SOC 382 Chapter 11

Deprofessionalization Occurring as result of the changes discussed

-Increasing government regulation -Managed care reducing physician authority -Physicians becoming employees of corporations -Increased consumerism on the part of patients

Substantive rationality is?

A process of making decisions with an emphasis on ideal values

The social control of medical practice has traditionally presented special problems for ?

American society.

_______________________ was a more important norm than accountability undermining attempts at critical evaluation and control by overlooking fault in order to maintain group harmony

Etiquette

___________________ is defined by Max Weber (1978) as the purposeful calculation of the most efficient means to reach goals, while substantive rationality is an emphasis on ideal values. Ritzer and Walczak claim that formal rationality has become dominant in medical practice.

Formal rationality

With the coming of the corporation represents a loss of autonomy

Less control over the timing and pace of work, closer scrutiny over mistakes, and less control over decisions on policy, hospital budgets, capital investments, personnel appointments, salaries, and promotions

___________________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

Managed care

For the physician, health care corporations:

Provide jobs, offices, staffs, equipment, hospital privileges, and perhaps even a salary guarantee

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

Formal rationality is?

The purposeful calculation of the most efficient means to reach goals.

Society is thus justified in granting the physician professional autonomy because he or she is ?

a member of a self-controlled collectivity performing a vital function for society's general good. This argument contains three serious defects.

Organization of medical care has changed dramatically, reducing?

authority of physicians

Public attitudes toward the medical profession have shifted ___________ from unquestioning acceptance of physician authority

away

physicians are double agents because?

because they look out for the interests of the patient as well as for the interests of the managed care organization. Primary care physicians have to consider the interests of both in the treatment they provide.

The third major defect in the professional autonomy argument 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.

conditionally

The choices of clients act as a form of social ________ over professionals and can mitigate against the survival of a group as a profession or the career success of particular professionals

control

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

decline

Primary care physicians, on their part, function as both?

double agents and gate keepers

the dominant pattern of medical practice in the United States is becoming one in which many, perhaps most, doctors will be?

employees

Professional standards review organizations, as previously discussed, were established to____________the care given to Medicare and Medicaid patients. Even though PSROs were controlled by doctors, their function was a signal that the government wanted to ensure a standard of quality care.

evaluate

The specific issues usually cited are those of the rising financial costs of services and the failure to provide quality care for all Americans, despite the medical profession's claims of?

excellence and technological achievement.

Starr (1982:428) found that once government financing for Medicare and Medicaid showed health care could be ______________________ for providers, large for-profit corporations moved into the health field and established a foothold in the market by buying privately owned hospitals and nursing homes.

financially rewarding

Ritzer and Walczak argue that government policies 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 _____________________ (stressing efficiency) in medical practice leading to greater profit.

formal rationality

The ___________ function by primary care physicians also affects the patient's ex

gatekeeper

What is promoting the trend away from self-employment, according to Kletke and his associates, is a general evolution in the health care delivery system toward?

greater size and complexity.

Public dissatisfaction with the medical profession and its provision of health care in the United States is generally viewed as?

having largely economic and social origins.

The past decades have seen the emergence of numerous?

health care and health-related corporations E.g., for-profit hospitals and free-standing emergency centers

Doctors were regarded as "_____________," so a new provider-consumer relationship emerged in direct opposition to the old physician-patient relationship with its emphasis upon patient dependency.

health providers

The evolution f the organization of medical practice represents a major shift in the organization of American health care delivery because solo, self-employed, fee-for-service doctors have been the nation's traditional model of medical practitioner. However, this does not mean that medicine is no longer a ________________ profession.

high status

Another development has been the expansion of free-standing emergency centers that take business away from?

hospitals - these free standing centers are sometimes referred to as "Docs-in-a-Box" or "7-Eleven Medicine," these centers (called free-standing because they are not affiliated with a hospital) are typically open 7 days a week, 18-24 hours a day, and try to attend to their patients with a minimum of waiting time.

