Medical Socy exam 3
When did the image of the deal doctor-patient relationship change?
1960s
In 2020-2021, about _______ of all students entering medical schools were women
56%
Depending on the severity of symptoms, Szasz and Hollender argue that physician-patient interaction falls into one of three possible models.
Activity-passivity model (seriously ill patient), guidance-cooperation model (acute condition), mutual participation model (manage chronic conditions)
Midwives
Assist mothers in childbirth Resurgence of midwives for natural childbirth, home deliveries, drug-free deliveries nurse midwives and lay midwives
What is the central rule of the doctor-nurse game?
Avoid open disagreement between players
Physician assistants (PAs)
Bachelor's degree 75% were women Licensed to practice medicine, but under physician supervision Provides a level of primary patient care to or higher than that of nurse practitioners
List four major criticisms of Parsons' concept of the sick role? Should the concept be abandoned?
Behavioral variation, varies by disease, relationships between patients and doctors, oriented toward middle-class (lower class may deny sick role)
List three medical techniques that were practiced before 1850 that are now considered ineffective, painful, dangerous, or fatal?
Bloodletting, purgatives, cholera treatments
Professional Standards Review Orgs (PSROs)
Conjunction with medicaid and medicare to review and evaluate the medical care given to patients eligible to use these services
Pharmacists
Doctor of pharmacy Key source of medication information for the public Need authorization from doctor to dispense drugs Supplement rather than challenge healthcare practitioners Practice in hospitals, clinics, pharmacies
As discussed in class, list three potential problems that can arise between the interactions of male physicians and female patients
Doctors may be insensitive to patients needs, decisions may not be in patients best interest, misdiagnoses, gender disparities in healthcare
List three examples of medicalization?
Dug and alcohol abuse, obesity, menopause
Give two specific examples of the differences between "biographical medicine" and "techno-medicine"
Focus on personal history vs technological intervention
Doctors in early 20th century
Had solo practice Were independent Charged fee for service
List three key factors associated with the Golden Age of Doctoring. When was the Golden Age?
High professional control, increasing prices, unnecessary tests, hospitalizations, prescriptions Golden Age was in 1950s
Prestige factors (Hall)
Hospital affiliation Clientele Inner Fraternity-Sorority
Explain the six stages of socialization of a nursing student
Initial innocence, labeled recognition of incongruity, psyching out, role simulation, provisional internalization, stable internalization
Nurses
Largest group of healthcare workers in the US Licensed registered nurse (RN) Licensed practical nurse (LPN)
There is a changing relationship between physicians and their patients. Identify elements of this relationship and discuss trends contributing to this change
Less time getting to know the patients from a doctor's perspective, affected by government regulations and other healthcare industries
Self-Care
Most common response to symptoms of illness Self-initiated and managed
What are features of professionalism?
Most legislation concerned with the profession is shaped by that profession As the occupation gains income, power, and prestige, it can demand high-caliber students The practitioner is relatively free of lay evaluation and control Members are strongly identified by their profession
Doctor-Nurse game
Nurses do not directly challenge doctor's orders Avoid open disagreement Doctor-nurse game is changing More assertive nurses More male nurses More female doctors
American Medical Association (AMA)
Physician is independent practitioner Publishes JAMA Opposed many healthcare reforms Supported some aspects of the Affordable Care Act
Patient advocates
Physicians convince various bureaucrats that more specialized and expensive care is warranted, must be secure the permission that patients need to receive the proper care
New technology in medicine
Prescription drugs ordered online Health and medical apps Electronic monitoring devices Electronic support groups (ESG)
List four specific forms of new medical technology as discussed in class
Prescription drugs ordered online, health and medical apps, electronic monitoring devices, electronic support groups
What are two of the key takeaway points of Timmermans (2020)? What is the most powerful tool in medicine?
