Medical Sociology Exam 3

How has managed care affected doctors and/or patients?

"Manage or control by monitoring doctors" - Reduces authority of physicians because they are constantly being monitored - Question authority and medical knowledge of doctor - Double agent → Doctors are now working for patients and managed care - Gatekeeping → screen patients before referring for expensive procedures

Medical advancements

1800s --> germ theory of disease Pasteurization of milk Antibiotic discovery Anthrax

What % of nurses work in hospitals and nursing homes?

70%

Why do people engage in self-care?

Alternative healing options Don't trust doctors Depersonalization in healthcare Cheaper alternative Modern medicine has limits

Psyching out

Anticipate instructor's intentions and focus on these

Characteristic of midwives

Assist mothers in childbirth One of earliest forms of care for women Midwives attended - Virtually all births in colonial America - Half of births in 1900 - Exceptionally few births in 1950 - 12% of all births in 2021 in U.S. Resurgence of midwives for - Natural childbirth, home deliveries, drug-free deliveries - Includes middle-class women

What are key aspects of doctor-nurse relationship?

Avoid disagreements Nurses should not question doctors Hierarchy that needs to be upheld

What were some questionable techniques?

Bloodletting (George Washington died of this) Purgatives (caused vomiting) Cholera treatments Cocaine Snake oil

Where and when was the first medical school?

College of Philadelphia; 1765

Timmermans (2020)

Cyberchondria - Internet searches lead to more concerns (Web MD) Importance of communication The single most powerful tool in medicine is conversation between doctor patient New age of TV ads directly to consumer Pharmaceuticalization has led to over prescribing

What changes have occurred in the medical profession and why?

Decline due to... More government regulations Corporations in the healthcare industry (money and economics) Rising costs Smaller gaps between physicians and other health care personnel Patients are becoming more critical and less satisfied with their care

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

Declining

labeled recognition of incongruity

Disconnect between training and expectations Collectively articulate disappointment (question choice of becoming a nurse)

What role does doctor-patient relationship suggest about the relationship?

Doctor's have more authority Imbalance of power

Mutual Participation

Doctor-patient interaction model Full participation on the patient's part Not severe symptoms

Guidance-cooperation

Doctor-patient interaction model Medium participation Acute illnesses

Activity-Passivity

Doctor-patient interaction model Symptoms are the worst Patient is being treated on an emergency basis Doctor has all the power

Flexner Report

Early 1900s The quality of medical education was bad in the U.S. Urged standards - considering the admission of students - qualifications of medical school faculty needs to be raised

Who talks about prestige in medicine?

Hall

What are the characteristics of the golden age of doctoring?

High professional control Increasing prices and overcharging Unnecessary tests, hospitalizations, prescriptions, operations Provider-structured insurance paid for most costs, inc. mistakes Major growth industry

What are three factors and their characteristics of prestige in medicine?

Hospital affiliation - more prestigious hospitals provide better paying practices Clientele - hospital connections - patient referral Inner fraternity - Help secure patients through referrals - Urban hierarchy

What is managed care?

How healthcare organizations control costs

What are the 6 stages of socialization?

Initial innocence Labeled recognition of incongruity Psyching out Role stimulation (end of 1st year) Provisional internalization Stable internalization

Trends in nursing

Initial reputation of nursing - high stress - long hours - unattractive Status and income increased in the 1980s because of shortage of nurses (increasingly drawn from middle and upper class)

Characteristics of PAs

Licensed to practice medicine, but under physician supervision Provides a level of primary patient care similar to or higher than that of nurse practitioners Bachelor's degree, previous experience Complete 26-month training program Similar to master's degree 75% were women

SES and doctor interaction

Lower class tends to be more passive when dealing with their doctor - Just accepts what doctors says Middle and upper class seem to be more consumer oriented - You can shop around for your provider - More active when dealing with doctor - Will negotiate with doctor Patients with similar backgrounds to doctors share similar communication styles - Easier to communicate

How and what factors affect doctor-patient interactions?

Male doctors are more likely to misdiagnose heart attacks in female patients Female doctors are more attentive to patient's history Questions ignored if patient is less educated than doctor (Provider doesn't think very highly of patient, Treated very impersonally)

Nursing students characteristics

More female based Lower-middle class and working class are typical social origins

How is the doctor-nurse game changing?

More females are becoming doctors Nurses being more assertive More male nurses Leads to decline of inequality

______________ assist in delivering babies under the supervision of a physician.

Nurse midwives

What characteristics account for the subordination of nurses?

Nurses have less prestige than physicians Do not have same technical knowledge for approval that doctors need

What are some concepts related to the social standards and control of medical practice?

Orgs Rules of etiquette Gentleman's agreement (exists among physicians to overlook other mistakes) iatrogenic effects (could be technical or moral error)

What has overprescribing led to?

Over prescribing medications has led to... - Antibiotic resistance - Opioid epidemic (misuse of these drugs)

Role stimulation (end of 1st year)

Perform to elicit favorable responses from instructors

Who developed medicalization?

Peter Conrad

What are the AMA's guiding principles?

Physicians are independent practitioners Generally free of control from public Fee-for-service medical practice

What are the other features of professionalism? (8)

Profession determines education/training standards Student exposed to stringent socialization Profession recognized by licensure Licensing boards staffed by profession members Profession primarily shapes legislation High-caliber students attracted to income, power, prestige Lay evaluation and control have minor impact on practitioner Strong identification of members by profession

What are the two essential features of professionalism?

Prolonged and specialized training Service orientation

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

Rules of etiquette

What are the forms and characteristics of errors in medicine?

