Ch 6-10 Flashcards
1
Q
Sociological definition of health
A
6 primary orientations:
1) physical functioning
2) mental health
3) social well-being
4) role functioning
5) general health perceptions
6) symptoms
2
Q
Physical functioning
A
A primary orientation of the soc def of health
D: taking care of oneself physically (exercise/able to perform physical tasks)
3
Q
Mental health
A
A primary orientation of the soc def of health
D: psychological well-being, levels of anxiety/depression, emotions
4
Q
Social well-being
A
A primary orientation of the soc def of health
D: communicating with friends/family; maintaining social relationships
5
Q
Role functioning
A
A primary orientation of the soc def of health
D: having freedom/no limitations within roles & being able to fulfill role (no role overload)
6
Q
General health perceptions
A
A primary orientation of the soc def of health
D: self-assessment of pain/health status (is the pain frustrating?)
7
Q
Symptoms
A
A primary orientation of the soc def of health
D: the ability to report physiological & psychological symptoms
8
Q
Biomedical definition of health
A
Solely on individual’s physiological state and presence or absence of symptoms. “Absence of disease.
9
Q
4 assumptions that LIMIT the Biomedical definition of health’s utility:
A
1) “Presence of disease”
2) “ONLY medical professionals” are capable of defining health & illness
3) Health and illness should be defined SOLEY in terms of physiological function
4) “health” as merely “the absence of disease”
10
Q
“presence of disease”
A
A limitation of the biomed def of health
Doctors view the presence of disease as being objective, but it is hard to find an accurate presence of disease due to 1) cultural/individual differences in reacting/reporting symptoms; 2) sometimes NO signs/symptoms are present
11
Q
“ONLY medical professionals” are capable of defining health & illness
A
A limitation of the biomed def of health
Reality: patients & others (e.g. family) are involved in the process
12
Q
Health and illness should be defined SOLEY in terms of physiological function
A
A limitation of the biomed def of health
people are NOT MERELY BIOLOGICAL BEINGS (not just physiological) — psychological and social creatures (mind-body-soul)
13
Q
“Health” as merely “the absence of disease”
A
A limitation of the biomed def of health
This definition excludes a lot about well-being and only focuses on disease
14
Q
WHO definition of Health
A
Inclusive, positive, and proactive view, “…a state of complete physical, social, and mental well-being and NOT mentally the absence of disease or infirmity.”
15
Q
Parson’s def of Health
A
The ability to perform tasks
16
Q
Twaddle’s ideas about health and illness
A
Health and illness are on a spectrum
17
Q
CDC said <___% of Americans are of a “healthy” weight, eat adequate _______, and _____ to stay fit
A
40; fruits/vegetables; exercise
18
Q
CDC says Americans _____ and _______ too much
A
Smoke; drink
19
Q
Tobacco kills >_____ Americans/year and has caused ______ deaths world wide
A
400,000; 1 billion
20
Q
In 1960 ____% of American Adults were >10 lbs overweight, and that percentage has risen to ____% today.
A
28; 68
21
Q
4 Key Dimensions of Health Behavior
A
1) prevention
2) detection
3) promotion
4) protection
22
Q
Prevention
A
A key dimension of health behavior
D: employing health protection behaviors (HPBs)/ attempting to stay healthy
23
Q
Detection
A
A key dimension of health behavior
D: finding the disease before symptoms arise by attending medical exams and screenings
24
Q
Promotion
A
A key dimension of health behavior
D: persuading people to do health protective behaviors (HPBs) and persuading against health-harming activities.
25
Protection
A key dimension of health behavior
D: societal levels of preventing illness; creating a healthy environment, public health
26
Health Protective Behaviors (HPBs)
Individual actions taken o protect, promote, or maintain health
27
Prescriptive HPBs
Diet, seatbelts, exercise, check-ups, etc.
28
Proscriptive HPBs
Driving safely, not smoking, limiting alcohol, etc
29
Male vs. Female criteria for defining health
M: strength/fitness level
F: Energy, vitality, ability to cope with challenges, maintaining social relationships
30
Micro-approach to Healthy Lifestyle
Americans favor this model; focuses on individual decisions to do positive/negative things for one’s health. People gauge what is good for their health based of the Health Locus of Control (HLC): using previous experience with HPBs to figure out what is “good” for one’s health.
