Medical Sociology Test 3
What does Cockerham say about Flexner and professionalization?
"In summary, by the mid 1920s, the medical profession had consolidated its professional position to the point that it clearly had become both the model of professionalism and a powerful profession."
What is a physician's bias?
Bias toward finding illness in patients and prescribing drugs, ordering lab tests, etc.
What is required for patients to comply?
Communication, comprehension, and compliance
What is the current trend of AMA?
Decreasing power. The AMA opposed both Medicare and Medicaid, which passed. Supported Affordable Care Act to expand insurance coverage to uninsured- but lost 9,000 members.
What are major barriers to communication?
Differences in status, education, professional training, and authority
How can genetic advancements influence the physician-patient relationship?
Genetic screening= physicians inform patients about what disease they MIGHT get Gene therapy= physicians treat or cure disease by replacing defective genes with healthy ones Designer drugs= physicians match pharmaceuticals with patients' DNA
How does social class influence physician- patient interaction?
Lower class = more passive in all health situations, treat doctors as authority figures, decreased sense of personal control over health matters Middle and upper class = more consumer oriented, discerning seekers of health care, active participants in physician- patient encounter
Is reproductive cloning legal?
Not in the United States (and some other countries.)
How are upper- and middle- class patients and communication connected?
Receive more personalized service, more active in presenting ideas to physicians, seek further explanation of their conditions.
What are the male dominated specialities?
Surgery, sports med, internal medicine
What does Cockerham say about physicians and gender?
"In a culture that prizes risk and outsize reward- where professional heroes are college dropouts with billion dollar websites- some doctors and lawyers feel they have slipped a notch in social status, drifting toward the safe and staid realm of dentists and accountants."
What does Cockerham say about gender?
"Judith Lorber found that when male doctors assessed their accomplishments, they tended to speak only of their technical skills and choices of appropriate treatment. The personal side of the physician- patient relationship was rarely mentioned. Women doctors on the other hand, stressed their value to patients and did so using words like 'help' and 'care.'"
What does Cockerham say about physician- patient interaction?
"Physician- patient interaction constitutes a structured relationship and mode of discourse that is inherently social. It is the patient's experience with the illness, including the relationship with the physician, that allows the person to socially construct his or her understanding of an affliction and how to deal with it." BUT such interaction does NOT allows follow preset course with mutual understandings; it can have misunderstanding, uncertainty, and resistance to physician's method of treatment by patients.
What is an example of culture and communication according to Cockerham?
"Researchers found a tendency on the part of physicians to give less information to black patients and for black patients to request less information than non- Hispanic white patients. The pattern indicated a cycle of passivity in which certain patients would receive less information and, in turn, fall to request that doctors provide more."
What does Cockerham say about race and physicians?
"The effects of social distance apply not only to class differences but also to race, as patient satisfaction is greatest when both doctor and patient are of the same race... However, the physician's behavior toward the patient- regardless of either person's race or ethnicity- is the most important factor engendering trust in the doctor- patient relationship."
What does Cockerham say about changes in Physician- Patient relations?
"The high cost of care, high salaries of many doctors, and superior attitudes on the part of some, along with organized oppositions to health reform, caused certain patients to become disillusioned with the medical profession. Doctors, on their part, became resentful about patients and others who questioned their commitment. As a result... doctor-patient relationships in the United States have eroded."
what does Cockerham say about class, race, and social distance?
"The influence of social class on the doctor- patient relationship is best understood in terms of social distance. Those patients who are similar to physicians in social class are more likely to share their communication style and communicate effectively with them. Those with dissimilar class backgrounds are likely to find communication different because their communication style differs from that of the doctor and they lack the social skills to negotiate the medical encounter effectively."
When does David Hayes- Bautista's model apply?
"The interaction is a process of negotiation, rather than the physician simply giving orders and the patient following them in an automatic, unquestioning manner. The model is limited, however, to those situations in which the patient is not satisfied with treatment and wants to persuade the doctor to change it."
