Message-Id: <9811109107.AA910710372@gvsu.edu>
Date: Tue, 10 Nov 98 10:04:41 -0500
From: "Gayla Jewell"<jewellg@gvsu.edu>
To: <MedSoc@csf.colorado.edu>, <MedSoc@csf.colorado.edu>
Subject: Re[2]: Request for Info - Culture & Healthcare  
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     Re: prescriptive authority for nurse practitioners.  This varies state 
     board of nursing by state board of nursing.  Most states have 
     legislated some type of limited prescriptive authority.  A few states 
     have legislated full diagnostic and prescriptive rights.  Someone 
     correct me if I'm wrong, but Oregon and Vermont come to mind.  Here in 
     Michigan, in 1998, we pushed for a prescriptive authority bill with 
     the backing of a senator who is a physician.  During the wee hours 
     before the final vote, he met with lobbyists from the Michigan chapter 
     of AMA and agreed to amendments that made the bill not only flaccid, 
     but regressive.  
     Research continues to bear witness to the fact that nurse 
     practitioners do in their clinical practice 70-80% of that which 
     physicians do yet within a holistic health concept.  Research on 
     treatment of hypertension shows better client response with NP care 
     than MD.....less medication prescribed and more success at lifestyle 
     changes that bring down the blood pressure.  This is evidence that 
     more time spent with the client assessing and creating therapeutic 
     responses to the entire person, not just the body system, is an 
     incredibly effective method of health care.
     
     Bottom line is that nurse practitioners and physicians are working 
     through a field of struggle about turf guarding and socio-cultural and 
     political power.  The health of the client, family, society and 
     country is the football.


______________________________ Reply Separator _________________________________
Subject: Re: Request for Info - Culture & Healthcare  
Author:  <MedSoc@csf.colorado.edu > at internet
Date:    11/9/98 2:21 PM


Gayla - I like your comment because it floored me.  I admit that I 
was so focused on the question at hand I completely overlooked my own 
implicit biases.  Thanks for keeping the conversation honest.  I also 
think that perhaps the best question would be how is care negotiated 
amongst health care professionals, particularly since the physician 
will be the one with the final "legitimate" decision for a treatment 
regimen, particularly a pharmaceutical treatment, although the actual 
diagnosis and primary care will be based on the decision of a nurse 
practitioner, PA, or a physical/mental health therapist.  At least in 
GA scheduled pharmies can only be prescribed by MD/DO's (although 
there is always a dialogue on the need of PA's, NP's, and clinical 
psychologists to have the capability for some meds), what about other 
states?
     
Dave
     
> 
>      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
>      
> 
> 
> 
David M. Long, MPH
Department of Family and Preventive Medicine 
Emory University School of Medicine
69 Butler Street, SE
Atlanta, Georgia 30303-3219
404-616-2389 (voice)
404-616-6847 (fax)
dlong@fpm.eushc.org
     
"Man makes himself... Life is nothing until it is 
lived." - Jean-Paul Sartre 
     
"God can be shaped. God is Change." - Octavia Butler
     
"The tradition of all the dead generations weighs like 
a nightmare on the brain of the living." - Karl Marx
     
"Resist or serve." - D. Long