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Sociomedical Perspectives on Patient Care

Sociomedical Perspectives on Patient Care

Jeffrey Michael Clair
Richard M. Allman
Copyright Date: 1993
Pages: 304
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  • Book Info
    Sociomedical Perspectives on Patient Care
    Book Description:

    Social change has placed new demands on the practice of medicine, altering almost every aspect of patient care relationships. Just as medicine was encouraged to embrace the biological sciences some 100 years ago, recent directives indicate the importance of the social sciences in understanding biomedical practice. Humanistic challenges call for changes in curative and technological imperatives. In this book, social scientists contribute to such challenges by using social evidence to indicate appropriate new goals for health care in a changing environment.

    This book was designed to stimulate and challenge all those concerned with the human interactions that constitute medical practice. To encompass a wide range of topics, the authors include researchers; practicing physicians from the specialties of family, general, geriatric, pediatric, and oncological medicine; social and behavioral scientists; and public health representatives. Cutting across disciplinary boundaries, they explore the ethical, economic, and social aspects of patient care.

    These essays draw on past studies of the patient-doctor relationship and generate new and important questions. They address social behavior in patient care as a way to approach theoretical issues pertinent to the social and medical sciences. The authors also use social variables to study patient care and suggest new areas of sociomedical inquiry and new approaches to medical practice, education, and research.

    Its cross-disciplinary approach and jargon-free writing make this book an important and accessible tool for physician, scholar, and student.

    eISBN: 978-0-8131-5843-3
    Subjects: Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-ii)
  2. Table of Contents
    (pp. iii-iv)
  3. List of Figures and Tables
    (pp. v-vi)
  4. Foreword
    (pp. vii-xii)
    Eugene B. Gallagher and John R. Durant

    I spent two weekends steeping myself in the 13 chapter manuscripts that comprise this intriguing and rich book. In its implications for medical education and practice, for the social-behavioral sciences, and for public debate on health care, this book could not come at a better moment. It reminds us of how much more there is to medical care than the technical means to carry it out and the economic means to pay for it—important as those factors obviously are.

    In current public debate, thoughts, anxieties, and strategies overwhelmingly fasten on economic issues. How can we provide medical services for...

  5. Acknowledgments
    (pp. xiii-xiv)
  6. Introduction
    (pp. 1-10)
    Jeffrey Michael Clair and Richard M. Allman

    This book has its origins in an examination of patient care relationships and ethics undertaken by a group of multidisciplinary scholars who came together to discuss their ideas in December of 1990. The enterprise was funded by the American Sociological Association/National Science Foundation Fund for the Advancement of the Discipline, and by the Department of Sociology and the Department of Medicine at the University of Alabama at Birmingham. The project provided the opportunity to explore the theoretical and empirical contributions of the social sciences to medicine, particularly as they relate to patient care. We were united by the common assumption...

  7. Issues and Perspectives

    • 1 The Application of Social Science to Medical Practice
      (pp. 12-28)
      Jeffrey Michael Clair

      The doctor-patient relationship is often portrayed as one of care, compassion, and trust. Many students of medicine are familiar with the nineteenth-century paintingThe Doctorby Sir Luke Fildes (1891). The scene is a dimly lighted cottage living area with the physician seated, like Rodin’sThe Thinker,at the makeshift bed of a child. The elderly doctor presents an image that at once combines concern, sensitivity, and intelligence. The illusion of this moment is that he is in control of the situation. In the background the father looks at the doctor with an expression of solicitude. The mother reflects despair,...

    • 2 Reconciling the Agendas of Physicians and Patients
      (pp. 29-46)
      Richard M. Allman, William C. Yoels and Jeffrey Michael Clair

      Relationships between physicians and patients constitute the most intimate core of medical practice. Many researchers stress the clinical and theoretical importance of these interactions, as witnessed by an explosion in studies investigating doctor-patient relationships. James Hughes (1991) estimates that this topic has generated about 600 articles per year during the last decade.

      There is increasing evidence that all is not well between physicians and their patients, and discrepant agendas may be one of the major problems in their encounters (Levenstein et al. 1989:119). Those outside the medical system argue that many physicians do not realize that patients have their own...

