H&W Exam 2

Holistic Medicine

"Holistic medicine is the art and science of healing that addresses the whole person - body, mind, and spirit. The practice of holistic medicine integrates conventional and alternative therapies to prevent and treat disease, and most importantly, to promote optimal health. This condition of holistic health is defined as the unlimited and unimpeded free flow of life force energy through body, mind, and spirit." -Patients are people -Responsibility, not dependency -Personal treatment

Mutuality

*This seems to be the optimal doctor-patient relationship model -Neither the patient nor the physician are dominant -Each bring strengths and resources to the interaction and relationship -Based on the communication between doctors and patients -Advantages: The patient will communicate and interact to listen to the Dr., and vice versa. It is a mutual relationship based on respect -Disadvantages: If you are not comfortable with speaking or your body, this might turn people off.

Consumerism

-"Buyer" / "Seller" relationship -Reversal of the power relationship -Patients can challenge decisions made by doctors in making diagnoses and working out treatment plans -Doctor: passive -Patient: active role "You get paid to do what i tell you" -Doctor: to do things the patient can't do on their own like medicine, scans, xrays -not common form of doctor patient interaction

Expanding role of pharmacists

-21st cent. -They no longer just prepare and dispense medication but also provide advice, info, and instructions about drug use. -most accessible of all health care personnel as they practice in a wide range of settings. -reduce social distance between customers by using terms they can understand -now Pharm degree for 6 years-was 5

.Changing demographics of medical students: % female and minority medical students 2009-2010 versus 1969-1970

-48% female 1st year 2009-10 -10% first year 1970

Direct to Consumer Advertising: what it is and where it is legal

-A form of marketing promotion that is aimed toward the end patient rather than healthcare professionals. -Pharmaceutical DTCA are used in newspapers, magazines, internet websites and on television. -Nearly one-third of Americans asked their doctors about an advertised medicine, and 82% of those who ask say their physician recommended a prescription -US: FDA regulation

Factors that influence illness behavior

-Age and gender in illness behavior -Ethnicity, education -Family structure and social network -Healthcare coverage and insurance -Socioeconomic status; with lower-class individuals most likely to delay seeking health care even with severe symptoms

Seven essential elements in physician-patient communication

-Build on the doctor-patient relationship -Open the discussion -Gather information -Understand the patient's perspective -Share information -Reach agreement on problems and plans -Provide closure

Nonprofit health insurance

-By the late 1920s and the Depression, millions of individuals were without work and therefore without health insurance and health care. -Blue Cross was created in 1929 as a non profit health insurance company.

Social Networks

-Close and ethnically exclusive social relationships tend to channel help seeking behavior toward the group rather than professional health care delivery systems. -Some research suggests that family is more critical than ethnic group. The family is the first person's first sign. social group and the primary source of societal values. Knowledge of disease and family authority appear as key intervening variables in a person's medical orientation. (geertsen) -*role of social network is to suggest, advise or coerce an individuals into taking or not taking particular courses of action. Folk treatments as opposed to hospital care -Economic realities may dictate use of alternatives to medical practitioners -they will seek care or not seek care if it is consistent with their cultural beliefs and practices.

Complimentary & Alternative Medicine

-Complementary medicine: Used together with conventional medicine -Alternative medicine: In place of conventional medicine Generally incorporates a holistic approach, focus on treating whole body and mind (herbalism, homeopathy, and acupuncture)

Impact of medical education experience on medical students

-Emphasizes the effort to become emotionally detached from patients

The American Medical Association

-Founding of the American Medical Association (AMA) in 1847 eventually organized physicians into a professionally identifiable group. Journal of the American Medical Association (JAMA developed in 1883. (an internal organizational measure that was highly significant for this process). It developed awareness among the members of the AMA of their allegiance to the medical profession. 1902, AMA was divided into component societies on the local level, constituent societies, a national house of delegates, a board of trustees, and national officers. The result included the basic unit of the AMA becoming the local society. It now had the authority to set its own qualifications for membership. There is no alternative medical association -Women have AMWA -AMA view of the physician as an indep. practitioner largely free of public control, who engages in private medical practice on a fee-for-service basis. -Important influence on health policy during the 20th century, but influence is began fading In 1963, 70% of qualified doctors were members, compared to 2007 when less than 30% were members Early medical schools marked by low standards of instruction, poor facilities, and lax admission policies Significant developments in the early 1900s: 1904 AMA established Council on Medical Education to review and implement ways to improve medical education

