institute of the USSR Academia of Sciences in the laboratory of electrical systems headed I.Bruk. In this laboratory one of the first Soviet computers -M-1 was created. I.Bruk entrusted development of machine control device -the main program sensor to M.Kartsev.

In 1952, already qualified engineer Kartsev headed the design team of the computer M-2. Works on its creation were conducted as soon as possible from April to December 1952. The photos of the young engineer Mikhail Kartsev are stored in the personal fund of this scientist.

In 1957 M.Kartsev began to work in creating of the computer equipment, focused on the use of early warning systems and missile attack space surveillance. At that time it was the most difficult tasks of the amount of information to be processed, according to the requirements of computing speed, memory and hardware reliability.

In 1958, the special laboratory under the guidance of M.Kartsev was established in the Institute of Electronic Control Machines. It was intended to create the computer M-4 for control and data processing radar space surveillance. M-4 marked a new milestone in the activities M.Kartsev as the chief designer.

M-4 was one of the first computers built by transistors. The RAM cube of M-4 is stored in the museum's collection, photographs of racks with power supply and control panel of the M-4, link rack of Computer M-4 with radar are presented in the personal fund of M.Kartsev. Peripheral processors for parallel computing and eliminate contradictions between the CPU and external devices have been introduced in the M-4 for the first time.

In 1962 the M-4 passed state tests as part of the experimental complex radar and was proposed for serial production.

Original handwriting of Kartsev as the original computer architect clearly manifested in this development. The arithmetic unit was conveying. Operation of results obtain with high (double) precision ensured that extends the use of the computer at various levels of the computer system.

Modified with advanced transistors, this machine was produced serially and called M4-2M. It has performed 220,000 operations per second with high reliability (its mean time to failure was 800-1,000 hours) and was mainly used for the system of missile warning.

M4-2M computer in many of their characteristics was at the world's best computer technology of the time. Designed in 1965-1966 on the same elements of external de-vices and external computer M4-3M allowed to combine together dozens of computers M4-2M in a single computer network. The photos of M4-2M, its block diagram are stored in personal fund of Kartsev.

The computing complexes built on the base of M4-2M, provided round the clock operation mode of combat duty. They performed radar information processing securely at all levels of prevention, to ensure the military and political leadership of the country with reliable information about the situation in space.Manufacture of computers M4-2M lasted until 1985, and use -to mid-1990s. Several examples of these computers are in operation at the present moment.

The results of research conducted during the creation of this series formed the basis of M.Kartsev's doctoral dissertation, which he defended in 1965. The USSR State Prize was awarded to him in 1967 for the introduction of M4-2M computers and computer systems in the missile attack warning.

1967 turned out to be significant for Kartsev. Research Institute for Computing Systems was founded on the basis of the development team headed by him of this computer system, and he was appointed director of this institute.

Since 1965 M.Kartsev focused his creative work on the theoretical studies have been aimed at the search for opportunities to improve performance computing facilities. A multiprocessor computer system structure, which can provide simultaneous (parallel) solution of problems of the parts, has a real opportunity to get higher performance at the same level components.

Kartsev showed four kinds of parallelism and defined for each type of possible hardware implementation. Especially large tasks, that usually require high performance computing facilities, have generally a greater or lesser extent all kinds of parallelism. Therefore, multiprocessor computer systems are the most versatile way to create computer systems with the best possible performance. Kartsev's manuscripts and publications of his works kept in the museum indicate to this.

In March 1967 M.Kartsev made the presentation at the symposium in the Siberian Branch of the Academy of Sciences in Novosibirsk, which recounted not only ideas but also many technical solutions for creating a computer system with a capacity of one billion operations per second. It was a bold statement for the time: computers with a capacity of one million operations have not created but here the application sounded a billion! But the depth of study, specific schemes and their interaction convinced of the reality of this complex.

The final stage of Kartsev research questions of multiprocessor computer systems building has been a functional study of the structure of multicomputer complex M-9, submitted to the expert committee in the summer of 1967. Low level of integration of electronic circuits mastered the electronics industry at the time, did not allow realizing this project to life.

Only in 1969, the institute under the leadership of Kartsev could begin to develop one part of the M-9 -vector multiprocessor computer M-10 on the basis of emerging chip (Series 217), and an experimental model was made in August 1971. Such rates of development have influenced on the health of chief designer -a massive heart attack put him to bed a few months. But, fortunately, everything ended well.

In September 1973, the first industrial prototype passed a comprehensive review successfully, and production began in December of the same year and continued until the end of the 80s. M-10 is a synchronous multiprocessor system with an average capacity of 5 million operations per second and an internal memory of 5 MB. It had the ability to carry out parallel processing of data in various formats, to dynamically change the clustering of processors to match the data format.

In 1977 the USSR State Prize was awarded to the team of developers of M-10 and Kartsev was awarded the Order of Lenin.

In 1976-1977, when the domestic electronics industry had mastered the production of integrated circuits, new, more compact memory devices for M-10 have been developed. This allowed more than halve the amount of equipment, size and power consumption of the computer, while maintaining all of its specifications. Machine with the new memory devices called M-10M. Both machines were completely interchangeable and compatible software.

The several units of the M-10 and M-10M components are in museum collection: standard logic block, RAM on ferrite cores, permanent memory unit condenser type on metal punch cards, permanent memory unit of the M-10M on magnetic core with diametric holes and others. The photos of computing complex from 3 M-10 computers, the pictures of the several units of the M-10 are stored in the Kartsev personal fund.