What does Cockerham say about the AMA?
"The power of the local society was further enhanced because the AMA's organizational structure permits no formal right to a hearing or right to appeal the local society's decision. Thus, threats of denial of membership or of expulsion from the local society represented powerful sanctions because there is no alternative medical association and AMA membership may be important to a physician's career."
What is the trend in the options in the 3-model of interaction?
"The prevailing norm in contemporary doctor-patient interaction has become that of empowering patients to participate in decisions about their care."
What does Cockerham say about the changes in physician- patient relations?
"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- third party payers." This trend= eroding the long-term relationship between physicians and patients, making the interaction more like one's relationship with a cab driver or shoe salesperson.
How do physicians respond when patients attempt to modify prescribed treatment?
1. Pointing out their expertise. 2. Warning of threats to health if treatment is not followed. 3. Explaining that progress may be slow (even if treatment is correct) 4. Asking the patient to comply.
When do some patients pay little attention to physician guidance?
1. Symptoms are not obvious. 2. When patients begin to feel better
What is the current trend in medical school enrollment in the US?
145 accredited medical schools receive about 50,000 applications and choose about 20,000 students. Accepted students = 52% male, 48% female , 49% non- white. Typical- first year student= 21-23 years old with bachelor's degree in bio, chem, zoo, premed, or psych and at least 3.6 gpa from upper- and upper-middle class background. Most who enter medical school obtain MD.
What is the latest data from AMA in 2011 say?
15% of qualified doctors are members. Nonmembers= 1) retired, 2) employed by government, armed forces, research agencies, universities, 3) others who disagree with AMA, do not want to pay fees, etc. Less than 1/5 of female physicians are members
What was the Flexner Report?
1800s= 400 medical schools in the US, Low quality instruction, poor facilities, admitted anyone who could afford tuition. Abraham Flexner= issues report in 1910 Flexner- an educator, not a physician- visited every medical school in the US and issued devastating indictment of lack of quality.
Is the doctor always right?
Belief that "the doctor is always right" is no longer the norm. ESP. Among middle- and upper-class patients (who have equal or higher status than their doctors, are well-informed about treatments, have experience with bureaucracies, etc.) This trend began as part of challenges to authority in 1960s (civil rights movement, Vietnam War protests)
What about European medical schools in the early times?
Best training in early and mid 19th century= French and German Mid-1800s= germ theory of illness, cellular pathology, and bacteriology American students flocked to Europe for training = 15,000 trained in Germany between 1870-1914
What were the results of the Flexner report?
Better schools improved; lesser schools closed (bad publicity, financial adversity) Women's medical schools closed, wrongly thinking that women would be admitted to mainstream schools. 6 of 8 traditionally African American schools closed. Mainstream schools required to adhere to Flexner recommendations to receive needed philanthropy from foundations
How do intervening actors influence the physician- patient interaction?
Cockerham: "Physicians... find more actors (managed care systems, insurance companies, government regulations) intervening in their relationships with patients, are less paternalistic toward them, and more willing to share decision making with them."
How does prenatal genetic testing influence abortion decisions?
Cockerham: "Research in the United States show that public attitudes toward abortion- in the case of genetic defects- has become increasingly negative."
Are genes commodities? To whom do they belong?
Cockerham: "The general rule of law that has recently emerged is that genes are naturally occurring organic matter, and not something invented by humans, and therefore cannot be patented." U.S. Supreme Court ruled in 2013 that genes cannot be patented, but synthetic DNA created in a lab can be protected under patent law
How do upper-middle- class physicians communicate with class?
Communicate more info to patients than physicians with lower-middle- or working- class backgrounds.
What are some features of professions?
Determines it own standards of education and training. Has more stringent socialization experience than other occupations. Is legally recognized by some confirm of licensure. Has admissions boards staffed by members of profession. Involves members in shaping legislation about profession. Demands high-caliber students as members gain income, power, and prestige. Is relatively free of lay evaluation and control. Has members who are strongly identified by profession.
