sociology last exam questions

Chapter 12

The Physician in a Changing Society

Chapter 12: The Physician in a Changing Society

?the movement of public opinion has been toward less confidence in physician authority?
Economic and social origins contribute to public dissatisfaction of the medical profession

Social Control of Medical Practice

Physicians lack the two most common forms of social control in advanced...
It is argued the problem of controlling organized medical care is solved by...
High levels of trust, satisfaction, and participation in decision making are...
?Rules of etiquette? between physicians discourages criticism
It can be assumed that physicians are dedicated to their patients
Mistakes in medical practice can be defended as ?a difference of opinion?

Countervailing Power

The mid 20 th century was the height of the medical profession?s power and prestige in the US
?Golden Age of Medicine? or the ?Age of Gold?
The greatest impact on the autonomy (independence) of the medical profession is external and largely due to (1.) government regulation, (2.) the managed care system, (3.) corporations in the health care business, and (4.) changes in the traditional doctor-patient relationship

Government Regulation

Rising health care costs increase public demand for government intervention
Response of the federal government; support improvements in health care delivery for all segments of the population, exert limited controls over physicians, and initiate efforts to reform the health care delivery system

At their best

managed care organizes and improves health care in a stable, reliable, and less costly manner and combine prevention with patient education

At their worst

managed care disrupts doctor-patient relationships, take deep discounts out of doctor and hospital fees, and produce large profits without developing good managed clinical care

The Coming of the Corporation

Health Care Corporations acquired hospitals, nursing homes, emergency care...
Health care became regarded for the first time in the US as a major business...
About 14% of all US Hospitals are owned by profit-making organizations
A major goal of health care corporations is to attract patients with private...
Physicians employed by health care corporations that do not meet corporate...
In corporations, doctors are not as likely to dominate decision making on...

The Changing Physician-Patient Relationship

Leo G. Reeder shows the changing relationship between physicians and their patients by identifying (1.) the shift in medicine away from the treatment of acute diseases toward preventive health services, (2.) the growing sophistication of the general public with bureaucracy, and (3.) the development of consumerism
The physician-patient relationship has turned into a provider-consumer relationship among well educated, middle-and upper class background patients

The Deprofessionalization of Physicians

Increased consumerism and greater government and corporate control over medical practice have...
Deprofessionalization: decline in the professions independence and control over clients
Formal rationality: the purposeful calculation of the most efficient means to reach a goal
Substantive rationality: emphasis on ideal values
Formal rationality has become dominant in medical practice

Deprofessionalization

decline in the professions independence and control over clients

Formal rationality

the purposeful calculation of the most efficient means to reach a goal

Substantive rationality

emphasis on ideal values

The Evolution of the Organization of Medical Practice

The dominant pattern of medical practice in the United States is becoming one in which most doctors are employees

Chapter 13

Nurses, Physician Assistants, Pharmacists, and Midwives

Chapter 13: Nurses, Physician Assistants, Pharmacists, and Midwives

Medical care has evolved beyond the two-person...
The occupations performing the tasks of patient...
Reasons these occupations are subordinate to the...
Technical knowledge employed in health...
Workers usually assist physicians in their work,...
Work largely occurs at the ?request of? the physician
Physicians have the greatest prestige
Physicians control critical decisions, although...
Inroads are being made on the authority once...

Nursing: Past and Present

Nurses represent the largest single group of health workers in the US
Most nurses are employed by hospitals and nursing homes
Responsibilities include: bedside care of patients, following...
Certified Nurse?s Aides (CNAs) assist registered and practical...
Registered and practical nurses are typically female
Orderlies and attendants are usually male
The registered nurse has the most advanced training and...

Nursing

Past and Present

Responsibilities include

bedside care of patients, following physicians instructions regarding patients, supervise practical nurses

The Early Development of Nursing as an Occupation

The social role of the nurse has been profoundly affected by its identification with traditionally female functions
The original concept of nursing was not a formal occupation, rather a religious activity
In the developing years of nursing, being a nurse was not an occupation held in high regard by the general public

Florence Nightingale

Came from respectable wealthy family; believed God called upon...
Established a hospital for ?Sick Gentlewomen in Distressed...
Hospital was not entirely successful do to role conflicts
Crimean War allowed Nightingale to organize a contingent of...
After war she was praised and able to raise money for a nursing...
?Nightingale System? became model for nursing education...
Philosophy perpetuated the traditional social role of the nurse...