Parallel architecture contribution in productivity was so significant that before 80s the computer M-10 was the most powerful computer in the USSR. In terms of performance it exceeded domestic machines (BESM-6 -4.2 times, the older models of UCS -5.6 times). Information on the use of M-10, as well as on the previous machine M4-2M was closed to 90s. Only 10 years after the start of development M.Kartsev managed to get permission to publish materials on the M-10 in one of the collections of articles of the Academy of Sciences of the USSR.

In the computer systems of the M-10 computers M.Kartsev proposed and implemented the concept of a fully parallel computing system -with parallelization at all four levels (programs, commands, data and words).

New generation radars required a significant increase in performance computing facilities. In 1979, the institute under the leadership of Kartsev began developing computer fourth generation of the M-13. This supercomputer designed for wide use in processing large amounts of information in real time.

The exposition of the Museum shows the layout of the M-13, which is complemented by the layout of the radar "Darial U-4", also the cell fiber-optic communication line of the M-13 for transmission over fiber optic cable (transmitter-to-board, board-receiver and splitter) is exhibited. The several photos multiprocessor computer M-13 are stored in the Kartsev personal fund.

The heritage of Kartsev is significant and weighty. It created a whole range of them unique computers and systems: M-2, M-4, M4-2M, M-5, M-10, M-13, made significant contributions to computer science. Their practical significance for our country is very high. The museum has been carefully preserved inventors' certificates obtained Kartsev on separate devices of his computers and multiprocessor systems.

In 1995 the museum collection of computers was replenished the some blocks of high-performance computers M-series, created under the direct supervision of Mikhail Kartsev, one of the most prominent developers of computers and systems in our country.

In subsequent years, the staff of the Research Institute of computer systems and son Vladimir Kartsev transferred to the museum documentary materials, allowed to form the museum's personal fund № 215 of this outstanding creator. Now the museum collection of computers and the personal documentary fund constantly replenished with new exhibits thanks to the collaboration with the institute and family of M.Kartsev.

Currently 9 original blocks and units of computers and 1 layout, developed by the ideas of M.Kartsev in the Research Institute of computer systems, are stored and exhibited in the museum. Personal documentary fund of this scientist is 30 items of documentary materials related to his creative and professional activities.

Kartsev's son found his military poems in the family archives. Red Army newspaper "Stalin Banner" with printed Kartsev poem "It is so! ..." and a handwritten version of this poem Vladimir Kartsev gave the Polytechnic Museum.

The series of books written by him was the table as the developers of computers and students of technical universities in related disciplines: "Arithmetic Units of Electronic Digital Computing Machines" (1958), "The Arithmetic of Digital Machines (1969)," Architecture of Digital Computing Machines"(1978), "Computing Systems and Synchronous Arithmetic" (1978).

Kartsev mission was computer science and technology. This brought him happiness and creativity and grief. He devoted all his spare time -at work, at home, on vacation.

M.Kartsev belongs to the category of scientists, whose enormous scientific achievements in life have not been evaluated and officially recognized academic elite.

In 1993 the leadership of the Research Institute of Computing Systems has made the institution name M.Kartsev assignment.

Conclusion

In 2013 the main building of the Polytechnic Museum was closed for reconstruction. But the museum continues to conduct research on cultural heritage of the peoples of Russia in the field of science and technology. Work in the framework of "Outstanding engineering projects of Russia" and "Engineering Heritage XIX-XX centuries" continues, adding even more personal funds of Russian scientists, inventors and designers.

The updated exposition of the Museum is planned to open in 2018. Most of the materials from personal funds of scientists -founders of the national computer technology will be on display in the exhibition hall of computers, making it the more interesting and meaningfully for visitors.


Jani S S Koskinen

Sari Knaapi-Junnila
email: sari.knaapi-junnila@utu.fi

Information Technology -The Unredeemed Opportunity to Reduce Cultural and Social Capital Gaps between Citizens and Professionals in Healthcare

Keywords: information technology, cultural capital, social capital, professional-patient relationship, communication, health services, layman´s terms

des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.

Introduction

Patient involvement has become an important factor for healthcare and policy makers [START_REF] Callaghan | Publics, patients, citizens, consumers? Power and decision making in primary healthcare[END_REF]. Research on patient centeredness and patient empowerment has shown the crucial meaning why people must have a possibility to participate to their own health care [START_REF] Mead | Patient centredness: a conceptual framework and review of the empirical literature[END_REF][START_REF] Rappaport | Terms of Empowerment/Exemplars of Prevention: Toward a Theory for Community Psychology[END_REF][START_REF] Holmström | The relation between patient-centeredness and patient empowerment: A discussion on concepts[END_REF]. If people are treated in a paternalistic way, the outcome is not supporting patient commitment to their own care of health and wellbeing. At the same time there is a discussion in the society of how to support and encourage people to take better care of their health. The conflict is obvious but the reasons for this situation are complex and not easily solvable. In this paper, we are approaching this issue by presenting some common problems in healthcare and by reflecting those problems with research which is conducted in the Coper-pilot project, a sub-project of the Pump-project1. Firstly, traditional behaviour in healthcare settings emphasizes the unbalanced interaction between patients and professionals. Secondly, in communication and language level occurs many problems that complicate interaction. Thirdly, also structural problems exists -the medical appointments are arranged mainly to meet professional's needs.

