Всего публикаций в данном разделе: 320
Опубликовано на портале: 25-03-2007Ред.: Abbie Perry
Great Britain: Arnold, 1996
В книге предлагается cоциологический анализ деятельности основных агентов здравоохранения - врачей, медицинских сестер, менеджеров и государства. Используя различные аналитические подходы, авторы исследуют медицину с точки зрения ее роли и значения как социального института. Цель книги – описать и еще раз попытаться решить основные методологические и содержательные проблемы, стоящие перед медицинской социологией, начиная с множественности подходов к определению здоровья и заканчивая спецификой управления и социальной политики в сфере здравоохранения.
Опубликовано на портале: 25-03-2007David Kelleher, S.M. Hillier
London: Routledge, 1996, 257 с.
There are concerns about the poor health and prevalence of chronic illness among a number of ethnic minority populations. There are also debates about how best to improve the situation. For some, the answer is to see their experiences as part of the general social class inequality in health. However recent evidence questions the extent to which social class can explain the variations in health which ethnic minorities experience. "Researching cultural differences in health" offers a range of accounts of how people in ethnic minority groups perceive and manage their illness. Some of the chapters focus on Bangladeshi, and other South Asian groups, as well as Afro-Caribbeans and Irish people. The illnesses discusses include diabetes, hypertension, sickle-cell disorder, mental illness and coronary heart disease.
Challenging medicine [книги]
Опубликовано на портале: 25-03-2007Ред.: Jonathan Gabe, David Kelleher, Gareth Williams
London: Routledge, 1994
Modern medicine is a powerful institution. With the help of highly-developed drugs and surgical techniques, it promises to relieve suffering, improve the quality of life and extend the life-span. Conversely, it is expensive for the governments, insurance companies and individuals who pay for it and sometimes appears to be insensitive to the needs of those for whom it provides. And while recent restructuring of health care delivery services has provided medical practitioners with new challenges, there has been very little consideration of the range of pressures that they now face. Challenging Medicine offers a lively appraisal of the current changes to the health service and analyzes their effects on the status and practice of health professionals. It also provides original debate on the challenges posed from within medicine from the nurses, managers, alternative practitioners and self-help groups and beyond to the women's movement and the media.
Открыть свое дело: социологический анализ предпринимательского действия (на примере частной стоматологической клиники г. Магадана) [статья]
Опубликовано на портале: 23-03-2007Ефим Сергеевич Фидря Экономическая социология. 2004. Т. 5. № 1. С. 61-80.
Цель исследования – изучение социальной укорененности предпринимательского действия на основе анализа стратегии открытия своего дела. Данный вопрос исследуется на примере частной стоматологической клиники г. Магадана. Автор делает вывод о том, что на формирование предпринимательской ориентации действуют социальные факторы: социально-экономический контекст, культурные нормы, ценности, сформированные в период «допредпринимательского» биографического пути и определяющие предпринимательское действие. Открытие своего дела является адаптивной стратегией, позволяющей реализовать значимые жизненные цели, однако выбор именно такого пути также неслучаен и обусловлен личными характеристиками субъекта, сформированными у него в период первичной социализации. В основном автор концентрирует внимание на проблематике предпринимательства, однако исследование проливает свет и на то, как устроена и функционирует частная стоматологическая клиника - один из основных акторов рынка стоматологических услуг.
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: 23-03-2007David 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.
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: 23-03-2007Diane 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: 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.
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: 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.
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: 23-03-2007Catherine 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: 23-03-2007Margaret K. Nelson Journal of Health and Social Behavior. 1982. Vol. 24. No. 4. P. 339-352.
This paper reexamines the impact of preparation for childbirth on birth-related attitudes and events. Data were collected from approximately 300 obstetric patients before and immediately following childbirth. These data are used to demonstrate that working class and middle class women (in this study, defined on the basis of highest level of education) who do not attend childbirth classes have different attitudes toward, and experiences during, childbirth. The data also demonstrate that the impact of childbirth education is much greater among working class women than it is among middle class women. Theoretical and practical implications of these findings are discussed.
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: 23-03-2007Joan R. Bloom, Jeffrey C. Alexander Journal of Health and Social Behavior. 1982. Vol. 23. No. 1. P. 84-95.
Nursing teams are conceptualized as coordination mechanisms that respond to task interdependence within the hospital unit. The form of coordination is predicted to result from organizational decision makers' conceptions of the work to be performed as well as the more objective characteristics of the work. The effects of these technological variables on coordination are mediated by the size of the unit and the degree of professionalism exhibited by the nursing staff. A path model is constructed and tested using a sample of 146 patient care units from a national sample of 17 hospitals. In general, the results are supportive of the model: both conceptions of a task and task predictability (or known technology) appear to affect coordination through other structural characteristics of the unit. On larger units the nursing team provides a hierarchical control mechanism, whereas teaming in units characterized by greater staff professionalism provide a means of lateral coordination as well as hierarchical control.
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.
Опубликовано на портале: 23-03-2007Debra Parker-Oliver OMEGA: The Journal of Death and Dying. 2000. Vol. 40. No. 4. P. 493 - 512 .
The social construction of a dying role is emerging in response to terminal illness for which the sick role is no longer functional. When people are in the process of dying, in the absence of a dying role, they take on the rights and responsibilities of the sick role to which they have been socialized. This is problematic for the individual who will not get well no matter how hard the effort. Hospice, a professional community with a central purpose of bringing the drama of dying to an appropriate close, marks the transition from a sick role to a dying role. This article looks at how the hospice community directs this transition and redefinition of self for the dying and significant others. Utilizing the symbolic interactionist and phenomenlogical perspective and the sick role theory of Talcott Parsons, this view of the drama is demonstrated through stories of hospice patients.
Опубликовано на портале: 23-03-2007Larry Nuttbrock Research on Aging. 1986. Vol. 8. No. 3. P. 368-387.
This study examines sick role identification and sick role retention as interrelated aspects of socialization to a chronic sick role. Focusing on physically impaired older people (55-85) and adopting an interactionist view, sick role socialization is seen in terms of both conformity (mirroring the role casting of others) and improvisation (portraying sickness in pursuit of social support, legitimated dependency, and relief from social strain). Both models are generally supported by the data.