Seeking medical care

-Illness is a social state. -It is not just a disturbance of body -It has social meanings and impact -Only small numbers of people with symptoms decide to consult GPs (many self-medicate / self care) People often discuss symptoms with others before the discuss them with their doctor ('lay referral') "Lay referral network" (Friedson, 1960) -When do patients report illness? When they're unable to engage in day-to-day activities When they have decreased energy When they feel pain, nausea, fatigue When they just don't feel well -wealthier ppl go to doctor and women

Parson's sick role

-Illness is disruptive for society -Society instituted a special role for sick people -Legitimize illness and help you go back to functioning in society -he or she cannot help it -it is not deliberate -Two Rights: You are exempt from your traditional role and exempt from your wellbeing -Two Obligations: get better as soon as possible (steps to take) and consult and cooperate with medical experts

Japan Germany and Mexico

-J: national health insurance plan but its benefits are low (gov. fee schedule is primary mechanism for cost containment) does not cover all japanese -G: compulsory insurance, free health services and sick benefits. Public health insurance coordinated by national federation of health insurance M: pubic social security, health provided through the govs. secretary of health and welfare and private health care system

Affordable Care Act & Provisions

-March 2010 U.S. Congress passed: -Patient Protection and Affordable Care Act (HR 3590) -Health Care and Education Reconciliation Act of 2010 (HR 4872) *President Obama signed into law, creating: Patient Protection and Affordable Care Act (Public Law 111-148) Health Care and Education Reconciliation Act of 2010 (Public Law 111-152 ) Together, commonly known as The Affordable Care Act (ACA) of 2010 -makes major changes in 4 basic areas: 1.Insurance company accountability 2.Lowering costs and improving quality 3.Increasing access and choice 4.Patient rights and consumer protections -Rescission outlawed (dropping coverage for those who get sick) Ban on discriminating against kids with pre-existing conditions Expanded coverage to adult children up to age 26 Ban on lifetime coverage limits Some free preventive services including vaccines Expanded some Medicare benefits Expanded some Medicaid benefits for those with disabilities Provides self-funded long term care insurance through work place Bans denying coverage based on pre-existing conditions for anyone. Expansion of Medicaid eligibility in some states. State Health Insurance Exchanges - for those who fall between Medicaid and Employer covered Health Insurance

Gentleman's Agreement

-Millman -existed over hospitals to overlook each others mistakes -honest errors exist and they all make them -technical errors in good faith were less serious than moral ones.

Self Care

-Most common response to symptoms. It includes taking preventative measures (such as consuming vitamin supplements), self treatment of symptoms (such as taking home remedies or over-the counter drugs, and managing diagnosed chronic conditions -consists of health and illness behavior -When an individual's symptoms are familiar, the type of care needed and the likely outcome are known, and a physician is not required, that person is likely to engage in self-care.

Medicalization

-Parsons: medication is and should be an institution for the social control of deviant behavior. It is medicine's task to control abnormal behavior by medical means on behalf of society. -need to protect public's health, the economy and social order *(joseph davis) is the proccess by which medical definitions and practices are applied to behaviors, psychological phenomena, and somatic experiences not previously within the conceptual or therapeutic scope of medicine. -occurs when non-medical problems are defined as problems that need to be treated medically, usually as an illness or disorder of some type

Talcott Parsons's view

-Physicians' and patients' roles in illness and societal functioning. -too much illness is disruptive for society because you can not be a productive member of society when you are sick -idea patient: Permitted to: Give up some activities and responsibilities Regarded as being in need of care In Return : Must want to get better quickly Seek help from and cooperate with a doctor

Private health insurance

-Private health insurance companies began appearing in the mid-1800s -Foundation of health care financing the in the U.S. in the early 1900s. -profit driven -Health insurance policies are sold to individuals, families, and groups (usually businesses). -you may be able to choose the doctor and hospital you are treated in at a time that suits you. Private health insurance also provides cover for services not covered by Medicare such as physiotherapy, optometry, general dental and podiatry services.

