Transcript Document

Chapter 10
Medical Care:
Physical and Mental Illness
The Problem In Sociological
Perspective
• Health care outranks taxes, terrorism, and crime as
problems the government needs to address.
• Not just biology
 Social component
• Industrialization and lifestyle
 Greater affluence
• Iatrogenesis
 Illness caused by medical care staff
 If the number of Americans killed by medical errors
– became an official classification of death, it would
rank as number 6 in the top 10 leading causes of death
• Changing ideas about health and illness
 The way pregnancy is handled by physicians
highlights social nature of health and illness (In
and out as quickly as possible)
 Definitions of “diseases” are not fixed either
• Environment and disease on a global level
 Medical researchers are investigating how
environment affects human disease
 Looking at how human activities reshape
environment and profound effects on the diseases
that humans experience
The Social Organization of Medicine
as a Social Problem
• An explosion in medical costs
 Medical costs continue to soar
• Reasons for the explosion in costs
 Increase in the standard of living, people live longer
 Development of expensive technology
 Seek out health care after illness arises, rather than
investing time and energy in preventive care
 Accepted view that medical care is a commodity that
should be sold for profit
• Medicine for profit: a two-tier system of medical care
 Medicine for profit is also known as a fee-forservice
system.
 Two-tier system of medical care: one for those
who can afford insurance, and another for those
who cannot
• Women’s reproductive organs
 Doctors report a bias against women’s reproductive
organs.
 Most of the 600,000 hysterectomies performed
each year in the United States are unnecessary.
• Medicine for profit: cesarean delivery
 Some physicians driven by profit
• Why have cesarean births increased?
 Profit
 Convenience
 Technology
• A Feminist Controversy
 Central issue is the relative power of women
 Cesarean delivery takes power over childbirth away
from women and places it in the hands of doctors
Physical Illness as a Social Problem
• Life expectancy and infant mortality
 Researchers analyze life expectancy when determining
how healthy or ill a society is as a whole.
 Infant Mortality Rate (IMR)
• Number of babies who die before 1 year of age,
per 1,000 live births
• Most accurate measures of a group’s health
conditions
 Countries with less poverty have better health
• Lifestyle
 Although poverty is important, lifestyle may be even
more significant.
 Lifestyle is the major cause of illness and death.
• Heroic medicine
 U.S. creates a need for specialists in the pursuit of
profit.
 Emphasis on specialists has led to a shortage of
primary care doctors who treat routine problems.
 Health Affairs estimates that the United States
spends $1 billion on health care for illegal
immigrants each year.
• Uneven distribution of medical services
 Some areas house an abundance of physicians,
while other regions have very few doctors
Mental Illness as a Social Problem
• Measuring mental illness
 Experts argue that the rates of mental illness have increased
because people are experiencing more stress while their
social support systems are weaker
 Attempts to measure rates of mental illness today are also
inaccurate
 Data are inadequate because experts rarely agree on
definitions and classifications of mental illness
• The social nature of mental illness
 How we define mental illness is a matter of dispute
 Has a strong social influence
• A two-tier system of mental health delivery
 Made up of two parts: the illness and the medical
delivery system
 Deinstitutionalization
• The release of hospitalized mental patients into
the community
• Plan was to support them with medication and
community health services
• In reality, few of the planned community
centers were ever built.
Symbolic Interactionism
• Determining the meaning of symptoms and
behavior
 People from different backgrounds interpret symptoms
differently
 Use cultural symbols to determine what our symptoms
mean
• The significance of definitions
 Groups compete to get their view of health accepted
 Definitions are socially created, developing out of social
interaction
• Different referral networks
 Patient’s frame of reference lies within a lay referral network
 Physician’s frame of reference, in contrast, lies within a
professional referral network
• Depersonalization
 Consequence of the professional referral network is that some
doctors treat patients not as people, but as objects
 Defensive Medicine: cautious practice incorporating the use
of any and all available tests to ensure that an identifiable
illness is not overlooked
• Problems in communication
 Different backgrounds and expectations often make it difficult
for patients and physicians to communicate with one another.
Functionalism
• Does society benefit?
 Functionalists assume that customs or social institutions
persist only if they fulfill social needs.
• Whose needs are met by a health care system that is
hospital-based and oriented toward acute illnesses?
• Who benefits from allowing environmental diseases to
flourish?
• What are the benefits of depersonalizing patients or of
making childbirth a rigorous medical procedure?
• Fee-for-service means profits
 Difficult for doctors to make money if people are not
sick.
 Profits, not health care, are the engine that drives the
U.S. health care system.
 The more services doctors sell at the highest price, the
more they earn.
 That system is functional for patients is indicated by
rising life expectancy and decreasing infant mortality
rates.
• A self-correcting system
 Functionalists argue that system is self-correcting
 Functionalists view fee-for-service health care as a
system that responds to shifting needs of the nation
• The global level
 Functionalists also analyze functions and dysfunctions of
medicine on a global level.
• Exporting modern Western medicine to the Least
Industrialized Nations
• Also dysfunctional because they encourage
populations of these nations to surge
• Outpace the nations’ food production, leading to
mass starvation and political upheaval
Conflict Theory
•Conflict theorists argue that the U.S. medical
system is not self-correcting.
•View American patterns of illness and health
care as the outcome of clashes between
interest groups controlled by the most
powerful
•Argue that the poor are more often sick
because they lack sufficient income and highquality education, food, housing, jobs, and
medical services
• Medicaid
 Viewing Medicaid as a first step to socialized medicine,
the AMA fought against its passage.
 Congress designed Medicaid to satisfy the public’s
criticism while still providing profit for doctors.
