quiz 2 Flashcards
sociological definition of health
broad-based concept of
6 Primary Orientations:
- Physical functioning
- Mental health
- Social well-being
- Role Functioning
- General health perceptions
- Symptoms
biomedical definition of health
solely on an individual’s physiological state and presence or absence of symptoms. “Absence of Disease”
WHO definition of health
inclusive, positive and proactive view; “… a state of complete physical, social, and mental well-being and NOT merely the absence of disease or infirmity.
4 key dimensions of health behavior
Prevention
Detection
Promotion
Protection
4 assumptions that limit health behavior utility
- ”Presence of disease”: faulty: 1) cultural / individual differences in reacting / reporting symptoms; 2) sometimes NO signs / symptoms.
- “ONLY medical professionals” are capable of defining health & illness: Reality: Patients & others (e.g. family) are involved in the process.
- Health & illness should be defined SOLELY in terms of physiological function. Fact: people are NOT MERELY BIOLOGICAL BEINGS – psychological and social creatures. <Body – Mind – Soul>.
- “Health” as merely “the absence of disease”: This excludes A LOT about “well-being”.
health protective behaviors
individual actions taken to protect, promote, or maintain health.
prescriptive vs proscriptive
Prescriptive – what you should do (diet, seatbelts, exercise, check-ups, etc.)
Proscriptive – what is recommended/should not do (driving safely, not smoking, limiting alcohol, etc.)
micro vs macro approach to healthy lifestyle
- Micro- approach to Healthy Lifestyle – focuses on individual decisions to do +/- things.
- Macro- approach – to change community behaviors, including social structure (racism, sexism, unemployment, etc.). BUT* corporations resist (tobacco, alcohol, food…).
- Calls for Quality Education, Jobs, Public Health, Mass Transit, etc. (ALL of which COST MONEY – and require TAXES.)
Suchman’s stages of illness experience
- Symptom Experience
- The Sick Role
- Medical Care Contact
Seeing someone with medical legitimacy - Dependent Patient Role
Agree or reject medical treatment/suggestion - Recovery & Rehabilitation
How do we assess Symptoms when they arise?
social construction of illness definition
its definition and ability to cope with illness are culturally and socially determined with the socialization process. “How we learn to be ‘human’ & interact w/others.”
the sick role definition
when one is ill – you not only exit ‘normal’ social roles – but rather enter into a NEW role with certain exemptions and responsibilities.
labeling theory
helps define roles of illness as well.
In Sick Role, one enters into “normlessness” to stay in the Sick Role (legitimately) … the person must convey a desire to get well.
medicalization definition
a process allowing the medical professional to determine what is “normal” and “desirable” behavior … AND … how to CONTROL, MODIFY/ELIMINATE “undesirable” behaviors.
palliative care
increase, treating the pain / suffering of seriously ill patients.
result of medicalization
↑ POWER of Medical Institutions / Professionals
↓ Religions / ↓ State (legal) definitions of POWER
May be Good (+): *Less stigmatizing *Less punitive
May be Bad (-): Representing some “societal” label of disapproval
medicalizing deviance
SIN → CRIME → ILLNESS
de-medicalization
deinstitutionalization of mental patients,
and other American Psychiatric Association disorders (DSM)
Homosexuality
- Much of this from Sociological critiques
labeling theory with de-medicalization
definition of illness is a subjective matter, worked out in particular CULTURAL contexts.
BUT »_space;»> CAN YOU ELIMINATE IT? EVER? HOW?
Range of Choices for Medical Care & Advice (inverted)
- “Other” – Self Care
- Lay Advisors
- Non-Medical Professionals
- Alternative Medical Practitioners
- Modern Medical Practitioners
class effects on the poor
*Much less likely to have regular health care.
*Much more likely to use ER as primary care.
*Less likely to be admitted to hospital but much sicker when they are.
class effects on race, ethnicity, and gender
Hispanics – have LOWEST rate of use of health services
Women – controlling for reproductive services, women still use MORE health services than Men.
e.g. Indian Women
*husbands must approve
*don’t have direct access to family $$
*don’t go to health clinics ALONE
self care
Important concept including BEHAVIORS to
- Promote optimal health
- Prevent illness
- Detect symptoms of ill health
- Heal acute illness
- Manage chronic conditions
concerns with dependent patient role
Loss of personal independence
Withdrawal from key Social Roles
Changed body image
stigmas associated with illness
Social Rejection
Financial Insecurity
Internalized Shame
Social Isolation
professional dominance
Early 20th century is when physicians gain dominance in Medical field – replacing family and church. (Paul Starr)
Strengthened with ↑ AMA and its overseeing licensure & education.
