Med Soc Quiz 2

Jon Ledyard and Chapters 6-10

risk factors for cardiovascular disease

• smoking

• lack of exercise/sedentary lifestyle

• high cholesterol

• stress

• hypertension

• diabetes

• dyslipidemia, high fat

• stress/depression

Smoking cessation rate at UPMC Cardiac Rehab facilities

50%

holistic approach to Cardiac Rehab Science

• emphasizes lifestyle changes

• more exercise sessions to benefit patient

fastest growing segment of US population

people over 90-100 years old

Hippocrates words of wisdom

walking is the best medicine

exercise alone for weight lose

• can lose 3-5 pounds

• 90% of weight loss is diet and nutrition

sedentary lifestyle

equivalent to smoke 1.5-2 packs of cigarettes a day

Leading causes of death 2020-2021

• heart disease

• cancer

#1 cause of death

coronary heart disease

how to fix coronary artery disease?

balloon angioplasty and stents, helps open up arteries

coronary bypass surgery

heart attack

• build up of plaque leads to blood clot that blocks artery

phases of cardiac rehab

• Phase 1: inpatient

  • range of motion exercises

  • ambulating

  • discharge planning

• Phase 2: early outpatient

  • individual treatment planning

  • supervised exercise

  • lifestyle counseling and support

Pulmonary Rehabilitation

• reduced likelihood of patients with COPD will be readmitted to the hospital

• improves quality life

• improves functional capacity

• reduces breathing related readmissions

Vascular Rehabilitation

• supervised exercise therapy

enrollment rates in rehab

after 50 years 27% cardiac rehab

after 40 years 2% pulmonary rehab

after 8 years <1% vascular rehab

#1 cause of death in people under 25

alcohol

1 MET increase in Functional Capacity

20-25% drop in mortality

FITT

program design

frequency, intensity, time, type of exercise

smoking

• leading cause of preventable death

• 15.5% of all adults

• quitting at any age lowers risk

• smoking lowers life expectancy by average of 18 years

Sociological Definition of Health

6 primary orientations

• physical functioning

• mental health

• social well-being

• role functioning

• general health perceptions

• symptoms

Biomedical Definition of Health

based on individual’s physiological state, absence of disease

4 limits of the biomedical approach to health

• based only on presence of disease, but cultural background can affect view of symptoms

• only medical professionals can define health, but often it is patients and family members too

• focus only on physiological function, not on mind, body, and soul

• health as absence of disease, does not fully represent well-being

the WHO definition of health

a state of complete physical, social, and mental well-being and not just the absence of disease

What percent of Americans are a healthy weight, eat well, and exercise?

40%

4 Dimensions of Health Behavior

• Prevention

• Detection

• Promotion

• Protection

HPBs

Health Promoting Behaviors

individual actions taken to protect, promote, or maintain health

Prescriptive behavior

• diet, seatbelts, exercise, check-ups

(to do something positive)

Proscriptive

• driving safely, not smoking, limiting alcohol

(to limit a behavior)

Micro approach to health behavior

• focus on individual decisions

• favored mindset by Americans

Macro approach to health behavior

• community behaviors, social structure influences behavior

• corporations will resist

• for community/structural changes there will be costs that require higher taxing

Women vs Men in HPBs

women more likely to engage in HPBs compared to men

3 reasons for not getting diagnostic screening?

• lack of insurance

• cost

• work conflicts

What does Harvard school of public health consider “Binge Drinking” for men and women

• women: 4 drinks in one sitting

• men: 5 drinks in one sitting

Illness Behavior

the way that symptoms are perceived, evaluated, and acted upon by person who recognizes some pain, discomfort or other signs of organic malfunction

Schuman’s 5 Stages of Illness Experience

1. symptom experience

2. assumption of the sick role

3. medical care contact

4. dependent patient role

5. recovery and rehabilitation

The Symptom Experience

when someone starts to sense that something is wrong

• pain or discomfort

• cognitive recognition of symptoms

• emotional response of concern

Theory of Help-Seeking Behavior

how individuals act prior to seeking a healthcare provider

The Social Construction of Illness

definition of illness and ability to cope with illness are culturally and socially determined by the way people interact with others

The sick role

when someone is ill they will pause normal social roles AND enter a new role with exemptions and responsibilities (ex. expected to stay home, rest, and not work)

Labeling Theory

illness as subjective that are worked out in cultural contexts and within physician/patient encounters

what percentage of Americans experienced Chronic pain in the last year? constant pain?

• 60% chronic pain

• 40% constant pain

Who is likely to have chronic pain?

• adults age 18-34 just as likely compared to those who are older

People in pain at time of death

about ½

Palliative Care

treating pain and suffering of seriously ill patients

Sick Role defined by Talcott Parsons

• illness not just biological and psychological

• sick people exit their normal roles and enter a sick role

how is sickness dysfunctional in family and society?

• family: other members expected to pick up slack

• society: attraction to escaping responsibility

2 behavioral requirements and 2 obligations of a sick person

requirements

• temporarily excused from normal social roles

• not responsible for illness

obligations

• must want to get well

• must seek medical advice or else seen as illegitimate

criticisms of the sick role

• variability in behavior

• only applies to acute illness

• does not account for all physician interaction

• more applicable to middle/upper class because not everyone has freedom to withdraw from responsibilities

Medicalization

process that allows medical professional to determine what is normal and desirable behavior, and how to control, modify/eliminate undesirable behavior

Effects of Medicalization

• less stigmatizing

• less punitive

• ex. ADHD not bad behavior, but a condition that can be managed

• could also be a societal label of disapproval

• better than church defining sickness as they may relate it to sin

De-Medicalization

countermovement to medicalization, remove certain behaviors from DSM ex. homosexuality, deinstitutionalization of mental patients

3 types of legitimacy in illness states

• illegitimate: some exemption from role responsibilities ex. stammer

• conditional legitimacy: temporary exemption from role responsibilities with some new privileges ex. cold

• unconditional legitimacy: permanent and unconditional exemption ex. cancer

• can have minor or serious deviation categories

what are the average physician contact rates for Americans (in Mid-90s)

about 6 contacts/year with MDs

how are contact rates changing by age and gender?