When thinking of the problems in healthcare, Bourdieu's work can be seen as a strong tool to help understanding the reasons behind faced problems. Bourdieu is one of the most known sociologist who has researched power and social relations in different organizations and different levels of social life [START_REF] Bourdieu | Originally La Distinction translated by Nice R[END_REF][START_REF] Bourdieu | Homo Academicus[END_REF][START_REF] Bourdieu | The Forms of Capital[END_REF][START_REF] Bourdieu | Social Space and Symbolic Power[END_REF]. The field of healthcare seems to be a field which has a strong own hierarchy, strict rules, dominant biomedical worldview and self-governing mechanism securing the field. Western healthcare is strictly regulated and healthcare professionals are required to have formal education and authorisation to act in their positions. This is essential for the safety of the patient, but it has also costs -it creates unequal relation between layman´s and professionals´ positions. When some field have very strong cultural and social capital, the field gains an extraordinary position in society. In this paper we claim that professional's cultural and social capital may leave patients outsiders or visitors in encounters within healthcare. The aforementioned forms of capitals are used as Bourdieu is using them in his own work [START_REF] Bourdieu | The Forms of Capital[END_REF].

Common language may miss in a patient-doctor interaction because of the differences of professionals´ and laymen´s cultural capital. If a doctor uses professional jargon when (s)he talks with patients, unintelligible language leaves the patients as an outsiders. This kind of behaviour can be seen as a symbolic violation. In addition to that, patient contacts with healthcare -like doctor's appointmentsare still too often arranged in such a way that doesn't enable patient empowerment or cannot be described as patient centric. Current healthcare system seems to have such a strong biomedical worldview, which does not take the patients´ everyday life sufficiently into account.

The key area of this paper is in developing the worldview and the social and cultural characteristics of healthcare to better enable patients´ empowerment and participation. In addition, we argue that information technology can be used to reduce effects of the aforementioned problems of healthcare, even though technology itself is not in the focus of this paper. Patients´ cultural and social capital related their own health can be increased with proper technology, which is designed to meet the pa-tients´ needs. That kind of systems can lower the needed effort for gaining such capital that establishes more equal relationship with healthcare professionals. So, information technology is seen as a tool which can be used to reduce the gap between patients and professionals, but the main aim of the paper is to raise awareness about the issue of problematic inequality of cultural and social capital in healthcare.

Cultural and Social Capital as a Source of Asymmetry between Citizens and Professionals in Healthcare

Cultural capital can exist in three forms: in an embodied state, in an objectified state and in an institutionalized state. The Embodied state is a form of capital, which is achieved by self-improvement or other personal investment, and thus has personal costs. One cannot get such capital by second hand; it is embodied to a person and in many cases in the person's body (e.g. gained capacity or embodied skill) [START_REF] Bourdieu | The Forms of Capital[END_REF]. Healthcare professionals have created this kind of capital by developing medical skills and knowledge. On the other hand, patients possess crucial understanding and information about their own life, health and potential consequences of their own actions, and that knowledge is not obtainable for others and thus is embodied state of their own. That kind of deep understanding differs from professional's capital and can be achieved only by living one's life. The objectified state is a kind of cultural capital which is objectified in its embodied form [START_REF] Bourdieu | The Forms of Capital[END_REF]. One form of this are writings which have cultural value in the society. In healthcare such cultural capital are e.g. papers and information systems (artefacts) which contains medical and other relevant information. Likewise, patient can have capital which is objectified: notes, diaries etc. but it seems that those are not recognised like the professionals' ones are. The institutionalized state is a form of capital which has granted a formal position (e.g. academic education, qualification for a physician´s job) and thus can be seen as the way to give recognition for some certain embodied skill or set of skills [START_REF] Bourdieu | The Forms of Capital[END_REF]. While embodied state of capital is implemented by personal self-improvement the institutionalized one is recognized by some institution or society, like doctors are usually licensed (institutionalization) to act. However, this institutionalization is not implemented for the capital possessed by patients, and thus it elevates the position of professionals by cost of the position of patients supporting asymmetricity in their relationship.

Bourdieu's social capital is such form of capital which is bounded to some social group. It can be seen as a network of relationships which produces benefits for its members. Usually the network members have some common goals and benefits. This social network (as healthcare is) is a product of investment strategies, individual or collective, and it establishes or reproduces the relations which are worthwhile for the network [START_REF] Bourdieu | The Forms of Capital[END_REF].

Status, Attitude and Organization Culture as Manifestations of Cultural and Social Capital

Healthcare professionals have gained certain cultural capital (education, knowledge and experience) during their education and practise of the profession. They need this kind of embodied capital to apply when practicing the care and treatments for patients. However, along with objectified and institutionalized capital (which are seen e.g. in courses of action and decision-making structures), it enables professionals to exercise power [START_REF] Callaghan | Publics, patients, citizens, consumers? Power and decision making in primary healthcare[END_REF]. Doctors are highly respected professionals, who are often thought to be capable of even heroic actions. When healthcare professionals have such social capital, the inequality between professionals and patients is understandable but still not acceptable.

Buetow et al. have pointed out, that along with information societies, where increasingly many occupations have become professions, people´s behaviour have changed. These effects of modernisation has reduced social distances between doctors and evermore educated patients and revised healthcare´s traditional patterns to more modern ones. Many of these patients want to be active social actors and collaborate with their doctors. However, like less modern or non-modern patients, there are also non-modern doctors [START_REF] Buetow | Shrinking social space in the doctor-modern patient relationship: A review of forces for, and implications of, homologisation[END_REF]. So, not everyone long for or welcome more active collaboration in doctor-patient interaction. Because of doctors´ medicine-based capital, their position in healthcare settings enable them to choose, what kind of course of action is used. As for patient, (s)he does not necessarily have sufficient authority for influencing them. Difficulties, that hinder the abandonment of traditional patterns [START_REF] Ponte | Making Patient-centered Care Come Alive. Achieving Full Integration of the Patient's Perspective[END_REF][START_REF] Robinson | Patient-centered care and adherence: Definitions and applications to improve outcomes[END_REF] keeping patients more passive, involve both individual-and organization level in healthcare [START_REF] Ponte | Making Patient-centered Care Come Alive. Achieving Full Integration of the Patient's Perspective[END_REF]. Still existing asymmetry of cultural and social capital in doctorpatient interaction may in part explain why these patterns are so hard to revise.

