medical dominance in decline Flashcards
What is medical dominance
physicians have autonomy over their conditions + terms of work
physician control?
over work of other occupations in HC field
4 threats to medical dominance?
the state
the public
other occupations
from within medicine itself
the state - intervened?
intervened more directly in areas previously left to discretion of physicians
three areas the state has control?
compensation
number of physicians
working conditions
how does state have control over compensation?
decide cost. decide fee-for-service.
decide how well paid doctors are.
2 examples of state controlling compensation
- AB well-paid physician, rising cost of HC, need ABgovt to control cost. 0% increase in salary, looks like physicians doing poorly but still highest paid
- ont govt. previous govt wanted to reign in doc price. no negotiation. reduce docs making millions a year = abusing system. govt wanted to reign these ppl in.
govt control over # physicians
in past province reduced overall enrolment to medical school
now, canada has more docs than ever before. high unemployment among specialists
=> allocative efficiency. how many do we need to ensure good HC? rural area problems. need incentive to rural. incentive to educate + specialize
state control over working conditions
increased surveillance in electronic health records + wait times
what is electronic health record
lifetime health record of an individual that is accessible online from many separate, inter-operable automated systems within an electronic network.
Alberta: Netcare
how AHS describes EHR?
- what are key elements?
secure lifetime record of albertan’s key health info. not patients full health/medical record
- > personal demographic
- > prescribed drugs
- > allergies/intolerances
- > immunizations
- > lab test results
- > diagnostic imaging reports
- > other medical reports
issues with EHR
privacy issues = given to insurance without consent, consequences
-> less obvious is how EHR can be used to control what physicians do.
control cost - ID physicians to take above-average time.
define wait times
length of time it takes on average for a procedure to be done
-broken down by region + compared to provincial average
the public threat to medical dominance
- direct challenges to medical decision-making
= patient -> consumer
=self help groups
= the internet
how does patient -> consumer challenge medical dominance?
HC commodified, power dynamic shifts.
patients no longer passive. exercise choice demand satisfaction.
= direct-t-consumer ads
ratemymd.ca = rate physician. can see + comment to pick doc in best way
how does self help group challenge medical dominance?
emotional + social support + practical help.
experiential knowledge > medical knowledge. doc cant provide experiential knowledge.
- may be collectively engaged in efforts to change medical practice.
2 examples of self help groups
diabetes canada
- “we” lead fight against. authoritative, advocate for, interest in cure, change awareness, influence thought abou
canadian cancer society
- advocate for, push for research, prevention + reducing risk. trusted source. powerful advocated to govt on behalf of ppl with cancer
how internet challenges medical dominance?
access to privileged knowledge
=> now novice can read journal. use knew knowledge to challenge doctor.
-> pper-to-peer HC. online to see similar health concerns. rare + unusual conditions. wealth of knowledge beyond immediate community.
how other occupations are threat to medical dominance?
nurse (can perscribe), pharmacy (pharmacy prescribe) - professionalize
CAM popular - holistic approach. challenge medical model approach
how docs themselves are threat to medical dominance
- no longer homogenous group
- specialization
gender differences in medicine
more female now than male who are in first year
- more male currently working than female
why does gender difference in medicine matter?
docs -> govt
when all white male - same vote, same idea.
now heterogeneous group. diff interests, diff views. many ideas around same table.
what is specialization
professional attention to particular branch of medicine/surgery that is recognized by board of physicians
how specialization is threat to medical dominance
fragmentation + loss of shared interest.
-> inequality as specialists have higher status compensation than GP
despite challenges - what’s still going right with physicians holding medical dominance?
- med has more autonomy + influence than most other professions
- compensation of physician still high
- regarded as top occupational aspiration
