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HSS 2321- Final Notes.docx

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CHAPTER 11 THE MEDICAL PROFESSION1Profession as Occupation The Trait ApproachProfession accumulation of traits William Goode professions involve prolonged training in body of specializedabstract knowledgeare a service orientation 10 traits determines own standards of educationtraining stringent educational requirements licensingadmission determined by members most legislation shaped by members high powerprestigeincome free of lay controlevaluation norms enforced by members and are more stringent than legal standards members more strongly ID by profession than other occupations members usually stay in for lifeLimitations accepts ideologies of the profession ignores importance of power of group doesnt account for change over time and ignores relationship between professionrest of society Overall ignores historical development of profession and political economic moral place in society2Profession as ProcessProfession social construction various occupational groups progressaspire to progress over time under various conditionsGoode The goal is professionalization accomplishment of titlestatus of professionWilensky5 Steps to become profession members engage in fulltime work establish relationship with trainingeducation program establish association gain legal status construct code of ethicsJohnsons Power Analysis Approach focuses on how professionals come to think of themselves as professions as they increase in power discusses theoretical explanations for power of professions sees power as ability to define reality in broad way and even define the good life for clients ability of group to impose its perspectivenecessity of services to clients power comes from uncertaintysocial distance btwn parties 3 variables that determine power more esotericless accessible knowledge greater social distance btwn clientprofessional greater homogeneity in professionalsgreater heterogeneity of client groupSubordination Limitation and Exclusion in the Medical Labour ForceWillis doctors also try to restrict the scope of other practitioners 3 processes to achieve dominance subordination threatening occupations come to work under the control of medicine eg thnursing limitation indirectly controlled by legal restrictions eg pharmacy in the 19 century were primary caregivers and made compromise with doctors that they would stop prescribing exclusion certain jobs not licensed and thus denied official legitimacytax support eg chiropractors naturopaths1991 Regulated Health Practitioners Act restricts allopathic monopoly consumers choose from health care they desire but may have to pay Medicine is limited to specific acts controlled activities which may harm patients Others can perform all other actsHomeopaths reflexology acupuncturists and herbalists are unregulated3Profession as IdeologyIdeology group of descriptiveprescriptive beliefs used to explainlegitimize certain viewpointsParsons 4 characteristics of professions universalism functional specificity affective neutrality and a collectivity orientationPhysician is expected to apply universal scientifically based standards to all patients not differentiate between patientstreatments based on social differences all patients get same level of care functional specificity exerted doctor cant offer advice on nonmedical matters refrain from emotional involvement express concern with a good bedside manner impartialunemotional collectivity altruistic selfinterest not OK Friedson professionalism professed ideology 3 assertions medical knowledge complex medical workobjective as professionals doctors trusted to put others welfare aheadDeprofessionalizationIncreasing control of doctors by insurance companies and government billingDemystifying medical knowledge through the internet health information growing power of individuals ie AIDS mvmtHealth promotiondisease prevention is more recognized alternative HCW legalized layscepticism 1962 doctors strike in Saskatchewan 1986 extrabilling in Ontario erode trust in doctorsStill doctorspharmacists ranked higher than 16 other professions 7773 higher than police clergy etcChaoulli Case doctorpatient sued CQ government after yearlong wait for hipreplacement surgery struck down law stopping purchase of private insurance to cover procedures already offered QC offered guaranteed wait timesprivate available in CanadaNorman Bethune1890 thoracic surgeon who served in 3 wars on 3 continentsAfter wounded at Ypres returned to Canada to complete medical degree contracted TB tried to develop a statesupported Medicare system for Canadians organized the Montreal Group and sailed to Spain to help with civil war Devised a method to transport blood to wounded on battlefieldsConvinced Mao that they needed surgery at the front linesBogus Medicines700000 people die each year from counterfeit prescriptionsOTC medsProblem is growing particularly in developing regions Asia Africa Latin America75 billion marketSir Frederick BantingCharles BestDiscovered Insulin1923 Banting corecipient of Nobel Prize shared with BestMedical Education in Canada Today1824 Montreal Medical Institution McGillBy 1997 30 decrease in number of positions at med schoolsSince thendoctors1000 people grows due to immigration of doctors and higher enrolment577 of all med school students are females16 universities in Canada grant MD Medical students continue to be drawn from middlemiddleupper class family backgroundsThe Process of Becoming a Doctor1950s1960s most influentialcomplete studies of med school Chicago BeckerColumbia MertonBecker2 values learned doctors in training become aware of 2 values clinical experience belief than much of practice is based on art of determining from subtle interpersonal cuesinteraction lead students to focus on practical things rather than science medical responsibility enormous responsibly of lifedeath decisions that confront doctors emphasis on interesting cases Merton 2 traits developed ability to remain detached ability to deal with inevitableuncertainty Medical education continuous process where doctors absorb enough knowledge and identify selves as doctorsFox 3 sources uncertainty impossible to learn everything about medicine awareness that medical knowledge is incomplete uncertainty distinguishing between lack of knowledgemedical inadequacySexism past unknown quota system governed women admittance Medicine built around masculinity Male body is the normStudy phone interview would you be OK with gay physician 12 said they would refuse felt incompetentuncomfortable Menolder more likely to respond like this Getting DoctoredShapiro 2 features of medical education alienation relationships with each other med school etc authoritarian personality experienced at all levels of medical education MarxAlienation of labour competition between students enormous workload little direction Alienation from product of labour worker doesnt feel product true reflection of selfvalues eg way that doctors talk to patients Alienation of relationships competition is central fear of failure etcConrad Findings med school discourages caring clinical perspective focused on disease not illness not taught how to talk fixit mentality long hourssleep deprivation inhibit compassion12 medical students are depressed 15 doctors depressedsome reports say 25Organization of Medicine AutonomySocial Control2 Control bodies College of Physicians and SurgeonsCanadian Medical AssociationBoth attempt to define expectations improve standards protect statussecurity of membersCanadian Medical Association amalgamation of provincial medical associations National lobby group Provincial bodies negotiate with medical care plans for fee scalesother matters QC different Fed of General PractitionersFed of Medical Specialists of QCCollege of Physicians and Surgeons bodies in each province w responsibility to oversee practiceprotect the public Canadian Medical Act defines qualifications to get into practice certification investigation of misconduct etcMedical Act Medical Council of Canada responsible for licensing qualified practitioner supervise prevent unqualified from practice Provinces have power to eliminate registry of those convicted of certain offenses
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