Nursing Education

The first nursing schools in the US were in New York...
Since only a few trained nurses were available and money...
Nursing failed to obtained centralized control over...
2 year associate degree program
Hospital-based diploma schools requiring 2� to 3 years...
Baccalaureate program is most prestigious
Associate degree programs are the largest single source...
The late 1980?s sparked a nursing shortage that still...

Nursing Students

Nursing is ranked by sociologists as a...
Six distinct stages of nursing students...
Initial innocence: nursing students wanted...
Labeled recognition of incongruity: students...
Psyching out: began when students attempted...
Role simulation: students performing so as...
Provisional internalization
Stable internalization (during stages 5 and...
Not all nursing students view a career in...
Overall image of nursing: an occupation...

Hospital-based diploma schools requiring 2� to 3 years of study

5 year university baccalaureate programs

Gender and ?The Doctor-Nurse Game?

Nursing (traditionally female) is paired...
Gender inequality is losing some of its...
Valium study- 16 out of 18 nurses failed to...
?doctor-nurse game?- nurse supports...
Nurses may make recommendations to doctors...
Nursing has attracted larger numbers of...
Male nurses are less likely to play...
Female physicians not as likely to play the...
Female physicians questioned by nurses more
Gender issues have not damaged...

Initial innocence

nursing students wanted to do things for patients out of care and kindness; stage is characterized by feelings of inadequacy, worry, frustration

Psyching out

began when students attempted to anticipate what their instructors wanted them to know and concentrated on satisfying these requirements

Hospital Administration

The RN has evolved into an administrative role (RN?s can be used more economically in managerial and supervisory positions because lower paid personnel are available for bedside tasks
Patients are supportive of the removal of most professional nurses from their bedsides because they want the most professional person in charge of their care

Role simulation

students performing so as to elicit favorable responses from instructors; typically occurs at end of first year

The Nurse Practitioner

RN trained in the diagnosis and management of common ailments needing medical attention
This role frees the physician from routine tasks
Average annual salary: $92,000
Doctorate of Nursing Practice Degree (DNP) : program for advanced nurses with masters degrees (such as a nurse practitioner) that is taught advanced clinical skills, collaboration with other health professionals to solve complex clinical problems, leadership, and other topics

Physician Assistants

Typically have a bachelors degree, experience in health care as a nurse or paramedic, and become qualified after...
Provides a level of primary patient care similar to or higher than that of a nurse practitioner
Average annual salary: $86,000
The use of physician assistants and nurse practitioners will increase as long as the extend the medical functions of...

Pharmacists

Prepare and dispense medication as well as provide advice, information, and instructions about drug use
Key source of medical information for the general public

Midwives

Women who assist a mother during childbirth
One of the earliest forms of care available for women
Births attended by midwives dropped rapidly as physicians took over responsibility for delivering babies
Nurse midwives are registered nurses trained to deliver children without a doctor?s direct supervision

Average annual salary

$86,000

Chapter 14: The Hospital in Society

Hospitals offer considerable advantages to patients and society: sick patients have access to centralized medical knowledge and the greatest array of technology; from the standpoint of society, hospitalization protects the family from disruptive events of caring for the ill in the home and operates as a means of guiding the sick and injured into medically supervised situations where their problems are less disruptive to society as a whole

Chapter 14

The Hospital in Society

Hospital

a facility with at least six beds that is licensed by the state as a hospital or that is operated as a hospital by a federal or state agency

The Development of the Hospital as a Social Institution

Hospital: a facility with at least six beds that is licensed by the state as a hospital or that is operated as a hospital by a federal or state agency
4 distinct phases of development
Centers of religious practice
Poorhouses
Deathhouses
Centers of medical technology

Hospitals as Centers of Religious Practice

The origin of hospitals is associated with the rise of...
Early hospitals provided a widespread spectrum of social tasks...
During the Renaissance and the Reformation, religious character...
Three basic features of the modern hospital are derived from the...
The concept of a service oriented toward helping others
?Universalistic approach? (accept all people for treatment)
The custodial nature of hospital care (housing patients within...

