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Medical encounters are interactional/interpersonal processes taking place within contexts shaped by macro-level social structures. In the case of sexually transmitted diseases (STDs), medical encounters occur at a stigmatized crossroads of social control and gendered norms of sexual behavior. When women are diagnosed and treated for chronic STDs, practitioner demeanor has an important impact on how patients will view not only their health status but also their moral status. This chapter draws on in depth interviews with 40 women diagnosed with genital infections of herpes and/or human papillomavirus (HPV – the cause of genital warts) to explore three models of patient–practitioner interaction. The analysis focuses on the relationship between gender, construction of illness, and practitioner interaction style. In a broader context, the health risks posed by particular interaction styles to female STD patients shed light on larger public health implications of combining morality with medicine for the broader range of patients with stigmatizing diagnoses.

Chapter X of The Social System is often cited as the “charter” for the specialty field of medical sociology. A notable feature of its analysis is the argument that the physician is an agent of social control in relation to the patient. This argument grounds the application to medical practice of Parsons’ general conception that social control is an aspect of all social relationships. Parsons started by addressing the situation of a patient who assumes the sick role and then becomes the patient of a physician. The sick role involves a suspension of at least some of the performance expectations associated with a person's everyday social life, such as expectations of working productively at one's job, attending the meeting of a civic association, or caring for one's family members. But in assuming the sick role, an individual encounters new expectations that he or she should try to get well. For minor illnesses this may involve only resting, drinking fluids, and avoiding stress. For more serious illnesses, given our culture's valuation of scientific medicine, it typically involves placing oneself in the care of a physician. It then becomes the physician's duty to offer treatment and guidance to restore one's health and enable one to return to meet expectations of everyday roles. Thus the physician becomes an agent of social control.

Purpose: The Internet provides patients easy access to scientific information originally, limited to medical professionals. However, this information may not be entirely relevant to the patient’s context. Therefore, doctor–patient conversations need to contextualize this information to the specific circumstances of the patient’s illness. A problem exists insofar as this conversation may not always meet the patient’s expectations. Interpersonal competence, an important aspect of emotional intelligence, is therefore critical for medical practice in the digital era. “Medicine” is viewed as a “masculine” profession requiring competence, while compassion as “feminine”. Gender stereotyped socialization prescribes gender - congruent emotional display norms for men and women thereby, influencing both gender behavior and emotions. Psychological androgyny is the coexistence of masculine and feminine behavior traits in the same individual irrespective of biological sex. This leads to responses, which are appropriate for situations irrespective of biological sex, rather than gender-stereotyped behaviour. In this study, I explored the role of gender personality and interpersonal competence in doctor–patient interaction.

Design/ methodology/approach: Sixty Indian doctors across different specializations completed the self-report format of emotional intelligence appraisal (Emotional Intelligence Appraisal-EIA) as measure of interpersonal competence and Bem’s Sex role Inventory (BSRI) as a measure of psychological androgyny.

Findings: Psychologically androgynous doctors scored significantly higher on interpersonal competence than non-androgynous doctors.

Practical implication: Since both male and female doctors undergo similar training, there is a need to explore in greater depth the nature of the relationship between androgynous gender behaviors in doctors and corresponding interpersonal competence correlates, to understand their impact on patient care and healthcare related outcomes for both patients and doctors. This is especially critical because, in addition to increasing incidents of violence against doctors in Internet-empowered world, previous research also points to varying patient outcomes and legal complications based on biological sex of doctors.

This study illustrates that differences across health-related websites, as well as different Internet usage patterns, have significant implications for how individuals view and interact with their health care providers.

We rely on a qualitative study of three health-related websites and an ordinary least squares regression analysis of survey data to explore how websites with different organizational motives frame health-related issues and how variations in Internet usage patterns affect patients’ perceptions of the patient-doctor interaction.

Results reveal differences across three health-related websites and show that both the number and the type of websites patients visit affect their perceptions of physicians’ responses. Specifically, visiting multiple websites decreased perceptions of how well doctors listened to or answered patients’ questions, whereas using nonprofit or government health-related websites increased evaluations of how well doctors listened to and answered questions.

This study suggests that practitioners and scholars should look more closely at how patients use the Internet to understand how it affects doctor-patient interactions. Future research could expand the analysis of website framing or use methods such as in-depth interviewing to more fully understand on-the-ground processes and mechanisms.

This study highlights the importance of fleshing out nuances about what it means to be an Internet-informed patient given that varying patterns of Internet use may affect how patients perceive their physicians.

