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Medical Sociology (final Notes)

This class was taught but Giertsen.

Course

Medical Sociology (SOC 3330)

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Utah State University

Academic year: 2015/2016

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Interest in health beliefs 1. model was found to be highly predictive of preventative health behavior. (immunizations) 2. Prediction for illness behaviors were much more variable and inconsistent This implies two distinct models Health: a motivation model based on psychological reasoning Illness: a psychological model based on the social context of illness Health Preventitive Possible problems Future situation Individual Illness Treatment Actual problems Present situation Social Suchmman: group structures and health beliefs 1. Skepticism and lack of knowledge may produce delays in seeking help and may lead to alternative sources of care 2. Skepticism and lack of knowledge are produced parochial group structures (see diagrams in notes) Internals 1. 2. 3. 4. 5. Respond when environment offers choice More task oriented with better cognitive skills Smaller social networks More health activity and knowledge seeking More responsive to messages about self control. Externals 1. 2. 3. 4. 5. Respond best when environment not controllable More responsice to social pressure Larger social networks More prone to passively accept what comes More responsive to messages about chance Medical Sociology Alternative persons giving treatments for diseases that are not consistent with the established scientific factor procedures. Types of healers Holisitc practitioners using natural remedies to help the body heal itself (used in addition to doctors) practitioners using manipulation of the spine to cure disease (used in addition to doctors.) Faith practitioners using prayer of faith to heal Folk practitioners using magic, rare herbs, or old traditional cures that can cure anything. practitioners posing as doctors who have lost their medical license or who never had one. Alternative medicine in Northern Utah Survey of 466 adults, age Subjects were asked you ever used any of the following in the past year? Chiropractic Herbal medicine Acupuncture Other Of the 146 that said yes to some form of use 132 had also seen MD in the past year. Overall use (Utah) Overall use Modern medicine focuses on specific remedies for specific diseases that exist apart from individuals. What does scientific mean? 1. 2. 3. 4. Single causal factor cures Prospective evidence Specific double blind It also means conventional or established scientific thinking (ex. What most scientist think are true.) Double blind study 1. Random assignment to experimental and control tracked number 2. disguise treatments or medicines so patients know which group they are in (label all the same, track with numbers) 3. Second let doctors know who is receiving the real thing (have same doctor administer both treatments.) Now control groups are treated standard treatments and experimental group is the one testing new treatment. Alternative view Attorney from N. Carolina was told he had less than a month to live due to lung cancer Given tonic to take daily, told not to eat processed tomatoes, pork vinegar, table salt, or white sugar. Problem he loved pizza, vinaigrette salad death Gerson therapy 13 glasses of juice daily (must use fresh organically grown fruits and vegetables with special juicer.) Coffee enamas every 4 hours, needed to stimulate liver bile and to detoxify body as poisons are released proper diet. Vegetarian meals (organically grown fruits, vegetables, and whole grain.) lugol (iodine pancreatic enzymes, potassium, thyroid horomone Injections: liver extract with vitamin Exclusions: no salt, spices, or aluminum cookware. November 18 Placebo Effect Body does what the mind thinks supposed to do from Latin verb meaning Shall 4 Stage Process 1. 2. 3. 4. Faith confidence in doctor (strong doctor patient relationship) Belief that is getting something that will solve some problem. (given an inert substance) Activation of immune system. Body improves or symptoms disappear Placebo is strengthened : 1. Close doctor patient relationship 2. The enthusiasm or ability to convince. 3. Adding mild side effects to the treatment, such as making the pills bitter, or making therapies that are somewhat unpleasant or difficult 4. Making the treatment more expensive 5. Added difficulty or sacrifice Alternative healers 1. 2. 3. 4. 5. Personnel are friendly and nice Have something for everything Show personal interest Instill faith and hope Provide easy to understand information Overall emphasis: Personalized care Alternative ways of testing placebo 1) No Treatment vs. Placebo a. Track course of disease 2) Same different doctor a. One enthusiastic and 1 skeptical 3) Same treatment different supports (social) a. strategy Defense medicine: leave any doubts about downside possibilities doctors tell patients the worst in order to protect themselves against the possibilities of a lawsuit. Profile of mood states mean change score Anxiety Control Experimental dejection Control Experimental Quality of life Control experimental Immune cells LEU7 Control Experimental Control Experimental Post treatment 0 6 month post treatment 0 .04 7 8 1 0 2 .05 .80 .12 2 Difference is made in support groups and it continued even after treatment strategy Model: same different supports (supports vs no usual cares) Logic: more practical to try to enhance what doctors are doing. Entrance requirements: must bring a really funny story. Goal: cultivate powers of the mind through social support. Procedures: Build confidence through feedback and support Examples Meditation and relaxation imagery Role playing to promote assertive patient role Exchanges of robust laughter Testimonials key persons who have beat the odds Phantoms in the best seller Rational Choice theory Actors make rational choices between alternatives to maximize their interest Maximized rewards X probability Rewarded actions get repeated Directed 2 way exchange 1. 2. 3. 4. Doctor provides service and patients pay. Personal trust and internal controls Patients were billed according to their ability to pay Each doctor carried a of patients Some patients payed with goods (potatoes from a farmer) Direct contact maintained balance between services and cost Problem: risk of high cost to both doctor and patient Marine hospital service (1798) First prepaid care system funded wage deductions. Provided government to merchant sailors. World War 2 (1940) Wages were frozen to avoid having the scarcity of workers result in high inflation. Companies were allowed to compete for workers with improved this was thought to be less inflammatory. Medicare and Medicaid (1960) Government started providing medical care for elderly and poor people. Logic of insurance coverage Goal: spread the cost across a group of workers to reduce their fear of being left with unpaid medical bills and improve access making them more attractive to doctors who know they will get paid. Procedure: o Compute medical costs of total group of prospective workers for past year. o Add a surcharge to insure profit, commissions and emergency reserve for coming years. o Charge deductible for common treatments to avoid patient incentive to over use medical services o Provide full coverage on rarely used treatments to make the benefits more attractive o Let every worker pay equal portion whether they use it or not. Indirect exchange Doctors provide service to patient, patient pays insurance company, insurance company pays doctor. 1. 2. 3. 4. Lead to coalitions and external controls Healthcare became focused on patients with insurance Doctors and hospitals bill insurance companies for majority of costs Insurance companies covered costs with adjusted premiums The indirect exchanges were left to open market fluctuations. (Limited external controls) Problem: risk of coverage biases in medical practices. 3 latent consequences 1. Insurance coverage pushed toward more surgery 2. Insurance coverage pushed towards more hospitalization 3. It was easier to raise premiums than challenge bills, so insurance companies paid bills without hesitation. Free market logic 1. 2. 3. 4. It is supply and demand problem Competition will drive down prices as the supply of doctors goes up. A voluntary approach is more consistant with democracy Economics incentives are needed to insure the highest quality of care. Solution: give medical schools money to increase medical school enrollment Containment logic 1. 2. 3. 4. Open market logic falsely assumes that the patient is a true consumer The doctor not the patient defines and prescribes what is no true consumer Competition requires comparative information about but there is no advertising Outcomes are often ambigious , so doctors want patients to pay regard less of the outcome Problem increased supply of doctors will raise rather than lower prices. Containment strategies Restricted insurance payments diagnostic related groups o Fixed reimbursement diagnosis preffered provider organizations o Medical discounts for high volume Effect of on Medicare costs Medicare was growing at a rate of a year VS. for other health spending. After spending growth dropped to a year compared to for other health care spending reaction Cost shifting o Make up deficits from privately insured patients Corporate medicine o Salaried physicians Rising cost figure in healthcare (see Cockerham) regionalized medicine most cost effective Britian System Docs Choice Access Reactions Cost control Great Britain Socialized medicine employed of US Capitation list Everyone has general practitioner Quick routine care Long priority list for specialty care dissatisfaction Specialty care referral only Canada health insurance Make of US Choose own doctor Fees set NHI Quick routine care Short priority list for specialty care Most are satisfied Regionalized Health care reform: changes implemented in 2010 Children covered until 26 Children be excluded because of conditions Adults with high risk security pool No lifetime limits on coverage Change implemented 2011 2500 annual cap on contributions to flexible spending accounts Private plans that meet minimum standards CANCELED Implemented 2014 Citizens fined who have acceptable health insurance All conditions are covered insurance rates cannot vary depending on gender Happening in 2018 All plans must offer preventative care with no or deductibles. 1. Treatment oriented system a. much more emphasis on prevention 2. specialized treatments for general problems a. we need more general practitioners 3. investment oriented practice a. more evidence based medicine 4. high costs of new technologis a. regionalize new medicine 5. expansion of elderly population a. help patients determine when palliative care is more realistic than cure Illness and deviance Believes this distinction between illness and sickness is artificial because both are social states Location in social network Premise: role pressures reduce the perceived seriousness of or, willingness to seek help for symptoms of probable illness. Role pressures o Greater the demands on a role the greater the pressure to perform o The fewer the temporary role replacements, the greater the pressure to perform Role pressure and the response to symptons o Generally those that have low demands or have role replacements view symptoms as serious. o Those that have high pressure and no role substitutes view symptoms as Illness is a social state

