Journal of Health and Social Behavior
Опубликовано на портале: 23-03-2007Michael S. Goldstein Journal of Health and Social Behavior. 1984. Vol. 25. No. 2. P. 211-229.
This is a study of physicians in Los Angeles who made the performance of abortions a major or sole component of their practice in the five years (1967-72) subsequent to the legalization of abortion in California. A semistructured interview was used to obtain data on the attitudes, values, and experiences of 42 such physicians. Four distinct career patterns (entrepreneurs, academics, workers, and community physicians) were found. As expected, the physicians tended to be specialists in OB-GYN, concerned about financial rewards, and influenced by past observation of negative consequences of illegal abortions. The major finding is the existence of a subgroup of physicians whose primary identity is businessman or entrepreneur; these fit into the pattern of "outsider entrepreneurs." Elements of this pattern were also found among other types of physicians to varying degrees. There is a need to recognize entrepreneurial elements as part of the conceptualization of physicians and other professionals.
A Critical Theory of Medical Discourse: Ideology, Social Control, and the Processing of Social Context in Medical Encounters [статья]
Опубликовано на портале: 23-03-2007Howard Waitzkin Journal of Health and Social Behavior. 1989. Vol. 30. No. 2. P. 220-239.
The personal troubles that patients bring to doctors often have roots in social issues beyond medicine. While medical encounters involve "micro-level" interactions between individuals, these interpersonal processes occur in a social context shaped by "macro-level" structures in society. Examining prior theories pertinent to medical discourse leads to the propositions: (a) that medical encounters tend to convey ideologic messages supportive of the current social order; (b) that these encounters have repercussions for social control; and (c) that medical language generally excludes a critical appraisal of the social context. The technical structure of the medical encounter, as traditionally seen by health professionals, masks a deeper structure that may have little to do with the conscious thoughts of professionals about what they are saying and doing. Similar patterns may appear in encounters between clients and members of other "helping" professions. Expressed marginally or conveyed by absence of criticism about contextual issues, ideology and social control in medical discourse remain largely unintentional mechanisms for achieving consent.
Опубликовано на портале: 23-03-2007Diane Hayes, Catherine Ross Journal of Health and Social Behavior. 1987. Vol. 28. No. 2. P. 120-130.
Most research on the determinants of protective health behaviors examines health beliefs as the major motivating force. Authors hypothesize that concern with appearance is also a motivating force in eating diets low in calories and cholesterol and high in fruits and vegetables. Using a representative sample of 400 adults in Illinois (collected in 1984), they find that both health beliefs and appearance concerns affect eating habits. Health beliefs are modeled as an interaction between concern with health and health locus of control, since it is expected that concern with health has the largest impact on eating habits for persons who believe they have some control over their health. This interaction term is significant. For the average person, appearance is as large a motivating factor in eating habits as is concern with health. The implications of this finding for the health of the population, especially women are discussed.
Опубликовано на портале: 04-03-2007Robert E. Clark, Emily E. LaBeff Journal of Health and Social Behavior. 1982. Vol. 23. No. 4. P. 366-380.
This research focuses on the strategies used by various professionals in delivering news of death. The lack of well defined, normative guidelines for such deliveries adds to the problematic nature of the interaction. From in-depth interviews with physicians, nurses, law enforcement officers, and clergy, a loose framework based on common themes was generated providing a processual view of death telling. Five distinct strategies of delivery developed within the framework. Discussion of each strategy indicates the significance of situational and occupational factors in delivering news of death. This study, though exploratory in nature, clarifies some of the processes involved in the delivery of bad news, and identifies several important problems surrounding death telling, such as lack of training and preparation among professionals for this role and their dislike for this aspect of their work.
Explaining the Social Patterns of Depression: Control and Problem Solving - or Support and Talking? [статья]
Опубликовано на портале: 19-02-2007Catherine Ross, John Mirowsky Journal of Health and Social Behavior. 1989. Vol. 30. No. 2. P. 206-219.
Research on the social patterns of depression in the community finds consistently that high levels of education and income, being male, and being married are associated with lower levels of depression. Authors attempt to explain these patterns as the result of two essential social perceptions: the sense of controlling one's own life rather than being at the mercy of powerful others and outside forces, and the sense of having a supportive and understanding person to talk to in times of trouble. In theory, the sense of control reduces depression because it encourages active problem solving, and the sense of support reduces depression because it provides others to talk to. They find evidence for the first proposition: persons who feel in control of their lives are more likely to attempt to solve problems. Perceived control and problem solving decrease depression and largely explain the effects of income and education on depression. At the same time they find, however, that support has mixed effects. Support decreases depression, but talking to others when faced with a problem, which increases with the level of support, increases depression. Support explains a small part of the effect of marriage on depression. Control and support have an interactive effect on depression, suggesting that control and support can substitute for one another to decrease depression: a high level of one reduces the need for the other, and a low level of one is remedied by a high level of the other.
Information Giving in Medical Care [статья]
Опубликовано на портале: 23-03-2007Howard Waitzkin Journal of Health and Social Behavior. 1985. Vol. 26. No. 2. P. 81-101.