    • 3 The Changing Pattern of Physician-Patient Interaction
      (pp. 47-58)
      William C. Cockerham

      The physician-patient relationship in American society is undergoing fundamental change. The physician’s role in the health care encounter is evolving from that of an all-powerful, dominant figure to one emphasizing greater partnership with the patient. For most of the twentieth century, this has not been the case. Parsons (1951) perhaps explains it best in his concept of the sick role where he describes the traditional physician-patient role relationship as asymmetrical, with an imbalance of power and technical expertise extremely favorable to the doctor. The power of physicians rests in medical expertise that the patient lacks but needs to alleviate a...

  8. The Social Context of Medical Practice

    • 4 From Bedside to Bench: The Historical Development of the Doctor-Patient Relationship
      (pp. 60-81)
      Charlotte G. Borst

      From the dim photos of Louis Pasteur in his laboratory to modern television videos interviewing AIDS researchers in France and the United States, some of the most potent images of physicians focus on their role in the research laboratory. Soberly clad in the uniform of science—the white laboratory coat—doctors tell us news of the latest research findings for curing disease. At the same time, however, television programs, newspaper articles, books, and even professional medical journals wistfully detail the life and times of the old-time general practitioner. Almost always portrayed as a selfless caretaker of the community, this historical...

    • 5 High Tech vs ʺHigh Touchʺ: The Impact of Medical Technology on Patient Care
      (pp. 82-95)
      H. Hughes Evans

      Technology is inextricably entwined in American medical care. Behind the scenes, in hospitals and doctors’ offices, computers keep track of patient records, laboratory results, and costs. Hundreds of machines operate, analyzing body fluids, developing X-rays, and responding to the numerous demands of patient care. Ventilators enable diseased and fatigued lungs to breathe. Pacemakers sense abnormal cardiac rhythms and trigger the heart to beat normally. Ultrasound enables parents to see the movements of the fetal heart just weeks after conception. In a routine visit to the doctor, the typical patient is bombarded with medical technology; the stethoscope, thermometer, and sphygmomanometer occupy...

    • 6 Contractual Arrangements, Financial Incentives, and Physician-Patient Relationships
      (pp. 96-113)
      Robert L. Ohsfeldt

      The relationships between physicians and their patients are quite complex. In theory, at least, the patient seeks advice from a physician concerning the most appropriate course of medical treatment or other actions to ameliorate the effects of a particular malady or maladies. The patient consults a physician because the physician’s knowledge about the diagnosis of disease and the effects of treatments is generally superior to the patient’s, and the physician has greater ability to provide treatments. Ideally, the physician would recommend the course of action that the patient would rationally select if given the information known to the physician.


    • 7 Fear of Malpractice Litigation, the Risk Management Industry, and the Clinical Encounter
      (pp. 114-138)
      Ferris J. Ritchey

      A malpractice claim asserts two things: 1) that a physician has injured a patient, and 2) that the injury was the result of negligence, a failure of the physician to follow acceptable standards of practice. In the United States, the number of malpractice claims has increased immensely since 1970, and physicians currently spend considerable sums on liability insurance premiums.¹ This financial emergency has created what is often called “the malpractice crisis.” At a systems level, it has intensified cost inflation and reduced accessibility to care—for instance, by forcing obstetrician/gynecologists (OB/GYNs) out of rural areas where hospitals are insufficient to...

  9. Communicating with Patients and Caregivers

    • 8 Incomplete Narratives of Aging and Social Problems in Routine Medical Encounters
      (pp. 140-161)
      Howard B. Waitzkin, Theron Britt and Constance Williams

      When older people talk with doctors, their conversations often touch on social problems. Bereavement, financial insecurity, isolation, dependency, inadequate housing, lack of transportation, and similar issues cause difficulties for the elderly. In some cases, patients or doctors raise these issues directly. Alternatively, such problems may surface indirectly, in passing, or marginally, as doctors and patients focus on technical concerns.