Controls Supply of Doctors (drives out “untrained”)
Won the Great Trade of 1910 (Review)
However»_space;»
↑ Corporatization ↓ Medical Profession’s Power
by 2000, 1/3 of MDs in the AMA* (decline)
corporatization of medicine
includes the overwhelming influence of Health Maintenance Organizations (HMOs), hospital corporations, hospital construction firms, labs and pharmaceutical corporations.
Deprofessionalization vs Proletarianization definiton
Deprofessionalization in losing control (with ↑ patient knowledge and assertiveness)
Proletarianization as they are more like “employees”
unionization
↑Unionization of MDs / health workers as a strategy to regain control of their work (steady and slow rise in rate).
AMA as a professional organization with fundamental elements of a “profession”
Rigorous Standards
Significant Autonomy
Considerable Prestige & Identification w/ profession
countervailing power theory
When profession achieves DOMINANCE →
↑ Efforts by others to balance that profession’s POWER
social control of medicine
Can / should doctors regulate themselves? [internal control] or should there be external control from outsiders?
Internal Control: including Peer Reviews, Hospital Reviews, state boards of medicine, and National Practitioner Data Bank.
External Control: including Medical Malpractice (when errors occur it’s considered failure of internal control).
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.
Incidence / Severity of Malpractice Litigation:
↓ Cases/physicians since late ‘80s
≈ 20% Result in Pay-Out
Most actual cases DON’T get filed*
consequences of malpractice crisis
Defensive Medicine
↑ Medical Malpractice Insurance ($)
Embittered Doctors
Doctors stopping service / practice
↑ Strife between MDs & Lawyers
efforts to reduce malpractice crisis
Improve Physician →← Patient Relationships
2 Policy Initiatives
- Capping $Dollar Value on Awards
MDs / insurance love it
Patients / lawyers don’t
*Constitutional Problem: Legislative usurping Judicial prerogative.
- No-Fault Insurance System
Quicker / Less adversarial than current system
With smaller payments
us physician demographics
↑ Physicians over last thirty (30) years
↑ Women Physicians ≈ 300% in last twenty (20) years
Urban areas have much better physician:population ratio
PCPs declined (in favor of specialists), now rebounding
Women more likely to be PCPs and to take salaried posts
Men more likely to train in surgery
- Historical / Structural Racism / Sexism
Older MDs overwhelmingly Men
Younger MDs more evenly distributed
Only 7% of US MDs are Racial / Ethnic minorities, BUT many foreigners*
physician work life
Relatively Strenuous
Work – Life Balance is DIFFICULT w/long & irregular hours
Stress Coping often includes:
Drugs
Alcohol
Often with Psychological Depression
physician chemical dependency rates
30 – 100 X > general population
result of increase of corporatization of medicine
↑ Workloads
↓ Pay
↓ “Mission of Service”
AMA’s Council on Medical Education as initial “accreditor” agency.
urrently, 141 Medical Schools in the US; 17 in Canada
All accredited NOW by the
Liaison Committee on Medical Education (LCME)
2012-13 ≈ 45,000 Applications for 20,000 slots
Average applicant applied to 14 schools
Women are ½ of medical school students
Minority students with Cuts in Public School funding (ED)
medical school syndrome
↓ Free Time ↓ Family/Friends Time
↑ Seeking high-paying specializations
Coping with Medical School Stress:
↑ Alcohol use ↑ Drug use
Also has included:
“Detached Concern” – Emotional distance from patients because of the degree of knowledge required to be a doctor. This is related to …
Medical School “Desensitization” to patients.
AMA pushing ↑ Compassion emphasis.