Patient-doctor interaction is significant when it comes to health outcomes [START_REF] Ponte | Making Patient-centered Care Come Alive. Achieving Full Integration of the Patient's Perspective[END_REF][START_REF] Robinson | Patient-centered care and adherence: Definitions and applications to improve outcomes[END_REF][START_REF] Steinhart | Patient autonomy: evolution of the doctor-patient relationship[END_REF][START_REF] Braddock | The Doctor Will See You Shortly. The Ethical Significance of Time for the Patient-Physician Relationship[END_REF][START_REF] Neumann | Can patient-provider interaction increase the effectiveness of medical treatment or even substitute it?-An exploration on why and how to study the specific effect of the provider[END_REF] and patient satisfaction [START_REF] Ponte | Making Patient-centered Care Come Alive. Achieving Full Integration of the Patient's Perspective[END_REF][START_REF] Robinson | Patient-centered care and adherence: Definitions and applications to improve outcomes[END_REF][START_REF] Robinson | Asymmetry in action: Sequential resources in the negotiation of a prescription request[END_REF]. Successful communication strengthens the doctor-patient relationship, enhances their mutual agreement and improves patient´s self-care skills [START_REF] Robinson | Patient-centered care and adherence: Definitions and applications to improve outcomes[END_REF][START_REF] Street | How does communication heal? Pathways linking clinician-patient communication to health outcomes[END_REF]. Moreover, it can increase the effect of medical treatment [START_REF] Neumann | Can patient-provider interaction increase the effectiveness of medical treatment or even substitute it?-An exploration on why and how to study the specific effect of the provider[END_REF] and decrease costs through diminishing the need for diagnostic testing [START_REF] Epstein | Patient-Centered Communication and Diagnostic Testing[END_REF]. So, there are many reasons to put out for satisfactory patient-doctor interaction.

Unintelligible Language and Availability Restrictions of Information as Manifestations of Cultural and Social Capital

The relationship and interaction between patients and doctors have developed recently more equal in many countries [START_REF] Buetow | Shrinking social space in the doctor-modern patient relationship: A review of forces for, and implications of, homologisation[END_REF][START_REF] Steinhart | Patient autonomy: evolution of the doctor-patient relationship[END_REF]. By providing patients with more information, doctors can enhance communication as well as (care) outcomes [START_REF] Steinhart | Patient autonomy: evolution of the doctor-patient relationship[END_REF]. Despite the progress, that has taken place, there are still issues, which need deeper inspection and advancement. Patient-centric care (or patient-driven approach), just like shared decision making, collaboration and partnership, is an issue, which has been discussed widely recent years, and its many advantages have been noticed [START_REF] Ponte | Making Patient-centered Care Come Alive. Achieving Full Integration of the Patient's Perspective[END_REF][START_REF] Robinson | Patient-centered care and adherence: Definitions and applications to improve outcomes[END_REF]. If the common goal in healthcare is to improve patient-doctor interaction so that it would become a more equal partnership, common and mutually understandable language must exist.

Sometimes the obstacle to an effective communication can be for instance Latin terms and other uncommon words, that doctors use [START_REF] Steinhart | Patient autonomy: evolution of the doctor-patient relationship[END_REF], when it comes to illness, operations and care. If healthcare professionals use difficult language -when also comprehensible terms could be used -it can be seen as using symbolic power. Symbolic power is a form of power, which is based on social and cultural capital of agents of some group (such as doctors), and is used to enforce the relations that constitute the structure of social space (in healthcare settings) [START_REF] Bourdieu | Social Space and Symbolic Power[END_REF]. When symbolic power is used, it emphasises a situation where professionals are hierarchically above patients. In such situations professionals have control over the information [START_REF] Steinhart | Patient autonomy: evolution of the doctor-patient relationship[END_REF], situation and treatments instead of collaboration, even when the patient would wish the opposite action. Healthcare professional may have a noble goal to make right decisions and ensure the patients´ health and subsistence. However, if the patients are not trained to use that kind of healthcare jargon, it hinders their understanding of the facts related to their own condition and care. Obviously, this situation limits patients´ rights to consider their options and to be aware of potential consequences of their decisions. Furthermore it prevents their empowerment. Therefore, a severe effort to revise communication more effective and break down barriers of cultural differences between patients and healthcare professionals is essential. [START_REF] Steinhart | Patient autonomy: evolution of the doctor-patient relationship[END_REF] It appears that patients would be more eager to revise patient-doctor interaction style from biomedical style to more patient centric than doctors so far [START_REF] Epstein | Patient-Centered Communication and Diagnostic Testing[END_REF]. The modern-way, more equal, patient-doctor interaction seems also to create more benefits than costs to patients. These benefits, mostly related to communication and collaboration, would be worth providing to patients and also non-modern doctors, by assisting them if needed. [START_REF] Buetow | Shrinking social space in the doctor-modern patient relationship: A review of forces for, and implications of, homologisation[END_REF]

Place, Course of Action and Operating Model as Manifestations of Cultural and Social Capital

