Socialization: how do doctors and patients learn their roles?

Question 1

What is socialization?

Answer 1

Process by which individuals learn the culture of their society

Question 2

What is primary socialization?

Answer 2

infancy, usually within family

• most influential part of the process
• traditionally pink gifts are given to girls and blue gifts are given to boys
• language used in front of the newborn is also affected by their gender

Question 3

What is secondary socialization?

Answer 3

Lifelong process, education system, peer group, occupational group

• what is expected of us in school, peer groups and at work
• e.g. way we learn to behave in society - queueing in Britain
• occupational group - learning to be a doctor -socialisation process you learn at medical school is very powerful

Question 4

What are the two types of curriculums for medical students and how do they differ?

Answer 4

Manifest curriculum - information tested in the exams - small aspect of learning to be a doctor
Hidden curriculum -aspects of becoming a doctor that are not taught

Question 5

What did Hippocrates say about doctors?

Answer 5

They must be well dressed, clean and in good health because the public find these things pleasing
Must be gentleman in character and appearance
Must be serious but not harsh countenance, as this would come across as arrogant

These behavioural characteristics underpin the GMC guidelines

Question 6

How does Hippocrates definition of a doctor compare with the way current society portrays a doctor’s appearance, behaviour and personal attributes?

Answer 6

Gender in medicine has changed, with females being more dominant
Doctors are no longer seen as trusted heroic individuals
In the media nowadays, there are many figures that portray doctors in a very different light e.g. carrying out inappropriate operations and abusing patients

Question 7

How can you tell someone is a doctor in a hospital? and why is this different in a psychiatric hospital?

Answer 7

Smart clothing, stethoscope and domineering presence - their mannerisms help to identify them as doctors
In psychiatric hospitals it has been suggested that identifying doctors is more difficult because it is more informal = therapeutic alliance between doctors and patients

Question 8

Out of all the healthcare professions, which has the highest status?

Answer 8

Doctors - people try to impersonate them because of their power and status

Question 9

Why is there such an outcry when doctors are found to have abused their position?

Answer 9

They have breached their rights and obligations as a doctor - abused their position which doesn’t fit in with what society expects of doctors

Question 10

What are the characteristics of a profession?

Answer 10

Extensive body of specialised knowledge which involves theory and research as well as practical skills. Specialised knowledge passed on to trainees usually in a university setting and controlled by the profession

Extended period of formal training for which standards of entry and qualifications are determined by the profession

e.g. People that don’t fit the entry requirements for a doctor are not allowed into medical school

Monopoly of practice in .a particular area for which the profession concerned is self accounting with control over its own activities - autonomy to organise, define and develop their work
Ethical background of service to individual with public ideology of service to the community, prohibits exploitation of clients and regulates professional relations
Status
Power

Question 11

How has control over its own activities changed in medicine?

Answer 11

Slightly been eroded due to NICE and GMC guidelines dictating what can and cant be prescribed
- relatively large degree of autonomy for each HCP to practice in their own way

Question 12

What is the “formal curriculum”?

Answer 12

What is formally taught in the formal curriculum of the medical school in lectures etc. (acquisition of relevant knowledge, testing this knowledge in exams)

Question 13

What is the “informal curriculum”?

Answer 13

learning at the side of members of the profession and watching how they behave (acquiring the appropriate attitudes, language and behaviour towards clients, colleagues and fellow workers)

Question 14

What are some examples of informal agents of socialisation?

Answer 14

Appearance - GPs tend to be smart causal whereas surgeons tend to be in suits - as medical students we model ourselves upon the doctors we see
Specialised vocabulary - jargon, abbreviations e.g TATT, BP
“Rites de passage” - public ceremonies celebrating the transition of an individual or group to a new status - medical school socialises you, medical parents, segregation from the rest of the uni

Question 15

How do the informal agents of socialisation fo doctors have an affect?

Answer 15

they:
1) distinguish doctors from others (nurses, patients)
2) make doctors identify strongly with the profession and its own values and norms- creates a strong professional identity (lay statements about doctors as “closing ranks” always sticking up for each other)
3) it can be difficult for doctors to leave the profession once they have been trained as it is difficult to go back to the “outside” again where people do not speak the same language as them or hold values similar to them
= medical socialisation - likened to being in a cult

Question 16

What are the main agents of socialisation for patients?

Answer 16

Media
Lay referral system - family is the primary one 
Self-help groups
Handbooks 
Leaflets for patients about "what to expect"
Chronic illness
Experience of the healthcare system 
Expert patients

Question 17

What was Goffman theories on socialisation of patients?

Answer 17

Hospitals socialise patients
They way we present ourselves varies based upon the setting - both patients and the doctor know how they are supposed to behave in the consultation

Question 18

What did Goffman say about total institutions?

Answer 18

“those institutions whose inmates are separated from social intercourse with the outside world”

• they are not just hospitals, they can be any place where people within the institution are separated from the rest of the world - some have said medical schools are total institutions

Question 19

What are the characteristics of total institutions?

Answer 19

All aspects of life are conducted in the same place and under a single authority
Daily life is carried out in a group with others (batch living)
There is a basic distinction between the managers and the managed between who there may be little communication
There is an institutional perspective and therefore the assumption of an overall rationale

Question 20

What are the mechanisms used in institutions to facilitate management of inmates?

Answer 20

Physical and psychological reminders of a person’s identity are stripped by removing personal possession and restricting privacy and individual responsibility
Information about the individual and the institution is controlled
Mobility is restricted

Question 21

What are the effects of total institutionalisation?

Answer 21

Stress and anxiety
Depersonalisation - everything that is individual about that person in the real world is take away= loss of self
Institutionalisation- patients become apathetic with an inability to undertake simple tasks of make decisions

Question 22

What are the different modes of adaptation used by patients?

Answer 22

1) SITUATIONAL WITHDRAWAL- patient withdraws attention from everything except events immediately surrounding their own body, minimises interactions with others
2) INTRANSIGENT LINE - patient flatly refuses to co-operate with staff, exhibits hostility, short lived as strong effects by staff to break resistance
3) COLONIZATION - patients define life in situation as more desirable than life on the outside, may try to remain inside as discharge approaches
4) CONVERSION - individual adopts staff’s definition of model inmate and acts out part
5) PLAYING IT COOL - alternating between other modes of adaption depending on the situation

Question 23

What is the permeable institution?

Answer 23

Evidence for permeability

• ward membership is temporary of revolving
• contact with outside world is maintained
• institutional identities are blurred

Consequences of permeability

• reduced risk of institutionalisation - less likely if you remain in contact with outside world
• increased risk of staff and patients - increased risk of infection, inappropriate food, drugs, cigarettes when in contact with outside world

Management of permeability

• limiting unwanted movement - staff asking patients what they want to happen ensuring their views are encompassed alongside the doctors
• using discretion
• patient input: negotiation and subversion