TODAY

public hospitals tend to hospitalize people with chronic health problems requiring long term hospitalization; private hospitals tend to hospitalize patients with acute disorders; and several hospitals established to be institutions for the poor

Hospitals as Poorhouses

After the church removed itself from hospitals, many failed...
Marked the beginning of a new definition as institutions active...
At the end of the 16 th century in Europe, many people were...
Many hospitals reopened when measures were eventually taken by...
These hospitals resembled boarding houses (offered food and...
Invalids, the aged, orphans, and the mentally defective could be...
TODAY: public hospitals tend to hospitalize people with chronic...

Hospitals as Deathhouses

Following the Renaissance and the Reformation, doctors noticed hospitals...
By the 17 th century, physicians acquired a virtual monopoly over the...
By the early 19 th century, hospitals clearly assumed their present-day role...
Hospitals acquired an image as where the poor went to die, due to the fact...
The high death rate was not only the fault of physicians, but appalling...
Virtually no sanitation in hospitals and disease were easily transferred...

Hospitals as Centers of Medical Technology

The end of the 19 th century provided a new image of hospitals that have...
Medicine had become a science in terms of employing the scientific method to...
Antiseptic measures in the hospital were discovered to help cure curtail...
The quality of hospital personnel significantly improved (entry on to the...
?No single change has transformed the day-to-day work in a hospital more...
In the 20 th century, the hospital has become the major institutional...

Hospitals in the United States

First US hospital established by William Penn in Pennsylvania in 1713; primary purpose-providing shelter for the poor,...
First US hospital to be established solely for the purpose of the CARE of the sick was the Pennsylvania Hospital...
These hospitals were not government undertakings, rather based on voluntary initiative
First federal government participation in health care began in 1798, with the US Public Health Service hospital...

Hospital Ownership

Three major types of hospitals in the US: (1.) nonprofit (2.) for profit...
Most common type of hospital in US: nonfederal, nonprofit community hospital...
Nonprofit hospitals: exempt from federal income taxes, generally...
The trend for profit-making hospitals is to merge into a multi-hospital...
Government hospitals tend to lack prestige in comparison to other hospitals...
America?s hospital system remains a two class system of medical care: (1.)...

Nonprofit hospitals

exempt from federal income taxes, generally characterized as emphasizing high quality of care for all social classes, highly dependent on community physicians for membership on their staffs and for the referral of patients

The Organization of the Nonprofit Community Hospital

The primary goal of the hospital is to provide medical treatment to patients within the limits of contemporary medical knowledge, technology, and the hospital?s available resources

The Hospital

Dual Authority

The Hospital: Dual Authority

Authority system of a hospital operates on a dual level (administrative and medical) [Figure...
In the 1930?s trustee domination succumbed to medical domination due to (1.) emphasis on free...
The role of the hospital administrator was created and gained importance as a way to set...
Board of trustees still remains nominal-center of authority in the general hospital
The social order of the hospital is not fixed or automatically maintained, but the result of...

The Hospital-Patient Role

A prominent theme of the hospitalization experience is depersonalization of patients
The organization of the hospital?s work favors rules and regulations that reduce patient autonomy and encourage patient receptivity of the hospital routine

Stripping, Control of Resources, and Restriction of Mobility

Patients are alienated from their usual lives and reduced to a largely impersonal status through stripping, control of resources, and restriction of mobility

Best attitude predictors

age and education (younger and better educated the patient, the less likely to express highly conforming attitudes/older and more poorly educated patients were the least likely to express deviant attitudes)

Conforming Attitudes

Some patients are so seriously ill that feelings of depersonalization do not affect them, as their only desire is to...
Conforming attitudes more common in cancer patients than patients hospitalized for serious surgeries, although the...
Best attitude predictors: age and education (younger and better educated the patient, the less likely to express...
In the doctor?s eyes, the less time a patient took, the better s/he was perceived to be

Hospitalized sick role

an obligation to accept hospital routine without protest (differs from Parson’s concept of the sick role, which applies to an outpatient and a private physician; inpatient care subjects the hospital patient to a role additionally characterized by submission to authority, enforced cooperation, and depersonalized status)