There are many kinds of asymmetry when it comes to interaction between doctors and patients. These kinds of issues can link at the macro level with the operating model in healthcare organization whereas at the micro level they can relate to courses of action and structures of clinical visits. One micro level example is, who takes the initiative when a patient meets a doctor at clinical setting. Like ten Have has argued about doctor-patient interaction, usually there seems to be some level of consensus that it is the doctor´s right and responsibility to manage the agenda at appointment [START_REF] Ten Have | Lay diagnosis in interaction[END_REF]. So, usually it is the doctor who is the initiator and the patient who responds to his/hers initiatives by asking questions. In this respect, the doctor has more power over talking points than the patient. When the interaction proceeds in such traditional way the doctor controls the situation, where disease-orientation in addition to biomedical issues are in the main part [START_REF] Ponte | Making Patient-centered Care Come Alive. Achieving Full Integration of the Patient's Perspective[END_REF][START_REF] Robinson | Patient-centered care and adherence: Definitions and applications to improve outcomes[END_REF][START_REF] Epstein | Patient-Centered Communication and Diagnostic Testing[END_REF]. Because of this information about patients´ experiences, which could also be highly relevant to diagnosis and successful treatment, are inevitably taken to a back seat. For patients, gaining opportunities to ask questions from their doctors would be also important way to enhance understanding and satisfaction. [START_REF] Robinson | Asymmetry in action: Sequential resources in the negotiation of a prescription request[END_REF] Furthermore, Jones [START_REF] Jones | Missing assessments: Lay and professional orientations in medical interviews[END_REF] has pointed out that after patients´ newsworthy answers in medical interviews, doctors do not usually offer to respond with an assessment although it would be a normal act in everyday talk and it would also be an excellent opportunity to give social support to their patients and to influence positively health outcomes. Instead, they do not respond at all, they just go on and stay strictly in the interview format. An action like this is surprising and troublesome for the patients and because of that there are gaps in the conversation when they think the doctor should answer with an assessment. Sometimes patients try again to get a response from their doctor. They can for example upgrade their answer, request an opinion or offer a lay diagnosis, but even then the doctors do not respond or when they do so, they use only a minimal acknowledgment token (for example "okay"). As Jones mentions, doctors pass up opportunities such as elaborating with their patients and showing empathy to them, when they direct attention away from patients´ answers. [START_REF] Jones | Missing assessments: Lay and professional orientations in medical interviews[END_REF] In Finland the citizens know quite a lot about illnesses because of good education. What is somewhat surprising, it seems that people tend to act in spite of that rather un-assertively with their doctor when the diagnosis is at issue. Peräkylä [START_REF] Peräkylä | Agency and Authority: Extended Responses to Diagnostic Statements in Primary Care Encounters[END_REF] has explored patients´ and doctors´ interaction in Finnish primary care with data which consisted of doctors´ diagnostic statements. He found that only in one thirds of the cases the patients responded by talking about diagnosis after their doctor had told the diagnosis to them. And, what is noteworthy, even then the patients responded with caution so that they displayed the doctor´s authority in medical reasoning. And further, he found that the way in which the doctor told about the diagnosis had a significant effect to the patient´s response. When the doctor explicated the diagnosis, it was more common that the patient responded by talking about diagnosis, otherwise not. [START_REF] Peräkylä | Agency and Authority: Extended Responses to Diagnostic Statements in Primary Care Encounters[END_REF] So it seems like the patients expect that their doctor puts across if it is appropriate for them to say something about that issue.

Patients are by no means passive members at these occurrences, they have also their ways to influence the conversations with the doctors, but it seems that they have to be careful. It is known that the patients can request a course of action, expand their answers to offer information which the doctor has not asked [START_REF] Jones | Missing assessments: Lay and professional orientations in medical interviews[END_REF][START_REF] Drew | Spotlight on the patient[END_REF], request an opinion, or offer a lay diagnosis [START_REF] Jones | Missing assessments: Lay and professional orientations in medical interviews[END_REF], which means a sort of explanation about the symptoms of illness that a person often makes himself/herself to make sense of his/her experiences, before (s)he decides to arrange an appointment to see a doctor [START_REF] Ten Have | Lay diagnosis in interaction[END_REF]. However, when doing so, the patients are conscious of how sceptical the doctors might be if they tell about their lay diagnosis [START_REF] Drew | Spotlight on the patient[END_REF]. So, if they have enough courage, they try to tell their concerns in a delicate, respectful way and avoid to overtly challenge their doctor´s authority [START_REF] Ten Have | Lay diagnosis in interaction[END_REF][START_REF] Drew | Spotlight on the patient[END_REF].

Visit length varies a lot between countries, but when longer visits exist, it enables the doctors to respect patients´ autonomy in clinical decision making [START_REF] Braddock | The Doctor Will See You Shortly. The Ethical Significance of Time for the Patient-Physician Relationship[END_REF]. A study conducted in six European countries (Belgium, Germany, Netherlands, Spain, Switzerland, United Kingdom) revealed that the mean length of consultations with general practitioner was only 10,7(SD 6,7) minutes. If the doctor perceived a psychosocial problem, consultation time increased significantly but this was not the case if the patient perceived the psychosocial problem (and the doctor not). So, the doctor has a remarkable impact on the duration of the consultation (and the issues at hand) although variables related to the doctor´s country and those related on patient have also an effect on the use of time. [START_REF] Deveugele | Consultation length in general practice: cross sectional study in six European countries[END_REF] 3

Coper-Pilot -Information Technology as a Possibility for Empowerment of Citizens Salutogenic approach embeds with understanding of health as patients' experience of home-likeness in their own lives is used in Coper-pilot. This kind of viewpoint is needed if we are going to develop tools, like information systems, for patients [START_REF] Lahtiranta | Electronic health services for cardiac patients: a salutegenic approach[END_REF].