Provides comparisons of conversations between doctors and patients in the 1970s with similar encounters today, a shift toward greater assertiveness on part of the patient. Conversation between patient and physician is most power tool in medicine
Give two examples of the medical decision rule
Rather than deny illness, doctors biased in finding illness
Explain how midwifery has remained in existence and also experienced a resurgence despite the opposition of the medical profession
Resurgence of midwives for natural birth, home deliveries, drug-free deliveries. Medical profession argued for hospital deliveries surgical deliveries, access to drugs, sanitary conditions
What is the Flexner Report, and how did it affect medical education?
Reviewed states of medical education, only 3 medical schools fully approved (Harvard, Johns Hopkins, Western Reserve) Recommended schools should have full time faculty and lab and hospital facilities available to students, med students should receive education in natural sciences, resulted in closure of all women's medical schools
List four reasons for declines in the dominance of the medical profession that occurred in the beginning of the 21st century
Rising costs, more government regulations, changes in doctor-patient relationships, corporations in the healthcare industry
What restricted the evaluation of work and discouraged the expression of criticism within physician circles?
Rules of etiquette
Gatekeepers
Screen patients before referring for expensive procedures and specialists Treatment may be delayed or denied
Other dangerous treatments
Snake oil Cocaine
According to Nicholas Christakis, what are the three specific ways that obesity can spread?
Social networks
4 characteristics that account for subordinate position to doctor
Technical knowledge needs physician approval Typically assist doctor in diagnosis and treatment Subordinate to and work at request of doctor Have less prestige than doctor
Bosks contended that ______ errors, if they were made in "good faith", were less serious than ____ errors
Technical; moral
Describe ways in which the doctor-patient relationships has changed and, also, what it may look like in the future
Technology has improved so more information through technology. Upper class is more consumer oriented and have more personal control. Barriers between patients and doctors with age, gender, SES. Eroded in recent years in US
Describe the features of professionalization and how the professionalization of the medical discipline occurred
Two basic characteristics are prolonged and specialized training and service orientation The professionalization of medicine would not have been possible without control over the standards for medical education
Which type of program produces the most registered nurses today?
University baccalaureate programs
The __________ model applies when the patient is seriously ill or being treated on an emergency basis in a state of relative helplessness, due to a severe injury or lack of consciousness
activity-passivity
The "inner core" of physicians consists of which of the following groups?
administrative elite
Which group aged 18-64 had highest percentage of persons without health insurance in 2017, according to Cockerham?
american Indians/alaskan natives
"The single most powerful tool in medicine" according to Timmermans (2020) is:
conversation between patient and physician
Medicare
covers those 65+
At the beginning of the 21st century we are witnessing that the dominance of medical profession is:
declining
Physicians take on a variety of roles to induce patient adherence to their treatment regimens. What are those roles?
educator, salesperson, cheerleader, detective
_______ protects women against heart attacks until menopause, when levels drop
estrogen
Techno-medicine
extensive use of advanced technology for testing, diagnosis, and the scientific determination of treatment
Midwifery is a new form of care available to women true or false
false
most physician assistants are men true or false
false
What attracted corporations to health care delivery is the potential for:
financial profit
Biographical medicine
focus on patient oral accounts of medical history
the doctor-nurse game is changing due to which of the following?
greater assertiveness by nurses, increased numbers of male nurses, the growing numbers of female doctors
what is true about nurse practitioners?
in the future, nurse practitioners may provide much of the primary care for patients nurses are concerned the role of nurse practitioner may be consumed by the medical profession There are new Doctoral of Nursing Practice degrees
Nursing Instructors fail to support the lay image of the nurse in what stage of socialization, according to Davis?
initial innocence
This stage of socialization in the nursing students education consisted of nursing students wanting to do things for patients within a secularized Christian-humanitarian ethic of care and kindness , consistent with the lay image of nursing:
initial innocence
American medical schools in the 1800s were known to have:
low standards, poor facilities, incentive programs, financially strong students
Many people in the _______ may tend to deny the sick role
lower class
Iatrogenic Effects
medically induced illnesses or deaths
What are iatrogenic effects?
