Marie R. Haug

Consumerism in medicine : challenging physician authority

Chapter One Power and Health Chapter Two Legitimative Power Chapter Three Gathering the Evidence Chapter Four The Realities of Public Challenge and Physician Responses Chapter Five Reasons Why -- The Public Chapter Six Reasons Why -- The Physicians Chapter Seven Consumerism and Physician Utilization Chapter Eight Identifying Consumerisms Effects Chapter Nine Consumerism in Medicine References Appendices

Issues in Elderly Patient-Provider Interactions

The current state of knowledge concerning relationships between elderly patients and their health care providers is reviewed in this article, chiefly in terms of physicians as providers. Characteristics of physicians, including age, gender, practice styles, and psychological attitudes, are shown to be relevant to the course and content of interactions. Equally critical are characteristics of the elderly patients, such as cohort membership, health status, gender, race, and health-related attitudes and beliefs. Also significant are the organizational settings in which interactions occur. Implications for elderly patient compliance and satisfaction, as well as health services utilization, are discussed in light of communication issues. The need for according elderly patients respect and dignity is stressed, particularly in light of ageist attitudes still prevalent among health practitioners and the society at large.

Self-care among older adults

Defining self-care as treatment for a perceived symptom, this paper posits that explanations for such illness behavior will differ depending on whether symptoms experienced are perceived as not serious and most amenable to self-treatment or more serious and less likely to respond to self-care. Borrowing from the Health Belief Model, two major concepts, a health set (consisting of five measures of perceived physical and mental health) and an attitude set (comprising four indicators of belief in physician efficacy) are included to explain rates of self-care across all reported symptoms. Self-care rate, calculated as the percentage of experienced symptoms self-treated without professional advice, was slightly higher for persons whose symptoms were seen as less serious. Measures of self-assessed health were related to self-care for those less severe symptoms, while lower faith in doctors as well as health were more closely related to the ailments perceived as more serious. Implications of the results for further studies are discussed.

Professional Autonomy and the Revolt of the Client

One of the normative characteristics of a profession is autonomy, the right to determine work activity on the basis of professional judgment. This activity increasingly occurs in a bureaucratic context, with the professional sharing in organizational authority. The public grant of autonomy has presumably been based on recognition of two other characteristics of a profession—store of esoteric knowledge and service orientation. Various publics may be viewed as presently questioning these claims to special knowledge and the humanitarian ethos, and challenging institutional delivery systems, either because they are inadequate or because they exceed appropriate bounds. Among middle-class groups, students deny the pedagogic expertise and good will of their educators, while demanding a redefinition of administration and faculty organizational power. Among poverty groups, clients, claiming to know more about community needs and problems than the professional social workers and to be more concerned, are organizing for a voice in welfare benefits and their distribution. Among blacks, the demand for power confronts the professional teacher, social worker, and public official. The thrust of the client revolt is against the delivery systems for knowledge application, as controlled by the professionals, and against the encroachment of professional authority into areas unrelated to their claimed expertise. Professionals have sought to preserve their institutional power and autonomy by coopting their challengers. The “new careers” movement, poverty programs and other forms of dealing with the revolt of the client are discussed from the perspective of cooptation, and implications for modifications in professional autonomy are reviewed.

The Deprofessionalization of Everyone

Abstract Historical and cross-cultural data call into question the concept of profession as formulated by British and American sociologists. A common underlying theme, however, is the monopolization of esoteric knowledge as a basis for professional authority. Because of the rapid proliferation of knowledge and technology, Daniel Bell has forecast a professionalized society, in which knowledge will be a source of power. This paper projects an alternative hypothesis based on several societal trends, using medicine as the prototypical profession and providing some cross-cultural evidence. These trends include an erosion of the knowledge monopoly as a result of rising levels of public schooling and sophistication and specific patient education, as well as computerization—which changes accessibility patterns—and new divisions of labor, which disseminate practice skills and information more widely. The consequences are decline of trust in professional decisions and diminution of professional power and authority...

Sustained personal autonomy: A measure of successful aging

Objectives: This study addresses the following question: What characteristics of urban, noninstitutionalized elders predict which individuals are most likely to remain independent of personal assistance during a 2-year observation period? Methods: A population-based sample of 602 noninstitutionalized urban residents aged 70 and older was followed for 2 years. Results: Ninety-eight of the 487 survivors remained independent. Factors associated with sustained independence were relatively younger age, male gender, fewer medical conditions, good physical function, and nonsmoking. The attitudes “favors family or self over agency assistance” and “does not expect filial obligation” were also independently associated. Discussion: The results are consistent with previous studies of successful aging and showthat attitudes expressed at baseline favoring personal independence are associated with sustained autonomy during a period of at least 2 years.

Decision and Adaptation Research on Female Retirement

Review of the literature shows that while womens adaptation to retirement has been closely studied, little is known of the female retirement decision. No gender differences in adaptation have been demonstrated. Hampered by poor data sets and design, and responsive to the prejudicial assumption that women had low work commitment, early adaptation studies found that women workers adjusted poorly to retirement, often more poorly than men. However, these results have not been confirmed. Recent research shows that most women adjust well, and no consistent gender differences have been found. Gender differences are much more likely to be observed in the decision to retire. Analysis of the timing of retirement among married couples indicates that the characteristics of the spouse influence individual retirement decisions. The effects of these characteristics differ in strength and direction, depending on gender. Future research on female retirement should focus on decision making in the marital unit.

Service delivery structure and continuity of care: a case study of a pediatric practice in process of reorganization.

The effects of the reorganization of a medical practice on continuity of care were investigated in a case study of a changing pediatric practice. Continuity, which has often been conceptualized as one indicator of quality of care, was measured by an index of which the numerator was the number of visits with own pediatrician and the denominator was the total number of pediatric visits for the year. Increased number of pediatricians and incorporation of the practice into an academic setting resulted in a decline of continuity of care accompanied by a rise in the number of doctor visits for acute illness care. Patient satisfaction, although related in some of its aspects to continuity, was by and large unaffected by the change. The consequences of changes in practice size and goal complexity for interpersonal aspects of patient care and quality of care are discussed.

Effect of Giving Care on Caregivers’Health

This longitudinal study of 121 caregivers of the elderly evaluates the change in their self-assessed mental and physical health over two years. The care recipients, who were drawn from a random sample of noninstitutionalized urban elders, showed increased need for help with personal and instrumental activities of daily living in this period. Both the physical and mental health of the caregivers declined significantly during the study. Predictors of decline in physical health of the caregivers at the end of the study were poorer physical health at the start, the amount of help they provided, a decline in their own mental health, and an increase in the number of other persons also available to provide care. In contrast, decline in caregivers’ mental health at the end was predicted only by poorer mental health at the start and by decline in physical health.

Mental health and the elderly: factors in stability and change over time.

Data from the Cleveland GAO Study reveal that, over one year, more elderly persons improved or remained stable than declined in self-assessed mental health and psychiatric symptoms. This pattern is contrary to findings that mental impairment increases with age. Factor analysis of a commonly used psychiatric symptom checklist identified two subscales, one a measure of psychological symptoms and the other of somatic symptoms; both of these are analyzed in this report. Secondary analysis of the 1,332 persons for whom data from both Ti (1975) and T2 (1976) are available evaluates this unexpected stability and improvement. Good physical health at T2 and less illness during the year emerged as the most powerful explanands for gains in all mental health measures, with higher educational levels also contributing to such gains. Improvement in self-assessed mental health was more likely for blacks than for whites, and males were more likely than females to show improvement in somatic symptomatology. Implications offindings for measurement of mental health and for the quality of life among the elderly are discussed.