Medical Socy exam 3

When did the image of the deal doctor-patient relationship change?

1960s

In 2020-2021, about _______ of all students entering medical schools were women

56%

Depending on the severity of symptoms, Szasz and Hollender argue that physician-patient interaction falls into one of three possible models.

Activity-passivity model (seriously ill patient), guidance-cooperation model (acute condition), mutual participation model (manage chronic conditions)

Midwives

Assist mothers in childbirth Resurgence of midwives for natural childbirth, home deliveries, drug-free deliveries nurse midwives and lay midwives

What is the central rule of the doctor-nurse game?

Avoid open disagreement between players

Physician assistants (PAs)

Bachelor's degree 75% were women Licensed to practice medicine, but under physician supervision Provides a level of primary patient care to or higher than that of nurse practitioners

List four major criticisms of Parsons' concept of the sick role? Should the concept be abandoned?

Behavioral variation, varies by disease, relationships between patients and doctors, oriented toward middle-class (lower class may deny sick role)

List three medical techniques that were practiced before 1850 that are now considered ineffective, painful, dangerous, or fatal?

Bloodletting, purgatives, cholera treatments

Professional Standards Review Orgs (PSROs)

Conjunction with medicaid and medicare to review and evaluate the medical care given to patients eligible to use these services

Pharmacists

Doctor of pharmacy Key source of medication information for the public Need authorization from doctor to dispense drugs Supplement rather than challenge healthcare practitioners Practice in hospitals, clinics, pharmacies

As discussed in class, list three potential problems that can arise between the interactions of male physicians and female patients

Doctors may be insensitive to patients needs, decisions may not be in patients best interest, misdiagnoses, gender disparities in healthcare

List three examples of medicalization?

Dug and alcohol abuse, obesity, menopause

Give two specific examples of the differences between "biographical medicine" and "techno-medicine"

Focus on personal history vs technological intervention

Doctors in early 20th century

Had solo practice Were independent Charged fee for service

List three key factors associated with the Golden Age of Doctoring. When was the Golden Age?

High professional control, increasing prices, unnecessary tests, hospitalizations, prescriptions Golden Age was in 1950s

Prestige factors (Hall)

Hospital affiliation Clientele Inner Fraternity-Sorority

Explain the six stages of socialization of a nursing student

Initial innocence, labeled recognition of incongruity, psyching out, role simulation, provisional internalization, stable internalization

Nurses

Largest group of healthcare workers in the US Licensed registered nurse (RN) Licensed practical nurse (LPN)

There is a changing relationship between physicians and their patients. Identify elements of this relationship and discuss trends contributing to this change

Less time getting to know the patients from a doctor's perspective, affected by government regulations and other healthcare industries

Self-Care

Most common response to symptoms of illness Self-initiated and managed

What are features of professionalism?

Most legislation concerned with the profession is shaped by that profession As the occupation gains income, power, and prestige, it can demand high-caliber students The practitioner is relatively free of lay evaluation and control Members are strongly identified by their profession

Doctor-Nurse game

Nurses do not directly challenge doctor's orders Avoid open disagreement Doctor-nurse game is changing More assertive nurses More male nurses More female doctors

American Medical Association (AMA)

Physician is independent practitioner Publishes JAMA Opposed many healthcare reforms Supported some aspects of the Affordable Care Act

Patient advocates

Physicians convince various bureaucrats that more specialized and expensive care is warranted, must be secure the permission that patients need to receive the proper care

New technology in medicine

Prescription drugs ordered online Health and medical apps Electronic monitoring devices Electronic support groups (ESG)

List four specific forms of new medical technology as discussed in class

Prescription drugs ordered online, health and medical apps, electronic monitoring devices, electronic support groups

What are two of the key takeaway points of Timmermans (2020)? What is the most powerful tool in medicine?