Components of sick role

-Promotes individual health -Social control of occupancy of status 'sick'. Doctor is gatekeeper and legitimizes illness -Promotes health of society

Gov. health insurance

-Public (Government) Health Insurance -Medicare -Federal insurance program for those 65 and older developed in 1965. Those permanently disabled, their dependents and people with end-stage renal disease were added in 1972. Part A - hospital insurance program and Part B - physician program. -In 2003 Part D - prescription coverage was passed. -Medicaid Jointly funded federal-state program designed to make health care accessible to the poor. Eligibility varies from state to state.

Private market approach to health care: supply and demand

-Rationale - competition strongest possible motivator -Supply & demand: *The prices can be high because demand is high in US. *The other reason for high prices is because supply is limited -This model views health care as an economic good or privilege -Proponents of this model argue that this kind of competition has led to various strengths con:some health-care suppliers have significant market power.government has a significant influence on prices, it is not always based on supply and demand -Many countries started with this type of system but later moved away from it. The U.S., though holds tight to the principle of individualism.

Illness behavior involves

-Recognized disease -Fear of disease -Positive rewards and support provided for a person in the sick role -Behaving normally even with an undiagnosed illness

Types of nurses

-Registered nurses: responsible for nature and quality of all nursing care patients receive, as well as for following the instructions of physicians regarding patients. Also, they supervise practical nurses and other health personnel involved in providing patient care. -Practical nurses: bedside care of patients and also assist in the supervision of CNAs -Certified Nurses Aides (auxillary nurses): assist registered and practical nurses by performing less skilled medical care tasks and by providing many services designed for the overall personal comfort and welfare of patients

Illness Behavior

-The activity undertaken by a person who feels ill for the purpose of defining that illness and seeking relief from it -refers to the varying ways individuals respond to bodily indications, how they monitor internal states, define and interpret symptoms, make attributions, take remedial actions and utilize various sources of informal and formal care (David Mechanic) -Sickness has often been viewed by sociologists as deviant behavior -bodily changes, symptoms of illness that are disruptive, painful. and visible, are determinants o medical help seeking.

Arguments for and against autonomy of medical profession

-The federal gov. has implemented several measures to control costs and improve quality of medical care. Professional standards review organizations. Gov, regulation, diagnostic related groups that schedule fees placing a ceiling on how much the gov. will pay. Initiated efforts to reform the health care delivery system -patient's don't know what theyre talking about -it should be their decision because its their life -if their not in danger, the patient should be able to decide -Public attitudes toward the medical profession have shifted away from unquestioning acceptance of physician authority. There is tremendous dissatisfaction with rising costs and the failure to provide quality care for all Americans. This combined with how medical care is now organized has reducing authority of physicians Arguments for: Physicians themselves established the medical standards enforced by governmental regulating agencies Patients aren't able to judge the quality of care received Therefore, the physician is a member of a self controlled group who performs a vital function for society's general good - it's a quagmire for society

Federal & State government entrance into health care

-The federal government participation in health care began in 1789 -State governments in the 1800s

Determinants for seeking medical care

-Visibility and recognition of symptoms -Extent to which symptoms are perceived as dangerous -Extent to which symptoms disrupt family, work or social activities -Frequency and persistence of symptoms -Amount of tolerance for the symptoms

Folk Healing

-are used by low-income persons usually belonging to a racial and ethnic minority group that view it as a resource b/c it represents a body of knowledge about how to treat illness that has grown out of the historical experiences of their family and ethnic group. -few non Hispanic whites go to folk healers, although some elderly persons living in poverty and rural areas may be prone to use folk remedies in treating ailments. -common ingredients: ginger tea, honey, sugar, lemon juice, etc. -practicing folk healers are more likely African Americans, Hispanics, and American Indians -regarded as a residue of health measures left over from prescientific historical periods. -Afri. Amer. FH: they subscribe to the belief system because it does not differentiate b/w science and religion. -healthy: fortune sick: misfortune. emphsizes cause of problem and not symptoms. Can be cured by magic. Chicago black comm. -do not demand direct contact and will handle over the phone *Two types of black healers: Traditional (mentioned above) and Caribbean (voodoo)

Barriers to effective communication between doctors and patients

-compliance -social class differences -different perspectives or point of views -language barriers -gender

Labeling theory and illness behavior

-from the symbolic interactionist view (Freidson) -the key to distinguishing among sick roles is the notion of legitimacy. 3 types: - conditional, unconditional. and illegitimacy -there are different consequences for the individual and that his or her treatment by other people depends on the label of definition applied to the deviant's health disorder by others. -fails to explain diffs. in the way people define themselves as being sick adn in need of profession medical care.