The Sick Role for Hospital Patients

Hospitalized sick role: an obligation to accept hospital routine without protest (differs from Parson?s concept of the sick role, which applies to an outpatient and a private physician; inpatient care subjects the hospital patient to a role additionally characterized by submission to authority, enforced cooperation, and depersonalized status)

Routine costs

expenses of providing room and board in a hospital

Ancillary expenses

cost of labs, pharmacy, X-ray rooms, and other specialized hospital facilities; plus the cost of all medical supplies

The Rising Cost of Hospitalization

Most hospitalization costs today are paid by a...
90% of all expenses for hospital services are...
31% of all the money spent on health in the US in...
Routine costs: expenses of providing room and...
Ancillary expenses: cost of labs, pharmacy, X-ray...
Most expensive hospitals in US are located in New...
Least expensive hospitals in US are located in...
Many of America?s uninsured use the hospital ER...
When the price of goods and services in general...

Chapter 15: Health Care Delivery and Social Policy in the United States

Major issues in public debate regarding health care delivery in the US are those of cost, equity, and distribution of...
Virtually all Western countries (other than the US) provide all their citizens with medical insurance coverage
People without medical insurance have problems obtaining medical care
People without insurance are less likely to have their health problems treated or hesitate before seeking treatment,...

Chapter 15

Health Care Delivery and Social Policy in the United States

Rising Costs

Rise in cost of medical care is due to the aging of the population, demand by growing numbers of elderly patients, increases in hospital expenses, higher...
Personal medical care exceeds CPI
DRGs (diagnostic related groups) listed medical procedures and what the government would pay for patients receiving these procedures

Managed Care

Mid-1990?s private health care in the US reorganized into managed care plans (group or...
Managed care was considered the most effective means of reducing cost (initially kept rising...
Managed care organizations (HMO?s and PPO?s) control the cost of health care by monitoring...
Alters physician-patient relationship by introducing third party (case manager)
Central cause of the decline of managed care is the repudiation of its rationing services by...

Equity in Health Services

Economically disadvantaged people are medically disadvantaged people in a free market system that lacks national health insurance
Most individuals/families without health care insurance make too much money to qualify for Medicaid although they struggle financially

Distribution of Services

American system of health care is not distributed evenly geographically
Less doctors in rural areas because doctors prefer to practice in urban areas closer to extensive technological resources
More financially rewarding medical practice in large cities
Overspecialization has reduced the number of doctors engaged as general practitioners in primary care and family practice

Social Legislation in Health Care

The medical profession as a group has opposed workman?s comp laws, social security and voluntary health insurance in their initial stages, Medicare and Medicaid, PSROs to review physicians work in federally funded programs, and expansion of HMOs, and resisted proposals for national health insurance (medical profession has been on the negative side of social issues when the general public has been on the affirmative side)

Medicare and Medicaid: Passage and Programs

Despite strong resistance from the medical profession, Congress passed the Medicare and Medicaid amendments to the Social Security Act in 1965
Resistance of the medical profession to these plans pointed out to the general public and lawmakers that the medical profession could not always be relied upon to place public interest ahead of professional interest
Medicare and Medicaid information in notebook

Medicare and Medicaid

Evaluation

Medicare and Medicaid: Evaluation

Turned out to be a financial boon to organized medicine and health care as they channeled billions of dollars into health care; can also be argued Medicare...
Medicare and Medicaid did provide needed health services to the old and those in poverty where the services were previously unavailable and established the...
Federal government participation in health care is now an important and substantial reality

Health Reform

Many presidents have tried in the past for health reform, the only with...
Most recent plan (Clinton) also failed to become adopted, however it had two...
Stimulated movement toward the massive reorganization of American health...
Moved health to the forefront of domestic politics
Some states took it upon themselves to attempt health care reform for their...
Massachusetts is the only state providing the means for all its citizens to...

Conflict theory

social inequality leads to conflict

Health Care: A Right or a Privilege

Conflict theory: social inequality leads to conflict
Conflict exists between the rights of citizenship considered inherent in a democratic society and the capitalist social system

Summary

Efforts at health care reform represent the beginning of a potentially profound change in the system of health care delivery in the US-one that would guarantee access to health care for Americans and establish health care as a social right
While many believe this change is forthcoming, others argue ?fundamental changes are unlikely until a significant proportion of the population is threatened and personally dissatisfied?