Pellegrino’s 4 Areas of Compassion
Selecting Humanistic students for Medical School
↑ Behavioral & Social Sciences (Medical Sociology)
Teaching values, ethics and humanities
Positive faculty role models
advanced practice nurse
Registered Nurses (RNs) w/additional education & certification in one or more (of about 20) nursing specialties.
licensed nurse practitioners
High school graduates who have completed a short, vocational program leading to certification as an LPN.
nurse practitioner
An RN with additional training able to provide 70-80% of basic preventive and primary care
certified nurse midwife
An RN who is certified by the American College of Nurse Midwives to assist in childbirth.
STATE regulation of nursing
Avenues to Registered Nurses (RNs):
3 year Hospital-based school of nursing
2 year Nursing program in Community College
Major in Nursing (B.A.)
Nursing has become:
↑ Increasingly bureaucratized with ↓ Less patient care
Aiken’s study of nurse discontent
Too few nurses to provide quality care
↑ increased workload
↑ Time for NON-nursing tasks
physician assistants
LESS < Autonomous than Nurse Practitioners.
certified registered nurse anesthetist
Administer about ≈ 65% of all anesthetics in the United States.
obstacle for mid-level practitioners
LACK OF 3rd PARTY REIMBURSED COVERAGE ($ MONEY)
prevention
A longer life
A better life
* Primary Prevention – before a disease or health
related event occurs
* Secondary Prevention – after a disease or health
event occurs
leading causes of death in US
*Smoking
*Sedentary Lifestyle
*Poor diet
*Alcohol
smoking
The leading cause of preventable death
* 15.5% of all adults (down from 20.9% in 2005)
* Higher in men, lower educated, disabled and
LGBT
* Accounts for more than 480,000 deaths (1 in 5)
per year
* Quitting at any age lowers risk
sedentary lifestyle
americans sit on average 11 hours/day
hippocrates:
“All parts of the body which have function, if used
in moderation and exercised in labours in which
each is accustomed, become thereby healthy,
well-developed and age more slowly; but if
unused and left idle they become liable to
disease, defective in growth and age quickly.”
“If we could give every individual the right amount
of nourishment and exercise, not too little and
not too much, we would have found the safest way
to health.”
physical inactivity
4th leading underlying cause of mortality
* Adversely effect 23 chronic diseases and health
conditions
* Annual direct medical costs in the U.S. alone as
high as $26 billion
* In 2012 48% of adults age 18 and above; 68% of
adults age 75 and up did not meet federal physical
activity guidelines
benefits of exercise
Reduces mortality rates from All Causes
* Reduces the incidence of CAD, Stroke, and Cancer
(breast and colon)
* Lowers risk of High Blood Pressure
* Increases HDL and lowers triglyceride levels
* Helps control BS in Type II Diabetes – improved insulin
sensitivity
* Reduces injurious falls
* Prevents or positively impacts depression
* Slows loss of cognitive function
Lowers risk of excessive weight gain
* Improve intestinal motility and nutrient absorption
* Increases plasma in the blood
* Increases exercise/activity tolerance
* Reduces bone loss
most effective ways to lose weight
nutrition and diet
cardiac risk factors
Smoking
* Sedentary Lifestyle
* Diabetes
* High Blood Pressure
* Hyperlipidemia (cholesterol)
* Obesity
* Stress/Depression
Cardiac, Vascular and Pulmonary Rehab
Phase I/ Inpatient
following acute event
Phase 2/ Early Outpatient
2 to 3 months
Phase 3 Maintenance
Lifetime
phase 1 inpatient goals
Progressive ambulation
* Teaching on pathophysiology of their
condition (post PCI, HF and COPD)
* Risk factor overview including brief nutritional
tips.
* Benefits and skills training on exercise.
* HF and COPD Self Management Skills
* Smoking cessation
phase 2 outpatient monitored
12 week boot camp for better health
Initial Consultation and Individual Treatment Plan
* Demographics
* Medical history
* Nursing assessment
* Exercise Prescription
* Aerobic
* Resistance training
* Home exercise
* Psychosocial assessment – PHQ9 and SF 12
* Smart phone app at UPMC Shadyside
phase 3 comprehensive lifestyle training
Education
* Pathophysiology
* Activity and exercise guidelines
* Risk factor modifications
* DM and pre-DM schooling (Group Lifestyle
Balance Course)
* Smoking cessation counseling
* Medication compliance
* Exercise (3 days per week for 3 months)
* Nutritional Counseling (RD on staff)
* Psychosocial Support – depression and QOL
