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Purpose – This chapter examines medical consumerism and the changing relations between patients as consumers and the medical system across two women's health contexts, breast cancer and infertility.

Methodology/approach – The analysis draws on two qualitative studies: The first explores the experiences of 60 breast cancer survivors through in-depth interviews and participant observation (Sulik, 2005), and the second uses in-depth interviews to analyze 18 women's experiences with infertility (Eich-Krohm, 2000).

Findings – The medical consumer is an individualized role that shifts attention away from the quality problem in health care and toward the quality of the person as a medical consumer who is characterized to be optimistic, proactive, rational, responsible, and informed.

Research limitations/implications – As medicine has become a form of mass consumption, the category of medical consumer has elevated the individual in medical decision-making. The shift from patient to medical consumer is an ongoing process that is grounded in a tension between medical control and individual agency, and is exacerbated by the intensity and incomprehensibility of modern medicine.

Practical implications – The proliferation of medical information and personal illness narratives through the Internet, advice books, and self-help groups have advanced lay knowledge about preventive medicine and medical treatment while simultaneously introducing new fears and anxiety about the multitude of options and outcomes.

Originality/value of chapter – This study contributes to our knowledge on medical consumerism and its impact on illness experience and the synthesis of lay and professional knowledge.

Purpose: We analyze how medical providers use accountability processes or the regulatory means through which individuals hold themselves or others accountable to social norms, to uphold their medical authority. We use the case of trans medicine because in this medical domain, providers often have little to no expertise and few are trained specifically in delivering trans medicine or working with trans patients. As a result, providers experience uncertainty and are left without the typical tools and expertise on which they depend in most other areas of medical decision-making.

Design/methodology/approach: We conducted in-depth interviews with 23 medical providers and observations of transgender healthcare conferences in the United States between 2012 and 2015.

Findings: Our work offers insight into the provider side of patient-provider encounters and medical decision-making in gender minority health. The first accountability strategy providers employed was to invoke the language of evidence as a method to maintain their authority, in spite of the paucity of scientific evidence that undergirds this emergent medical domain. The second strategy was to mandate compliance by holding trans people accountable to the expectation of acquiescing to medical authority.

Originality/value: We contribute to the scholarship on gender minority health by examining how high power actors use accountability processes to restore order in interactions with trans and nonbinary patients. We demonstrate how enforcement to expectations through accountability processes is a plausible, though oft-overlooked, dimension of health inequalities.

This chapter introduces Learning Health Systems (LHS) and the impact of data science on such systems. It also examines the necessary properties of data used in LHS and identifies patients who may benefit from a transition to palliative care. Finally, it examines the way LHS can be used to identify racial and social disparities in access to palliative care.

Two parallel developments in health care have begun to converge: (1) the demand for greater patient participation in health care, and (2) the evolution of computer tools designed to inform patients of health care options so they might decide among them. Little is known about how patients see these tools and how these perceptions affect participation in care. This study examines patients' responses to the routine use of “knowledge coupling” computer tools in primary care, and their influence on “shared decision making”. Three hundred fifty seven (357) patients responded to a survey that asked about various aspects of the knowledge coupling system used in a primary care practice. The results indicate that how patients see the knowledge coupling tools used in the practice affects perceptions of their involvement in care and decisions. Perceptions of involvement also positively relate to age, but remain unrelated to gender, education, income, and home computer use. Trends toward using computer tools to assist in health decisions will likely continue. This study suggests that as these tools become integrated into the routine care of patients they will have important implications for patient participation in care and decision making.

Legal standards that allow teens to make health care decisions, or any important decisions, must account for the contingency and variability of minors’ capacity. Traditional law denied minors’ legal authority to make any decisions, giving all power to parents. This rule goes too far; the Supreme Court has held that minors have constitutionally protected autonomy-based rights, and modern views about adolescence are inconsistent with the rule. The question is how and where to draw lines.

Legal standards are based on minors’ evolving maturity, policy favoring decisions that follow medical advice, and policy supporting parental authority. This paper uses four hard cases to show how these considerations factor into legal rules.

We investigate whether information technology (IT) can help physicians more efficiently acquire new knowledge in a clinical environment characterized by information overload. We combine analysis of data from a randomized trial with a theoretical model of the influence that IT has on the acquisition of new medical knowledge. Although the theoretical framework we develop is conventionally microeconomic, the model highlights the non-market and non-pecuniary influence activities that have been emphasized in the sociological literature on technology diffusion. We report three findings. First, empirical evidence and theoretical reasoning suggests that computer-based decision support will speed the diffusion of new medical knowledge when physicians are coping with information overload. Second, spillover effects will likely lead to “underinvestment” in this decision support technology. Third, alternative financing strategies common to new IT, such as the use of marketing dollars to pay for the decision support systems, may lead to undesirable outcomes if physician information overload is sufficiently severe and if there is significant ambiguity in how best to respond to the clinical issues identified by the computer. This is the first paper to analyze empirically and theoretically how computer-based decision support influences the acquisition of new knowledge by physicians.

This study proposes targeted modernization of the Department of Defense (DoD's) Joint Forces Ammunition Logistics information system by implementing the optimized innovative information technology open architecture design and integrating Radio Frequency Identification Device data technologies and real-time optimization and control mechanisms as the critical technology components of the solution. The innovative information technology, which pursues the focused logistics, will be deployed in 36 months at the estimated cost of $568 million in constant dollars. We estimate that the Systems, Applications, Products (SAP)-based enterprise integration solution that the Army currently pursues will cost another $1.5 billion through the year 2014; however, it is unlikely to deliver the intended technical capabilities.