Medical Sociology

Male Vs Femal Physician

-1st year females med students are more patient , place higher value on patient contact , but these dissipate during med school -Females demonstrate superior communication skills, more opportunities for pt to talk, make more empathetic statements *Most pts prefer a phys. that's the same gender as them

Biopsychosocial Model

-Determinants of diseas -Broader approach: Whole person, continuous relationship, biotechnical AND interpersonal skills, equal negotiation

What is the Activity-Passivity Model?

-Doctor does something to the patient -Similar to the asymmetrical rel. of the Parsonian model. -Physician represents the medical expertise. Controls the communication flow b/n the phys. and pt. , makes the important decisions, pt relies on the physician for knowledge.

3. Mutual Participation

-Doctor helps pt help themselves -equalitarian -Acknowledge that pt must be a central player -Assuming a competent, educated adult pt

What is the Guidance-Cooperation Model?

-Doctor tells pt what to do to get better -Typical of most medical encounters -pt alarmed by medical problem --> has certain hopes and aspirations for the outcome -increased involvement in providing info. -Physician is still in charge but seeks the cooperation of the pt

Disparities in Care

-Feel more comfortable when physician is the same race -Whites more likely than blacks to receive attentive care. -One of the reasons whites have a higher survival rate with life-threatening illnesses

Isreal Patient Rights Act

-Israel will provide unviersal coverage and allows informed consent, however they're not provided with the right to refuse treatment

What do patients want?

-Most pts present psychosocial issues, not only medical ones -Pts want discussions -Physicians not good at detecting psychosocial -All of the information. Not the filtered information.

What is Friedson's Criticism of the Parsonian Model?

-Overstates the mutality of Phys and Pt -Conflict is inevitable; especially when there are different backgrounds and power is so unequally distributed

Principle of Benficence

-Physicians obligation to act in pts best interest -overriding pts wishes -paternalism -'best interest' unwanted by patient

Biomedical Model

-Scientific -Disease/Illness oriented (not pt oriented) -Effective medical care=proper application of the curative agent -Little attention or consideration of social, psychological, and behavioral dimensions

Nature of the Parsonian Model

-Talcott Parsons (1951) -Subsystem of the large social system -key values in sub system reflects key values in society -Asymmetrical power necessary (in pts best interest)

Patient Self Determination Act

-hopsitals and other providers required to inform pts that they have the right to make their own health care decisions, and to refuse unwanted treatment

Principle of autonomy?

-informed consent self determination -Ability to make rational and competent decision. -children, handicapped, elderly, extremely ill or coerced under pressure of physician may have difficulty w/ this -

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Gender of the Physician

1. Female vs male physicians: females are more nurturent and expressive. On the other hand females that have developed assertiveness to break into field may be less likely to follow traditional sex roles. Males are less empathetic and more reserved

Key Dimension of Doc-Pt Relationship

1. Model of Health: Belief in biomedical/biopsychosocial health 2. Ethical Obligations: 3. The extent of commitment to genuine therapeutic communication

Physician Frustration

1. Noncompliance-Pts lack of adherence to recommended therapies and treatments 2. Complaining Pt-Pt with a large number of complaints that require excessive time 3. Demanding/Controlling 4. Lifestyle Complaints-Pts with substance abuse problems

Therapeutic Communication

1. Physician-engages in full and open communication and discuss psychosocial as well as physical conditions 2. Patient-provides full and open info to the physician and feels free to ask questions 3. Ideal Result: Pt-Phys build a genuine rapport, but this rarely occurs

3 Components of the Parsonian Model

1. Professional Prestige: Phys. med. expertise, years of training and societal view of physician as ultimate authority on health matters 2. Situational Auth: Pt sharing inadequacies with physician 3. Situational Dependency: Pt seeking service , scheduling appt., waiting past scheduled time etc.

Barriers of Therapeutic Communication

1. Setting of the medical encounter -uncomfortable, naked/freezing, paperwork 2. Length of medical encounter -typically brief, abbreviated segments of time; Long wait, short talk 3. Mental state of patient -Often times worried, sick, concerned with getting back to work on time. 4. Mismatched expectations -Physicians trained to convert complaints into medical diagnosis, therefore uncomfortable discussing psychosocial issues. Makes therapeutic communication difficult or unlikely. Focus on medical facts 5. Language Barrier -Not just english, but bio-scientific language, possibly AAE causes a barrier as well 6. Physician Communication Style -Controlling the interchange. Often talk down to patient and cut them off. Show disinterest in what patient has to say.

The Szaz-Hollender Model consist of:

1. The Activity-Passivity Model 2. The Guidance-Cooperation Model 3. The Mutual Participation Model

What are 5 Models of the Physician-Patient Relationship?

1. The Parsonian Model 2. The Szasz-Hollender Model 3. The Activity-Passivity Model 4. The Guidance-Cooperation Model 5. The Mutual Participation Model

Changing to Patient-Centered Care

1. Use of comparative effective research 2. Increased use of patient satisfaction for physician reimbursement (medicare) 3. Increased public availability of health info

Four changes employers have made

1. discounted employee covg 2. increased the amount of health plan that has to be paid by employee 3. reduced the types and amount of hc covered by policies 4. Increased the deductible, coinsurance, and copayment

Cult. Competence Training

1. examining and understanding attitudes such as mistrust, subconscious stereotyping, and bias 2. Knowledge of health disparities and coming up with a solution 3. acquiring the skills to communicate effectively

Dollars Spent on HC

1. hospitals 2. physician services 3. drugs 4. nursing home 5. dental care

Difficult Patients

1. little hope for cure-chronic pain, cancer, obesity etc. 2. Devalued lifestyles-alcoholism, prostitution, homelessness, attempted suicides 3. Vague and difficult to describe symptoms pts 4. Pts whose symptoms have psychosocial basis

Public Health Ins

1945-Truman's universal hc denied 1960-Kennedy (same issue) 1965-Lyndon Johnson; Mcr/Mcd

Physician Gender

2. Alteration of expectation that pts bring to encounter: See female phys. and assume that she is nurturing

Physician Gender

3. Alteration of status relationship b/n physician and pt: Female pt may be more comfortable with a female phys. rather than a male.