Information giving is a crucial element of medical care. This research project considered two theoretically grounded hypotheses: (1) Doctors may withhold information and maintain uncertainty to preserve power in the doctor-patient relationship, and (2) class-based sociolinguistic differences in language use may create further impediments to information giving. A multivariate research model was operationalized to study these hypotheses and to assess other associations between information giving and the characteristics of doctors, patients, and the clinical situations in which they interact. An analysis of a sample of 336 encounters recorded from several outpatient settings revealed that doctors spent little time informing their patients, overestimated the time they did spend, and underestimated patients' desire for information. Contingency-table analysis showed that information transmittal was associated with (1) doctors' income, social class background, political ideology, and perceptions of patients' informative needs; (2) patients' age, sex, social class, education, and prognosis; and (3) situational characteristics such as the length of acquaintance, numbers of patients seen per day, and the types of patients in the doctors' practices. Multiple regression analysis assessed the relative importance of these variables in explaining the variation in information transmittal. The findings did not clearly confirm a relationship among information withholding, uncertainty, and power but did clarify the importance of class-based sociolinguistic barriers to communication.
Опубликовано на портале: 19-02-2007Samuel W. Bloom Journal of Health and Social Behavior. 1986. Vol. 27. No. 3. P. 265-276.
The emphasis of this analysis is on the social institutional history of medical sociology. This subfield is described as (1) closely connected with the patterns of development in its current discipline, (2) as containing a dual thrust between applied and basic science, and (3) as struggling with "insider-outsider" ambiguity involving the work of subgroups working either in medicine or from roles external to medicine but studying the sociology of medicine. Tracing a detailed historical fragment from the decade following World War II, it is predicted that the continuity of an accepted position for medical sociology is assured even though the style and quality of its professional life are full of uncertainty.
Опубликовано на портале: 23-03-2007David Mechanic Journal of Health and Social Behavior. 1989. Vol. 30. No. 2. P. 147-160.
Why is it that quantitative and qualitative researchers on health issues often have divergent findings and conclusions? Exploration of such differences can be a useful way of bringing separate intellectual enclaves in medical sociology together and also can stimulate future inquiries. Some differences can be resolved by more precise definitions, by comparable frequency and timing of measurement, and by careful evaluation of meaning contexts. The triangulation of methods, using diaries as a bridge between surveys and qualitative measurement, offers particular promise. Improved theory on the relationships of method to data, and more attention to behavioral sequences and the social context of measurement, can serve as a stimulant to innovative solutions.
Опубликовано на портале: 23-03-2007Renee R. Anspach Journal of Health and Social Behavior. 1988. Vol. 29. No. 4. P. 357-375.
This paper examines a segment of medical social life that has not been studied extensively: formal presentations of case histories by interns, residents, and fellows. Because they are presented by physicians in training to their status superiors, who are evaluating them, case presentations are exercises in self-presentation which serve as a vehicle for professional socialization. This analysis of the language of case presentation is based on case presentations collected in two intensive care nurseries and an obstetrics and gynecology service. Four features of case presentation are identified: 1) the separation of biological processes from the person (de-personalization); 2) omission of the agent (e.g., use of the passive voice; 3) treating medical technology as the agent; and 4) account markers, such as "states," "reports," and "denies," which emphasize the subjectivity of patients' accounts. The language of case presentation has significant, if unintended, consequences for those who use it. First, some features of case presentation eliminate the element of judgment from medical decisions and mitigate responsibility for medical decision making. Second, some are rhetorical devices which enhance the credibility of the findings that are presented. Third, the language of case presentation minimizes the import of the patient's history and subjective experience. Finally, case histories socialize those who present them to a culture or world view which may contradict the explicit tenets of medical education.
Perceptions of Patients by Emergency Room Staff: Substance-Abusers versus Non-Substance-Abusers [статья]
Опубликовано на портале: 23-03-2007Lois Biener Journal of Health and Social Behavior. 1983. Vol. 24. No. 3. P. 264-275.
Studies suggest that health care providers' evaluation of patients is related to aspects of the presenting problem, i.e., its seriousness, curability, and rarity; the extent to which the problem was self-caused; and to aspects of the patients, i.e., their age, social distance from providers and cooperativeness. Analysis of 220 emergency room staff members' perceptions of 14 hypothetical patients showed that with the exception of rarity of problem and social distance, the tested factors were significantly related to ratings of rewardingness of patient encounters. Results indicated that predictors of reward derived from substance-abusing and non-substance-abusing patients were different. While seriousness of illness was the primary predictor with non-substance-abusers, perceived cooperativeness was primary with substance-abusers. Predictors of rewarding patient encounters also differed according to staff level. Implications of these differences for emergency treatment of substance-abusers is discussed.
Опубликовано на портале: 23-03-2007Mary Klein Buller, David B. Buller Journal of Health and Social Behavior. 1987. Vol. 28. No. 4. P. 375-388.
