Medical Sociology Test 3
Oswald Hall identified three factors important in establishing prestige within the medical profession: Hospital affiliation, clientele, and the inner fraternity . (pp.265-268) Provide a brief description of each. How do these work together to maintain the power structure of the medical profession?
(institutional position) •Hospital affiliation- the more important hospital positions were usually associate with the more financially rewarding medical practices. •Clientele- (retaining and improving it) physicians need to play the role of a promoter. The physician was required to interact with patients so as to secure their approval of the services provided. •Inner fraternity-in medicine that operated to recruit new members, allocate these new members to positions in the various medical institutions, and help them secure patients through referrals.
What are PSROs, what is their function? (p.278)
-professional standards review organization -composed of licensed physicians who determine if services rendered are medically necessary, meet professional standards, and are provided as efficiently and effectively as possible
As we discussed in class and Cockerham mentions in the text, we are moving close to 50% of medical students being female; this in and of itself is a change in the traditional power structure of medicine. What tools have female medical students/residents used in their interactions (within medical education as well as with patients) while functioning in a traditionally male based medical system.? (p.228-230 )
...
What are the two basic characteristics that William Goode identified as sociologically relevant in explaining professionalism? (p.250)
1). Prolonged training in a body of specialized and abstract knowledge. 2). And orientation toward providing a service.
What are two basic beliefs prevalent in Faith Healing? (p.317)
1. Healing occurs through psychological processes 2. Healing is accomplished by intervention of God and constitutes a present-day miracle.
Potter and McKinlay have identified three other relevant factors, name one of these (p.234)
1. shift in government role of protecting medical profession to protecting corporate health care 2. commercial products for use by the patient independent of physician (over the counter meds) 3. Rise of chronic diseases
We saw a TED talk by Abraham Verghese, in which he talked about doctor-patient interaction. How soon into a medical interaction do doctors typically interrupt patients?
14 Seconds
What percentage of fully qualified physicians belong to the AMA? (p.253)
15%
According to the NIH website, what percentage of adults, and what percentage of children, use CAM? (p.315)
38% adults 12% children
Among what racial/ethnic groups are practicing folk healers most likely to be found? (p.321)
African Americans, Hispanics, Native Americans
What did Deborah Glik's research identify as the most common form of healing for participants in spiritual healing groups? (p.318)
Alleviation of symptoms leading to reduced stress and greater support
How did the Christian Science church change its position in 2009? (p.321)
Allowed members to seek professional medical care if necessary and use Christian Science as a supplemental form of healing
What purpose do social workers, pastoral counselors, and psychologist on the hospital staff often serve? (p.225)
Calming patient and family
What are two reasons that chiropractors may be favored over physicians? (p.316)
Cheaper and Kinder towards patients
What does Cockerham state to be key to avoiding noncompliance by patients with physician orders? (p.232)
Communication
In what areas were female physicians found to be better compared to their male colleagues? (p.228)
Communication and patient centered care
In what areas were female physicians found to be better compared to their male colleagues? (p.228)
Communication, Preventative Care, Following clinical guidelines
What is CAM (p.313)
Complementary and alternative medicine is the use of treatments that are not commonly practiced by the medical profession
What is the identifiable pattern among many Americans that Cockerham identifies? (p.233)
Consumerism, consumer wants to make informed choices about services and not be treated as inferior
What do curanderismo healers believe about the purpose of a patient's suffering, why does God allow people to suffer? (p. 325)
Cuanderos believe that suffering is for sin and should be seen as an opportunity to learn from mistakes
What sorts of practitioners fall under the umbrella of complementary and alternative medicine? Give two examples. (p.313)
DO (Doctor of Osteopathic Medicine), Chiropractors
What are DRG's? (p.280-81)
Diagnostic related groups: schedules of fees placing a ceiling on how much the government will pay for specific services rendered to Medicare patients by hospitals and doctors.