The salutogenic approach focuses on wellbeing and life plan of people instead of sickness and other biomedical issues, which are the general points of view in healthcare. Hence, salutogenic approach foregrounds the patient´s role as a main actor. [START_REF] Antonovsky | Health, Stress and Coping[END_REF][START_REF] Antonovsky | Unraveling The Mystery of Health -How People Manage Stress and Stay Well[END_REF] The aspect, which is presented in this paper, is patients´ need to move from their current role into more active role as a professionals of their own life, and by implication of that, into equal partners with healthcare professionals. This is possible through proactive interventions in healthcare whilst developing information systems [START_REF] Lahtiranta | Electronic health services for cardiac patients: a salutegenic approach[END_REF]. This approach -if put in practise -gives patients real possibilities to make informed consent about their care and treatments.

Coper-Pilot

Coper-pilot is a qualitative, citizen-driven research project, where University of Turku cooperates with Welfare Division of Turku and CGI Suomi Oy to develop and study a communal e-health-service. Defining what sort of requirements citizens have about ehealth services has been a key issue in this pilot. Because we looked for patientinvolving and empowering solutions, citizens with some kind of long-term disease were considered suitable for the target group. The decision about the target group was made together with the Welfare Division. Eventually, those citizens, who had some kind of heart related symptoms, and who were supposed to have an appointment at Internal Diseases Outpatient Clinic of Turku City Hospital because of those symptoms, were determined as the target group of the pilot. The study protocol was approved by University of Turku ethics committee and Welfare Division of Turku before the study began and the research team began to get in touch with citizens in May 2013.

Coper-pilot´s perspective to information systems can be defined as human scale. Our aim has been to find out ways in which e-services could assist and empower citizens in their everyday life and self-care to feel "home-like being-in-the-world" (see Svenaeus' definition of health [START_REF] Svenaeus | The Hermeneutics of Medicine and Phenomenology of Health: Steps Towards Philosophy of Medical Practice[END_REF]) even if there were some health issues on their hands. As for the term "Home-like", it could be figured as a state where one feels comfort in his/hers own life. So, the aim, amongst other things, was to gather understanding about our target group´s everyday life, their experiences about electronic services and their experiences about interactions between themselves and professionals in any kind of healthcare settings.

Citizens suitable for the above-mentioned target group were informed about the Coper-pilot by enclosing a letter of participation request in pursuance of the appointment notice to Internal Diseases Outpatient Clinic of Turku City Hospital. The research team provided the Internal Diseases Outpatient Clinic of Turku City Hospital with copies of the letters of participation requests, which were forwarded to the citizens by the departmental secretary (from May to December 2013). The citizens were asked to get in touch with research team if they were interested to hear more about this project or if they considered to get involved in it. After the citizens had been contacted the research team, they were given more information verbally and also on paper moreover they had an opportunity to ask further details before signing agreement of involvement in the research.

All in all 34 persons (13 women and 21 men) decided to participate in the Coperpilot. Their average age was 68 and age range was 47 -81 years. There were various data collection methods in Coper-pilot, and one of those was interviewing. In this context we are going to present only a few points that came out in the first round interviews. These thematic interviews (n=34) were held at places of interviewees´ choice, generally in a negotiation room at university or at their homes from June to December 2013. The interview themes dealt with health, well-being and being ill and also with experiences of healthcare and information technology in the interviewees´ everyday lives. In these individual and rather informal meetings two persons operated as interviewers at a time. The duration of each of the interviews was approximately two hours. All interviews were recorded digitally. The data collection and also lettering and analysis of its content were made by research team members (four persons).

Next we are going to present a few sections about aforementioned interviews. In some cases there seem to be problematic issues related to unequal cultural and social capital. At times the issues seem to be traditional behaviours or structural problems in healthcare settings that causes a friction between citizens and doctors. Also restrictions on availability of information and unintelligible language (language barrier and healthcare jargon) appear to separate the citizens from the professionals. Beside the problems, the citizens tell also about situations, where patient-doctor interaction has come true successfully and how this happened. All quotes are freely translated from Finnish to English for this paper. After the quote there is an identification letter and a number in square brackets.

Status, Attitude and Organization Culture as Manifestations of Cultural and Social Capital in Coper-Pilot

In Coper-pilot there were a wide variety of the citizens´ experiences, when it comes to doctors´ status and attitude in healthcare. Some of the citizens feel, that the organization culture enable the doctors to act nearly godlike, as for some of them have noticed positive progress, which has facilitated communication at least with some doctors. Like one citizen [A7] said, doctors attitude is quite important for a patient, it can be also a remarkable thing easing patient´s stress experience. "It can be seen at hospitals even nowadays…their atmosphere has not changed a much, the doctor is the same as God, dictates everything…it is the hospital culture…it is such a wretched culture like Tutankhamun era, dominated by doctors…"[A8]

"He [the doctor] does not bother to listen and he has no time…and if he had [time], he has no interest…I can understand that…there are priests in a rut…doctors in a rut…they do not listen or tell nothing much…" [A12]

"The doctors have begun to treat people much better…I do not know if they know nothing, but it is nice to meet them…nicer than earlier, they treat people a bit bet-ter…Nowadays they ask, what kind of symptoms there are and what do I think that the problem is and things like that…In the olden days …the patient was not allowed to know anything at all, he knew everything…even though not anywhere near…that much it has been changed…" [A10]

"It depends on the doctor, I must say. Yesterday there was a cardiologist whose attitude was positive. That is a very important point, I can see that now, how important it is… I nearly stopped to be stressed…" [A7]

The citizens admit readily, that beside doctors, it is also patients who have an influence to patient-doctor interaction and therefore also citizens have to be responsible for a good contact.