Decentralized national health programs

-gov. control and management of health care delivery is more indirect. The gov. acts primarily to regulate the system, not operate it. Mediate and coordinate health care delivery b/w providers and the ogan. provided in the financing of services. Commonalities: 1. indirectly controls the financing and organz. of health services in a capitalist economy, 2. regulates payments to providers 3.owns some of the facilities 4.guarantees equal access to the general pop. 5. allows some private care for patients willing to be responsible for their own expenses -Japan, Germany, and Mexico

which group is most ignored / treated impersonally in communication and class background?

-poorly educated persons -upper and middle class person tend to receive more personalized service from physicians and are more active with presenting their ideas to a doctor and seeking further explanation of their condition -social class differences were the most important factors in physician patient comm.

Parsons' "Ideal Patient"

-sick role influenced by Vaber Permitted to: Give up some activities and responsibilities Regarded as being in need of care. Be open to treatment and what the Dr. prescribes In Return: Must want to get better quickly Seek help from and cooperate with a doctor

Communication & gender (of patients and physicians): female physicians and role/status

-some patients may perceive women physicians as less of an authority figure than male phys. (west) -family practice, pediatrics and psychiatry are considered "soft" and surgery and internal medicine are "masculine, tough, demanding," -women had to be assertive, highly professional, and not express warmth to be successful in the macho fields -impact on the doctor patient relationship is signf. -females are more empathetic and egalitarian in their relationship with patients

The Flexner Report

-sponsored by Carnegie Foundation for the Advancement of Teaching, Flexner visited every medical school in the country and issued his famous report in 1910 on medical education in US -It came out as a devastating indictment of the lack of quality medical education in the U.S. Only 3 schools were given full approval. Others were called "plague spots". -wanted medicals schools to be part of universities where medical students could receive a strong education in the natural sciences, have its own biomedical departments for research, teaching hospital, difficult entrance requirements, and a doctoral degree for graduates. -The AMA Council on Medical Education and the Flexner Report resulted in a tightening of medical education standards and Increased the profession's control over its own education

Socialized medicine

-system of healthcare delivery in which healthcare is provided in the form of a state-supported consumer service-health care is purchased but the buyer is the gov. which makes the service available at little or no additional cost to the consumer -Canada, Britain, and Sweden -Commonalities: 1.directly controls the financing and organization of health service in a capitalist economy 2.directly pays providers, 3. owns most of the facilities (Canada is an exception) 4. equal access to the general population 5.allows some private care patients willing to be responsible for their own expenses.

Social Justice approach to health care: right to care

-the right of everyone to the enjoyment of the highest attainable standard of physical and mental health -all people should have access to the means to avoid premature death and preventable morbidity pro: universal health care regardless of SES con: limited resources, expensive, high demand, low supply

Pharmaceuticalization

-the translation or transformation of human conditions, capacities, and potentialities into opportunities for pharmacological interventions. Six dimensions: 1.Selling sickness 2.Changing forms of governance 3. Reframing health problems in media/popular culture as having a pharmaceutical solution 4.Role of patients/consumer groups 5.Use of drugs for non-medical purposes 6. Pharmaceutical futures

Paternalism: Doctor- patient relationship

-traditional relationship -The doctor takes on the role of "parent" -The doctor is the expert and the patient is expected to cooperate -The patient is submissive and the doctor is dominant -The focus is on care, not on patient autonomy

Four components of Parsons's sick role concept

1. The sick person is exempt from normal social roles 2.The sick person is not responsible for his or her condition ( their condition is beyond their control) 3.The sick person should try to get well (exemption is temporary. Person has obligation to get well) 4.The sick person should seek technically competent hep and cooperate with the physician

