Medical Sociology Exam 3

Front 1

3 Institutions of Rule-Breaking

Back 1

1) Medicine (Disease)
2) Law (Crime)
3) Religion (Sin)

-Medicine as the most powerful institution

Front 2

Type I Error

Back 2

-The physician rules that the patient is well, even though they are ill

-Greater Consequences

Front 3

Type II Error

Back 3

-The Physician Rules that the patient is ill, even though they are well

-Physicians are taught that this is the better error to make

Front 4

Iatrogenesis

Back 4

-Illness Caused by doctor

Front 5

True State

Back 5

Either the person really is sick, or they are not

Front 6

"Classic Medical Decision Rule"

Back 6

-Golden Era of Medicine (1910-1989)

-Minimize Type I Error

-Bias towards illness

Front 7

"New Medical Decision Rule"

Back 7

-Era of Managed Care (1990-???)

-Minimize Type II Error
-----Over-treatment
-----Unnecessary treatments and procedures
-----High rate of infection in hospitals
-----COST

-Bias against illness

Front 8

Waitzkin

Back 8

Latent and Manifest Functions in institutions

Front 9

Manifest Function

Back 9

-The reason you explicitly do something

-You go to school to get educated

-Deliberate

Front 10

Latent Function

Back 10

-Unexpected functions that happen to go along with your intentions

-Unconscious and Unintended

Front 11

Contingency Model (Who and What?)

Back 11

-Anderson

DRAW OUT MODEL

Front 12

Health Belief Model

Back 12

-DRAW OUT MODEL

Human Behavior is Dependent On
---Value placed by a person upon a particular outcome
---The person's belief that a given action will result in that outcome

Front 13

Lay Referral System (Who and What?)

Back 13

-Freidson

-DRAW OUT DIAGRAM

Front 14

Limits of Traditional Utilization Models

Back 14

1) How much of use is a "choice"?

2) What other options are available for healthcare?

Front 15

Pathways to Care

Back 15

Pathways to Care

-Individual Choice
-Supported Choice

-Hard Coercion
-Soft Coercion

-Muddling Through
---With Agents
---Without Agents

Front 16

Findings of Indianapolis Mental Health Study

Back 16

-Fewer than half "choice"

-1/4 Coercion

-Does not fit with traditional utilization models

Front 17

3 Traditions of Healing

Back 17

1) Traditional Chinese Medicine

2) Homeopathy

3) Chiropractic

Front 18

Models of the Physician-Patient Relationship

Back 18

1) Activity-Passivity

2) Guidance-Cooperation

3) Mutual Participation

Front 19

2 Groups most likely to have communication problems in medical encounters

Back 19

-Lower Class

-Women

Front 20

Moral Evaluations of the ER

Back 20

Julius Roth

-Social Role Expectations and Therapeutic Role Expectations
-Moral Evaluation
-Labels
-Good Or Bad
-Diagnoses, Treatment, and Outcome

Front 21

Clinical Evaluations and Weight

Back 21

-Young and Powell

Front 22

Medical Students Acquire 2 Traits

Back 22

Renee Fox

1) the ability to emotionally detach from patients

2) the ability to tolerate uncertainty

Front 23

Social Processes and Trends in Medical School

Back 23

-Gender Gap in Applicants

-Race

-Pay

Front 24

The Social Network Theory of Socialization (Pescosolido - Example of Medical School)

Back 24

Medical School -> Socializes Physicians -> Manifest and Latent Functions

-Manifest Function
----Technical Curriculum

-Latent Function
----"Hidden Curriculum"

Front 25

The Hidden Curriculum (and Example)

Back 25

-Students are Socialized in Medical School

-Develop attitudes and beliefs on Medicine, Sick People, and Healthy People

---EX = Beliefs about a certain disease and race

Front 26

Student Subculture

Back 26

Renee Fox

-"Noobies" (Medical Students) develop and share beliefs, thoughts, and ideals

Front 27

Training for Uncertainty

Back 27

Renee Fox
-You will never be able to learn everything in medical school

1) Uncertainty of something that is known
2) Uncertainty of something that is not known
3) Not knowing the difference between the first 2 types of uncertainties = WISDOM

Front 28

A Profession must be....

Back 28

1) Autonomous

2) Self-Directing

Front 29

Theories in the Rise of the Profession of Medicine (What and When)

Back 29

1) Great Man Theory (Medical Science) = 1860
2) Professional Dominance = 1910-1965
3) Social Transformation to Sovereignty = 1890-1920
4) Marxist correction
5) Network-Resource Transfer Model

Front 30

Monopoly

Back 30

1) Exclusive Right to Treat Illness
2) Obtained Through Politics

Front 31

Consulting Status

Back 31

1) Sufficient Condition
2) Advisor of Health

Front 32

Great Break

Back 32

Germ Theory of Illness + Antiseptics + Anesthesia

1860 = Bacillus Causes Anthrax

Front 33

Cultural Authority

Back 33

-Collective Programming of a given society in regards to their norms and expectations

Front 34

Medical Social Contract

Back 34

1) Is health care a right?