"The doctors will listen..., if you just tell them. But often there are such persons, who do not dare to ask anything….I have got all that I have asked. So, I could not ask anything more and I would not need either [anything more]. Therefore it has been very nice…It depends on a lot of the person, who happens to be on the opposing side, you have to take it into account. There are sometimes difficult ones on the opposing side…such [persons] might be also in healthcare…"[A14]

Unintelligible Language and Availability Restrictions of Information as Manifestations of Cultural and Social Capital in Coper-Pilot

In Coper-pilot it turned out that many citizens have difficulties getting information about their health, treatments and test results. Sometimes the citizens are not able to get information at all and sometimes the information they get is unintelligible for one reason or another (language barrier or professional jargon). These kind of situations make them angry and at the worst they can feel that the healthcare system have abandoned them. "After heart operation I have been completely down and out. Information about myself is not obtainable hardy anywhere, because the only doctor appointments at the health centre are once a year. I have learned how hard it is to get information about myself.... It feels like dropping to nowhere, the operation..

. were handled correctly at the hospital but after that nobody…I have not been able to control…" [A3]

"There were 18 blood tests and the doctor told me nothing at all…I was angry at the night, why I was not allowed to know those…I realized that many issues, that I could had asked there right away, left once again without solving. Yet afterwards, I act up, why I did not ask those issues…" [A7]

Like the citizen cited beneath, many citizens were also interested, if there were some better than present-day ways to make an appointment (to a doctor or to an examination), to get results from examinations and to communicate with their doctor if needed during their care.

"It is one problem. I run, I have just been at the blood tests…Every time I have to call them. I think that it takes also the doctors´ time to no avail. If I could see that [blood test result] there [from computer]…it would be so much easier, the doctor would not have to, I would not have to bother every time the personnel at the health centre. Their time run out anyway…" [A3]

Even if the citizens manage to meet their doctor to get some information about their health, there can still remain some obstacles. Sometimes there seems not to be shared language between citizens and doctors: either the citizens find that some doc-tors´ have shortage of Finnish skills or their doctor speaks such professional language, jargon, that they are not able to understand. Lack of understanding causes uncertainty, because the citizen cannot be sure if (s)he has missed some important information. It is common that citizens just try to cope in spite of shortcomings in patient-doctor communication, many of them seek answers elsewhere (for example from Google) and only some of them continue asking until their doctor´s answer is understandable enough.

"All the medicines I use and I get from someone, I search for [from the computer], what it is, to which purpose it is used for and…It was just today, when I checked something about my blood test, what is the meaning of all those words…I have written them one by one to Google, that [an abbreviation of a blood test]and…One at a time it has turned out, what they are and what are those meanings…" [A10]

"It is that monks´ Latin in all those doctor´s accounts, even with Internet you do not manage to make out... what he is meaning…you can only guess…I could ask, if I and the doctor were just the two of us, but usually it is such a hurry that talking is out of question…" [A11]

"Generally speaking I have pretty good experiences about doctors….but when I had an Estonian... doctor...Finnish that she spoke was very weak…she said, she cannot understand…It causes to the patient such an uncertain feeling, that you doubt, if you can get all the information needed. But in other respect she was very kind and nice doctor…" [A20]

Fortunately sometimes a shared language between a citizen and a doctor is possible to find, but does the citizen have to understand medical jargon to make that happen? Is it not required, that the doctor would use such kind of terminology that the citizen can understand it?

"When I visited the cardiologist it was such kind of extremely good co-operation, although it was the first time I met him, we spoke immediately the same lan-guage…And he asked me, if I am a healthcare professional." [A27]

Place, Course of Action and Operating Model as Manifestations of Cultural and Social Capital in Coper-Pilot

The everyday difficulties, that the citizens told about healthcare´s practices, involved most often their doctors´ busyness, too brief appointments and missing possibilities to create a proper relationship in which they could collaborate with their doctor. Many citizens find it hard to settle their affairs with healthcare. Therefore, they are interested in seeking new courses of action to collaborate with their doctors, and they are also open to new operating models in healthcare organizations. "Usually when you go to doctors´ practice, he is so busy that he has no time to even think. He is not listening.

" [A22]

"The situation is like that…the doctor´s…there is hurry and it can see…do not feel like bothering them…" [A1]

"Our healthcare is so foolish that these ...doctors change nearly every time when you go to doctors´ practice….There is no time to discuss, there is 15 minutes and when there is a new patient, a new doctor relationship, it takes 13 minutes to get know each other, so the decisions should be made in 2 minutes." [A2] "It is also such a nasty thing that you have to hop from one doctor to another doctor and every time you have to tell the same [story]…" [A28] In those cases when the citizens are outstandingly pleased with their doctors and other health professionals, there seems to be typically a confidential, friendly and at best long relationship. The citizens have a high opinion on their doctor if they have positive, personal relationship with him/her, if they think (s)he is also competent and if they feel that the things move on smoothly.

"I have been in such a blissful situation, that I have had a personal doctor [at private sector], the familiar doctor... has helped me loads of, so I am in a better position than many other.

" [A21]

"There were a very good male nurse which was sometimes better than a doc-tor…In a small town, if the person have been there long time, he knows those peo-ple…and he is able to immediately…" [A23]

"He [the doctor] sent the referral immediately…so I will get there…Things like these, I feel that the things are taken care of…I do not have to ask everything sepa-rately…" [A24]

4

A Possibility to Increase Patients´ Cultural and Social Capital with Information Technology

