Date: Mon, 9 Nov 1998 16:35:14 -0600 (CST)
From: "Andrew C. Twaddle" <ansar@showme.missouri.edu>
To: MEDICAL SOCIOLOGY <MedSoc@csf.colorado.edu>
Subject: Re: Request for Info - Culture & Healthcare 
In-Reply-To: <3.0.5.32.19981109171734.007c58a0@pop.uky.edu>
Message-ID: <Pine.A41.3.95q.981109163220.61712B-100000@sp2n23-t.missouri.edu>
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Gene-
	I would add that there is reason to believe that managed care is
shifting the balance of power away from physicians.  While they are still
the nominal primary care providers within health plans, an increasing
amount of patient interaction is taking place with nurse practitioners.
While they are nominally under the license of the physician, they are
required to make independent judgements and they seem to have considerable
autonomy in the patient-system encounter.  I have not seen any systematic
study of this, but I offer it as an observation from the clinics of
Mid-Missouri.
						Andrew

===============================================================================
Andrew C. Twaddle                              www.missouri.edu/~ansar
Professor of Sociology
University of Missouri
Columbia, MO 65211				for non- MU  related
phone 573+882-7031 				correspondence	please use
fax 573+884=6430				ansar@gwi.net
==============================================================================

On Mon, 9 Nov 1998, Eugene B. Gallagher wrote:

> I was interested to learn via Gayla Jewell that there are now  some 15 or
> so non-physicians for every doctor who provides medical information to
> patients. I did not know the ratio was that high.
> 
> I am not entirely satisfied however that a simple body count of health care
> workers answers the question about influence and authority in the
> health/medical field. I think that all providers should their due with
> regard to number of hours of service logged and number of patients seen.
> But how many of those non-physician providers are working under the
> authority or legal shadow of an MD? Going back to Paul E. Starr's notion of
> "cultural authority", would it make sense to say that physicians have a
> great deal of-- a preponderant amount- of CULTURAL authority, while all the
> others in the body count hold the overwhelming preponderance of SOCIAL
> authority.  By SOCIAL I mean roughly face-to-face contact. I don't know
> quite what I do mean by CULTURAL not how I would index or measure it. If
> you hold with CULTURAL/SOCIAL, what rough measures would you propose?  Or
> is the whole notion of CULTURAL/SOCIAL hopelessly obscurantist -- or
> perhaps still worse, cozying up to the most powerful profession?
> 
> Gene Gallagher, University of KentuckyAt 12:30 PM 11/9/98 -0600, you wrote:
> >AMen..
> >	When Hessler and I were doing our text more than a decade ago, we
> >found hundreds of articles on physicians, a handful on nurses, and only
> >scattered work on any other health occupation.  We lamented that at the
> >time, and things have still not changed.
> >
> >===========================================================================
> ====
> >Andrew C. Twaddle                              www.missouri.edu/~ansar
> >Professor of Sociology
> >University of Missouri
> >Columbia, MO 65211				for non- MU  related
> >phone 573+882-7031 				correspondence	please use
> >fax 573+884=6430				ansar@gwi.net
> >===========================================================================
> ===
> >
> >On Mon, 9 Nov 1998, Gayla Jewell wrote:
> >
> >> 
> >>      We are well past time that physicians are looked to as the primary 
> >>      source of information or data from the health care field.  About 16 
> >>      other kinds of providers exist for every physician.  Patients spend 
> >>      incredibly more time with nurses than with physicians.  By focusing 
> >>      mostly on physicians, med sociologists inadvertantly perpetuate the 
> >>      "cultural authority" (Paul Starr) and hegemonic dominance of the 
> >>      medical profession.  We must begin to look more thoroughly at the 
> >>      health care profession and various of providers of care and not just 
> >>      the "medical field".
> >>      This comment is not meant to point fingers at you, Melvin.  I'm 
> >>      venting my frustration at an academic group who espouse critical 
> >>      analysis....yet continue to support physician hegemony.
> >>      
> >>      
> >> 
> >> 
> >> ______________________________ Reply Separator
> _________________________________
> >> Subject: Request for Info - Culture & Healthcare 
> >> Author:  <MedSoc@csf.colorado.edu > at internet
> >> Date:    11/5/98 9:32 AM
> >> 
> >> 
> >>      
> >>      
> >> Hello Everyone.
> >>      
> >> Does anyone know of books, journal articles, or other materials that
> provide 
> >> discussion on conflicts that arise between patients and physicians (or
> other 
> >> allied medical personnel) who hold different/conflicting cultural
> beliefs about 
> >> what constitutes appropriate diagnosis and treatment of health problems?   
> >>      
> >> Any information you can provide will be appreciated.
> >>      
> >> Melvin Bobo
> >> Department of Sociology
> >> Iowa State University
> >> e-mail: melb12902@sprynet.com
> >>      
> >> 
> >> 
> >
> >
>