Chapter 16

Global Health Care

Chapter 16: Global Health Care

All nations of the world are faced with the pressure of public demands for...
Social and political values underlie the choices made, institutions formed,...
Germany established the first national health insurance program
Americans have historically been less committed to government welfare...
The US spends more on health than any country in the world
The highest life expectancy for men is in Japan

Socialized Medicine

Canada, Great Britain, and Sweden

Socialized medicine

a system of health care delivery in which health care is provided in the form of a state-supported consumer service

Socialized Medicine: Canada, Great Britain, and Sweden

Socialized medicine: a system of health care delivery in which health care is provided in the form of a state-supported consumer service
Systems of socialized medicine directly control the financing and organization of health service in a capitalist economy, directly pay providers, own most of the facilities, guarantees equal access to the general population, and allows some private care for patients willing to be responsible for their own expenses

Canada

Physicians in Canada are generally private, self-employed, fee-for-service...
Canada?s health care is often discussed as a future model for the US
Does not have a single health care delivery system, rather 10 provincial and...
Virtually every Canadian has insurance coverage for doctor and hospital...
Canada also faces problem of rising cost
Essential difference between Canada and US: the Canadian system combines...

Great Britain

Formed in 1948, the National Health Service nationalized and took over the...
Government became the employer for health workers, maintained facilities,...
Britain was the first country to offer free medical care to the entire population
National Health Service Act reorganized British health care into 3 branches;...
Patients have the right to be a private patient as well and pay for their...
The general health profile of Britain is among one of the best in the world

Sweden

The Swedish National Health Service is financed through taxation
Taxes in Sweden are among the highest in the world
Sweden has the lowest proportion of poor people in Europe
Considered one of the world?s healthiest populations overall
Physicians are obligated to work a fixed number of hours per...
Hospitals are owned by county and municipal governments
The total health bill is met by 71% of county taxes and only 3%...

Decentralized National Health Programs: Japan, Germany, and Mexico

In decentralized programs, the government acts to regulate the system, not operate it
The government indirectly controls the financing and organization of health services in a capitalist economy, regulates payments to providers, owns some of the facilities, guarantees equal access to the general population, and allows some private care for patients willing to be responsible for their own expenses

Japan

Highest life expectancy for males and females
Patients pay 30% of cost of health services and the national plan pays the...
1/3 of Japanese doctors are in private practice, the rest are hospital employees
All Japanese doctors in private practice are paid the same amount regardless...
The excellent health of the Japanese population could be contributed to...
Patients rely on what doctors tell them, rather than asking for information...

Germany

Germany?s health care program has not changed much since the late 1800?s and is based on...
Insurance plans are based upon profession
Approx. 90% of all Germans participate, involuntary or voluntary, in the nation?s public...
Corporatism consists of compulsory membership on the part of the population in a national...
About 50% of physicians are general practitioners

Mexico

Mexico has a decentralized national health system covering most of the general population through a variety of...
Only half of the population has health insurance
Mexico suffers from misdistribution
There are about 80 doctors for every 100,000 people

Socialist Medicine: Alterations in Russia and China

Socialist method of health care: central government ownership of all facilities, employment of workers, and free universal care paid out of the nation budget

Socialist Medicine

Alterations in Russia and China

Russia

Health insurance plans consist of compulsory (financed by...
Health care in Russia is moving away from socialist plan and more...
More doctors per capita than any other major nation (3/4 are women)
The decline of life expectancy in Russia was one of the most...
Gender (male), age (middle age), and class (working class) were...
Russia has the highest per capita consumption of alcohol in the world
Russia lacks a self-protective health culture

China

The Chinese health care system is no longer a socialist system, it is now financed largely by...
Health improvements were one of the major goals of the Communist Chinese government
Only country that consistently tests traditional and scientific medicines equally
Responsibility for health services was delegated to provincial and county governments
Tax revenues from tobacco sales are the government?s single largest source of income; if...

Conclusion

No nation has an ideal system of dealing with health problems; all are faced with problems of rising demands for quality care and limited resources
Several general trends are appearing in developed societies which are likely to have an effect on health care policy in the future; considerable attention is...
All countries appear to be moving toward a system that will reduce inequalities and control costs

sociology last exam questions

Sociology 210 with Hansell at Rutgers University - New Brunswick/Piscataway

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