9.13.07 med - 1Sociology of Medicine and Health Care...

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1Sociology of Medicine and Health Care Thursday, September 13, 2007 Class 3- More Topics in Medical Sociology XIV. Organization of health care providers Our med system fails to work well. A. Education and training of physicians, nurses, physician assistants How do you train physicians and nurses etc? It is not clear how to do it. They can read, operate, or a combination. First year of medical school are science courses. Final 2 years are apprenticeship training, and accompany senior residents and physicians. Problem–med students overworked and underpaid. 1989–reduced number of hours to 128 hours/week max. 25% of med students are reporting working more than 80 hrs/week in med school. Sleep deprived residents MAKE MISTAKES. The residents also suffer from psychological depression more, more likely to premature birth giving, and make mistakes because they are sleep deprived. Medical errors committed by sleep deprived residents resulted in over 10,000 lives in previous decades. New residencies start in July–many are just starting their training. B. Professional relationships among health care providers Doctors rely on nurses and other assistants, tech’s, etc. Team has to work together. Medical professionals have to cooperate. Doctor/nurse relationship is most important. Nurses are absolutely crucial. Doctors have dominance and power in medical world. Nurses have low status, women occupied. Conflict among nurses and doctors = patient loses!! C. Factors that interfere with their working together Doctors also have various status. Lower tech physicians, like pediatricians, make a lot less money. XV. Sociology of the hospital Max Weber – figured out how organizations work. Most have pyramid hierarchy. A. Very complex social organization Hospitals do not follow Weber’s pyramid of hierarchy. They have TWO pyramids. 1. Medical hierarchy – just doctors Top–top physician, then other physician, then house physicians, then med students. 2. Business hierarchy – administration. The operating executives of hospitals. The two hierarchies must cooperate for hospital to operate efficiently. Each is crucial to other for operation of hospital. Huge pay and status differential between top of administrative hierarchy and med hierarchy. B. Different types of hospitals with different rules (and different priorities) 1. Public v. Private (ownership) Public are almost all non-profit, public operate for-profit. 2.
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9.13.07 med - 1Sociology of Medicine and Health Care...

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