What is a physician?
Dominant rule (based on professional medical training and recommendations)
What about early medical education?
Early US= physicians had service orientation but lacked formalized training. Medical practitioners= mostly ship's surgeons, apothecaries, and clergy (who may have obtained medical knowledge while studying in Europe). Few had been trained in university or medical school.
What are the two organizational factors that aided the AMA?
Establishment in 1833 of the Journal of American Medical Association (JAMA). Reorganization in 1902 into local societies (with authority to se its own qualifications for membership)
What are the influences on entering medical profession?
Family influence= having physician for parent, close relative, or family friend is distinct advantage in promoting desire to be doctor. Common reason for wanting to be a doctor= "to help people"
How do female and male doctors compare?
Female and male doctors = similar diagnostic therapeutic skill levels but different communication styles Female doctors= more empathetic, egalitarian, respectful, and responsive to patients Female doctors= MORE attentive to patients' comments and medical histories (esp. those of women), better at communicating, providing preventative care, and following clinical guidelines This creates greater sense of partnership between patients and female doctors
What about medical schools in the early US?
First established in 1765 at College of Philadelphia by small group trained at University of Edinburgh (foremost medical school in Great Britain) After 1800s= many medical schools established, but training quality low, and physician= low status until 1850s. Common methods= unpleasant and often fatal (bleeding, purgatives)
Who are the three majors third-party payers?
Government= Medicaid and Medicare Private health insurance companies Managed care programs
Which groups have the most difficulty communicating with physicians?
Groups that speak little or no English. Especially low-income Hispanics... as well as Chinese, Korean, and other immigrants.
What three schools were given approval in the Flexner report?
Harvard, Western Reserve, and Johns Hopkins
What do the two models imply about physician- patient interaction?
In non-emergency situations = patients are not passive (they ask questions, seek explanations, make judgements, resist treatment, check info on the Internet). However, in some situations, physicians do exert authority and make decisions regardless of patients' desires.
What is the arc of physician-patient relations?
Medicine was a low-status occupation until beginning of 20th century (with advancements in medical training) There was an upward mobility of physicians in the 1960s (with image of caring physician and trusting patient) But as status increased, physicians became increasingly distant. Patients then became more active, informed participants in health care.
Why is the medical profession as a whole undergoing decline in status?
More exciting career opportunities= investment banking, hedge funds, private equity firms, etc.
What are other ways that technology is influencing medicine?
New forms of drug delivery (pills, injections, patches, nasal sprays, inhalers) Hospital or clinical treatments now available at home (some chemotherapy) Use of robotics and computer guided imagery (robotic surgery)
What is the trend with female medicine students?
Number of female med students = rising to just about half Female med students often face sexual harassment from male patients and male doctors About 40% of med school faculty=women
What about female physicians?
Often perceived to have LESS authority than male physicians. Often face conflict between career and motherhood. Often specialize in areas considered "soft" as compared with "macho," "tough," "demanding" areas. Women moving into top specialities= tend to take on masculine traits
What is the consolidation of power?
Once established, professions will consolidate power by formalizing social relationships with clients, colleagues, and official agencies outside the profession.
How is technology changing the physician- patient relationship?
Patients can consult physicians using home computers, email, Skype, teleconferencing, etc. Physicians can use computers to diagnose illness, determine treatment, and learn new protocols. Drugs can be ordered and delivered online. Cockerham: "This expanding reliance on new technologies has promoted a shift away from 'biographical medicine', with its focus on the patient's oral account of his or her medical history."
What is the David Hayes- Bautista model?
Patients often attempt to modify prescribed treatment by physicians in two ways: 1. Trying to convince physician that treatment is not working. 2. Countering treatment with actions of their own (deliberately reducing or increasing amount of prescribed modification)
How do social factors influence these online behaviors?