31
Macro-approach to Healthy Lifestyle
To change community behaviors, including social structures (racism, sexism, unemployment, etc.) BUT corporations resist (tobacco, alcohol, food, etc.)
Calls for Quality Education, Jobs, Public Health, Mass Transit, etc. Doesn’t happen because of costs (increased TAXES).
32
Women are ___ likely to engage in HPBs.
More
33
In _____, Women enjoy free ________ care
Europe; free
34
Access to diagnostic screening is LIMITED by:
- cost
- lack of insurance
- work conflicts
35
Harvard School of Public Health definition of Binge Drinking
- 5 drinks in one sitting for Men
- 4 drinks in one sitting for Women
36
“Austerity”/“Cuts” to Government spending have been to:
- Public education
- public health
!! Why not to sports/stadiums/etc???
37
Mechanic & Volkart's definition of Illness behavior
The way in which symptoms are perceived, evaluated, and acted upon by a person who recognizes some pain, discomfort, or other sign of organic malfunction
38
Stages of Illness experience (Suchman)
Culture and Socal expectations as playing key roles.
1) Symtoms Experience
2) The sick role
3) Medical care contact
4) dependent patient role
5) recovery and rehabilitation
39
The social construction of illness
The definition and ability to cope with illness are culturally and socially determined with the socialization process. “How we learn to be ‘human’ and interact with others.” (Society determines how to act when symptoms are felt).
40
The sick role
Included in the social construction of illness
When one is ill — you not only exit ‘normal’ social roles, but enter into a NEW role with certain exemptions and responsibilities (Parsons)
41
Labeling Theory
Helps define roles of illness; is culturally defined/labels can be subjective.
Sick label —> person enters sick role.
42
In the sick role, one enters into "_______", to stay in the Sick Role (legitimately) a person must convey a ______ ___ ___ ____.
Normlessness; desire to get well
43
Pain
A key trigger symptom of illness
44
Almost ____% of American adults experience Chronic Pain
60
45
____% say they’re in constant pain
40
46
Palliative care
Has increased recently
D: treating the pain/suffering of seriously ill patients.
47
In the US, there are _____ hospital-based palliative care programs and _____ HOSPICE programs
1,600; 5,300
48
Medicalization
A process allowing the medical professional to determine what is “normal” and “desirable” behavior AND how to control, modify/eliminate “undesirable” behaviors
49
Results of Medicalization (power)
Increased power of medical institutions/professionals
Decreased power of religions & State/government
50
+/- results of Medicalization
+: less stigmatizing/punitive
-: representing some “societal” label of disapproval
51
Medicalizing deviance
Stating that deviance from societal norms is a medical issue that must be treated (LGBTQ, alc, etc.)
52
Illness legitimacy types (Freidson)
1) Illegitimate/Stigmatized —> symptoms are minority deviated from “healthy” experience; illness is stigmatized and prevents people from entering the sick role
2) Conditional legitimacy —> exemption of responsibilities if person tries to get better
3) Unconditional legitimacy --> permanently in the sick role
53
_____ concerns/questions about how much _____ Medicine has taken over the ______ of illness
Increased; power; social control
54
De-medicalization
Powered by money & Sociological critiques (Rosenhan + Szasz)
Reversals:
- deinstitutionalization of medical patients/ other American Psychiatric Association disorders (DSM)
- homosexuality
55
Labeling theory & stuttering
Label “stutterer” places people into a category where they are seen as incomplete or different from society.
