Medical Sociology Exam 2
Shift in gender, racial, and class makeup of medical students
-48% of 1st year students were female in 2012-2013 - 1970's 10% of 1st year students were female -42% of med students are minorities
What are some features of professionalism?
-The profession determines its own standards of education and training -Student professional goes thru more stringent socialization experience that the learned in other occupations -professional practice is often legally recognized by some form of licensure -licensing and admission boards are staffed by members of the profession
Guidance-cooperation model
-acute illness (flu) -patient knows what is going on and can cooperate with the physician, but physician makes the decision
AMA
-formed in 1847 -physicians into professionally identified group
The decline in the status of physicians is largely due to greater
-gov't regulation -corporations in the health care market -changes in physician-patient relationship
physician autonomy
-increasing gov't regulation -managed care reducing the authority of doctors -corporations taking over more of the medical market, hiring physicians as employees -people with more education or more resources are increasingly consumer oriented toward health care
Arguments against autonomy
-layperson do judge technical performance, regardless of whether they are competent to do so -autonomy granted to the medical profession is granted conditionally; assumed that physicians will resolve issues in favor of public interest -restrict the evaluation of work and discourage the expression of criticism
Actual Outcomes
-reduction in the authority of doctors to make referrals and choose mode of treatment -reorganize health care into stable, reliable -less costly -preventive care
What are some relevant factor driving consumerism?
-shift in states; role from protecting the medical profession to protecting corporate health care interest in order to reduce costs, proliferation of commercial products for the baby that the patient can use independent of the physician, rise of chronic disease
How many young adults have a mental illness?
20%
What is the percentage of teenage girls that have an eating disorder?
35%
The shift toward consumerism in health care means patients have more status in the doctor patient relationship. However, this relationship is significantly affected by an external influence:
3rd party payers
In 2009-2010, about __% of all students entering medical school were women
50%
By 2025, the US is expected to have a __,___ doctor shortage
90,000
Which group has a higher rate of those covered by private insurance than the national average?
Asians
Physician Deprofessionalization
Driving Factors: changing organization of medicine, patient dissatisfaction with lack of cost control
Consumerism is now a feature of healthcare interactions. Which group is least likely to engage in consumerism?
Lower class
_______ ____ refers to health care organizations that control the cost of healthcare by monitoring how doctors treat specific illnesses, limit referrals, and require authorization prior to hospitalization, among other measures
Managed Care
Which group has the highest % of population without health insurance?
Mexican Americans
Who has the lowest insurance rates?
Mexican Americans
Which social class visits the doctor the LEAST?
Upper Class
Medicalization
a process by which previously non-medical problems are defined and treated as medical problems, usually in terms of illnesses or disorders - expand boundaries of treatable conditions - new biotechnology, consumers, and managed care
substantive rationality
a process of making decisions with an emphasis on ideal values
illness
a subjective state pertaining to an individuals psychological awareness of having a disease and usually causing that person to modify his or her behavior
main forms of stigma
abominations of the body (physical deformities), blemishes of individual character (mental disorder, alcoholism, STDS), stigmas of race, religion, and nationality
illness behavior
activity undertaken by a person who feels ill for the purpose of defining that illness and seeking relief from it
Deviance
acts or behaviors that violate social norms within a given social system and how people view your choice of action
Factors of self-care
acute ---> chronic, depersonalized medical care, limits of modern medicine recognition, awareness of alternative healing processes, lifestyle does affect your health, control your own health when possible, high cost of medical care
What are types of illness behaviors?
acute, chronic, life threatening, heroic, terminal
Disease
an adverse physical state, consisting of a physiological dysfunction within an individual
Managed Care
articulated goals, actual outcomes, and altered physician roles
Types of uncertainty that doctors have to learn to deal with
awareness of not being able to learn everything, realization of limitations in medical knowledge and techniques, lack of personal knowledge from limits of available knowledge
What influences patient compliance?
comprehension from the patient -Influences - motivation to be healthy - perceived vulnerability to an illness - effectiveness of treatment
Professional Standards Review Organizations
determines if the services for Medicare and Medicaid are medically necessary - meet professional standards of quality, efficiently and effectively
Women have been historically under-represented in medical school classes owing to which of the following?
