Medical Sociology Twelfth Edition William C. Cockerham Chapter 9 Doctor-Patient Interaction
Introduction Parsons concept of the sick role details the obligations of patients and physicians toward each other Patients should cooperate with doctors, and doctors attempt to return patients to as normal a level of functioning as possible Medical decision rule The guiding principle behind everyday medical practice Since the work of the physician is for the good of the patient, physicians tend to impute illness to their patients rather than to deny it and risk overlooking or missing it
Models of Interaction Szasz and Hollender: interaction depends on severity of symptoms Activity passivity model Patient is seriously ill or being treated on an emergency basis in a state of relative helplessness Guidance cooperation model Patient has an acute, often infectious illness Patient knows what is going on and can cooperate with the physician, but the physician makes the decisions Mutual participation model Management of chronic illness Patient works with the doctor as a full participant in controlling the affliction
Models of Interaction Hayes-Bautista Emphasizes the interaction as a process of negotiation Model is limited to situations in which the patient is not satisfied with treatment and wants to persuade the doctor to change it Model of interaction also influenced by Social class Age Education Severity of symptoms Satisfaction with treatment Mutual participation is the normative model in most instances
Misunderstandings in Communication Information can be an important therapeutic tool in medical situations if it meets three tests: 1) Reduces uncertainty 2) Provides a basis for action 3) Strengthens the physician patient relationship There are still instances of misunderstanding in communication or times when a doctor withholds information
Communication and Class Background Doctors from upper-middle-class backgrounds tended to communicate more information to their patients than doctors with lower-middle- or working-class origins. Patients from a higher class position or educational level usually received more information The greater the dissimilarity between patient and doctor in social class, the increased likelihood for miscommunication Patients and doctors sharing a similar class also share similar communication styles
Male Physicians and Women Patients Women s health movement to combat sexual discrimination in medicine Sexist attitudes and behavior toward women patients and health workers Lack of sensitivity to the needs and complaints of women seeking care Example: tendency of male physicians to misdiagnose heart attacks in women as anxiety or stomach problems
Women Physicians Women medical students and physicians still face problems in being recognized as equal colleagues by male physicians and as real doctors by male patients Sexism may be most evident in the top posts in academic medicine where women physicians are rare Specialties such as surgery and internal medicine seen as more masculine than soft specialties like family practice and pediatrics Women entering more masculine specialties tend to adopt masculine traits in order to be more successful
Women Physicians Men and women physicians have similar diagnostic and therapeutic skills Female physicians tend to be more empathic and egalitarian in their relationships with patients, more respectful of their concerns, and more responsive to patients psychosocial difficulties
Will Medicine Remain a Masculine- Dominated Profession? Two explanations have been given for gender segregation in medical practice Structural explanation: barriers, such as a lack of mentors, keep women from advancing to top positions in medicine Voluntaristic view: women are socialized to follow stereotypical gender expectations and consequently tend to make occupational choices that fit those expectations Feminization Indicates a female majority in an occupation and signals the gradual decline of the status and autonomy of work when women enter a profession
Cultural Differences in Communication Modern-day medical practice is provided within the context of middle-class norms Emphasizes scientific beliefs, the application of sophisticated technology, and cooperation with physicians Patients with different cultural perspectives may find interaction with doctors difficult and subject to misunderstanding on both sides Lower class and minority immigrant groups
Patient Compliance Requires comprehension by the patient Influences on compliance: Motivation to be healthy A perceived vulnerability to an illness The potential for negative consequences Effectiveness of the treatment Sense of personal control Effective communication
The Future of Doctor-Patient Relations Trend toward consumerism, in which the consumer wants to make informed choices about the services available and not be treated as inferior Marks a shift away from the traditional model of interaction which characterized Parsons sick role Increased importance of third-party payers in monitoring and limiting doctor autonomy
Doctor-Patient Relations and New Technology The Internet is especially influential in changing how patients approach the medical encounter Major source of easily accessible medical information Electronic support groups (ESGs) are forming on the Internet among people with similar health needs who wish to share their experiences online and develop greater expertise
Doctor-Patient Relations and New Technology Electronic monitoring devices track physical and mental states and report back to doctors via computer Patients may consult physicians via email or teleconferencing, rather than only face-to-face Prescription drugs may be ordered electronically More drugs becoming available in a variety of forms (e.g., pills, injections, patches, nasal sprays) Robotics and computer-guided imagery improve surgery precision
The New Genetics Sociology of genetics Examines the social use, control of information, risks, and ethics of genetic research Controversies surrounding: Genetic testing for diseases Prenatal genetic screening Human cloning
The New Genetics Genetic testing makes it possible to learn about someone s likely health future that even that person does not know Creates unique situations for families and groups E.g., Havasupai Indians This information is potentially valuable to employers, insurance companies, researchers, and pharmaceutical firms who would use it for their own purposes