What do people who use CAM practitioners, and people who use faith and folk healers, have in common? (p.315)
Dissatisfaction with professional medicine
Give the major reason that folk practices continue to persist in modern societies. (p.321)
Dissatisfaction with professional medicine and cultural gap between biomedical practitioners
What are "designer drugs"? (p.238)
Drugs formulated in comparison to DNA to produce better effects with less side effects for a particular person
Cockerham describes several models of doctor-patient interaction: activity-passivity, guidance-cooperation, and mutual participation. What is the prevailing norm in contemporary doctor-patient interaction? (p.221)
Empowering patients to participate in decisions about their care
How do you see this affecting doctor-patient interactions as more and more women enter medicine? How do cultural differences and racial differences affect doctor-patient interaction? (p.230-32)
Female physicians may be more likely to choose feminized specialties
What are perceived strengths and weaknesses of differing communication styles when it comes to male/female physicians? (p.230)
Female physicians seem to be more empathetic and concerned with psychosocial situations of patients
Give two examples of iatrogenic illness. (p.277)
Giving patients vaccinations or drugs that make them sick or aggravate preexisting conditions, leaving sponges or surgical instruments inside a patient's body after an operation, amputating the wrong leg or breast, and so on.
Give one example of how the Internet can serve as a source of social support for people with health problems. (p.236-237)
Groups on social media for patients suffering with the same diseases
What is the medical decision rule? (p.220)
Guiding principle behind medical decision making
What is one advantage that black folk healers offer their clients? (p.323)
Healers are typically readily available, and offer fast relief in most cases
What two physician specialties are identified as being known for trying to retain decision-making authority for themselves? (p.223)
ICU physicians and surgeons
By 1900, where had the entire medical school faculties of Harvard, Johns Hopkins, Yale and Michigan been trained? (p.252)
In Germany
Name one example given by your textbook of how technology has affected/changed the doctor-patient interaction. (p.234-7)
Internet medicine, improved accessibility, decline in patient centered care
What is iatrogenic illness? (p.277)
Istrogenic illness: (medically induced) or deaths in which medical personnel do something that makes patients sick of kills them through unsafe procedures, careless, inadvertently transmitting infections from one patient to another and overprescribing or wrongful prescribing of drugs
Why did physicians in America strongly support the rise of scientific medicine? (p.252)
It gave them greater effectiveness I a rapidly industrialized society and provided them with higher status, prestige, and income.
What has happened to the traditional doctor-patient relationship? (p.234)
It has been intruded on by third party payers such as the government and insurance providers
In what way is Cree healing like folk healing? (p.328)
It treats the whole person, not just particular symptoms
How did the power and control of local medical societies serve to control a physician's admission to the AMA? (p.253)
It was enhanced
What did Levy maintain to be the reason for utilization of native healers and physicians? (p.327 )
Lack of access to medical facilities and lack of communication with physicians
In research done in Great Britain and the USA, was there a physician gender difference seen when considering more age-related diseases? (p.228)
Less gender difference in age related diseases
Which two groups in society have been identified as generally having the most communication problems with physicians? (p.226)
Lower class and Women
Which model is standard in most doctor-patient interaction? (p.223)
Mutual participation
What is one way that adult Americans use online resources regarding health or medical information? (p.235)
Negotiation of treatment with physician based on personal internet research prior to appointments
According to research by Allen and Wallis, did the Pentecostal church prohibit members from seeking professional medical care? (p.318)
No, but faith healing was the preferred method of care
What is one of the few states that Cockerham notes has assigned property rights to the individual over genes/tissues taken from an individual's body and used for research and development purposes? (p.240)
Oregon
Boyer and Lutfey's research on doctor-patient role relationships identifies several changes in these relationships compared to those in the past. What are some patient, and physician, based reasons for these changes and the move toward sharing of decision making? (p.223)
Patients becoming more active in their healthcare and Physicians becoming less paternalistic towards patients
What are some reasons that Cassell's research identified for physicians not communicating clearly with patients? (p.225)
Physician uncertainty of patient understanding, time to explain, etc.
