Lecture 17
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Stephen Hansell is a professor in the Department of Sociology at Rutgers University's Institute for Health Research. He can be contacted at shansell@rci.rutgers.edu or by phone at 609-203-2830. There will be an exam on Monday, November 8th from 9:50-11:10 AM. Students should bring pencils and know their RUID number. The exam will cover chapters 5, 8, 9, 10, and 11.
Lecture 17
- 1. Stephen Hansell, Ph.D. Department of Sociology Institute for Health Research http://sakai.rutgers.edu shansell@rci.rutgers.edu 609-203-2830
- 3. EXAM
- 5. EXAM Monday Nov. 8 9:50-11:10
- 6. EXAM Monday Nov. 8 9:50-11:10 Bring Pencils
- 7. EXAM Monday Nov. 8 9:50-11:10 Bring Pencils Know your RUID
- 8. EXAM Monday Nov. 8 9:50-11:10 Bring Pencils Know your RUID chapters, 5, 8, 9, 10, 11
- 9. Class 17 – Nurses, Physician
- 10. VI. Potential for conflict between doc and patient A. Conflicts worse for patients with low education • people with higher education are more similar to doctors, and they ask more questions and feel that they are treated well • people with less education feel intimidated, • people with higher education have an elaborate linguistic code. • people with less education use a restricted linguistic code, they use symbols
- 11. VII. Increasing demands for accountability by third parties who pay the bills A. Insurance companies • decide what treatment a patient should get B. Government health programs (Medicare and Medicaid) C. Businesses who buy medical care for employees
- 12. D. Corporatization of medical care E. Marketing of medicine • the medication have more side effects than effects • people are easy to reach through the internet 1. makes doctors look better because some medication need a doctor’s consultation 2. Emphasizes patient satisfaction – never talk about the patient outcomes – if the doctors looks and does what a patient thinks, they are satisfied if they dont then the patient run away – the characteristic is white old man with a stethesthokope and grandfatherly –
- 13. VIII. Determinants of patient satisfaction A. Doc matches patient expectations B. Good doc-patient interaction • its all marketing C. Patient satisfaction lower in certain settings • when the doctor is a minority or a woman
- 14. I. Nurses – no respect but the largest group of medical practitioners – about 2 million nurses – license practice nurses are assistant to registered nurses – average salary 62,000 A. History 1. Florence Nightingale (in england) 2. moved nursing out of the religious group to a more societal context and formed the first nursing school 3. she made nursing an acceptable occupation outside the home 4. always under a physician – nursing was religious and nuns were the first nurses 5. in us there are 3 ways to become a nurse 1. hospital training program (becoming less popular) 2. the associates AA degree from a community college (majo source of new nurses
- 15. B. In US, 3 pathways into nursing 1. Hospital diploma program (2 1/2 or 3 years) 2. AA degree in community college (2 years) 3. BSN degree in regular undergraduate college (4 or 5 years) – you get more knowledge and time to pick lectives – higher status than an AA degree – you get the same job, but theres more opportunity for future occupational growth –
- 16. C. Nursing occupation a good example of credential inflation • everyone wants a BSN now 1. Conflict among nurses with different educational backgrounds – theres a lot of conflict unlike doctors cz all of them want different pay D. Nurse practitioners a new nursing occupation • lisenced to practice under the supervision • 83,000 per year • you could use more knowledge and very good at helping people on site, like AIDS care, child care etc E. Nurse shortage since 1980’s • cz nurses are paid very poorly • so hospitals are forced to raise the salary
- 17. II. Conflict between physicians and nurses – nusese are underpaid – get no respect – doctors get to decide everyhting, nurses always just follow orders A. Nurses strongly affect the quality of care in almost every practice setting
- 18. B. Experimental Astroten study of doctor-nurse relationships (1966) (not in book) • oldest doctor nurse study • studied whether nurses went along with a doctors order to give an incorrect treatment • astro 10 was a fictional medicine and on the bottle it said 5 mg max dosage • the nurse got a call from a physician, she did not know, and ordered to give the patient a 50 mg dose stat • 3 violations • she needs an official writing • the astro medicine is not in the list of medicines • and the dose was a lot • 21/22 went along with the obviously incorrect order from a fictitious doctor • back in the day the nurses were not allowed to think on their own or oppose the doctor 1. Study a situation in which standards of nurses are challenged by doctors 2. When doctors and nurses conflict, it is usually the patient that suffers C. More recent Valium study (1977) C. new study 16/18 nurses tried to refuse the fake medicine D. they are not treated as colleagues E. increasing number of male nurses and female doctors
- 19. IV. Physician assistants – almost exactly the same salary as the nurse practitioner and takes less time to train – it is not dominated but any gender – starting salaries are better – can prescribe medications – take records and stuff – train in primary care, but sometimes train in specialty as well – doctors like them cz they do the routine stuff A. Relatively new occupation B. Midway between physicians and nurses 1. Training requirements 2. Practice responsibility 3. Income
- 20. VI. Pharmacists • 106, 000 a year A. Expanded role in late 20th century • they just used to prepare and give out medicine, but now its not just that • the grocery stores also have a pharmacy • the most accessible health care professional in the country • there are telephone pharmacists and internet pharmacists as well • buy you could be tricked on the internet B. Increased education • 6 year degree
- 21. VII. Midwives – deliver babies – women have been doing this for thousands of years without men – by mid 1900’s delivering babies was redefined as a medical procedure – but now midwives are back in fashion – 2 types of midwives – certified rn – average 89.000 – deliver in uncomplicated cases – work in hospitals, clinic a lot of places – other miswives, earn less than lisenced ones
- 22. Stephen Hansell, Ph.D. Department of Sociology Institute for Health Research http://sakai.rutgers.edu shansell@rci.rutgers.edu 609-203-2830