Sociology Exam 2- Doctor-Patient Interactions/CAM

Harris Wofford

1980s PA political upstart who won against well-established Dick Thornberg in special election for PA senate seat with health care ad that said "If a criminal has the right to a lawyer, why doesn't a person have the right to a doctor?" Made healthcare reform on agenda in advance of 1992 presidential election

National Center for CAM

CAM definition in which healthcare practices that are not an integral part of conventional medicine. As diverse and abundant as peoples of the world, these practices may be grouped within five major domains- alternative medical systems, mind-body interventions, biologically based treatments, manipulative and body-based methods, and energy therapies

Countervailing powers

Concept that puts medical profession into conversation with other institutions and replaced idea of physician dominance by thinking about medical profession as a field with different actors. Focuses attention on a few powerful actors in the field who are inherently independent yet distinct. Developed to address weaknesses of professional dominance perspective in current context

Hidden curriculum

Curriculum that embeds certain values, world views that are prized by a profession

Joking

Emotional management technique in which student can relieve tension without having to reveal weaknesses

Avoiding sensitive contact

Emotional management technique in which student covers body parts they aren't working on and skips exams they aren't comfortable with

Empathizing or blaming patients

Emotional management technique in which student focuses on emotion they feel towards patient

Transform patient or procedure into analytic object or event

Emotional management technique in which student makes person mechanical or analytical problem. Redefines human relationship (that would otherwise be equal) to smaller problem to make problem easier

Accentuating positives that come from learning

Emotional management technique in which student tries to create good feelings by talking about them when they don't arise naturally. Transform uncomfortable event to comfortable situation that they're familiar with

Professional Dominance

Era of doctoring from 1920-1965. Motto- "Quality of Care" Actors- independent physicians, professional associations, hospitals, and private insurance companies. Doctors viewed as fundamentally altruistic. Tried to stop CAM, control practices, put down competing threats to authority

Federal Involvement

Era of doctoring from 1966-1982. Motto- "Equality of Access" Actors- new federal and state agencies; new kinds of healthcare providers (community mental health centers). Medicare/Medicaid passed in 1960s, perceived and documented excesses in health care, wanted to control rising costs, promotion of managed care, patient health movements born and advocated for issues related to improving access to health

Managerial Control and Market Mechanisms

Era of doctoring from 1983-Present. Motto- "Cost control, efficiency" Actors- managed care organizations, purchasing coalitions of employers, consumer advocate groups. DRG legislation (1983) aimed to change payment by making hospitals assume financial risk in exchange for prospectively determined payment to reduce length of hospital stay, improve documentation, and increase efficiency. Instead, caused hospitals to deny access to care for unprofitable patients and reduced quality of care

Animism

Hmong religious tenet in which all objects have souls and spirits

Flexner Report

Indictment of medical education in the US by Alexander Flexner in 1910. Recommended medical schools to raise standards substantially and forced major changes. This redefined medical education, standardized profession, and made AMA powerful

Big pharma

Industry that is active in developing and marketing of new diseases, manipulating clinical trials, ghost-writing scientific articles, influencing drug approval through FDA, recruiting influential physicians to promote meds to other doctors (including off-label prescriptions) and to patients, and peddling drugs to doctors with 100,000 sales reps and to patients through DTCA. Relationship between this and medical profession may be of mutual dependence

Risk pools

Means of managing financial risk by spreading risks involved in a certain enterprise evenly across a given population so that no one person bears the risks of an unplanned catastrophe. Works better when there is an equal distribution and larger group. Used by health insurance companies

Szasz and Hollender

Model of doctor-patient interaction in which the seriousness of a patient's symptoms is determining factor

Hayes-Bautista

Model of doctor-patient interaction that focuses on manner in which patients try to modify treatment prescribed by a physician

ACA (Affordable Care Act)

Most significant healthcare legislation since 1965 that was signed into law on March 23, 2010 under President Obama and mostly upheld by Supreme Court on June 28, 2012. Contentious politics. Provisions included an individual mandate, prohibition against pre-existing condition denial, expansion of coverage to low-income people, financing changes, and health insurance exchanges

Ancillary

Part of Wardwell's classification of CAM as a subordinated profession defined as mainstream professions that function solely under MD direction and prescription. Ex. nurses, PT, clinical pharmacists

Marginal

Part of Wardwell's classification of CAM as a subordinated profession defined as naturopaths, herbalists, acupuncturists, lay midwives

Quasi practitioners

Part of Wardwell's classification of CAM as a subordinated profession defined as non-medical healers that use methods not subject to empirical verification. Ex. folk healers (curanderos), magical healers, faith healers (Christian Scientists), quacks

Limited

Part of Wardwell's classification of CAM as a subordinated profession defined as to part of body treated and therapeutic range. Ex. dentists, podiatrists, optometrists, psychologists, speech therapists, midwives