What group in society is the most likely to have their questions ignored and be treated impersonally? (p226)
Poorly educated
What distinguishes their practice and is particularly significant in the reduction of anxiety? (p.323)
Recognition that health problems are an integral part of other daily life problems
How does race of the doctor and patient affect patient satisfaction? (p.226)
Satisfaction is often greater when Physician and patient are the same race
What do Szasz and Hollender identify as the determining factor in doctor-patient interaction? (221)
Seriousness of patient's symptoms
Not all patients are dissatisfied with their medical care. What is the key variable in this situation? (p.233)
Social Class
The doctor-patient interaction that takes place appears to be strongly affected by what? (p.222)
Social class differences
Elianne Riska gives two explanations for gender segregation in medical practice: structural and voluntaristic. How does she define these? (p.231)
Structural: Barriers keep women from advancing to top positions in medicine. Voluntaristic: Women are socialized to follow stereotypical gender expectations and consequentially tend to make occupational choices to fit those expectations.
Define technical errors and moral errors. Which is seen as most serious? (p.276)
Technical errors: could be forgiven and often had the result of motivation the offending physician to work harder, spend more time with patients, double-check procedures, and learn from the mistake. Moral errors: making the mistake of being unreliable, being uncooperative, lacking in responsibility to patients, and failing to acknowledge subordination to superiors on the staff. MORAL ERRORS (technical errors if they were made in "good faith," were less serious than moral error)
What is one example your text provides of male physicians' misperceptions about female patients? (p.227)
Tendency to misdiagnose heart attacks as stomach upset or anxiety problems.
How do Christian health care sharing ministries work, where are the largest number of participants located, and what are some things that may not be covered under such a plan? Name two. (p.319)
Texas...members pay into accounts monthly and then is distributed to people with medical bill that meet the regulations. Broken bones or surgery are not covered by Christian Science practitioners
What is the most prominent group in American society advocating a preference for religious healing, and what did their founder maintain about pain and sickness? (p.319)
The Christian Science Church... Maintains that sickness and pain are illusions
What did Loudell Snow's research on faith healing show that folk diagnosis of a health problem emphasizes? (p.322)
The cause of the problem
What is the most important factor engendering trust in the doctor-patient relationship? (p.226-7)
The physician's behavior toward the patient
Cockerham gives an example of a study done by medical sociologist Rose Weitz on a family experience with ICU doctors. (p.222)
The physicians were unwilling to share decision making authority.
Name and explain the two ways that human cloning is characterized. (p.241)
Therapeutic or Reproductive
Are there limits as to how much the church pays? (p.319)
There can be
10. Research indicates that "medical education is having to adjust to new realities in medical practice" (p.263-4). (Name two of these realities).
They include the transition in American health care delivery from 1). A system run by doctors to one shaped by the purchasers of care and the competition for profits; 2).a decline in the public's trust in doctors to greater questioning and even distrust; 3). A change in emphasis on specialization and subspecialization to primary care and preventions; 4). Less hospital care to more outpatient care in homes and doctors' offices; 5). Less payments of costs incurred by doctors' decisions to fix prepayments, with demands for detailed accounts of decisions and their effectiveness.
How does social distance affect communication? (p226)
Typically makes communication more restricted
In Hardey's study of British households, who did he discover made decisions about what information was accessed and used? (p.235)
Users of the internet
What advantage does the curandero bring to the treatment setting? (p.325-6)
Work in a subculture that accepts curandero as fact and supports methods
Is sexism still an issue in medical schools, for female medical students and faculty? (p.229-30)
Yes
What is countervailing power? (p.279)
a high power profession declining to a less profitable one
What are one of the two specific issues cited as reasons for public dissatisfaction with the medical profession and provision of care? (p.273)
are those of the financial costs o services and the failure to provide quality care for all Americans, despite the medical profession's claim of excellence and technological achievement.
