Message-Id: <9811109107.AA910712777@gvsu.edu>
Date: Tue, 10 Nov 98 10:45:06 -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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     Much is being written about the issue of use of nurse practitioners in 
     managed care and in the health care system, in general.  Below is a 
     list of a few articles my students have brought to me.  This is just a 
     sampling.
     
     Managed CAre, Nurse Practitioners and Discrimination by Nancy Sharp in 
     Nursing Management, 26(9), 90-94.
     
     Managed Care Organizations' Arrangements with Nurse Practitioners by 
     Diana Mason, et a. in Nursing Economics. Nov-Dec, 1997, 15(6), 
     306-314.
     
     Advanced Practice Roles for Nurses in Tomorrow's Healthcare Systems by 
     Ann Berger, et al. in Clinical Nurse Specialist, 10(5), 250-255.
     
     Administrative Issues for Use of Nurse Practitioners by Sellards & 
     Mills in JONA, 25(5), May, 1995, 64-70.
     
     Measuring the Impact of Advanced Practice Nursing on Achieving 
     Cost-Quailty Outsomes:  Issues and Challenges by Carroll & Fay in 
     Nursing Administratiion Quarterly, 1997, 21(4), 32-40.
     
     Estimating Costs of Underusing Advanced Practice Nurses by Nichols in 
     Nursing Economics, 1992, 10(5), 343-350.
     
     A Nurse Practioner-Led, Collaborative, Outpatient Practice:  A Case 
     Study in Outcomes Management by Cook & Nolan in Seminars for Nurse 
     Managers, 1996, 4, 154-162.


______________________________ Reply Separator _________________________________
Subject: Re: Request for Info - Culture & Healthcare  
Author:  <MedSoc@csf.colorado.edu > at internet
Date:    11/9/98 4:35 PM


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
> >>      
> >> 
> >> 
> >
> >
>