medically induced illnesses or deaths
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
mutual participation
____________ assist in delivering babies under the supervision of a physician
nurse midwives
With founding of the American Medical Association ___________ could mark the beginning of a new era in medicine
physicians
Medicaid
public system for poor
The most common response to symptoms of illness by people throughout the world is:
self-care
A major barrier to effective communication lies in the differences between physicians and their patients with respect to:
status, education, training, authority
Charles Bosk contended that _______ errors could be forgiven and often has the result of motivating the offending physician to work harder, spend more time with patients, double-check procedures, and learn from the mistake
technical
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?
techno-medicine
The patient physician relationship involves mutuality in the form of behavioral expectations, and the status and power of the parties are _______.
unequal
Rules of Etiquette
Discourage criticism Evaluation Accountability
Describe the four basic aspects or categories of Parsons' sick role
Exempt for regular social role responsibilities, not responsible for their condition, obliged to get well, seek competent help and cooperate with doctor
What are some secondary gains of the sick role? List two examples
Exempt from normal responsibilities like work and school, gain privileges like needing help from a parent
Gentlemen's Agreement (millman)
Existed among the hospital physicians to overlook each others mistakes
What are the three important factors in the establishment of prestige within the medical profession? Please explain and give examples
Hospital affiliation, clientele, inner fraternity-sorority
What is managed care? What is its role in health care delivery? What effect does it have on the work of physicians?
Managed care is healthcare organizations that controls costs by monitoring how doctors treat specific illnesses, limiting referral to specialists, etc. Patients and employers have to pay a monthly fee for care. The care they receive could be stable, reliable, less costly. Physicians can be disciplined for excessive spending and have to oat deductibles and copayments for services
List three reasons why individuals engage in self-care
Modern medicine has limits, recognize importance of healthy behaviors, expensive medical care
Florence Nightingale
Nursing role changed in middle of 19th century Established nursing as a distinct and honorable occupation Brought code of behavior ot nursing Trained as nurse in Germany Founded hospital for "Sick Gentlewomen in DIstressed Circumstances" in 1853 in England Brought 38 volunteer nurses to care for British soldiers during Crimean War
Diagnostic and Statistical Manual of Mental Disorders (DSM)
Revised and had almost three hundred disorders 2000 Current fifth edition (DSM-5) has 341 disorders
Germ Theory (Louis Pasteur)
Revolutionized medicine and provided the foundation for the discovery, classification, and treatment of numerous diseases
Changes in Status of Doctors
Rising costs More government regulations Corporations in the healthcare marker Changes in doctor-patient relationships Smaller gap between physicians and other healthcare personnel
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 Continued the government's attempts to meet public demands to control the cost of health care
Explain how the role of the nurse practitioner/clinician came to be, how it is expanding, and what concerns doctors have
Similar to PA, increasingly common with Affordable Care Act, primary care centers in retail stores, trained to diagnose and manage common ailments
Nurse practitioners
Similar to physician assistants Often supervised by off-site physician whos on call Becoming increasingly common with Affordable care act and Primary care centers in retail stores
List four characteristics that account for the subordinate position of nurses, physician assistants, pharmacists, laboratory technicians, and physical therapists to doctors
Technical knowledge needs physician approval, typically assist doctor in diagnosis and treatment, subordinate to and work at request of doctor, have less prestige than doctor
Give two examples of iatrogenic effects
Unsafe procedures, transmit infections, amputate wrong leg or arm
Females are more likely to
Visit physicians Have higher morbidity Take better care of themselves Be admitted to hospital
Double Agent
Work for patients and managed care organization Become patient advocates for specialized care
6 Stages of Nurse Socialization (Davis)
initial innocence labeled recognition of incongruity psyching out role simulation provisional internalization stable internalization
What are used as forms of sanction?
jails, prisons, mental hospitals, juvenile detention