Fred Davis's study of nursing students

1. stage of initial innocence: nursing students want to do things for patients within a secularized Christian-humanitarian ethic of care and kindness. Characterized by feelings of inadequacy, worry, and frustration, as the nursing instructors failed to support the lay(mother surrogate) image of the nurse. 2.labeled recognition of incongruity: nursing students began to collectively articulate their disappointment and openly question their choice of becoming a nurse. 3. psyching out: students attempted to anticipate what their instructors wanted them to know an to concentrate on satisfying these requirements 4. role simulation: students performing so as to elicit favorable responses from the instructors. 5-6. .provisional internalization & stable internalization: last 2 years of the program where the nursing students took on a temporary self-identity as a "professional" nurse as identified by the faculty and settled into this identification by the time of their graduation

Szasz & Hollender's models of interaction: physician patient interaction falls into one of three models

1.Activity-passivity model: applies when patient is seriously ill or being treated on an emergency basis in a state of relative helplessness, because of a severe injury or lack of consciousness (decision making and power in relationship are all on side of doctor and patient is passive and contributes nothing to interaction) 2. Guidance-cooperation model: arises most often when the patient has an acute, often infectious illness, such as the flu or measles. The patient knows what is going on and can cooperate with the physician by following his or her guidance in the matter, but the physician makes the decisions. 3. Mutual participation model: applies to the management of chronic illness in which the patient works with the doctor as a full participant in controlling the affliction. Patient modifies lifestyle by making adjustments to diet. (diabetes or heart disease) responsible for taking medication and seeking periodic checkups

.Four stages of the development of the hospital as a social institution

1.Centers of Religious Practice (Christian theological duty to help sick and poor: spiritual salvation) ran by nurses and clergy: These early hops. provided a wide spectrum of social tasks for the benefit of the lower classes, especially the provision of food, shelter, sanctuary, and prayer as well as nursing (medieval period) accept all people who are sick, 2.Poorhouses: removal of church, secular control- municipal govs.Free to pursue any course of action desired. (abuse: neglect of facilities, misappropriation of funds, and lowering of standards of patient care).moved treating the ill and sick to return to society 3.Death houses: changes were taken place as physicians discovered that hosps. contained large amounts of injured or sick, ppl whose health problems could be studied and upon whom the evolving techniques of medical treatment could be practiced. Claimed role as institutions for medical care, research, and education of medical students. Produced few cures. Because so few patients survived treatment, despite occasional heroic efforts, hospitals acquired an image as places where the poor went to die 4. Centers of Medical Technology (all indivs. Can receive quality care) 19th cent: image of institutions where patients of all social classes could generally expect to find highest quality of medical care and expect to be cured of their diseases - 3 factors lead to change: medicine became science and dev. successful techniques based on scientific method to seek out accurate medical knowledge, the discovery of the antiseptic measures to decrease spread of protection through gloves, masks and washing hands (medical technology) , and significant of improvement in quality of personnel such as doctors nurses and training and support through administration

The approximate percentage of Americans who have looked online for health/medical info.

72%

Average length of doctor consultation

8 minutes

Parson's "Ideal Doctor"

Applies a high degree of skill and knowledge: applies experience to the patient Acts for the good of the patient, not for what is fastest or easiest Remains objective and emotionally detached Respects the position of privilege: doesn't abuse their position by condescending or offering treatment that may not be as effective

Health care as a right or privilege

As a commodity it is a privilege. (conflict theory)

Canada v. Britain v. Sweden

C: -future model for US. Does not have a single health care delivery system: 10 provincial and 3 territorial ones. rising costs. Taxes. B: General practitioner who works from an office or clinic are paid an annual capitation fee for each patient on their patient list, best health profile in the world S: financed through taxation, highest in the world. Universal health insurance, equal welfare benefits, old age pensions, unemployment insurance,. Healthiest population in the world. hospitals are owned by county and municipal govs. Come from county councils

Medicalization

Defining a problem as a medical illness or a disorder requiring medical intervention to treat it. -Child birth Menopause Sexual Dysfunction Anxiety Childhood Behavior Heartburn or Indigestion Post Traumatic Stress Disorder Obesity Hair Loss Short Stature -the process of transforming problems not previously considered "medical" (or "health-related", we might add) into medical ones, usually in the form of disorders or diseases.

First hospital and medical school in the U.S.

