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Sociology of Medicine and Health CLASS 16-2

Sociology of Medicine and Health CLASS 16-2 - Sociology of...

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Sociology of Medicine and Health – Class 16 I. Professional self-regulation A. Peer regulation fails to ensure quality of care i. Doctors respect each other professional judgment (do not question each other) ii. Cannot observe doctors work behind closed doors iii. Belief that mistakes are normal part of medicine a. Mistakes can kill people that why it is important (wrong treatment, wrong diagnosis) b. Must figure out which mistakes more common (accidental or intentional) iv. Good manners prevents doctors from criticizing each other B. Continuing education fails to ensure quality of care i. The main reason is to get more money, not improving patient care ii. It is not regulated, ie no exams iii. If you don’t do this you can lose your license C. Results – “medical standards of care” i. Rules of process rather than measures patients health ii. Difficult to measure patient outcome iii. If the one follow the steps – quality medical care even if patient dies iv. Cheaper to do II. How do doctors minimize errors in routine practice? A. Charles Bosk’s study “Forgive and Remember: managing Medical Failure” – 1979 i. How physicians help each other if they kill someone – social support B. Managing Medical Failure Study details C. How surgery is done i. Followed surgeons around for week ii. In high risk populations – 5 deaths a week iii. Attendee physician determines surgery/course iv. Chief residence – day to day v. 2 nd /3 rd year surgeons – do most of the cutting vi. Medical Students – Observers vii. Anesthesia viii. Nurses – often more knowledgeable than doctors, because they been their longer ix. The order people go in is backwards from this list D. How surgeons define error i. Eyes of their peers – viewed by other doctors ii. Technical errors – okay as long as it is reported
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iii. Judgmental errors – wrong treatment
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