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Medical Sociology (final Notes)

Course: Medical Sociology (SOC 3330)

3 Documents

Students shared 3 documents in this course

University: Utah State University

Was this document helpful?

11/4/15

Interest in health beliefs

1. Rosenstock’s model was found to be highly predictive of preventative health behavior.

(immunizations)

2. Prediction for illness behaviors were much more variable and inconsistent

This implies two distinct models

Health: a motivation model based on psychological reasoning

Illness: a psychological model based on the social context of illness

Suchmman: group structures and

health beliefs

1. Skepticism and lack of knowledge may produce delays in seeking help and may lead to

alternative sources of care

2. Skepticism and lack of knowledge are produced by parochial group structures

(see diagrams in notes)

Internals

1. Respond when environment offers choice

2. More task oriented with better cognitive skills

3. Smaller social networks

4. More health activity and knowledge seeking

5. More responsive to messages about self control.

Externals

1. Respond best when environment not controllable

2. More responsice to social pressure

3. Larger social networks

4. More prone to passively accept what comes

5. More responsive to messages about chance

Medical Sociology 11/11/15

Alternative healers- persons giving treatments for diseases that are not consistent with the established

scientific factor procedures.

Types of healers

Holisitc healers- practitioners using natural remedies to help the body heal itself (used in

addition to doctors)

Health Illness

Preventitive Treatment

Possible problems Actual problems

Future situation Present situation

Individual Social

Medical Sociology (final Notes)

Medical Sociology (SOC 3330)

Utah State University

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Medical Sociology (final Notes)

Course: Medical Sociology (SOC 3330)

University: Utah State University

Students also viewed

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