FH: William Penn in Philadelphia in 1713 FS: University of Pennsylvania School of Medicinein 1765

.History of Medical Practitioners: foundation of U.S. medicine, first medical school

Few practitioners had been educated university or or medical school. The first American medical school was established by European trained doctors in 1765 at the College of Philadelphia and from there they exploded. Private American philanthropic foundations such as Carnegie and Rockefeller funded foundations pushed American far ahead of Europe.

Inner core, new recruits, general practitioners, marginal physicians

IC: the specialists who have control of the major hospital positions NR: inherit new positions in the inner core at some time in the future GP: linked to the intercore by referral system MP: practices were less successful and would remain on the fringes of the system

Importance of effective doctor-patient communication

It encourages patient compliance 1.Accurate diagnosis. 2.Enhancing patient compliance to treatment plans. 3.Contributing to doctor clinical competence and self assurance. 4.Contributing to patient satisfaction. 5.Contributing to cost and resource effectiveness by preventing unnecessary prescriptions for medication that are either wrongly prescribed or not properly used by patients. -There are three components that are necessary for effective communication and for communication to be an important therapeutic tool 1.If it reduces uncertainty 2.If it provides a basis for action 3.If it strengthens the physician-patient interaction

Nurse practitioners vs. Physician assistants

NP: registered nurse trained in the diagnosis and management of common ailments needing medical attention. Like P.A. They provide some of the same care as physicians, but are limited in the types of treatment they can provide to patients. They are supervised by a physician. -in the future, they may provide much of the primary care for patients. -lesser form of doctor or be simply a nurse given a more complex form of tasks delegated by the physician. -doctoral degree to train them to work at the highest professional level. Master's degree requir. PA: have a bachelor's degree, previous experience in health care as a nurse or paramedic, and become qualified after completing a PA program of 26 months=masters degree. They are licensed to practice medicine under the supervision of a physician and are trained to handle routine medical problems. They provide a level of primary patient care similar to or higher than NP. -more women PAS

Suchmans Ethnic Parochial & Cosmopolitan groups

Parochial groups: self care, less likely to use medical professionals, Cosmopolitan groups: -city, more likely to use medical professionals, have vast friends but fewer deep friendships, low ethnic expositity,

Managed care: control costs

Refers to health care 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 -combine prevention with patient education -take deep discounts out of doctor and hosp. fees and produce large profits without developing good managed clinical care.

Illness behavior stages

Stages 1st:symptoms, something is wrong: cough or pain. You decide something is wrong. 2nd:assuming sick role: push aside some responsibilities like missing class, social engagement or work 3rd: seek medical assistance and 4th: take on the dependent patient role, 5th : recovery and rehabilitation. A lot of the burden is on patients. Your doctor cannot come home with you so you have to listen to everything they prescribe for recovery

Why does "Doctor-Patient" Interaction matter

The doctor-patient relationship is fundamental for providing and receiving either excellent or terrible (or anywhere in between) care The doctor-patient relationship is essential to the healing process; to improved outcomes Based on trust

Lay referral Network

an informal system of individuals who provid advice or information regarding a person's symptoms and health -People often discuss symptoms with others before the discuss them with their doctor

Medicare & Medicaid

care: federally administered program providing hospital insurance and medical insurance for people aged 65 or older, regardless of financial resources. Also includes disabled ppl under the age of 65 who receive cash benefits from SS. Most of the cost is paid by the federal gov. Aid: welfare program. It provides for the federal gov.'s sharing in the payments made by state welfare agencies for health care providers for services rendered to the poor. -both helped provide care for poor and aged indivs. as well as set a precedent of the federal gov's involvement in the admins. of health care.

Default

very rare, if it happens with both low control, they will be at odds with each other and things wont change. The patient and doctor will be unsatisfied. It can lead to dysfunction. -patient adopts passive role -doctor reduces his control

The impaired role

when the prognosis is not grave. Normal social expectations and roles are expected. The impaired role assumes four characteristics: the role played by a person who is disabled or chronically ill and who is experiencing a state of wellness and realization of potential commensurate with the condition. Unlike the sick person, the impaired person cannot be expected to "want to get well" but is expected to resume as much normal behavior as is possible -assumes 4 characteristics: *the individual has an impairment that is permanent *the indiv. does not give up normal role role responsibilities, but is expected to maintain normal behavior within the limits of the health condition, *the indiv does not have to want to get well but is encouraged to make the most of the remaining capabilities