Provides comparisons of conversations between doctors and patients in the 1970s with similar encounters today, a shift toward greater assertiveness on part of the patient. Conversation between patient and physician is most power tool in medicine

Give two examples of the medical decision rule

Rather than deny illness, doctors biased in finding illness

Explain how midwifery has remained in existence and also experienced a resurgence despite the opposition of the medical profession

Resurgence of midwives for natural birth, home deliveries, drug-free deliveries. Medical profession argued for hospital deliveries surgical deliveries, access to drugs, sanitary conditions

What is the Flexner Report, and how did it affect medical education?

Reviewed states of medical education, only 3 medical schools fully approved (Harvard, Johns Hopkins, Western Reserve) Recommended schools should have full time faculty and lab and hospital facilities available to students, med students should receive education in natural sciences, resulted in closure of all women's medical schools

List four reasons for declines in the dominance of the medical profession that occurred in the beginning of the 21st century

Rising costs, more government regulations, changes in doctor-patient relationships, corporations in the healthcare industry

What restricted the evaluation of work and discouraged the expression of criticism within physician circles?

Rules of etiquette

Gatekeepers

Screen patients before referring for expensive procedures and specialists Treatment may be delayed or denied

Other dangerous treatments

Snake oil Cocaine

According to Nicholas Christakis, what are the three specific ways that obesity can spread?

Social networks

4 characteristics that account for subordinate position to doctor

Technical knowledge needs physician approval Typically assist doctor in diagnosis and treatment Subordinate to and work at request of doctor Have less prestige than doctor

Bosks contended that ______ errors, if they were made in "good faith", were less serious than ____ errors

Technical; moral

Describe ways in which the doctor-patient relationships has changed and, also, what it may look like in the future

Technology has improved so more information through technology. Upper class is more consumer oriented and have more personal control. Barriers between patients and doctors with age, gender, SES. Eroded in recent years in US

Describe the features of professionalization and how the professionalization of the medical discipline occurred

Two basic characteristics are prolonged and specialized training and service orientation The professionalization of medicine would not have been possible without control over the standards for medical education

Which type of program produces the most registered nurses today?

University baccalaureate programs

The __________ model applies when the patient is seriously ill or being treated on an emergency basis in a state of relative helplessness, due to a severe injury or lack of consciousness

activity-passivity

The "inner core" of physicians consists of which of the following groups?

administrative elite

Which group aged 18-64 had highest percentage of persons without health insurance in 2017, according to Cockerham?

american Indians/alaskan natives

"The single most powerful tool in medicine" according to Timmermans (2020) is:

conversation between patient and physician

Medicare

covers those 65+

At the beginning of the 21st century we are witnessing that the dominance of medical profession is:

declining

Physicians take on a variety of roles to induce patient adherence to their treatment regimens. What are those roles?

educator, salesperson, cheerleader, detective

_______ protects women against heart attacks until menopause, when levels drop

estrogen

Techno-medicine

extensive use of advanced technology for testing, diagnosis, and the scientific determination of treatment

Midwifery is a new form of care available to women true or false

false

most physician assistants are men true or false

false

What attracted corporations to health care delivery is the potential for:

financial profit

Biographical medicine

focus on patient oral accounts of medical history

the doctor-nurse game is changing due to which of the following?

greater assertiveness by nurses, increased numbers of male nurses, the growing numbers of female doctors

what is true about nurse practitioners?

in the future, nurse practitioners may provide much of the primary care for patients nurses are concerned the role of nurse practitioner may be consumed by the medical profession There are new Doctoral of Nursing Practice degrees

Nursing Instructors fail to support the lay image of the nurse in what stage of socialization, according to Davis?

initial innocence

This stage of socialization in the nursing students education consisted of nursing students wanting to do things for patients within a secularized Christian-humanitarian ethic of care and kindness , consistent with the lay image of nursing:

initial innocence

American medical schools in the 1800s were known to have:

low standards, poor facilities, incentive programs, financially strong students

Many people in the _______ may tend to deny the sick role

lower class

Iatrogenic Effects

medically induced illnesses or deaths

What are iatrogenic effects?

