Chapter 12 - The Physician in a Changing Society

healthier

Porter finds that the _________ Western society becomes, the more medicine it craves and the greater the tendency on the part of the public to demand maximum access to it

government policies

Ritzer and Walczak argue that ___________ _________ emphasizing greater control over health care and the rise of the profit orientation in medicine identify a trend in medical practice away from substantive rationality (stressing ideals like serving the patient) toward greater formal rationality (stressing efficiency) in medical practice leading to greater profit

deprofessionalization

Ritzer and Walczak indicate that medical doctors are experiencing a process of ____________________ - a decline in a profession's autonomy and control over clients

Coming of the Corporation

Starr describes how America was on its way to a major change in its system of health care delivery through the intervention of large health care conglomerates

health maintenance organizations (HMOs)

a form of prepaid group practice emphasizing preventative care where a flat fee is paid monthly for regular health service measures - did not work well because accountants were essentially telling physicians the most "economically friendly" path to take when caring for a patient

super physician

although the physician remains in charge, the idea of a "______-______" towering high above all other personnel on a health care team become unrealistic when other members of the team know more about their specialties than the physician

diagnostic related groups (DRGs)

are schedules of fees placing a ceiling on how much the government will pay for specific services rendered to Medicare patients by hospitals and doctors

social control of medical practice

argues that since physicians themselves have established the medical standards enforced by government regulating agencies and since laypersons are generally unable to judge technical performance, the two most common forms of social control in advanced society (bureaucratic supervision and judgement by the patient) are lacking

Golden Age of Medicine

by the mid-twentieth century (1950s-1960s), the medical profession in the United States stood at the height of its professional power and prestige, enjoying great public trust - illustrated by the professional dominance theory formulated by Eliot Freidson to account for the unprecedented level of professional control by doctors over health care delivery that no longer exists

private insurance companies

companies that reduce the risk of nonpaying patients through the coverage they provide

moral errors

errors of making the mistake of being unreliable, uncooperative, lacking in responsibility to patients, and failing to acknowledge subordination to superiors on the staff

honest errors

errors that exist among all physicians

technical errors

errors that, if hey were made in "good faith," are less serious than moral errors

government, managed care, corporations, doctor-patient

four countervailing sources of power limitation on medicine: (1) __________ regulation (2) the _________ ______ system (3) __________ in the health care business (4) changes in the traditional ________-______ relationship

corporate health care

in the context of _________ ______ _____, the physician is an employee rather than an independent practitioner - the doctor is bound by the rules and regulations of the corporation that, in all probability, is manage by people trained in business, not medicine

substantive rationality

is an emphasis on ideal values

formal rationality

is defined by Max Weber as the purposeful calculation of the most efficient means to reach goals

iatrogenic illnesses

medically induced illnesses or deaths in which medical personnel do something that makes patients sick or kills them through unsafe procedures, carelessness, inadvertently transmitting infections from one patient to another, and overprescribing or wrongful prescribing of drugs - example is Heath Ledger, who died from taking a combination of pain-killers and sleep medication

managed care systems

patients pay a set fee on a per capita basis every month and in return are entitled to whatever health care they require

primary care physicians

physicians that function as both "double agents" and gatekeepers" - double agents because they look out for the interests of the managed care organization as well as the patient - gatekeepers to more expensive medical procedures and care by specialists

professional

pressure on physicians from below (consumers) and above (government and business corporations in the health field) resulted in a decline in their __________ dominance

patient advocates

primary care physicians are forced to spend time as _______ _________, since they must secure the permission that patients need to receive the care

managed care

refers to health organizations - HMOs 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 - one of the most extensive changes in health care delivery reducing the authority of physicians, has been the introduction of ________ _____

free-standing emergency centers

sometimes referred as "Docs-in-a-box" or "7-Eleven Medicine," these centers are typically 7 days a week, 18-24 hours a day, and try to attend to their patients with a minimum of waiting time

Bernice Pescocolido

stated that "the movement of public opinion has been toward less confidence in physician authority"

acute, preventative, bureaucracy, consumerism

the changing physician-patient relationship (1) the shift in medicine away from the treatment of _______ diseases toward _____________ services intended to offset the effects of chronic disorders (2) the growing sophistication of the general public with __________ (3) the development of ____________ in medicine

countervailing power

used by Light and Hafferty to show how the medical profession was but one of many powerful groups such as the state, patients, and producers of medical products, in society maneuvering to fulfill its interests in health care

health insurance companies

the entities that determine who gets insurance coverage and what health conditions are covered

AMA

the passage of legislation establishing Medicare and Medicaid public health insurance in the 1960s was accomplished despite the opposition of the ____

medicalization

the process of turning human conditions commonly regarded as normal into medical ailments

conditionally

three defects to social control of medical practice arguement: (3) arises from the fact that the autonomy granted to the medical profession is granted ____________ on the assumption that it will resolve significant issues in favor of the public interest

laypersons

three defects to social control of medical practice argument: (1) __________ do judge technical performance, regardless of whether they are competent to do so

rules of etiquette

three defects to social control of medical practice argument: (2) physicians have _____ ___ ________ that restrict negative evaluations of colleagues work to maintain harmony, discouraging the expression of criticism

professional standards review organizations (PSROs)

were established in 1970 in conjunction with Medicaid and Medicare, to review and evaluate the medical care given to patients eligible to use these services