• Colliding interests of doctors and patients
 Emphasize that doctors and patients form two sorts of
classes
 Those who control medicine and those who receive
treatment.
 In a capitalist system of production for profit, alienation
of patient and physician is like that of owner and
worker.
An Overview of
Physical Health Problems
• Historical changes in health problems
 6 of the 10 leading causes of death have remained
the same according to Figure 10-9.
 Symbolic interactionists would point out that these
labels are arbitrary.
 Several of the top killers in both centuries are
caused primarily by lifestyle and environmental
pollution.
 Leading causes of death reinforce the point made
earlier about how health and illness are related to
lifestyle and the environment.
•Infectious diseases
 Two reasons for the decline in infectious
diseases:
• Prescription drugs and vaccinations have
wiped out many diseases
• Clean running water
 The resurgence of infectious diseases
• Develop new strains that are resistant
• Most feared infectious disease today is
HIV/AIDS
How Disease Is Related to Behavior and
Environment: the Case of HIV/Aids
•Background
 Example of the relationship between behavior, environment,
and disease
 The disease no longer discriminates
•A global epidemic
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25 million people have died
40 million people around the world are infected now
5 million more people are being infected each year
Common in Sub-Saharan Africa because lack of sex education
and protection
 15 million children have been orphaned as a result of AIDS
• HIV/Aids in the United States
• Antiretroviral drugs (ARVs)
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•
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Halt the progression of AIDS
Not equally available to all
Not readily available in some Least Industrialized Countries
Combination of ARVs and education caused AIDS deaths in the
U.S. to decrease
• They do not prevent people from infecting others with HIV.
• Some groups have higher rates of HIV/AIDS because of social
factors.
• Sharing needles
• Sex with multiple partners
• Unprotected sex
• Ominous changes
• HIV virus mutates rapidly
• Some individuals have contracted strains of HIV that are resistant.
Social Inequalities in Physical Illness
• Poverty and health
• Economic factors largely determine who will be healthy and
who will be sick
 Social inequality is essential factor that underlies patterns of
disease and death
• Occupational health hazards
 Stem from lower-class working environments
 Occupational disease
• Results from long-term exposure to specific substances
or from continuous or repetitive physical acts
• Paying the bill
• Looking at who pays medical bills helps expose
social inequalities of health care
• Unanticipated consequences of Medicaid and
Medicare
• Undermining of public hospitals
• Because Medicaid’s rates were low, doctors and
private hospitals refused to accept Medicaid
patients
• Medical insurance
• Lack of medical insurance highlights racial–ethnic
inequalities
Social Inequalities in Mental Illness
•Social class and mental illness
 Sociologists found that people’s emotional
well-being declines with decreases in social
class.
 More likely to be depressed, anxious,
nervous, and phobic
• The delivery of mental health services
• Individual psychotherapy
• Psychoanalysis
• Short-term directive therapy
• Group therapy
• Drug therapy
• Electroconvulsive therapy (ECT)
• Consequences of ability to pay
• Type of therapy does not depend on
person’s problems, but on person’s
ability to pay
Social Policy
• Fee-for-service system encourages physicians to sell specialized
services to get patients to come back for visits.
• Focusing on acute problems creates depersonalization.
• Malpractice insurance is expensive, and drives up the cost of
medical care.
• Concentrating on heroic intervention is more expensive and
less effective than long-term prevention.
• Being paid to stay healthy
 Some employers give their workers a rebate for staying
healthy.
Prepaid Medical Care: The Example of
Managed Care
• Managed Care
 Often purchased as a contractual package by
employers
 Health Maintenance Organization (HMO)
• The positive side
 Because doctors make more money when patients
stay well, they encourage preventive care.
• Profits and a conflict of interest
• Ethical dilemma: profits or patient care
• Physicians argument against HMOs
• Loss of autonomy and reduced quality of
care
• Limiting medical treatment in order to
increase profits has led to severe problems
Physician Assistants
•Strategy for controlling costs
•Use of physician assistants has led to in-house
rivalry
•Must work under the supervision of physicians
•“If they want to do more, they can go to
medical school.”
Training Physicians
• Medical schools graduate about 16,000 physicians a year.
 Same today as 25 years ago
• In 2010 women will make up more than half of the nation’s
medical school graduates.
 Unsure if change in gender will have significant effect on
how medicine is practiced
 Female doctors are:
• As likely as male doctors to be generous or greedy.
• Patient or profit-oriented.
• In favor of heroic medicine or preventive medicine.
• Social policy that might reduce costs and help give care
to the poor would be to train more physicians.
• Suggest students be allowed to go to college and
medical school free in return for spending specified
amount of time in areas where there are doctor
shortages.
• Would increase physician presence in poorer areas and
increase competition among physicians.
• Outcry of physicians to such a proposal would be
loud, for their income would drop as prices for their
services fell.
Domiciliary Care
• Home health care, or domiciliary care
– Treatment given within a patient’s
home
– Less expensive and often more
humane
– May involve profiteering
– Another approach: create domiciliary
programs for mentally ill
• Eating ourselves to death
• 2 of every 3 Americans are overweight
• More likely to have strokes, to suffer heart attacks,
and to come down with diabetes
• Our culture encourages people to visit a doctor
when health problems arise, rather than to
exercise and eat healthier
• The problems with preventive medicine
• Quiet and unassuming
• Often obscured by the drama of heroic medicine
Humanizing Health Care
• Depersonalization: being treated as an inanimate object
• Process has to begin in medical school or in pre-med training
• Medical training needs to stress the inherent worth of patients
• Need to incorporate a holistic approach
• May require changing how fees are collected
• Self-care groups
 Aim of policies is to move health care away from hospital
into the home
 Offer inexpensive alternatives to highly technological and
costly medical care