People are not alike in their desire for autonomy in decisions related in health, in the matter of fact the differences are substantial although most of people want to engage in their health decisions. Although it is known that the desire for autonomy is higher among younger people, it is not clear if it relates to differences between generations or if the attitudes just change when the individual gets older. In any case, detection of patients´ wishes could simplify the patient-doctor interaction in both sides and moreover improve decision-making process. [START_REF] Cullati | Desire for autonomy in healthcare decisions: A general population survey[END_REF] By using information technology we can offer alternative solutions to log, watch and monitor personal health information so that both patients and healthcare professionals have an opportunity to take advantage of them. Furthermore, information technology enables many kinds of data capture, mediation and use. Accordingly, it is worthwhile for supporting self-care with individualized materials and communication between patients and healthcare professionals. [START_REF] Steinberg | Patient-Centric Communications Drive Quality, Fiscally Prudent Health Care Decisions[END_REF][START_REF] Breen | Improving Doctor-Patient Communication: Examining Innovative Modalities Vis-à-vis Effective Patient-Centric Care Management Technology[END_REF] Moreover, the possibility to use web/video-appointments or communicate with safe web messages alongside with traditional appointments at health centre or by phone, gives long desired alternatives for individual needs. These kinds of new options may facilitate patients´ everyday lives and also the routines at health centres. There are patients, who have difficulties to get involved in the decision-making process at the doctor´s practice when it comes to their illness, medical procedures and diagnosis. In our research some citizens consider that they have no ability or right to interfere in issues like that. Yet, it is known that patients commonly search information and talk with their family members about the symptoms of illness to search some kind of explanation to their experiences [START_REF] Ten Have | Lay diagnosis in interaction[END_REF]. This kind on pre-clinical phase when a person is working with the lay diagnosis before (s)he makes an appointment to the doctor, could be one potential moment to take advantage of information technology with supports the needs of patients by offering different ways of communication, gaining and using the needed information even before the first meeting with a healthcare professional. Lee et al. [START_REF] Lee | Development and evaluation of a patient-oriented education system for diabetes management[END_REF], for example, have presented an interesting system, where patients´ (type 2 diabetes) clinical data was integrated into education material so that it enhanced learning and individual care also between the hospital appointments. They found the system easy, efficient and inexpensive in self-care. [START_REF] Lee | Development and evaluation of a patient-oriented education system for diabetes management[END_REF] Adequate time is important when it comes to clinical visits, moreover it is important how the time is spent [START_REF] Braddock | The Doctor Will See You Shortly. The Ethical Significance of Time for the Patient-Physician Relationship[END_REF][START_REF] Ogden | I want more time with my doctor": a quantitative study of time and the consultation[END_REF]. Because patients sympathize with pressures on their doctors, even a short visit does not bother if only the patient feels that the quality of time is good, and it is effectiveness of the communications and flexibility in time which influences on that [START_REF] Braddock | The Doctor Will See You Shortly. The Ethical Significance of Time for the Patient-Physician Relationship[END_REF]. It is interesting that even a small increase in actual time may have a notable impact to patient´s experience of the adequateness of time [START_REF] Braddock | The Doctor Will See You Shortly. The Ethical Significance of Time for the Patient-Physician Relationship[END_REF]. The possibility to communicate before the meeting could raise the quality of an appointment by giving the possibility for the patient to give more information or ask how to prepare for appointment. The technical limitations are not the problem, the needed technology is out there. Instead we need to focus on shifting the development from healthcare towards more patient or even citizen-centric direction [START_REF] Lahtiranta | Electronic health services for cardiac patients: a salutegenic approach[END_REF].

At the fundamental level, ensuring that information system would be suitable for the patient needs, the aforementioned salutogenic approach of developing those systems is needed and should be used as guideline of development of healthcare [START_REF] Lahtiranta | Electronic health services for cardiac patients: a salutegenic approach[END_REF][START_REF] Knaapi-Junnila | Towards Citizens´ Empowerment with the Coper-pilot[END_REF]. The aim should be in finding such functions or solutions that support patient control of own life and well-being by enabling access to needed cultural and social capital with information technology. This also demands that the structure of healthcare and interactions between professionals and patients should be focused on patient's personal needs more than current system is doing.

Discussion

It seems that Bourdieu's conception of the cultural and social capital and salutogenic approach are strong tools when analysing the common problems in healthcare settings. The cultural and social capital, which is usually possessed by healthcare professionals, may leave patients in insecure positions. Likewise, the traditional biomedical worldview, which has not vanished yet, sets the patient to be an object with some medical problems and does not focus to the person behind the patient-role.

Based on the Coper-pilot´s preliminary findings, which support the former research, there exists a need to assist patients in narrowing still existing cultural and social capital gap in healthcare. We argue, that information technology offers countless opportunities, which are still unredeemed, to reduce cultural and social capital gaps between citizens and professionals in healthcare. The information system, which gives access to patient information and other medical information -that is easily understandable -would give the patients the capital they need: information about their own health and understanding about issue at hand. Then, translating the healthcare jargon to layman´s language, would give the needed common language for patientdoctor interaction. Information technology enables many alternatives for patientdoctor communication also between the traditional appointments so that interaction can meet both patients´ and professionals´ needs assisting their everyday lives.

For developing needed information systems we should have a new approachthe Salutogenic approach -which is designed to meet the people´s needs, not only the professionals´ and organizations´ needs, which is usually the case in healthcare. Salutogenic approach enables people to be more oriented towards their own health and wellbeing and thus makes possible to gain needed cultural and social capital so valuable in the field of healthcare. Future research, focusing healthcare interactions within different environments and methods, is needed for remeeding the available opportunities, that information technology has to offer.

The Pump project (2011-2014) is a project aiming to develop citizen-centric services to the field of health and well-being services in Finland. The project, funded by European Regional Development Fund (ERDF), is divided into five operational units. Each unit focuses on seamless service provisioning from a different perspective. In the Coper-pilot, the focus is on cardiac patients. http://workinformatics.utu.fi/coper/index.html

Acknowledgements

Many thanks to the other members of the Coper-pilot team, Antti Tuomisto, Anna Korpela and Ronald Otim, for collaboration, support and significant comments -all that have been enormously helpful when we have written this paper.