Adverse selection

People with higher risk who are purchasing insurance. Increases probability of loss, which can lead to higher premiums to cover risk

Loss of trust

Process associated with declining professional dominance of doctors that goes hand in hand with deprofessionalization. Due to government limiting doctors' power and rise of patient consumer

Deprofessionalization

Process associated with declining professional dominance of doctors that is defined as the loss of professional characteristics such as autonomous decision making. Due to rise in power of third party payers, managed care, rising malpractice claims

Proletarianization

Process associated with declining professional dominance of doctors that is defined as the movement from self-employment to waged labor, which decreases physician autonomy

Corporatization

Process associated with declining professional dominance of doctors that is defined as the turning of health care into profit maximizing organizations within medicine

AMA (American Medical Association)

Professional medical association formed in 1847 that standardized education, training, and licensing of medical profession, which caused the professionalization of medicine and has held lobbying power since then, which was one reason why NHI didn't form

VA (Veterans health Administration)

Program that provides all necessary OP and IP care for 8.76m veterans at over 1700 sites of care. Relatively generous but can be longer wait times. Largest integrated system of care in US. In 2010, $50bn budget

Medicaid

Public health program passed under LBJ as part of the War on Poverty in the 1960s that extended government health insurance to the poor. Federal government shares responsibility for payments made by state welfare agencies to healthcare providers for services for poor and each state required to cover all needy persons receiving cash assistance. Covered 47.1m (15.5% of pop) in 2008 at cost of $344.3bn

Medicare

Public health program passed under LBJ as part of the War on Poverty in the 1960s that was initially a program for the elderly (aged 65 and over). Administered by Secretary of HHS and includes care of disabled under 65. beneficiary responsible for specific co-pays and deductibles; benefits are not unlimited. Most of cost paid by federal government

Simple Unexpected Concrete Credentialed Emotional Story

SUCCESs

Mutual participation model

Szacs and Hollender model of interaction that applies to management of chronic illness in which the patient works with the doctor as full participant in controlling the affliction; patient works with doctor to manage illness

Guidance cooperation model

Szasz and Hollender model of interaction when patient has an acute, often infectious illness such as the flu or measles. Patient knows what's going on and can cooperate but doctor makes all the decisions

Activity passivity model

Szasz and Hollender model of interaction when patient is seriously ill or in emergency style helplessness. Decision-making and power are all on side of doctor

Curandero

Type of CAM healer that is a male Mexican American folk healer that classifies disorder based on what causes disorder rather than symptoms, don't separate natural and supernatural, often use religious healing, and usually don't charge

Shaman

Type of CAM healer that must have vision to become healer, which usually happens during illness. During healing, go into trance so he can go into spiritual world and find an answer to illness

Black folk healer

Type of CAM healer that seeks to treat whole person, not single symptom

Chiropractors

Type of CAM practitioner that is getting more popular, due to insurance reimbursement, desk job/technology injuries, specialized service, and increased value in services

Naturopathology

Type of CAM that believes that disease is caused by disruption of life force in the body

Osteopathy

Type of CAM that can write prescriptions and also trained in some techniques that might seem strange to traditional medical doctor such as manipulation

Single payer

Type of health insurance in which all of the money goes into a single pot and then gets dispersed to all citizens. Would make health insurance system simpler- only one insurance company, no copays or deductables, and would cover mental, dental, emergency, and necessary care

Disease

adverse physical state

Nocebo effect

counterpart of placebo effect; people expect something bad to occur when they learn there are negative repercussions of a treatment/drug

Third party payers

government, private health insurance companies, and managed care programs that decide whether they will reimburse a physician and how much they will pay, which can constraint what doctors might do and what patient is willing to accept because something might not be covered. Monitor number of patients seen by doctors, time spent with them, and influence clinical decisions

Social contract

in return for state's protection, medical profession serves needs of their patients through specialized services

Jurisdiction

link between profession and its work, a way of achieving and maintaining dominance. Claims are made in legal system, public opinion, and workplace

Profession

occupation which has assumed a dominant position in a division of labor so that it gains control over the determination of the substance of its work

Culture of medicine

prizes objectivity and rationality

Socialization

process by which a person becomes a member of a group or society and acquires values, attitudes, beliefs, behavior patterns, and a sense of social identity

Sickness

social state, signifying an impaired social role for those who are ill. Deals with expectations and normative behavior that wider society has for people defined as sick

Illness

subjective state, pertaining to an individual's psychological awareness of having a disease and usually causing person to modify their behavior

CAM (Complementary and Alternative Medicine)

use of treatments not commonly practiced by medical profession; no uniform definition. Includes chiropractors, faith healers, folk healers, acupuncturists, homeopaths, and naturopaths and use of dietary supplements