National Health Exp.

Administration etc.

CHIP

Children's Health Ins Program: created in 97 decreased kids w/o ins from 23% to 15%

Development of Nonprofit Health Ins

Depression (1920s) BCBS plans (early 1900s non profit; now for profit)

Pharmaceutical

Drug cost have been growing faster than the hc field too much money spent on advertising and marketing than research and testing; 20% of their budgets on researching and development and 40% on advertising other countries except US have a price control on medications 1/4 of biomedical researcher are invested and have financial ties to companies they are studying Limit on generic drugs that save ppl lives, therefore prolongs treatment process; shortages of cheaper drugs

Uninsured Population

Early years of their careers Just becoming financially settled

Patient Centered Care

Endorses a biopsychosocial model of medicine that values pt autonomy and the development of therapeutic communication Treats the whole person Shifts physician as centerpiece to PATIENT as the centerpiece

Types of MCOs

Health Maintenance Org (HMO) -Prepaid plans where a group of physicians and hospitals provide care for a fixed premium from enrollees -Based on number of pts theyre willing to see in a day -Incentive to reduce srvs -enrollees must select from a list of providers -enrollees receive more preventive care -apt to deny short-term services in order to maximize on profit -cash bonus for keeping calls short and not scheduling appt. -high rates of dissatisfaction

Cost Containment

High Deductible Health Plans (HDHPs) cost less b/c it incorporates a very high deductible typically linked to Consumer-Driven Health Plan (CDHP): -Health savings plan that allows consumer to set aside pretax dollars and save for medical expenses -unsuitable for low income families

Point-of-Service (POS)

Hybrid of HMO and PPO Adds flexibility for pt Discount like a PPO and Care mngmnt similar to HMO

Consumer Attiudes

Increased consumer dissatisfaction Satisfied with care, but dissatisfied with HEALTH CARE SYSTEM

US Healthcare System

Innovative yet poor quality of treatment Extremely expensive, ineffective, and wasteful US is 66/100 for performance

Medical entrepreneurialism

Investing in health as a mean of profit

Primary Ethical Obligation

Is priority given to pt autonomy or beneficence?

Lower Patient Activation (ml: more likely; ll: less likely; nl: not likely)

ML Unmet medical needs ML Unmet prescription drug needs ML to delay care NL to engage in preventive care LL to follow through on life style changes LL to ask questions -Which is important. Drs are humans as well and are capable of making mistakes

Lower Health Literacy

ML to report poor health status LL to obtain prevent health care Twice likely to be hospitalized More likely to make medication errors

Preferred Provider Org (PPO)

Network of physicians and hospital that agree to provide srvc at a discount Allows member to receive care outside of network -although copayments are higher Pay lower fees Fee for Service

MCR

Over 65 A-Hospital B-Physician Services Doesn't pay for prescriptions

Activity-Passivity Model is similar to?

Parent-Infant Relationship

Personal Characteristics

Phys. feel higher levels of anxiety when working w/ lower class; less interested in pt encounter

History of HCS

Private Market (Always) -no gov't involvement or intervention Economic good or accessible to privileged US maintains strong belief in individualism, where other countries have a stronger commitment to the health of its country

Physician Self-Referral

Referring a pt to a doctor for financial interest

Cost Containment

Strategy to give financial incentive ti provide only necessary srvc if service cost lest than mcr allocated, hospital can keep the difference If the pt cost over the amount, the hospital is responsible for portion that wasn't covered

What theory does the Freidson's Criticisms of the Parsonian Model resemble?

The Conflict Theory

Patient Activation

The skills and confidence that equip patients to become actively engaged in their health care Individuals assuming greater responsibility for managing their own health care

Defensive Medicine

Treating pt in a way that protects them from malpractice Majority of the time the extra services are unecessary

Who developed the Szaz-Hollender Model?

Two M.D.s (1956) -Thomas Szaz -Marc Hollender They argued that Parsons gave too little attention to the influence of physiological symptoms

Exorbitant CEO Salaries

UH group-50 mil Cigna-14 mil Amerigroup-12 mil

What is the competency gap?

When the pt is dependent upon the phys. for their knowledge *Would hope that phys. is using his/her knowledge to provide insight and not to boost his/her ego.

Development of Private Health Ins

Workers in comp in the early 1900s Now almost 1300 private ins: Profit making companies whose intention is to set premiums at a level that will allow them to: -pay all claims -pay for administration -salaries -overhead expenses -AND HAVE MONEY LEFT OVER FOR A PROFIT

Compare hmo vs ppo

hmos regulate pt care hmos have smaller rosters of providers hmos cost less than ppos phys paid by capitation; seeing more pts in a day

What relationship is the guid-coop model similar to ?

parent-adolescent relationship

Managed Care Org (MCO)

private ins that recruits providers to join network phys must agree to lower than normal reimbursement amount promises lots of pts; contracting local employers to cover all their employees

Cultural Health Capital

repertoire of cultural skills, verbal/nonverbal competencies