Countervailing power describes?

how a particular group may be only one of several groups in society maneuvering to fulfill its interests

Eliot Freidson's (1960, 1989) discussion of the __________________ made it clear that lay avenues of influence and authority exist independently of the physician and operate to guide the patient either toward or away from the services of a particular physician.

lay-referral system

it is important to note that _____________ do judge technical performance, regardless of whether they are competent to do so.

laypersons

Technical errors, if they were made in "good faith," were ______________serious than moral errors

less

At their best, ____________________ organizations organize and improve health care in a stable, reliable, and less costly manner and combine prevention with patient education

managed care

One of the most extensive changes in health care delivery, reducing the authority of physicians, has been the introduction of?

managed care

At their worst, ________________ disrupt doctor-patient relationships, take deep discounts out of doctor and hospital fees, and produce large profits without developing good managed clinical care

managed care organizations

As Freidson (1960:379) has stated, "in being relatively free, the medical profession should not be __________ for being absolutely free from control by patients."

mistaken

In an age of consumerism, the social role of the physician and the overall physician-patient relationship can hardly escape?

modification.

A ______________ was established in 1989, to identify incompetent physicians, dentists, and other licensed health practitioners

national data bank

___________governing colleague relations, essentially rules of etiquette, restricted the evaluation of work and discouraged the expression of criticism.

norms

A second major defect in the argument legitimizing the medical profession's autonomy relates to_____________efforts at peer regulation.

physicians'

Over time, the medical profession's control over its market faltered as these countervailing powers established powerful positions as well and ended the

profession's monopoly.

for doctors, managed care also means a significant _____________ in the authority to make referrals and choose modes of treatment.

reduction

managed care have the potential to reorganize health care into a?

stable, reliable, and less costly form that emphasizes preventive care

Rising costs of health care result in increased public demands for government intervention. The response of the federal government to these demands has been to ____________ improvements in health care delivery for all segments of the population, exert limited controls over physicians, and initiate efforts to reform the health care delivery system.

support

Autonomy assumed?

that physicians will resolve significant issues in favor of the public interest

Countervailing power suggests

that the medical profession is but one of many powerful groups in health care

DRGS initiated efforts to reform?

the health care delivery system

Physicians are patient advocates by?

working to convince case managers and other bureaucrats that more expensive care is warranted in a case

It has been argued that because physicians themselves have established the medical standards enforced by governmental regulating agencies and because laypersons are generally unable to judge technical performance, the two most common forms of social control in advanced society are?

—bureaucratic supervision and judgment by the recipient of services—are lacking

Light (2000) and Light and Hafferty (1993) used the term countervailing power to show how the medical profession was but one of many powerful groups in society

—the state, employers paying for health insurance for their employees, patients as consumers of health care, and the medical-industrial complex as producers of products and services for profit—maneuvering to fulfill its interests in health care.

George Ritzer and David Walczak (1988) indicate that medical doctors are experiencing a process of deprofessionalization. Ritzer and Walczak (1988:6) define deprofessionalization as?

"a decline in power which results in a decline in the degree to which professions possess, or are perceived to possess, a constellation of characteristics denoting a profession."

Arguments against autonomy of medical profession:

-Laypersons do judge technical performance, regardless of whether they are competent to do so -Autonomy granted to the medical profession is granted conditionally

Deprofessionalization?

A decline in power which results in a decline in the degree to which professions possess, or are perceived to possess, a constellation of characteristics denoting a profession

Arguments for autonomy of medical profession:

-Physicians themselves established the medical standards enforced by governmental regulating agencies -Laypersons are generally unable to judge technical performance -The physician is a member of a self-controlled collectivity performing a vital function for society's general good

doctors are moving from being the absolute authority in medical matters toward having ___________ authority.

lessened

With the emergence of new health care and health-related corporations these faculties minimize?

their expenses through an emphasis on the efficient use of resources - & are Generally aimed at more affluent patients who can pay for services, usually with private health insurance

Arguments against autonomy of medical profession:

-Rules of etiquette among colleagues restrict the evaluation of work and discourage the expression of criticism >Technical errors more likely to be forgiven by colleagues than moral errors -Incompetent and dishonest doctors may still be subject to sanction >Malpractice suits and government review boards

Three changes have particularly impacted the doctor-patient relationship:

1. shift in medicine away from the treatment of acute diseases and toward preventive health services 2. A growing sophistication of the general public with bureaucracy 3. Development of consumerism, which has led to more of a provider-consumer association between doctors and patients

Physicians are gate keepers by?

limiting access to more expensive medical procedures and care by specialists