differences in the socialization of boys and girls
Parson's Sick Role Critcism
does not account for behavior variation, does not account for type of disease, does not account for variations of in patient-physician relationship, does not apply well to LC, mostly middle class pattern of behavior
Criticism of labeling theory
does not example what causes deviance, does not example commonalities among deviant actors, does not explain why certain people commit deviant acts and others in the same circumstances do not
Uninsured are mostly the working poor
employers do not provide insurance, earn too much to qualify for Medicaid, cannot afford private insurance
Parson's Sick Role
exempt from "normal" social roles, not responsible for condition, should try to get well, should seek help, and cooperate with a physician
Parson's Sick Role 4 Stages
exempt from "normal" social roles, not responsible for condition, try to get better, seek help from a physician
legitimacy
exempt from some obligations but no additional privileges and may be stigmatized examples: epilepsy
lay-referral system
family members, friends, and neighbors suggest, advise, influence actions to take based on illness symptoms
Ways that poverty can shape perception of need for care, interpretation of symptoms
financial barriers, culture of poverty, system barriers
What attracted corporations to health care delivery is the potential for:
financial profits
Once a professional group becomes established, Goode indicates that it begins further consolidate its power by:
formalizing social relationships
Electronic support groups
forming on the internet among people with similar health needs who wish to share their experience online and develop greater expertise
Articulated Goals
health care organizations that manage or control cost of healthcare: - monitoring how doctors treat a certain illness -limiting referrals -requiring authorization to prior hospitalization
Sociodemographic Variables in demographic trends
help-seeking behavior often involves interaction between several variables acting in combination to influence specific outcomes in specific social situations -research tends to focus on one variable
Countervailing Power
how a particular group may be only one of several groups in society trying to fulfill its interest
Low _____, and low ____ will result in low rates of ______________.
income, education, private health insurance
Changes due to deprofessionalization
increasing gov't regulation, managed care reducing physician authority, physicians becoming employees of corporations, increased consumerism on the part of patients
Self-care
layperson preventing, detecting, and treating his or her own health problems
In 2007, what % of all eligible physicians were members of the AMA?
less than 30%
Physician Roles "Gatekeepers"
limiting access to more expensive medical procedures and care by specialists -go directly to specialist
Physician Roles "Double Agent"
look out of interests of both company and patient
Diagnostic Related Group
max amount that the gov't will pay for a specific services to medicare patients - made an effort to change the healthcare delivery system
The _______ _________ model applies to the managment of chronic illnesses in which the patient works with the doctor as a full participant in controlling the disease
mutual partcipation
Mutual Participation Model
norm in most doctor-patient relationships -patient work with the doctor as a full participant in controlling afflicition -patient often modifies lifestyle by making adjustments responsible for medications and going for check ups
other-defined level
other people attempt to define an individuals symptoms as illness and call those symptoms to the attention of that person
What are problems with virtual doctor visits?
over-prescription of antibiotics, missing things from history, limited diagnostic tools, fragmentation of medicine, lack of resources available
activity-passivity model
patient is seriously ill or being treated on an emergency basis, because injury or lack of consciousness - overrides mutual participant model when physicians exert their authority to make decisions regardless of the patients desires
unconditional legitimacy
permanent exemption from obligations, plus gain extra privileges because of hopelessness of deviance examples: cancer
Arguments for autonomy
physicians themselves have established the medical standards enforce by gov't regulation agencies, laypersons are unable to judge technical performance, physician develops self-controlled collectivity for society's general good
JAMA
prestige group and also promoted awareness of allegiance to group
Characteristics of the profession
prolonged training in a body of specialized and abstract knowledge, an orientation toward providing a service. -must obtain public acceptance of competence -gain control over its own membership -by the 1920's
Ways to improve culturally appropriate care
provide interpreter services, recruit minority staff, provide training to increase cultural awareness, coordinate with traditional healers, community health workers, incorporate family and community in health care decision making, locate clinics, expand hours of operation
Stigma affects health situations in four way
psychological stress, seeking health cares due to fears of being stigmatized and the subsequent discrimination, adverse reactions from other health care settings, withholding of resources by communities
What situation has reduced public confidence in medicine more than any other single issue?
resistance to cost controls
Flexner Report recommend what changes to medical education?
schools have full-time faculty, qualifications of both students and faculty raised significantly, associated with a university and taught at a graduate level - resulted in the tightening of medical education standards
What is the common response to symptom of illness by people throughout the world?
self-care
What is the mutual participation model influenced by?
social class, age, education, severity of symptoms, and satisfaction with treatment
Mary Boulton and her colleagues explain that the influence of social class on doctor-patient relationships is best understood in terms of
social distance
A major barrier to effective communicator lies in the differences btw physicians and their patients with respect to;
status, eduction, training, and authority
Passive orientation
symptoms must be placed to doctors, and they must solve all of their problems
self-care
taking preventive measures, self-treatment of symptoms, and managing chronic conditions
Consumer orientation
taking responsibility for their own health and deciding when to seek medical
conditional legitimacy
temporary exemption from normal obligations examples: cold pneumonia
self-defined level
the individual defines his or her own symptoms, see illness behavior as a culturally and socially learned response
Labeling Theory
what is regarded as deviant behavior by one person or social group may not be so regarded by other persons or social groups - what is deviant vs. undeviant
What is an increase in consumerism?
when the consumer wants to make informed choices about the services available - shift toward consumer in healthcare = the patient has more status
Patient Advocate
working to convince case managers and employees that more expensive care is warranted in a case