Soci 321: First Midterm Flashcards
Wertz and Wertz
Changing roles of midwives and doctors in the 19th century
1650-1850
continuous and substanial decline in mortality attributged to midwives improving their practices
1895-1910 then 1910-1935
small decline initially due to less deadly strain in strep throat
then introduction of doctors with poor education and unnecessary risky interventions
1935 unitl today
introduction of drugs and improvements of obstetrics care
Farmer
medical ethics: everyone has a right to universal health care and need to provide care to the most vulnerable and disempower
local standards of care
justification of HIV researchers to not providing drugs when doing research in developing countries
Berg
medical practice is a cognitive, asymmetrical model and doctors use medical disposals to take historical data and results and turn it into a solvable problem
DEFINE medical disposal
A limited set of actions in which the doctors provide a sufficient set of answers/treatment to a set of questions
They are constructed via biological and social factors
Conclusion of Berg’s Article
Need to develop routines that adequately create a frame of reference in which to use medical disposals
Timmerman
How the medical profession manages the potential of clinical, practical guidelines to expand it’s power while dealing with the potential that these guidelines will weaken autonomy
How do Doctors claim jurisdiction over the medical practice?
the profession sets educational standards, ethical codes, hospital and patient record guidelines and performance standards
Evidence Based Medicine
the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients
Biomedical Knowledge
Combination of patient history and results.
does not necessarily dictate medical practice. Medical criteria and disposal options are modified and reconstructed in order to align them with the transformation.
Bio-K cannot be considered the beacon that guides the construction of medical disposals in clinical practice
two major features of EBM & Issue of EBM
1) epidemiological findings, RCT’s 2) clinical guidelines
ISSUE: real people don’t look like epidemiological studies
DEFINE clinical guidelines
systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances
Example of Clinical Guidelines (& their flexibility)
Ultrasound guidleines have been proven to be ineffective in reducing morbidity and less interventions
motives for guidelines (4)
o Economic motives
o A non-adherence to guidelines creates issues in external validation of its jurisdiction
o Hold practitioners financially accountable
o Third party funders create financial incentive to follow guidelines: therefor it is a tool of accountability
Timmerman conclusion of guidelines
Guidelines don’t change behavior!
Can standardization be achieved?
RCT’S and EBM’s are based on population wide results .. an individual person is not a population wide average
- you can’t return a person the same was a tv
- certain surgeons prefer certain disposals
DEFINE supply sensitive care
Health care to a certain diagnosis is in response to the supply within that given health care facility
Ex: All Hip Fractures require hospitalization. But for other medical discharges, the rate of discharge is based on bed supply
DEFINE Preference sensitive care
The amount and type of care is sensitive to the preference of the physician and the patients
EX: As demonstrated in Fig. 2 of the autonomy to accountability slides; rates of surgery for hip replacement are consistent across 4 Florida hospitals BUT huge variation within knee replacement and back surgery.
McKinlay’s 7 Stages of Medical Innovation
(PPPS,RCT,D,E)
+ example of hormone therapy
- Promising Report
- Professional or Organization Adoption
- Public Acceptance and third-party endorsement (gov’t and insurance companies begin to pay)
- Standard procedure and observational reports
- Randomized Control Trial (gold standard)
- Professional Denunciation
- Erosion/Discredit
Beecher
Ethics and Clinical Research” compiled a list of 22 studies that were ethically problematic…His paper stimulated legal and gov’t intervention that made informed consent a required part of medical research
External Changes that were blows to the medical profession (4)
- Growth of the welfare state
- Increasing Complexity and resource-intensiveness of medical treatments
- Competitive threat from other health care workers
- Increased capacity of information technology
Self Inflicted Blows to the Medical Profession
- Opposition to Universal Health Care Coverage
- Failure to self police on health care costs and quality of care
- abuses of medical authority and trust
- attachment to paternalism
- medicalization of too much
Zola
Medicine as an institution of social control & the negative impact of the medicalization of society
Societal Aspects of Medicalization
rooted in our increasingly complex technological and bureaucratic system. Is as much a result of medicine’s potential as it is of society’s wish for medicine to use that potential
EXAMPLES of Medicalization
Childbirth, FMS, ADHD, Compulsive shopping disorder?
