Lecture 8 Flashcards
The Profession of Medicine
Goode definition (1960’s)
Three things
Goode (1960) defined a profession as having: autonomy, rigorous standards, and prestige
The Profession of Medicine Professional Dominance (Freidson, 1970)
Occupation has assumed dominant position in a division of labor, so it gains control over the determination of its own work.
The Profession of Medicine
How to become dominant? (2 Ways)
1: Convince the public of valuable work
– Knowledgeable authority on the subject
– Granting of legal autonomy by governing bodies
– Right to be self regulating
2: Control over # and credentials of practitioners + control over other health care workers
Has the profession remained dominant?
De-professionalization: Power decline (Haug)
Four
– Autonomy of work declines, dominion over patients lessened, public lost some confidence, knowledge become more widespread
Has the profession remained dominant?
Proletarianization (McKinlay) Marxist view
– Physicians are workers and not owners: slowly
lose authority
Has the profession remained dominant?
Corporatization: Light and Levine
– Corporate control without Marxist assumptions.
• Concerned with increasing corporate control of medicine
And for Freidson?
Physicians remain the health care experts
Has the profession remained dominant?
Countervailing Powers (Light et al.)
Three
P&P 4
– When one group gains considerable power, other
groups attempt to balance
– Relationship between profession and society is in flux
– Public and private sectors gained back power by: controlling costs, quality of life and cost effectiveness of treatments, issues, lack of technological restraint
Voluntary Associations: Weber (1910)
A voluntary association had two ideal-typical traits reminiscent of ‘the sect’: first, it had qualified people and, second, it rejected sanctions typical of an authoritarian organization (looser set of rules)
Professional Medical Associations
AMA
AMA: set up in 1847: Promote science and art of medicine
– Controlled entrance, training, and practice
Convening Doctor Power
Flexner Report
1904 AMA set up Council on Medical Education
• Pre-med requirements, standard training period, licensing tests.
• Issued a report judged schools: Many of which inferior but, this report was not published
AMA: gave Abraham Flexner task: 1910 issued his report on the best and worst schools
Professional Medical Associations
Women
Elizabeth Blackwell (1849) 1st female physician
Medical Women’s National Association (1915)
Professional Medical Associations
AAs
National Medical Association (1895)
Professional society for African American physicians
Social Control of Medicine
Defined
Defined ability of individuals or groups to regulate themselves (internal) and for others to regulate the individual or group (external)
Social Control of Medicine
Internal
Internal Control: Physicians have autonomy to self-regulate
Social Control of Medicine
External
External Control has come in the form of medical malpractice claims, federal and state legislation/regulation and corporate sector influences on work environment
Internal Control of Medicine
Three controls
Peer Review: comments, questions, suggestions and personal conversations (informal)
Hospital Review Committees: some mandates from govt.; credentialing, quality control, mortality review
Board of Medicine in each state: Informal or formal hearings vs. physicians: sanctions granted (very small % actual)
External Control of Medicine
Medical Malpractice
Compensate patients who have been harmed: prove
injury, negligence, and negligence caused injury
Civil penalties require payments of damages
External Control of Medicine
Consequences
Defensive medicine practiced: every test to be sure
Increase insurance = increase US HC dollars
Embittered physicians vs. patients
High costs = stop offering certain services
Increased acrimony between medical and legal professions
Socialization of Physicians
Defined
Socialization defined as the process by which a person becomes a member of a group or society and acquires values, attitudes, beliefs, behaviors and a sense of identity.
History of Medical Education US
Colonial Period: Apprenticeship system
Quality varied tremendously
Get a certificate just for registering
Others had 3 year apprenticeships
History of Medical Education US
By 1800: 3 formal medical schools
Harvard, Penn, Kings College
For-Profit Proprietary Schools dominant vehicle by mid 1800s
• Ability to pay fees: entrance requirement
• Two, four month terms, practical learning with no exams
• Some become “house pupils”: selected by examination to reside in hospital and manage cases
History of Medical Education US
Third option
Alternative European study which most could not afford
History of Medical Education US
Medical Education for African Americans
Formally denied in North and South prior to the Civil War
African Americans turned to missionary or proprietary schools for medical training
History of Medical Education US
Women
Elizabeth Blackwell: The First Women to Receive a medical degree in the US (1849)
History of Medical Education US
By the 1880s, what happened?
By 1880s: many formal schools reformed: 4 year training, tough entrance requirements, curricula stressed science and labs
Modern Medical Education
New Curriculum by 1920s supported by Flexner/AMA
– Separation b/w basic science and clinical science
– Heavy reliance on lectures with expert instructors (didactic learning)
– Independent and uncoordinated courses taught by different faculty members
Medical Education Curriculum
Year one and two
Basic sciences
Medical Education Curriculum
Years Three and Four
Solve clinical problems, due rotations to learn specialized
knowledge
Medical Education Curriculum
Residency
three to seven years