Research has linked the communication styles of physicians to patients' satisfaction with health care. Recently Ben-Sira (1976, 1980) offered a social interaction model to explain this relationship; this model, however, focused on a single, narrow style of communicating and overlooked the broader spectrum of styles. This survey assessed two general communication styles: affiliation and control. It also examined eight social characteristics of medical interviews as possible mediators of the impact of the physician's communication style on the patient's satisfaction. Patients' evaluations of the physician's communication were associated strongly with patients' evaluations of medical care, suggesting that competence in communication may be a facet of medical competence. Affiliative styles were related positively to patients' satisfaction, whereas dominant/active styles had a negative relationship with satisfaction. Severity of the illness, physician's age, physician's specialty, and the number of prior visits affected the importance of the physician's communication in the patient's evaluations of care.
Опубликовано на портале: 23-03-2007Catherine Ross, John Mirowsky, Raymond S. Duff Journal of Health and Social Behavior. 1982. Vol. 23. No. 4. P. 317-329.
Authors developed and tested a model of client satisfaction with medical care in which sociodemographic characteristics of the physician affect client satisfaction under conditions of unmet expectations and a lack of choice. They hypothesized that in small fee-for-service practices such as solo practice, where the client chooses his or her physician, status characteristics of the doctor would be unrelated to client satisfaction. Conversely, in large prepaid group practices where the client is assigned a physician, nonnormative physician status characteristics would create lower client satisfaction. Because expectations are based on statistical norms, it was hypothesized that clients in large prepaid multispecialty groups would be most satisfied with physicians who fit the norm-middle-aged white males from higher status Protestant or Jewish backgrounds. In a sample of pediatricians and their clients, authors found their hypotheses to be strongly supported, with one modification-the relationship between client satisfaction and the physician's socioeconomic background is parabolic. Furthermore, the negative effect of nonnormative physician religious status on client satisfaction in large prepaid groups is offset by the client-physician match and by experience with the physician.
Опубликовано на портале: 23-03-2007Marie R. Haug, Bebe Levin Journal of Health and Social Behavior. 1981. Vol. 22. No. 3. P. 212-229.
Traditionally, the sociological concept of the relationship between practitioner and patient has been the sick role, in which the physician as practitioner is in charge, and the patient is obligated to cooperate with the physician's prescribed regimen. More recently, this power relationship has been redefined by some from a consumerist perspective, in which physician and patient bargain over the terms of the relationship. Although each brings different resources to the encounter, neither participant is automatically in charge. Data from a sample of 466 members of the public and 86 physicians are used to assess the extent of reported public attitudes and behaviors that challenge the physician's traditional power, as well as physicians' reported response to such attitudes and events, as evidence of the public's propensity to a consumerist relationship and physicians' willingness to accept it. Among both the public and physicians, substantial minorities express beliefs and report actions congruent with this consumerist perspective. However, different demographic and health belief variables emerge in the two groups as explanatory factors. Doctor-patient power relationships are seen to depend on characteristics of the actors as well as on the illness situation.
Returning to the Doctor: The Effect of Client Characteristics, Type of Practice, and Experiences with Care [статья]
Опубликовано на портале: 23-03-2007Catherine Ross, Raymond S. Duff Journal of Health and Social Behavior. 1982. Vol. 23. No. 2. P. 119-131.
Although a number of policy-makers have suggested that previous experiences with medical care affect subsequent use of physician services, few researchers have examined the issue empirically. Authors divide the determinants of revisiting the doctor in pediatric practice into three categories: client characteristics, organizational characteristics, and characteristics of the doctor-client interaction; and we develop a causal model. Although race, income, and education have no direct effects on the frequency of returning to the doctor, they have indirect effects through the organization of health care and experiences within the health care system. Clients who are poorly educated tend to have consistently negative experiences with the health care delivery system. These experiences affect subsequent use of services. Positive experiences with the interpersonal, psychosocial aspects of the doctor-client interaction increase a client's proclivity to return to the doctor, while negative doctor-client interactions decrease the probability of returning to the doctor.
Опубликовано на портале: 23-03-2007William Cockerham, Guenther Lueschen, Gerhard Kunz, Joe L. Spaeth Journal of Health and Social Behavior. 1986. Vol. 27. No. 1. P. 1-14.
Data from the 1984 Illinois Comparative Health Survey are used to examine whether the poor have adopted a consumer orientation toward professional health services in view of the reduction of financial barriers and clear signs of increased physician utilization. It was found, however, that lower-status persons stand as more or less passive recipients of such services, with a significantly greater tendency to invest responsibility for their own physical health in the health-care delivery system itself. Yet there was a general lack of difference with respect to health lifestyles involving food habits, emphasis on appearance, sports and exercise, smoking, and alcohol use. A culture-of-medicine thesis was found to provide a stronger explanation of this situation than a culture-of-poverty perspective. Medicine and the mass media have promoted the practice of a healthy lifestyle, but have not encouraged consumerism in the physician-patient relationship. Consequently, it appears that where social institutions provide positive sanctions, self-management and consumerism seems to grow for the poor; but where negative sanctions exist, consumerism does not seem to flourish.