medically induced illnesses or deaths

The _____ model applies to the management of chronic illness in which the patient works with the doctor as a full participant in controlling the disease

mutual participation

____________ assist in delivering babies under the supervision of a physician

nurse midwives

With founding of the American Medical Association ___________ could mark the beginning of a new era in medicine

physicians

Medicaid

public system for poor

The most common response to symptoms of illness by people throughout the world is:

self-care

A major barrier to effective communication lies in the differences between physicians and their patients with respect to:

status, education, training, authority

Charles Bosk contended that _______ errors could be forgiven and often has the result of motivating the offending physician to work harder, spend more time with patients, double-check procedures, and learn from the mistake

technical

Which involves the extensive use of advanced technology for testing, diagnosis, and the scientific determination of treatment in a more differentiated world of health care delivery?

techno-medicine

The patient physician relationship involves mutuality in the form of behavioral expectations, and the status and power of the parties are _______.

unequal

Rules of Etiquette

Discourage criticism Evaluation Accountability

Describe the four basic aspects or categories of Parsons' sick role

Exempt for regular social role responsibilities, not responsible for their condition, obliged to get well, seek competent help and cooperate with doctor

What are some secondary gains of the sick role? List two examples

Exempt from normal responsibilities like work and school, gain privileges like needing help from a parent

Gentlemen's Agreement (millman)

Existed among the hospital physicians to overlook each others mistakes

What are the three important factors in the establishment of prestige within the medical profession? Please explain and give examples

Hospital affiliation, clientele, inner fraternity-sorority

What is managed care? What is its role in health care delivery? What effect does it have on the work of physicians?

Managed care is healthcare organizations that controls costs by monitoring how doctors treat specific illnesses, limiting referral to specialists, etc. Patients and employers have to pay a monthly fee for care. The care they receive could be stable, reliable, less costly. Physicians can be disciplined for excessive spending and have to oat deductibles and copayments for services

List three reasons why individuals engage in self-care

Modern medicine has limits, recognize importance of healthy behaviors, expensive medical care

Florence Nightingale

Nursing role changed in middle of 19th century Established nursing as a distinct and honorable occupation Brought code of behavior ot nursing Trained as nurse in Germany Founded hospital for "Sick Gentlewomen in DIstressed Circumstances" in 1853 in England Brought 38 volunteer nurses to care for British soldiers during Crimean War

Diagnostic and Statistical Manual of Mental Disorders (DSM)

Revised and had almost three hundred disorders 2000 Current fifth edition (DSM-5) has 341 disorders

Germ Theory (Louis Pasteur)

Revolutionized medicine and provided the foundation for the discovery, classification, and treatment of numerous diseases

Changes in Status of Doctors

Rising costs More government regulations Corporations in the healthcare marker Changes in doctor-patient relationships Smaller gap between physicians and other healthcare personnel

Diagnostic-Related Groups (DRGs)

Schedules of fees placing a ceiling on how much the government will pay for specific services rendered to medicare patients by hospitals and doctors Continued the government's attempts to meet public demands to control the cost of health care

Explain how the role of the nurse practitioner/clinician came to be, how it is expanding, and what concerns doctors have

Similar to PA, increasingly common with Affordable Care Act, primary care centers in retail stores, trained to diagnose and manage common ailments

Nurse practitioners

Similar to physician assistants Often supervised by off-site physician whos on call Becoming increasingly common with Affordable care act and Primary care centers in retail stores

List four characteristics that account for the subordinate position of nurses, physician assistants, pharmacists, laboratory technicians, and physical therapists to doctors

Technical knowledge needs physician approval, typically assist doctor in diagnosis and treatment, subordinate to and work at request of doctor, have less prestige than doctor

Give two examples of iatrogenic effects

Unsafe procedures, transmit infections, amputate wrong leg or arm

Females are more likely to

Visit physicians Have higher morbidity Take better care of themselves Be admitted to hospital

Double Agent

Work for patients and managed care organization Become patient advocates for specialized care

6 Stages of Nurse Socialization (Davis)

initial innocence labeled recognition of incongruity psyching out role simulation provisional internalization stable internalization

What are used as forms of sanction?

jails, prisons, mental hospitals, juvenile detention