Medical Sociology: Chapter 12 The Physician in a Changing Society Flashcards
Introduction
• Public attitudes toward the medical profession have shifted away from unquestioning acceptance of physician authority
–Dissatisfaction with rising costs and the failure to provide quality care for all Americans
– Organization of medical care has changed dramatically, reducing authority of physicians
Social Control of Medical Practice
• Arguments for autonomy of medical profession:
– Physicians themselves established the medical standards enforced by governmental regulating agencies
– Laypersons are generally unable to judge technical performance
– The physician is a member of a self-controlled collectivity performing a vital function for society’s general good
Social Control of Medical Practice:
Social Control of Medical Practice:
– Laypersons do judge technical performance, regardless of whether they are competent to do so
– Autonomy granted to the medical profession is granted conditionally
• Assumed that physicians will resolve significant issues in favor of the public interest
Social Control of Medical Practice:
• Arguments against autonomy of medical profession:
– Rules of etiquette among colleagues restrict the evaluation of work and discourage the expression of criticism
• Technical errors more likely to be forgiven by colleagues than moral errors
– Incompetent and dishonest doctors may still be subject to sanction
• Malpractice suits and government review boards
Countervailing Power
– Describes how a particular group may be only one of several groups in society maneuvering to fulfill its interests
- Suggests that the medical profession is but one of many powerful groups in health care
- The medical profession’s control over its market faltered as these countervailing powers established powerful positions as well and ended the profession’s monopoly
Social Control of Medical Practice
• Arguments against autonomy of medical profession:
– Rules of etiquette among colleagues restrict the evaluation of work and discourage the expression of criticism
• Technical errors more likely to be forgiven by colleagues than moral errors
– Incompetent and dishonest doctors may still be subject to sanction
• Malpractice suits and government review boards
Government Regulation
• The federal government has implemented several measures to control costs and improve quality of medical care:
– Professional standards review organizations (PSROs)
- Established by the government and composed of licensed doctors who determine if the services rendered for Medicare and Medicaid patients are medically necessary, meet professional standards of quality, and are provided as efficiently and effectively as possible
Government Regulation
- 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
- Initiated efforts to reform the health care delivery system
Managed Care
• Refers to health care organizations that manage or control the cost of health care by:
– Monitoring how doctors treat specific illnesses
– Limiting referrals to specialists
– Requiring authorization prior to hospitalization
• Represent a significant reduction in the authority of doctors to make referrals and choose modes of treatment
Managed Care
- Have the potential to reorganize health care into a stable, reliable, and less costly form that emphasizes preventive care
- But may disrupt doctor-patient relationships and deeply reduce doctor fees without providing quality managed clinical care
Managed Care
• Physicians play a variety of roles in such organizations
– “Double agent” because they must look out for interests of both company and patient
– “Gatekeepers” by limiting access to more expensive medical procedures and care by specialists
– “Patient advocates” in working to convince case managers and other bureaucrats that more expensive care is warranted in a case
The Coming of the Corporation
• The past decades have seen the emergence of numerous health care and health-related corporations
– E.g., for-profit hospitals and free-standing emergency centers
– These facilities minimize their expenses through an emphasis on the efficient use of resources
– Generally aimed at more affluent patients who can pay for services, usually with private health insurance
The Coming of the Corporation
• For the physician, health care corporations:
– Provide jobs, offices, staffs, equipment, hospital privileges, and perhaps even a salary guarantee
– Represents a loss of autonomy
• Less control over the timing and pace of work, closer scrutiny over mistakes, and less control over decisions on policy, hospital budgets, capital investments, personnel appointments, salaries, and promotions
The Changing Physician-Patient Relationship
Three changes have particularly impacted the doctor-patient relationship:
1) Shift in medicine away from the treatment of acute diseases and toward preventive health services
2) A growing sophistication of the general public with bureaucracy
3) Development of consumerism, which has led to more of a provider-consumer association between doctors and patients
The Deprofessionalization of Physicians
• Deprofessionalization
– A decline in power which results in a decline in the degree to which professions possess, or are perceived to possess, a constellation of characteristics denoting a profession
– Occurring as result of the changes discussed
- Increasing government regulation
- Managed care reducing physician authority
- Physicians becoming employees of corporations
- Increased consumerism on the part of patients