• number of contacts increases with age and higher with females over males

What group has the lowest rate of use of health services?

Hispanics

(tend to use ER as medical care and likely to get admitted)

Medically indigent/Working poor

People just above the poverty line, do not qualify for Medicaid, but cannot afford private care

what percent of homeless people have psychiatric disorders

25-50%

Indian women in seeking care

• husbands must approve

• no access to family money

• cannot go to health clinics alone

what age group tends to have regular preventative care?

• 65 and older

• 12% of population

what does self-care include?

behaviors that…

• promote optimal health

• prevent illness

• detect symptoms of ill health

• heal acute illness

• manage chronic conditions

dependent-patient role

when recommendation of health care provider for treatment is accepted, new role is continuing treatment and getting better

recovery and rehabilitation stage

treatment succeeds and recovery occurs, relinquish sick role and move back to normal obligations

chronic illness, impairment, disability

• chronic illness: ongoing, recurrent, persists for life

• impairment: loss of some anatomical or physiological function

• disability: consequence of impairment

concerns shared by chronically ill and disabled persons

• impairment of personal cognitive functioning

• loss of personal independence

• changes in body image

• withdrawal from key social roles

• the future

stigma

discrediting label on individual

stigmas associated with illness

• social rejection

• financial insecurity

• internalized shame

• social isolation

Why were physicians not highly regarded for healthcare? Who was?

• physicians did not have the best medical knowledge, inaccurate and dangerous at times

• no credentials

• wives/mothers/families were primary locus of healing

• apothecaries for medicine

Profession

• autonomy

• rigorous standards

• prestige

When did physicians gain dominance and how is dominance achieved

• in the 20th century

• convincing public that profession does valuable work, high standards for entry into field, rigorous educational standards, trusted to perform work ethically and police itself

• granting legal autonomy

physicians in the AMA in 2000s

• 1/3 physicians

• a decline

• started with 80% in 1963

• maybe because some joined other groups within their specialty

deprofessionalization

• over time patients have become more well informed about health and illness are asserting/assuming more control over their own health

who are physicians losing autonomy to?

• the federal government

• more corporate control over medicine

proletarianization

• physicians like other workers in capitalist economies eventually have autonomy and self-control stripped and replaced with control by corporate owners and managers

Countervailing Power Theory

• when any profession gains extraordinary dominance it stimulates countervailing powers in order to balance its power

• ex. government, nurses, chiropractors, consumers in advocacy groups, large employers that purchase healthcare, corporate sellers insurance companies

social control

• ability of individuals and groups to regulate themselves and the measures taken by outsiders to regulate an individual or group

• internal vs external control

• should doctors regulate themselves or should other people?

internal control mechanisms

• peer review

• hospital review committees

• state boards of medicine

• the national practitioner data bank

In peer review how many doctors actually report their peers?

about half

pros and cons of hospital review committees?

• internally keep physicians in check

• instead of causing publicity nightmare they force people out instead and they can continue practicing somewhere else so it does not reflect poorly on the hospital

National Practitioner Bank Data

• information about all health care practitioners and malpractice payments stored

• information not available to public

Medical Error Deaths

medical errors responsible for 44,000-98,000 deaths of hospital patients in the US each year

Medical Malpractice Litigation

• compensate patients who were harmed by a physician that could have prevented those things from happening

• must prove

  • injured/damaged

  • healthcare provider was negligent

  • negligence caused injury

Medical malpractice trend

• spiked in 80s and has gone down since then

How many physicians sued for malpractice each year?

1 in 14

How many malpractice cases result in payout?

20%

medical malpractice diagram

• most actual cases do not get filed

• good amount of cases filed that are not actually medical malpractice

How is the healthcare system affected by medical malpractice crisis?

• defensive medicine

• medial malpractice insurance

• embittered doctors

• doctors stopping service/practice

• strife between MDs and lawyers

defensive medicine

drs prescribe extra tests for patients to protect themselves from liability

medical malpractice insurance

• adds $ to healthcare bill for patients

• cost for medical malpractice insurance rising

embittered doctors

seeing every patient as a potential lawsuit

doctors stopping services

• physicians pay 3-4% of revenue to insurance

• causing doctors to cancel elective surgeries and transfer pts to hospitals

reducing malpractice crisis

• physicians having rapport with their pts

• communicating clearly

• maximum cap on awards for “pain and suffering” and punitive damages (may not cover pts expenses, unconstitutional for judicial system)

• no fault insurance system: covers bills regardless of who caused issue

• restricting the amount that lawyers make from the suits

physician stats

• # of physicians have increased over the last 30 years

female physicians stats

increased by over 300% in the last 20 years

urban area physicians

better physician:population ratio

PCPs vs specialists vs gender stats

• less PCPs because people preferred specialists, but is flipping

• women more likely to be PCPs, gap is closing

• women preferred salaried positions

• men more likely to be surgeons

Percentage of US MDs that are Racial/Ethnic Minorities

7%

many are foreigners

Physician Chemical Dependency Rates

• 30-100x more than general population '

• 12-14% of all physicians have or will have serious substance issues

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

history of medical schools

• used to be apprenticeships

• 1800 formal medical schools established

• only needed to be able to pay the fee to get in for white males

• females: only some schools allowed them

first female MD

Elizabeth Blackwell