Using data from the General Social Survey (2002), structural equation modeling is employed to examine the intersections and relationships between various socio-demographic and contextual variables, patient trust, and patient preference for behaviors that indicate a desire to be an active health care participant. In so doing, a gap in the literature is addressed by uniting previous research on patient trust with research on patient participation. Findings reveal that patient trust in doctors and various socio-demographic and contextual variables are associated with people wanting to participate in the health care process by learning about medical issues on their own and by contributing to medical decisions. Results also shed new light on past research, which finds a relationship between various socio-demographic variables and patient trust. Specifically, they highlight the importance of distinguishing between patient trust in doctors and patient trust in the broader health care institution and the economic pressures it exerts on doctors. A discussion of what these findings might mean for our understanding of the doctor-patient relationship and the delivery of health care concludes the chapter.

The race concordance hypothesis suggests that matching patients and health providers on the basis of race improves communication and patients’ perceptions of health care, and by extension, encourages patients to seek and utilize health care, which may reduce health disparities. However, relatively few studies have examined the impact of race concordance on the utilization of health services. This chapter is grounded on Andersen’s Emerging Model of Health Services Utilization (Phase 4) and extends that model to include race concordance.

The data were collected from a stratified random sample of adult beneficiaries enrolled in North Carolina Medicaid’s primary care case management delivery system in 2006–2007. Propensity score matching techniques were used to sort respondents on their propensity for race concordance and indices were constructed to generate key control variables. Poisson regression was used to examine the impact of race concordance on the utilization of primary care and emergency room care, under the assumption that race concordance would increase the use of primary care and decrease the use of emergency care for minority patients.

While blacks (compared to whites) used less primary care and had more emergency care visits, race concordance was not a statistically significant predictor of either primary care or emergency room use. However, patients’ satisfaction with their primary care providers was associated with significantly fewer primary care and emergency care visits while trust in one’s provider was associated with more primary care visits.

The study findings suggest that the central premises of the race concordance hypothesis require further study to confirm the assumption that better patient – primary care provider relationships result in less utilization of more costly and resource-intensive forms of health care.

The study makes a valuable contribution by expanding the relatively small body of literature dedicated to exploring the impact of race concordance on health services utilization. Additionally, by virtue of researching the experience of Medicaid enrollees, the study controls for health insurance status.

Much of the body of literature analysing the gig economy focuses on its exploitation of low-wage workers and its role in increasing precarious work. This chapter approaches the topic from a different angle, focussing on the contribution of the gig economy to the declining power of the medical profession. As well as facilitating and promulgating contingent work in healthcare, the gig economy disaggregates medical work into isolated on-demand micro-tasks on digital platforms. This has implications for the status and power of the medical profession, the doctor–patient relationship, and inter-professional boundaries in healthcare. The mechanisms through which these dynamics unfold, as well as the inter-related factors that support the transformations in the allocation and content of medical work, are discussed. These include the implications of heightened transparency of medical work resulting from unbundling of jobs, commodification of medical professionals, and platform-based vulnerabilities such as rating systems that impact doctor–patient relationships. Closure theory is drawn on to illuminate the dynamics of the transformation in professional boundaries and the arising conflict that it entails for the healthcare workforce at different levels. The conflict is theorised as an insidious exercise of closure by allied health professionals on the remit of the medical profession, which challenges remuneration, authority, and other exclusionary benefits traditionally accrued to the medical profession.

The resurgence of interest in professionalism necessarily focuses us on the moral core of medicine and the character of the good doctor. While medical education reform projects aimed at educating for professionalism are replete with lists of laudable virtues necessary for the doctor, we have made little progress in mapping those character traits, values and behaviors to admission procedures, curricular reform and faculty development. If educating for professionalism is to be effective, medicine must re-claim the moral core of professionalism and identify clearly the fundamental traits, values and virtues necessary for good medical practice in the twenty-first century.

Encouraging patient involvement is a cornerstone of many healthcare interventions and decision-making models to ensure that treatment decisions reflect the needs, values, and desires of patients. Involved patients are thought to be empowered patients who feel a sense of efficacy in regards to their own health. However, there is a lack of understanding of how patients relate to empowerment and involvement and, most importantly, how these constructs relate to one another in patients’ decision-making experiences.

Through an inductive analysis, this chapter draws on qualitative interviews of women diagnosed with breast cancer prior to 40 years of age (n = 69).

By examining the intersection of how patients define their own involvement in treatment decisions and their sense of empowerment, we find four orientations to decision-making (Advocates, Bystanders, Co-Pilots, and Downplayers) with involvement and empowerment being coupled for some respondents, but decoupled for others.

Our findings suggest expanding what it means to be an “active” patient as respondents had multiple ways of characterizing involvement, including being informed or following their doctor’s advice. Our findings also suggest a more critical examination of the origins and potential downsides of patient empowerment as some respondents reported feeling overwhelmed or pushed into advocacy roles. The sample was disproportionately higher socioeconomic status with limited racial/ethnic diversity. Empowerment and involvement may be enacted differently for other social groups and other medical conditions.

By examining first-person patient narratives, we conclude that patients’ experience may not fully align with current academic or clinical discussions of patient involvement or empowerment.