How are medical students taught to view disease and death? (p.260)
as a medical problem rather than a emotional problem.
Naturopathy? (p.313)
based on the idea that diseases arise from blockages in a person's life force in the body, and treatments such as acupuncture and homeopathy are needed to restore the energy flow
Why is there no forum for effective dissent within the AMA? (p.254)
because public debates are disapproved of in order to project and an image of a united profession in the association's interaction with outside agencies.
What are the two most common forms of social control in advanced society? (p.274)
bureaucratic supervision and judgment by the recipient of services --- are lacking
Which type of DNA can be patented, isolated or synthetic? (p.241)
c-DNA/complementary DNA
What was the Flexner Report, and how did it affect medical education in the United States? (p.256-257)
consist of full time faculty, lab and hospital facilities be made available to students. Standards of who can get into medical school. Graduate school level. To become model of professionalism
How do medical students' attitudes change as they progress through school? (p.261)
enter med school idealistic; medical students become cynical as a result of their education; graduation approaches idealism seems to return
In how many states are chiropractors licensed to practice?(p.316)
in all 50 states
How and why have third party payers intruded on the doctor-patient relationship? (p.280)
in order to control the cost of care by limiting physician prerogative.
In what areas can osteopaths specialize? Give two examples. (p.265)
in surgery, anesthesiology, psychiatry, pediatrics, radiology, and other medical specialties.
What is evidence-based medicine? (p.260) (EBM)
is an emphasis upon a technique that reduces uncertainty among students in the application of medical knowledge
What does Cockerham state to be the problem with a professional dominance thesis? (p.279)
it does not allow for decline.
What percentage of women physicians belong to the AMA? (p.253)
less than one fifth %
Why did women's medical schools close? (p.257)
mistakenly thinking that women would be admitted to the newly reorganized mainstream schools
What percentage of the total medical work force are made up of doctors? (p.250)
physicians constituted less than 10%
What is the hidden curriculum? (p.263)
refers to an "undercurrent" of norms, values, viewpoints that are embedded in the training process and adopted by students as they are integrated into the profession.
What is managed care? (p.281)
refers to health care organizations—health maintenance organizations or preferred provider organizations—that "manage" or control the cost of health care by monitoring how doctors treat specific illnesses, limit referrals to specialists, and require authorization prior to hospitalization, among other measures.
How are osteopaths trained, and are they recognized as a medical specialty? (p.264)
scientific medical training in such areas as surgery and pharmacology. Added skill of training in spinal procedures. Training as an intern and resident requited...they are recognized as a medical specialty.
What part of the ACA did they oppose? (p.255)
some aspects of the plan, namely, stipulations that affected physicians incomes.
What did Ellen Idler's study of health and degree of religious involvement among a sample of elderly persons reveal? (p.316)
that those persons with the highest levels of religious involvement showed the least depression and physical disability
What does research by Light state to be the key factor in organized medicine losing the power to determine health policy? (p.281)
the loss of public trust that began during medicine's "golden age of fee-for-service" in the mid-twentieth century when profits in health care soared.
What does Roy Porter mean by the statement that "medicine has become a prisoner of its own success"? (p.274)
the root of the problem is structural in that the public demands more medicine, and medicine feels pressured to respond-even if the response means over-doctoring, unnecessary lab test, more extensive and expensive treatments, and treatments for trivial complaints.
Homeopathy? (p.313)
the use of microdoses of natural substances to bolster immunity
What were proprietary medical schools? (p.255)
these schools, in the absence of any educational controls, were designed to offer medical degrees as a profit-making venture.
What does CAM include?Homeopathy? Naturopathy? (p.313)
visits to chiropractors, faith healers, and folk healers, as well as to acupuncturists, homeopaths, and naturopaths, and the use of dietary supplements to prevent or cure diseases
Are chiropractic services covered by Medicare and major private insurance carriers? (p.316)
yes
Did the AMA completely support the enactment of the Affordable Care Act? (p.255)
yes
