Term Paper on "Patients and Their Doctors Research"

Term Paper 5 pages (1747 words) Sources: 5

[EXCERPT] . . . .

Patients and Their Doctors

Research into the dynamics that are part of the patient-doctor relationship has been an ongoing theme for many years. In this paper the way in which the patient-doctor relationship has evolved will be reviewed. Also that relationship will be reviewed from a functionalist perspective, from a conflict theorist perspective and also from a symbolic interactionist perspective.

The Annual Sociology Review white paper -- published by the University of California at Los Angeles (UCLA) -- references thirty years of research into physician-patient interaction. In the review (Heritage, et al., 2006, p. 351). This paper offers a good perspective of the physician-patient interaction over the years. In 1972, for example, a revealing study (Korsch & Negrete) was conducted at the Children's Hospital of Los Angeles -- based on observations of "800 pediatric acute care visits" and using Bale's (1950) Interaction Process analysis (IPA) to code the data. About 20% of the parents left the clinic "without a clear statement of what was wrong with their child," Heritage writes (p. 351).

Moreover, about half of the parents in this survey "were left wondering what had caused their child's illness" (Heritage, p. 351). In addition about one-fourth of the parents surveyed indicated that they had not mentioned "their greatest concern" either because they didn't have an opportunity to mention it or they didn't sense that they were being encouraged to do so (Heritage, p. 351).

Online Healthcare Resources: Meanwhile the advent of the Internet has spawned the widely accepted use of legitimate, verifiable, informational healthcare-related Web sites. This online resource has become a help to patients who know how to research the World Wide Web. Among the "virtual communities" within the healthcare sector are WebMD.com; eHealth.com; eHealthforum.com; MayoHealth; WellMedd, and more (Misra, 2008, p. 322). Also, healthcare-related corporations are building websites of their own, Misra writes; some of those: Aetna U.S. Healthcare; CIGNA; Oxford Health Plans, etc. The research conducted by Misra shows that "only one half of adults" in the U.S. "place a high priority on seeking health information

But there are questions that need to be addressed regarding Web sites with healthcare advice and information. According to an article in the journal Health Communications, an estimated 40% to 66% of Americans have gone online to search for healthcare information (Imes, et al., 2008, p. 539). The authors posit that more people go online to find out what is hurting them or bothering them or just to research specific health problems "on any given day" than have a face-to-face visit with a healthcare provider (Imes, p. 539).

Those facts notwithstanding, people do not go online to search for healthcare often; in fact 80% of participants in a recent study referenced by Imes said they search for healthcare information "every few months or less" (Imes, p. 539). The online searcher, looking for healthcare information, tends to be female, tends to be more educated, have a higher income and is on average younger than 65, the authors report. Those searchers also tend to "self-report a poorer health status" than those who don't go online for medical information. The most interesting part of this article is the fact that while almost two-fifths of those who do go online to research healthcare information report that they talk to their doctor about that online information there are many (upwards of 18%) who go online bit do not tell the doctor what they discovered. Why is this so? Imes suggests that some patients fear that the doctor will be disapproving of their self-search for knowledge; some patients in fact withhold information because their doctors frowned on the data they found online.

On the other hand, if a healthcare provider feels his or her authority is being challenged in any way, "negative outcomes such as the poorer quality of healthcare, deterioration in the clinical relationship, and negative patient health outcomes may result" (Imes, p. 539). Among the most often-used reasons for not speaking to one's doctor about what information was found on the Internet was that "…he or she did not trust the quality or the source of health information" (Imes, p. 542). Another frequently used reason was that the information found was just intended as "background material" in preparation for an appointment, and not seen as the end-all to the health issue (Imes, p. 542).

Functionalistic Approach: Talcott Parsons viewed the physician-patient relationship "according to a normative framework defined by the pattern variable scheme" (Heritage, p. 351). The social system that is established through medicine is a normative mechanism, according to the late Parsons, intended to assist those "who fall ill"; the mechanism, if it works in a functionalist way, returns those ill patients to their regular world-related "contributory capacities" (Heritage, p. 352). There are problems with this functionalist approach to understanding patient-doctor relationships, however, because as Parsons understood, the patient's situation is actually an abstraction due to the fact that it was designed just to offer a "general picture" of the patient-physician relationship.

In a more realistic approach to viewing that relationship a functionalist would have to accept that there are a wide and diverse range of kinds of illnesses that patients can be hit with. According to Heritage, the functional importance of institutionalized rituals of medicine, such as those Parsons observed and recorded, have now (since the 1950s) been expanded as the medicalization of patients amounts to a social problem rather than just a medical problem. When Talcott Parsons wrote his functionalist theories about medicine, the country was going through "the golden age of doctoring" -- that is to say, the authority that people in medicine had reached it's peak.

During that era (1945-1965) the "modern doctor" worked his magic within a "sovereign profession" and dispensed "both medication and authoritative judgment"; Freidson (1988) posits that the 1945-1965 window of time medicine and the doctor-patient relationship "was at historically unprecedented peak of prestige, prosperity and political and cultural influence -- perhaps as autonomous as it is possible for a profession to be" (Heritage, p. 353).

Meanwhile the authors of this article suggest that a new approach to functionalism within the patient-doctor milieu is to take a "three-function model" and examine it. The three functions then would be: a) the psychosocial reasons why this person has become a patient, what the illness means to the patient and how the patient is responding to the illness; b) the process by which the doctor is building a "therapeutic relationship" (an alliance in effect) with the patient; and c) the doctor's ability to educate the patient, i.e., not just instructing the patient to take certain medicines and do certain things, but also "determining any areas of conflict between clinician and patient" and working with the "psychological" and "social" consequences of the illness (Heritage, p. 355).

Conflict Theorist Approach: There are many potential situations and scenarios during which conflict can come into play. A research study has been published in the Journal of General Internal Medicine (Breen, et al., 2001) that illustrates conflict theorist dynamics. In a qualitative analysis of six intensive care units at a university medical center -- where life-sustaining treatment was being administered to 102 patients -- some 406 physicians and nurses were conflicted over whether or not to continue life-sustaining services to those 102 patients. The doctor-patient relationship in this case is different than an office call dynamic; still, in interviews with the doctors "at least 1 healthcare provider in 78% of the 102 cases "described a situation coded as conflict" (Breen, p. 1525). The conflict was between a doctor and a family member related to the patient in 48% of the cases; conflict between two family members as to when to "pull the plug" occurred in 24% of the cases (Breen, p. 1525). Conflict over doctor-patient dynamics can be addressed "more constructively" by healthcare professionals by identifying potential sources of conflict at the outset of services to the patient.

Symbolic Interactionist Behavior in Healthcare: When the patient visits the doctor there is an intrinsic symbolic relationship established; there is meaning in the patient reaching out for help from the professional. According to Herbert Blumer there are three premises in this or any symbolic interactionist relationship; one, interaction between human is based on the "meanings" those interactions have for them (in the doctor-patient dynamic, health and help is the primary meaning); two, the language used in this interaction (the result of the interaction, the outcome, based on language) must have symbolic meaning, Blumer explains; if the doctor's conversational style does not convey his message in patient-friendly language there is a failure of symbolic interactionism; and three, the meaning that arises out of the doctor-patient meeting must "be modified through an interpretative process used by the person in dealing with the things he encounters" (Blumer, 1986, p. 2-3).

Deviance and Stratification: When patients, for whatever reason, do not comply with the doctor's considered medical advice, that indicates deviance. According to Donovan, et al., between one-third and one-half "of all patients are non-compliant" (Donovan, 1992). The principle… READ MORE

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