Technical - made in good faith - doctors should learn from their mistakes Moral - unreliable

Characteristics of NPs

Trained to diagnose and manage common ailments Treat Minor injuries, heath problems Vaccinations (flu, COVID shots) Manage chronic diseases Prescribe medications (in all 50 states) Controlled substances (in some states)

Characteristics of RNs

Typically responsible for the type and quality of all nursing care patients receive Follow doctor's instructions to care for patients Supervise practical nurses

Nursing instructors fail to support the lay image of the nurse in what stage of socialization, according to Davis? a. Initial innocence b. Labeled recognition of incongruity c. Psyching out d. Role simulation e. Provisional and stable internalization

a. Initial innocence

Bosk contended that _________ errors, if they were made in "good faith," were less serious than ______ errors. a. Technical; moral b. Moral; technical c. Accidental; real d. Real; accidental e. Accidental; personal

a. Technical; moral

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? a. Techno-medicine b. Electronic medical records c. eMedicine d. WebMD e. None of the above

a. Techno-medicine

What are the three doctor-patient interaction models?

activity-passivity, guidance cooperation, mutual participation

Where did physicians work in the 1800s?

apothecaries, ship surgeons

With the founding of the American Medical Association (AMA), _________ could mark the beginning of a new era in medicine. a. Nurses b. Physicians c. The government d. Hospitals e. None of the above

b. Physicians

A person may desire to retain the sick role more or less permanently because of what Parsons calls a _________________ , which is the exemption from normal obligations and the gaining of other privileges commonly accorded to the sick. a. Primary reward b. Secondary gain c. Tertiary exemptions d. Primary reaction e. None of the above

b. Secondary gain

What is the assumption of Parsons sick role based on?

being sick is not a choice of the person

Two examples of medicalization

binge eating disorder and cannabis withdrawal

The "inner core" of a physician consists of which of the following groups? a. Student elite b. Practitioner elite c. Administrative elite d. Surgeon elite e. None of the above

c. Administrative elite

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. a. Activity-passivity b. Guidance-cooperation c. React-revise d. Mutual participation e. None of the above

d. Mutual participation

Which group has the highest rate private health insurance coverage? a. American Indians/Native Alaskans b. Hispanics c. Non-Hispanics Blacks d. Non-Hispanics whites e. Immigrants

d. Non-Hispanic whites

initial innocence

desire to care for patient but feel inadequate

A major barrier to effective communication lies in the differences between physicians and their patients with respect to: a. Status b. Education c. Training d. Authority e. All of the above

e. All of the above

American medical schools in the 1800s were known to have: a. Low standards b. Poor facilities c. Incentive programs (e.g., trips to Europe) d. Students with money e. All of the above

e. All of the above

Which is a component of self-care? a. Taking preventative measures b. Self-treatment of symptoms c. Managing chronic conditions d. Consultation with health care providers e. All of the above are components of self-care

e. All of the above are components of self-care

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

financial profit

Stable internalization

identify as professional nurse

Quality of doctors was still _______ 50 years after 1800.

low

In the 1800's physicians were...

untrained (lacked specialized training)

What is medicalization?

when nonmedical problems are defined as problems that need to be treated medically

What are some government regulations?

Diagnostic related groups (DRGs) - Early 1980s - Government fee schedules with ceilings for Medicare patients for services by hospitals and doctors - Ceiling on how much government will pay Health maintenance organizations (HMOs) - a form of prepaid group practice emphasizing preventive care - Half of the funds earmarked for HMOs were allocated to areas that were medically underserved

What technique is emphasized in medical knowledge?

Evidence based medicine - approving diagnostic/therapeutic procedures - can result in step by step procedures for medical care (creates consistency) - improved application of knowledge

What are the 4 aspects of Parsons sick role?

Exempt for regular social roles, responsibilities Not responsible for their condition Seek competent help, cooperate with doctor Obliged to get well, move from undesirable state

How has consumerism affected the doctor-patient relationship?

External third party pairs have intervened (Patients have more status in the relationship, Access to doctors, Prescription price fixing) Shortening visits All about money!! (economics)

Urban hierarchy (4 major groups of physicians)

Inner core - administrative elites (have control over major hospitals positions) New recruits General practitioners Marginal doctors

How has the doctor-patient relationship changed over time?

Less trust in doctors (has eroded) Trust eroded by 1960s Doctors becoming distant with patients Patients are becoming less passive and more active - Increase in education - Have to advocate for themselves because doctor doesn't know them Superiority in doctors Few long term relationships Doctors have become more resentful of patients

Medicare vs Medicaid

Medicare - ages 65+ (federal level) Medicaid - low income families and children as well (issued through the states) Tricare - military

What is the relationship between Florence Nightingale and nursing?

She is the founder of modern nursing Brought code of behavior to nursing

What are the changes to technology in medicine?

Shift from biographical to techno-medicine Biographical information: patient gives oral data of healthcare Techno-medicine: Extensive use of advanced technology for testing, diagnosis, and the scientific determination of treatment" (ex: robotic surgery)

Characteristics of pharmacists

Used to be a bachelor degree but now a doctorate Source of the medication Practice art of discretion with doctors

Who is most likely to be insured and why?

Whites and asians most likely to be insured Elderly - medicare

When did the image of the ideal-doctor patient relationship (a caring physician and the trusting patient) change? a. 1940s b. 1960s c. 1980s d. 2000s e. 2020s

b. 1960s

The process of seeking medical help involving a group of potential consultants, beginning in the family, and extending outward to more select individuals until professionals are consulted, is known as the: a. Medical referral system b. Lay-referral system c. Professional referral system d. Health networking process e. None of the above

b. Lay-referral system