      The appearance of social problems within medical encounters poses a challenge for researchers and practitioners. Certain geriatric programs use multidisciplinary teams, including social workers, to help resolve problems that derive from the social context of medicine; to some extent, these interventions...

    • 9 Family-Centered Geriatric Medical Care
      (pp. 162-173)
      Rebecca A. Silliman

      At the turn of the century, the average life expectancy at birth was 47 years; now it is 75 years. The ramifications of this change are many and will be felt for many years to come. For example, birth cohorts are living into old age relatively intact (almost 90% of women can be expected to live to age 70 or greater) (Fries 1990). The life expectancy at age 65 for these women is 18.57 years, 13.61 years (73%) of which, by current estimates, will likely be spent being fully functional, while 4.96 (27%) will be spent in various dependency states....

    • 10 Parenting a Disabled Child: Problems in Interacting with Health Professionals
      (pp. 174-185)
      Jan. L. Wallander and Denise F. Hardy

      Parenting evokes a myriad of thoughts and feelings. The content of the thoughts and the emotional tone of the feelings are noticeably varied in scope; however, parental expectations that the child will be normal and healthy do not vary. What happens, then, to an individual’s perspective on parenting when confronted with the birth of a disabled child? As important, what happens when those charged with providing care for a disabled child—such as parents and health professionals—have markedly discrepant perspectives? Parents of disabled children oftentimes face impediments in dealing with such issues.

      This chapter will explore the differing perspectives...

    • 11 Quality-of-Life and End-of-Life Decisions for Older Patients
      (pp. 186-196)
      Robert A. Pearlman

      Quality of life is an increasingly popular goal of health care involving older patients. Whether the patient has heart disease and the goal of treatment is to reduce the frequency of angina or chest pressure, or the patient resides in a nursing home and the goal of care is to promote autonomy, the term “quality of life” is commonly heard. At the policy level, “quality adjusted life years” is a method of determining treatment effectiveness in social and economic calculations that attempts to consider quality of life and length of life in assessments of outcomes. In research, quality of life...

  10. Future Educational Considerations

    • 12 The Role of Patient Education in Doctor-Patient Relationships
      (pp. 198-210)
      Marie R. Haug

      In conventional social science theory, as embodied in the sociology of the professions, the client or patient is expected to accept a professional’s right to control any interaction between them, including the right to give directions in the form of recommendations and advice that will be followed. The authority of the professional in the encounter is taken for granted. It flows from the practitioner’s esoteric knowledge and dedication to service, and is institutionalized in legislation and administrative rules that forbid lay performance of many professional activities. In the health care field, Parson’s (1951, 1975) concept of the sick role epitomizes...

    • 13 Teaching Communication Skills to Medical Students and House Officers: An Integrated Approach
      (pp. 211-222)
      Richard M. Frankel and Howard B. Beckman

      The idea that communication between doctor and patient is an important dimension of medical practice has been a focus of scholarly attention since ancient times (Reiser 1980). Never has it been more important than in the 1990s, the final decade of a century that has witnessed unprecedented advances in the eradication of disease and improvements in both the quality and duration of life. Ironically, at the same time that such sweeping scientific successes have occurred, doctors and the medical profession in general have become the object of increasing dissatisfaction and criticism. Hardly a week goes by without a major news...

  11. Concluding Commentary

    • 14 Toward a Social Medicine
      (pp. 224-236)
      James E. Lewis and J. Claude Bennett

      The papers in this book on the physician-patient relationship give the reader a wide array of viewpoints presented by scholars from several social science disciplines and medicine. These scholars are committed to furthering our understanding of the complex relationship at the heart of clinical medicine—the interaction of an individual patient with an individual physician. Their questions, their approaches to answering them, and the way they interpret their data are shaped by the philosophies that underlie their disciplines, training, and subsequent experience as investigators and teachers. Thus, in this volume, we have at least twelve approaches to investigating, understanding, reacting...

  12. References
    (pp. 237-268)
  13. Contributors
    (pp. 269-273)
  14. Author Index
    (pp. 274-279)
  15. Subject Index
    (pp. 280-290)