2) Who owns health care?

3) What role does the state play in assuring the professional dominance of modern medicine?

Front 35

Social Contract of AMERICAN Medicine (1st and 2nd)

Back 35

1) No, Health Care is a Privilege

2) The Private Sector

3)
1) Minimal = Protect Monopoly, Drug Safety, Regulations

2) More = Assurance of Coverage by Insurance

Front 36

Passed a national health insurance plan for the aged....

Back 36

-Johnson (1965)

-Medicare

Front 37

Proclaimed US in health care crisis and proposed national health insurance plan

Back 37

Nixon (1970)

Front 38

Introduced first US socialized medical system

Back 38

Madison (1811)

Front 39

First proposed national health insurance and universal coverage

Back 39

T. Roosevelt (1911)

Front 40

Because of US experience in the Great Depression, proposed national health insurance and universal coverage

Back 40

Truman (1947)

Front 41

Passed CHIP coverage for all

Back 41

Clinton (1997)

Front 42

Passed National Health Insurance for those in poverty

Back 42

-Johnson (1965)

-Medicaid

Front 43

Public and Private Aspect of the American Health Care System

Back 43

-Largely owned and operated by the private sector

-Patchwork of Public and Private

-Government funded programs cover 28% of the population

Front 44

The Flexner Report

Back 44

-1910
-Marked the beginning of the modern profession of medicine
-Book-Length study of medical education in America
-Called for medical schools to shift towards a more scientific approach to teaching and testing

Front 45

4 Strains

Back 45

1) Ineffectiveness

2) Inefficiency

3) Unresponsiveness

4) Insensitivity

Front 46

The Role of the Public

Back 46

1) Professional Dominance = LEGITIMATOR

2) Cultural Transformation = ACCEPTOR

3) Class Struggle = DUPED

4) Network-Based Exchange = SATISFICER

Front 47

McKinlay - Reconsidering Health and Health Care

Back 47

1) Observed Morbidity and Mortality = Intervention with a curative focus ( Access to Formal System)

2) Various at-risk Behaviors = Intervention with Preventative Focus (Individual Responsibility)

3) The actions of the manufacturers of illness = Intervention with a political economic focus (government)

Front 48

Upstream Dilemmas (and examples)

Back 48

-Things that occur within the time, space, and place in which you live
-The environment will have effects on health

EXAMPLES

-Toxins (lead, PCB's, and Mercury) in the systems of women of childbearing age
-More than half of women tested were found to have at least 2 out of 3 toxins in their body
-These toxins can harm brain development

-Her foreign shrimp and tuna example

Front 49

Models of Medicine

Back 49

1) Socialist Model of Medicine

2) Single-Payer Model of Medicine

3) Insurance Model of Medicine

4) Free Market Model of Medicine

Front 50

Socialist Model of Medicine

Back 50

-Government owns facilities and pays salaries of providers

EX: Veterans Hospitals

Front 51

Single-Payer Model of Medicine

Back 51

-Government is the Insurance Company
-Reimburse a Private Health Care System

EX: Medicaid, Medicare

Front 52

Insurance Model of Medicine

Back 52

-Government Simply Regulates the System
-Assuring certain types of quality and insurance coverage
-Many insurance companies
-Insurance Companies reimburse the private health care system
-Most feasible model politically in the United States

Front 53

Free Market Model of Medicine

Back 53

-No Government Regulation
-No Insurance
-Individuals pay the costs

Front 54

The Network Episode Model

Back 54

-People Solve Their health problems with the help of others
-There are different pathways to care and different providers that they can use
-Utilization cannot be explained in one way; many factors

Front 55

Socialization of Medical Students and Idealist Trends

Back 55

-Professional idealism has a linear increase over time

-Humanitarian idealism drops drastically but recovers eventually, but never fully recovers

Front 56

Stages of Physician Socialization

Back 56

1) Idealism

2) Disillusionment

3) Reconciliation

Front 57

Network-Resource Transfer Model

Back 57

Science -> Middle Class Elites or Lieutenants (College Presidents, Philanthropic Bureaucrats, Scientific Physicians) Build a new medical marketplace -> Professional Dominance -> Cultural Authority Shift -> Sovereignty

Front 58

Canadian Health Care System

Back 58

Single Payer System

Front 59

Eras of Medicine

Back 59

=1910: Start of the Scientific Era of Medicine
=1910-1965: Era of Professional Dominance
=1965: Passage of Medicare and Medicaid
=1970: Nixon announces health care crisis
=1970-1990: Nothing significant occurs
=1990-2010: Failed Clinton Bill Ushers in Era of Managed Care
=2010-2014: Health Care Reform