56
Range of choices for Medical Care & Advice
1) Modern medical practitioners
2) Alternative Medical practitioners: traditional/religious healers
3) Non-medical professionals: police/lawyers/social workers
4) Lay advisors: friends/family/etc
5) other/self care
57
Mid 90s: Americans averaged ____ contacts/yr with MDs
5-6
58
Class effects of access to health care
Poor:
* much less likely to have regular health care (Medicaid doesn’t cover)
* much more likely to use ER as primary care
* less likely to be admitted to hospital but much sicker when they are
59
Race/Ethnicity Effects of access to health care
Hispanics: lowers rate of use of health services/sicker when admitted
Black individuals are less likely to have access to health care than whites
60
Gender effects on access to health care
M: don’t go/tough it out
W: make 70% of health care decisions; use more health care than men
I.e.: Indian women: husbands must approve; don’t have direct access to family money; don’t go to health clinics alone
61
Self-care
Important concept including behaviors to
- promote optimal health
- prevent illness
- detect symptoms of ill health
- heal acute illness
- manage chronic conditions
Increasing bc increased medical info availability + alternative medicine + cost of care
62
Concerns of dependent-patient role
- loss of personal independence
- withdrawal from key social roles
- changed body image
63
Stigmas associated with illness
1) social rejection: discrimination, avoidance, awkwardness
2) financial insecurity: hard to get/keep a job
3) internalized shame: self-blame; maintaining secrecy
4) social isolation: loneliness, feelings of inadequacy/uselessness; detachment
64
Early 20th century is when physicians gain _____ in medical field by replacing ____ and ____.
Dominance; family; church
65
The church was historically _____ than just religion, encompassed _____, ________, etc.
Greater; government; health care
66
Physician dominance over medical field strengthened with AMA overseeing ____ & ______.
Licensure; education
67
What gave the AMA power:
- supply of doctors (drive out “untrained”)
- complete control of medicine
- won great trade of 1910
68
Recently: as corporation fluency/power _____, medical profession's power ______.
Increases/rises; decreases/falls
69
By 2000, ____ of MDs were in the AMA, a ______ from ____ in 1963
1/3; decline; 4/5
70
Corporatization of Medicine
Includes overwhelming influence of Health Maintenance Organizations (HMOs), hospital corporations, hospital construction firms, labs and pharmaceutical corporations.
They prioritize money, which results in a decrease of MD autonomy
71
Deprofessionalization
MDs lose their monopoly over medical information as there is increased patient knowledge and assertiveness.
72
Proletarianization
MDs become more like employees; must follow the “allowed’ treatments for different disorders. Decrease in autonomy.
73
Unionization of MDs/health workers
A strategy to regain control of their work/autonomy: steady and slow rise
74
AMA as a Professional Organization
How AMA won the great trade
1) rigorous standards: stringent education/training
2) significant autonomy: progression handles education/licensure/quality of care
3) considerable prestige & identification w/ in profession: increased income/prestige comes from 1 & 2
75
Countervailing Power Theory
When profession achieves dominance (ex. Particular type of medicine;
Increased efforts by others (ex. Different types of healers, government, advocacy groups, etc) to balance that profession’s power.
76
Social control of medicine
Can/should doctors regulate themselves internally, or should there be external control?
77
Internal control
Peer reviews, hospital reviews, state boards of medicine, and national practitioner data bank (NPDB)
78
External control
Including Medical Malpractice (when errors occur it’s considered failure of internal control
79
Malpractice (legal definition)
All three things needed
1) proof of injury/damage
2) proof of health care provider’s negligence
3) proof that the negligence is what caused the injury
80
Malpractice litigation
Is intended to compensate patients whose harm by actions (or inactions) of a physician could have been prevented and to discourage such harms from occurring
81
Incidence/Severity of Malpractice litigation statistics
- 1960: 1:100 physicians accused; mid 1980s: 17:100
- decrease cases/physicians since late 80s
- ~ 20% of cases result in pay-out
- most actual cases don’t get filed
82
Consequences of Medical Malpractice crisis
1) defensive medicine: more tests to confirm disease
2) increased medical malpractice insurance: physicians need to pay more for insurance
3) embittered doctors: patients=walking law suite
4) doctors stopping service/practice
5) increased strife between MDs and lawyers
83
Efforts to reduce medical malpractice crisis
1) improve physician-patient relationships (improve communication)
2) capping monetary value on malpractice award: MDs/insurance like; lawyers/patients dislike
-constitutional problem: legislative usurping judicial prerogative
