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