People worried about stigma of illness (anxiety, herpes, urinary problems) often seek info online. People lacking social connection form electronic support groups
What class is the MOST likely to have questions ignored or be treated impersonally?
Poorly educated patients
What is a profession? Based on work of William Goode.
Profession= group engaged in.... 1. Prolonged training in specialized and abstract knowledge. 2. Providing a service to the public.
What caused the women's health movement?
Reaction to lack of male sensitivity to female patients. Goal= combat sexual discrimination in medicine Ex: natural childbirth, midwifery, home childbirth, self- help, abortion rights, breast cancer research funding
What is the model of interactions based on?
Seriousness of patient's symptoms = determining factor in doctor-patient interaction
Besides ICU physicians that have moral obligation to make life-saving decisions, who else does?
Surgeons- try to retain decision- making authority for themselves and to present information to their patients and their families that justifies action
What is guidance- cooperation?
Symptoms= acute or infectious illness (ex: flu or measles) Physician= makes decisions and provides guidance Patient= aware of circumstance, cooperates, follows guidance
What is mutual participation?
Symptoms= chronic illness ( diabetes, heart disease) Physician= provides insight and recommends behavior modification Patient= works with doctor as full participant, modifies lifestyle ( smoking, taking meds), seeks periodic checkups
What recommendations did Flexner make for medical schools?
Taught by faculty that is 1) qualified and 2) full-time. Implementation of admissions standards. Training by 1) universities 2) on a graduate level. Lab and hospital facilities made available to students. Integration of teaching and research at same institutions.
What are the two groups with the MOST reported communication problems with physicians?
The lower class and women.
What does Cockerham say about women gender and treatments?
Treatments decisions for women= not always in their best interest. "Fisher.. provides the example of a female graduate student whose doctor recommended a hysterectomy for a pelvic inflammatory condition after treatment with antibiotics failed. Fisher advised the student to inform the doctor that she was engaged to be married to a doctor and ask if there was another form of treatment. After learning about the forthcoming marriage, the doctor suggested another course of antibiotics that cleared up the infection, thereby avoiding having surgery."
What are the two requirements of a profession?
1. Public acceptance of claims to competence 2. Control of membership
What percentage of the total medical workforce in the US do physicians make?
10%
What is a patient's bias?
Bias toward demanding medical services
What do we know about cloning?
Cloning may be therapeutic (human organs for transplant) or reproductive (cloning of people).
What are the major influences on compliance?
Effective communication Motivation to be healthy Perceived vulnerability to an illness Potential for negative consequences Effectiveness of treatment Sense of personal control
What is a patient?
Subordinate role (can accept, reject, or negotiate treatment recommendations)
What does Cockerham say about the AMA and losing power?
" With its organization, financing, and claims to expertise, the AMA still makes policy recommendations and tries to guide the medical profession on public issues... However, its traditional role in maintaining the best policy and financial outcomes for medical doctors- regardless of whether or not it is in the public's interest- seem to have eroded much of its credibility with lawmakers and the public."
According to Cockerham, what are the possible pitfalls of genetic information?
"Genetic information therefore has unique implications for families and groups, and this information is potentially valuable to employers, insurance companies, researchers, and pharmaceutical firms who would use it for their own purposes. This situation opens up the possibility of discrimination with respect to employment and insurance, and many states in the US prohibit discrimination in health insurance based on genetic testing and have similar laws regarding discrimination in employment."
What are the three options of the model of interactions?
1. Activity- Passivity 2. Guidance- Cooperation 3. Mutual Participation
What are the three requirements for information that can be used an an important therapeutic tool?
1. It reduces uncertainty. 2. It provides a basis for action. 3. It strengthens the physician- patient relationship.
What explains the speciality segregation between females and males?
1. Structural explanation= women kept from advancing to top positions by barriers (lack of mentors) 2. Voluntaristic explanation= women make occupational choices according to stereotypical gender expectations they are socialized to follow
What is the number of active MD's in the US?