- no-fault insurance system: quicker/less adversarial than current system w/ smaller payments
84
US Physician Demographics
- increases physicians over last 30 years
- increased woman physicians (300% in last 20 years)
- urban areas have better physician:patient ratio (better recourses/pay for physicians)
- PCPs decline in favor of specialists; now rebounding
- women more likely to be PCPs + take salaried posts
- men more likely to train surgery
85
Historical/structural racism/sexism
- older MDs overwhelmingly men
- younger MDs more evenly distributed
- only 7% of US MDs are racial/ethnic minorities; many ‘foreigners
86
Physician work life
- relatively strenuous
-hard work-like balance (irregular hours)
87
Coping with Medical work stress
- drugs/ alcohol (30-100 times greater than the general population)
- psycological depression
88
With increased corporatization of medicine:
- increased workloads
- decreased pay
- decreased mission of service
89
Elizabeth Blackwell
1st woman to get a medical education
90
18th/19th century: _______/_______ limited opportunities
Racism/sexism
91
Later half of 19th century (minority education)
14 Women’s colleges and HBCs (Howards)
92
1904: AMA’s _____________ increased as an initial “accreditor” agency
Council on Medical Education
93
Currently: _____ Medical Schools in the US and ____ in Canada accredited by the _____________ (_____)
141;17; Liaison Committee on MEdical Education (LCME)
94
2012-2013 ~ _______ applications for ______ slots
45,000; 20,000
95
Average applicant applied to ___ schools
14
96
Women are ___ of medical school students
1/2
97
____ in minority students with ____ in public school funding
Decrease; cuts
98
Medical School Stress causes
“Medical school syndrome”; decreased free time; decreased family/friends time; increased seeking for high-paying specializations
99
Detached Concern/Desensitization
Emotional distance from patients because of degree of knowledge to be a doctor; taught by medical schools to prevent poor effects from the loss of a patients
AMA is trying to promote teaching compassion
100
Pellegrino’s 4 Areas of Compassion
1) selecting Humanistic students for Medical School
2) Increased behavioral and social sciences (med soc)
3) teaching values, ethics, and humanities
4) positive faculty role models (treat students with compassion)
101
Medical residence are ______ able to practice medicine if __________________.
Legally; under the supervision of a licensed physician
102
Medical students focus on _____ rather than _____ & don’t typically change ______ choices during graduate school (Conrad)
Disease; illness; career
103
Advanced practice nurse
RNs w/ additional education and certification in one or more (of about 20) nursing specialties
104
Licensed practical nurse (LPN)
High school graduates who have completed short, vocational program leading to certification as an LPN
105
Nurse practitioner
An RN with additional training able to provide 70-80% of basic preventative and primary care
106
Certified nurse midwife
An RN who is certified by the American College of Nurse Midwives to assist in childbirth
107
_____ regulate nursing in the US
States
108
Avenues to be an RN
- 3 year hospital-based school of nursing
- 2 year program in community college
- major in Nursing BA
109
Nursing has become:
Increasingly bureaucratized (with corporitization of medicine) and less about patient care.
110
Aiken’s Study (nursing)
Across 5 countries: 43,000 nurses expressed discontent with:
- too few nurses to provide quality care
- increased workload
- increased time spent on non-nursing tasks
111
Physician assistants
Less autonomous than nurse practitioners
112
Certified registered nurse anesthetists
Administer about 65% of all anesthetic in the US
113
MAJOR OBSTACLE for “Mid-level practitioners”
Lack of 3rd party reimbursed coverage; not getting paid
114
Primary prevention
Before a disease or health-related event occurs
115
Secondary prevention
After a disease or health event occurs
116
REAL leading cause of death
- smoking
- sedentary lifestyle
- poor diet
- alcohol
117
Smoking = _____ cause of ____ death
Leading; preventable
118
____ of adults smoke (down from ___ in 2005)
15.5%; 20.9%
119
Smoking rates higher in ___, ____, _____ and ____
Men; lower educated; disables; LGBT
120
_ in _ people die from smoking per year
1; 5
121
____ said giving the right amount of nourishment and exercise would be the safest way to health
Hippocrates
122
________ = 4th leading underlying cause of mortality
Physical inactivity/sedentary lifestyle
123
Benefits of exercise
Reduces mortality rates of all causes/ cardiovascular-related diseases
124
Best way to loose weight
Dieting
125
Cardiac, Vascular, and Pulmonary Rehab
Phase I: inpatient (education, family support, ROM exercises)
II: 2-3 months; individual treatment plan, monitored exercise, counseling
III: lifetime; continued exercise, lifestyle modification, no supervision
126
Cardiovascular Rehab (CR) resulted in an average ___ MET increase
2.3
127
Cardiovascular Rehab (CR) resulted in a ____ smoking cessation rate
37%