DEFINE attaching process
how the medical profession claims jurisdiction to label something ‘illness’.
controls drugs and surgery, therefore controls definition of illness
4 ways attaching process has caused increase in the medicalization of society
- Expansion of what in life is deemed relevant to the good practice of medicine
Increasingly necessary to alleviate disease by change of habits - Retention of control over certain technical procedures: surgery, drug prescription, etc
Prescribe powerful synthesized drugs provides a powerful tool and yet Dr’s are adverse to illegal drugs such as marijuana - Retention of absolute access to ‘taboo’ areas; ageing, drug addiction, alcoholism, pregnancy (prenatal, post natal, and pediatric care)
Expands medicine’s involvement in the span of human existence and becomes the primary resource for help with many personal and social problems - Expansion of what in medicine is deemed relevant to the good practice of life (use the language of ‘what is good for you’ to control people’s lives
The prestige of any proposal is enhanced when expressed through the idiom of science ex: healthy or unhealthy economy
Van Ryn & Fu
Social aspects of medical profession create disparities in the treatment of illness
how does the social impact public health workers disposal of treatments
- providers can influence how the help seekers view themselves
a. solely based on unconscious views - providers may not communicate as effectively with certain groups
a. ex: Tuskegee letter that described the research as a special treatment - Providers are gatekeepers for other services
a. Ex: middle aged women may not be referred to heart specialists
Barker
Self Help Lit & FMS identity
DEFINE biomedical authority
premised on the use of instrumentation to make disease visible and the concurrent reduced reliance on patient’s subjective evaluations
what is the Narrative of FMS
permissive! the illness narrative presented in the vast list of common symptoms, some which fall outside of medical orthodoxy
Why is it important to validate an illness
• If we have an experience that is illness but is not recognized by the medical profession, they can feel insane… so FMS patients create a way to validate their experience
Social Construction of Illness
How the social affects the way we perceive, understand, explain, and respond to illness
Dominant Narrative of Illness
Biomedical Narrative
o Individualizes illness and removes social circumstance
o FMS sufferers do not receive this kind of medical narrative so they create a self-help community to legitimize their personal experiences
Evidence in Enrenreich of the SC of Cancer
Openly dissented against the breast cancer movement and was received with exactly what she expected, prayers and calls to “be happy” or at least seek counselling
Ideal patient in the biomed model
passive, infantile woman
Frank: wounded storyteller
we are living in the remission society
Contradiction btw Parsons and frank
- Contradicts Parsons understanding of the sick role and provides a sense of how the world has changed
- Remission society where people are neither sick nor well, the medical profession does not serve this group of people
Post-Colonial Narrative
Medicine needs a body to be a part of society but in post-colonial medicine the body demands to be recognized and their identity is claimed
Colonial Narrative
o Modern medicine colonized the body by claiming it as its territory, in the most basic evidence during treatment
o In remission society, colonization continues as patients are required to regular check ups, the forever identity marker ‘survivor’
Sick Role differences between parsons and Frank
• Parsons’ sick role: patient is responsible for getting well, in Remission Society, the post-colonial person is responsible for what illness means in his life
DEFINE Sociological Imagination
A term coined by c.w. mills to describe the sociological approach to analyzing issues. We see the world through a sociological imagination or to think sociologically when we make the links between personal troubles ad public issues.
DEFINE Sick role
A concept used by Parsons to describe the social expectations of how sick people should act and of how they are meant to be treated
DEFINE Medicalization
The process by which nonmedical problems become defined and treated as medical issues, usually in terms of illnesses, disorders, or syndromes
DEFINE Attaching Process
How the medical profession claims jurisdiction to label something ‘illness’
DEFINE Remission Society
where people are neither sick nor can never be considered cured. Where the foreground and the background of sickness and health constantly shade into eachother.
DEFINE Social Cognition
A subfield of social psychology that studies how we make sense of other people, that is, the mental representations and processes that underlie social perception, social judgment, social interaction, and social influence.
DEFINE Biomedical Model
A purely cognitive practice in which facts (patient histories and test results) directly correlate into scientific fixed givens (medical criteria leading to disposal options)
DEFINE Social Model of Health
Focuses on social determinants of health, such as the social production, distribution, and construction of health and illness, and the social organization of health care. It directs attention to the prevention of illness through community participation and social reforms that address living and working conditions
DEFINE Evidence Based Medicine
An approach to medicine that maintains all clinical practice should be based on evidence from randomized control trials to ensure treatment effectiveness and efficacy.
DEFINE Medicalization
Process of defining a behaviour as a medical problem/illness and mandating or licensing the medical profession to provide some type of treatment
DEFINE Medicalization
Process of defining a behaviour as a medical problem/illness and mandating or licensing the medical profession to provide some type of treatment