850,000
What is happening with medical school enrollment?
About 50-50 equal numbers of women and men
What are the medical societies outside the AMA??
American Medical Women's Association= addressing female- specific issues Speciality societies= provide continuing med education and board certification ( American College of Physicians, American College of Surgeons, American Academy of Family Physicians)
What is the AMA?
American medical Association founded in 1847 in Philadelphia. "The AMA gradually extended its authority to become the single greatest influence on the organization and practice of medicine in the United States."
What has changed with changes in physician patient relations?
As physician authority decreases, patient consumerism increases. "When it comes to health care, an identifiable pattern among many Americans is one of consumerism, in which the consumer wants to make informed choices about the services available and not be treated as inferior."
What kind of pattern do we see with patient compliance?
Common pattern based on sick role: Patient seeks medical help, physician diagnoses and prescribes treatment, patient complies with treatment. (Ex of treatment= medications, diets, surgery, and other interventions
What does medical treatment usually begin with?
Face- to - face dialogue
What is one example fo male misperception about female patients?
Heart attacks. Female patients= chest and/ or arm pain, numbness on left side, sweating, nausea Male physicians tend to misdiagnose these heart attack symptoms as stomach or anxiety problems. Why? Male physicians assume estrogen will protect women from heart attack until after menopause.
What is the doctor- patient interaction?
Inherently SOCIAL
What does the effectiveness of physician- patient interaction depend on?
It depends on the ability of participants to understand each other.
What are examples of POOR communication between physician and patient?
Physician refusing to explain a disease because patient wouldn't understand. Physician being vague, evasive, or frightening (due to patient's lack of info).
What about the AMA as an organization?
Power= concentrated in hands of relatively limited number of physicians Vast majority of members= content to let AMA represent them to Congress and other government agencies No forum for dissent within AMA (due to system of electing national officers through its House of Delegates rather than directly by membership)
What are the female dominated specialities?
Primary care, geriatrics, pediatrics
Does social class make a difference in communication?
Social class difference= VERY important factor in physician- patient communication.
What were the 19th century medical advancements?
Stethoscope, anesthesia, hormone theory, surgical procedures, staphylococcus discovered, X-ray
What is activity- passivity?
Symptoms= serious illness (emergency treatment due to injury or lack of consciousness) Physicians= total decision making power Patient= contributes little or nothing to interaction
What will happen IF female enrollment begins to exceed male enrollment?
The profession would undergo feminization, which means we would expect a decline in physician status and autonomy.
What do we know about Internet usage?
There are about 10,000 websites on health problems. Of all Americans: 85% use the internet; 72% have looked online for health info. Cockerham: "Typically they investigate whether they or someone else has a disease or health problem, search for treatment options, seek information about health care providers, and look for tips on staying healthy." New trend= increase use of mobile and smart phones for health-related issues
How do these third-party payers affect the physician- patient relationship?
They monitor number of patients seen by physicians and amount of time spent with each patient. They micromanage physicians' clinical decision. They decide whether to reimburse physician for services and if so how much to pay.
Who came up with the models of interaction?
Thomas Szasz and Marc Hollander
Why doesn't English proficiency solve the rest of the communication problems?
Today's medicine= delivered in context of middle- class norms and values (scientific beliefs, sophisticated technology, cooperation with physicians) This helps explain why lower- class minority populations struggle to communicate with physicians.
True or False: Physicians have the highest status throughout most of the world.
True
True or false: It is likely that MOST patients comply with prescribed treatments.
True
What happened in the 20th century?
US medical research begins to surpass Europeans. Massive economic investments by rich philanthropists to maintain "the moral, social, and economic order of corporate capitalism"
What do we know about miscommunication?
When miscommunication happens= patients usually seek future care elsewhere.
What is Parson's sick role?
basic guidelines for understanding doctor-patient interaction
