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Samenvatting boek Medische sociologie voor essay (eindtentamen) - cijfer behaald 8
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- Vrije Universiteit Amsterdam (VU)
Samenvatting boek Medische sociologie voor essay (eindtentamen) - cijfer behaald 8
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Voorbeeld 2 van de 13 pagina's
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H8Introduction
Lay people and patients meet with health professionals in many different settings and for
many different reasons. The sociology of health and illness has for the most part focused on
those between doctors and patients. First, lay-professional relationships both reflect and
reinforce wider social relations and structural inequalities. Second, such relationships form
key dimensions of social control and regulation. Third, health professionals have often
neglected to take the patient's view seriously. Fourth, the quality of interaction affects the
outcomes of health care. Sociological analyses of professional-patient interactions can be
categorized into two main types: First, macro approaches and second micro approaches.
The professional-patient relationship is now more accurately described as a meeting
between experts. This is contributed by a number of factors: first is the changing nature of
disease, second is the fact that people are encouraged to take responsibility for their own
health, third health care users are being encouraged to exercise their own choice.
The changing context of lay-professional interactions
The medical knowledge that for so long was presumed to be accessible to qualified
practitioners is now available to everyone. There is a move from ‘industrial age medicine’ to
‘information age health care’. Doctors have to recognize that their patients may be ‘smarter’
than they are, work in networked organizations rather than hierarchical ones, acknowledge
that their clinical knowledge can be patchy, and make use of information tools and
systematic reviews of evidence, rather than just relying on their clinical experience. Such
transformations are likely to lead to changes in the relationships between professionals and
patients, between medical institutions and the state, and between medicine and sociology.
Doctor–patient interactions are now more accurately portrayed as ‘encounters’ rather than
relationships. It is instructive to acknowledge and include structure and context in the
analysis of relations.
Professional-patient relationships: norms and expectations
Society comprises actors who perform a range of social roles. In this respect, doctors and
patients perform and fulfill certain role obligations: the doctor treats ill people, and a person
who is ill enters the ‘sick role’ and makes an effort to get well. Doctors and patients have
certain rights and obligations. If they fulfill these obligations, society will, in return, grant them
three rights: the right to examine patients physically and emotionally, the right of autonomy in
their professional practice, and the right to occupy a position of authority in relation to the
patient. We can see, therefore, that although the relationship is reciprocal, it is not equal.
This has a number of positive consequences. It ensures that those who have formalized
knowledge and technical ability will gain rewards. It also means that patients will trust trained
health professionals. The asymmetry of the relationship is not problematic. This is because
the rights of physicians are underpinned by three social norms or values: universalism,
collective orientation and affective neutrality. Anyone will be granted legitimation to enter the
sick role and will be given help. This asymmetric relationship has been challenged. For
example, patients may have more knowledge about their condition than medical
practitioners. The underlying assumptions on which this type of ‘functional’ relationship is
based are also questionable. Diagnoses and treatments have been found to vary according
to the patient’s class, gender and race. Judgements may be made as to patients’ culpability
for their illness. clinicians feel pressured into making choices based on their perceived sense
of their patient’s willingness to be compliant and change their behaviors. responses to
, individual patients are likely to vary according to the economic and political context in which
they are made. The doctor–patient relationship is perhaps more accurately characterized by
conflict than by consensus (wederkerig - maar niet gelijkwaardig).
Professional-patient relationships: conflicts and challenges
The source for conflict lies in two basic assumptions held by doctors about how patients
should behave. On the one hand, patients should use their own judgment to decide when it
is appropriate to seek medical advice; yet, on the other, once this advice is sought, they
must defer to the doctors’ judgements and interpretations. The patient is thereby placed in a
‘double bind’. Deciding when it is appropriate to seek medical advice is a matter that many
people find difficult. Studies report that doctors work with stereotypes, labeling their patients
as ‘good’ or ‘bad’. Health professionals derive power from legitimized status and presumed
technical expertise. This enables them to function as mediators of social control.
The ideological bases of doctor-patient consultations
Doctors are becoming proletarianized and subject to false consciousness and alienation. It
demonstrates the heterogeneity of the medical profession and how the practices of doctors
are shaped by their employment status and contexts. Patients are not dupes and
practitioners are becoming increasingly aware of the limits of biomedical ‘solutions’. Other
variants of the conflict perspective are those approaches that emphasize the gendered
dimension of medical interactions. Medical science is ideological. Within doctor–patient
consultations, ideological messages are communicated under the guise of medical science.
The exchange of true information can take place only in a context where both parties are
equal. Symmetrical clinical encounters are characterized by concordance rather than
compliance.
From compliance to concordance
Patient compliance is the extent to which the patient’s behavior coincides with clinical
prescription. A materialistic account maintains the notion of patient compliance came as a
result of epidemiological transformations. there is an affinity between the preoccupation with
compliance and a profession under siege = ideology of control. The niche of self-critique
suggests that the concern with compliance arose as a result of critics who were emerging
from within medicine itself. Today the term noncompliance is no longer regarded as
acceptable. Sociological studies demonstrate that the use of treatments for illness and
disease is bound up with the complexities of people’s lives. ‘Concordance’ has been defined
as an open exchange of ideas on which prescribing and medicine decisions may then be
based. This represents a shift from the doctor-centered to the patient-centered approach in
medical care. Asymmetry and ideological assumptions are not limited to doctor–patient
encounters but are found extensively in relations between health care practitioners and
patients. This study reveals how micro level interactions can contribute to the reproduction of
health inequalities and how everyday discrimination reflects and reproduces macro level
structural disadvantage.
Communicating risk in consultations
The shift towards shared decision-making is bound up with changes in the content of
consultations. This can be in tandem with changes to the initiation of consultations, which
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