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69 Cards in this Set

  • Front
  • Back
•Socialization
process by which a person becomes a member of a group or society and acquires values, attitudes, beliefs, behavior patterns, and a sense of social identity
•Socialization of physicians
Physicians undergo formal and informal socialization in the medical profession. All professions we already have certain expectations
•History of medical education

•Modern medical education

•Academic health centers

•Medical students
•Medical education curriculum

•Physician (med student) internship and residency and role identify changes

•Criticisms of medical education curriculum

•Problem-based learning
developed at McMaster and Michigan State Universities in the 1970s, attempts to overcome the fact-based approach in the traditional curriculum by emphasizing student problem solving
•Evidence-based medicine
has become a significant curricular change
•Curriculum reform (the future)

•Detached concern
concern about the patient without excessive emotional involvement or over identification
•Controllable lifestyle
the extent to which particular specialties allow for some control over the hours worked
•Florence Nightingale
an upper-class British reformer, who believed that the proper, moral environmental, and physical order was necessary for the restoration of health. She accepted a sexual division of labor as a given and believed that women’s characteristics made them naturals for creating the conditions needed for care of the ill
•Allied health workers
health care workers (like physical therapists and medical technologists) whose work supports that physician and occurred during the second quarter of the twentieth century
•American Nurses Association (ANA)
certifies nurses. Types of nurses- licensed practical nurses- vocational program, registered nurses- diploma or degree in nursing, advanced practice nurses (NPs)
•Initial innocence
seeking to become mother surrogates by engaging in nuturant and helping behaviors
•Labeled recognition of incongruity
open statements of disillusionment and despair over the incongruity between their anticipated view of nursing school and their actual experience
•Role stimulation stage
usually occurs around the end of the first year, students engage in a type of role-playing in which they consciously attempt to exhibit the professional demeanor toward patients desired by the faculty
•Provisional internalization and stable internalization
accept a professional identity and get accustomed to it until, by graduation, it is typically fully accepted and internalized
•Nurse practitioners
a registered nurse with additional training, 90% complete a two-year master’s degree, some obtain additional degrees
•Certified Nurse Midwives-
a certified nurse-midwife is a registered nurse who has additional nationally accredited training in midwifery and who possesses certification by the American College of Nurse-Midwives
•Certified Registered Nurse Anesthetists
a registered nurse with an additional two or three years’ training for certification which provides a Masters degree
•Physician’s Assistant
under direct or indirect supervision of a physician, can perform most of the basic care given by the physician, including giving physical exams etc.
•Medical Home-Patient
centered medical home, physician-led team that includes nurses, nurse practitioners, physician assistants, health educations, and others working together to provide comprehensive primary care
•Complementary and Alternative Medicine

•Holism

•Vitalism

•Criticism of CAM

•Orthodox

•Mainstream interest in complementary and alternative healing practices

•4 CAM practices
•Basic principles of chiropractic

•Acupuncture, ying and yang, and chi

•Spiritual healing, Christian science, pshyic healing, psychic healers

•Acupuncture effectiveness

•Curanderismo
Mexican American folk healing which is a unique system of health care beliefs and practices that differ significantly from modern, scientific medicine
•Navajo healing, disgnostitician, medicine person or singer, herbalist, roadman

•Physician
patient relationship-Sick patient seeks comfort from a benevolent physician; the sincere and helpful patient places trust in the concerned and caring physician. Physicians—and patients--cannot always act in these idealized and uniformed ways
•An engineering model
the physicians assumes medicine to be a value-free enterprise whose primary task is the presentation of all relevant facts to the patient without involvement in actual decision making
•Priestly model
The physician is viewed as a quasi-religious figure who is an “expert” on ethical and all other matters that emerge in the relationship
•A collegial model
the physician and patient see themselves as colleagues pursuing a common goal of restoring the patient to good health
•A contractual model
the physician and patient interact with the understanding that there are obligations and expected benefits for both parties
•The biomedical model
the dominant, disease oriented or illness oriented rather than patient oriented. -Physicians seek to learn all they can about symptoms and abnormalities so that they can provide the appropriate magic bullet. -Psychological and social factors have traditionally received little attention
•Psychosocial concerns-
-Research shows that as many as half of patient visits to primary care providers include psychosocial complaints.

- 2/3 are without a serious physical ailment.


-Life stress and emotional distress.


-Normal anxiety, grief, frustration, and fear.


-How do we deal with these things as a culture? -How does our culture contribute to them? -Diagnosable psychiatric disorders.


-Although many experience them, few discuss them with their physicians

•The principle of autonomy
1) An autonomous person is able to make rational and competent decisions following contemplative thought..However, there are many who are incapable of acting autonomously 2) Action does not cause harm to others 3)Patients do not have the right to demand that physicians or other health care professionals violate a personal or professional moral code (chapter 12-13 slide 10 &11)
•Paternalism
when a physician overrides a patient’s wishes and takes action presumed to e in a patient’s best interest but is unwanted by the patient
•Therapeutic communication
1) the physician engages in full and open communication with the patient and feels free to ask questions about psychosocial as well as physical conditions 2) the patient provides full and open information to the physician and feels free to ask questions and seek clarifications 3) a genuine rapport develops between physician and patient.
•Barriers to therapeutical communication
1) Setting of the medical encounter 2) Length of medical encounter 3) Mental state of the patient 4) Mismatched expectations of physicians and patients 5) Language barriers 6) Physician communication style
•Patient satisfaction with physicians
Fully comply with medical regiments,More likely to return for scheduled follow-up,More likely to seek physician care when sick ,& Less likely to initiate a medical malpractice suit
•Noncompliance
studies show that physicians tend to see in terms of noncooperative patients
•Benevolent deception
many physicians believe that they have a professional duty to lie to patients if that is perceived to be in the patient’s best interest
•Freedom from information
suggests that too much has been made of “freedom of information” while too little consideration has been given to the idea
•Confidentiality
“privacy” the concept of privileged communication
•Privacy
refers to freedom from unauthorized instrusions into one’s life
•Privileged communication
comes from the legal system, which operates on the basis of testimonial compulsion—individuals with pertinent information can be required to present that information in a court of law
•HIPAA
included several measures to protect the privacy of patients and their medical records and to establish security of electronic health information
•Dependent patient

•The development of private health insurance-

•Medicare
federal insurance program originally designed to protect people 65 years of age and older from the rising costs of health
•Medicaid
a jointly funded federal-state program designed to make health care more available to the very poor
•Diagnostic related groups
an alternative reimbursement system for the care Medicare patients receive in a hospital
•High deductible health plans
a type of health insurance plan that costs less because it incorporates a very high deductible goes by the name consumer-driven health plans
•Managed care
goes beyond cost containment strategies like DRGs by combining the traditional insurance function of private insurance companies and the government with a delivery system of health care providers
•National health expenditures
the total amount of spending for personal health care and for administration, construction, research, and other expenses not directly related to patient care
•Personal health expenditures
include all spending for such health services as hospital care; physician, dental and other professional medical services; home health care; nursing home care; and drugs and over-the-counter products purchased in retail outlets but not money for things such as medical research
•Medical-Industrial complex
describes the huge and rapidly growing industry that supplied health care services for profit
•Medical entrepreneurialism
effort to invest in health as a means to profit