Doctors and the State


Book Description

All advanced health care systems face severe difficulties in financing the delivery of today's sophisticated medical care. In this study David Wilsford compares the health systems in France and the United States to demonstrate that some political systems are considerably more effective at controlling the cost of care than others. He argues that two variables--the autonomy of the state and the strength and cohesiveness of organized medicine--explain this variance. In France, Wilsford shows, the state is strong in the health policy domain, while organized medicine is weak and divided. Consequently, physicians exercise little influence over health care policymaking. By contrast, in the United States the state is weak, the employers and insurers who pay for health care are fragmented, and organized medicine is strong and well financed. As a result, medical professionals are able to exert a greater influence on policymaking, thus making cost control more difficult. Wilsford extends his comparison to health care systems in the United Kingdom, West Germany, Italy, Canada, and Japan. Whether the private or public sector finances health care, he discovers, there is now an important trend in all of the advanced industrial countries toward controlling escalating costs by curbing both the medical profession's clinical autonomy and physicians' incomes.




Doctors and the Law


Book Description

After the American Revolution, the new republic's most prominent physicians envisioned a society in which doctors, lawyers, and the state might work together to ensure public well-being and a high standard of justice. But as James C. Mohr reveals in Doctors and the Law, what appeared to be fertile ground for cooperative civic service soon became a battlefield, as the relationship between doctors and the legal system became increasingly adversarial. Mohr provides a graceful and lucid account of this prfound shift from civic republicanism to marketplace professionalism. He shows how, by 1900, doctors and lawyers were at each other's throats, medical jurisprudence had disappeared as a serious field of study for American physicians, the subject of insanity had become a legal nightmare, expert medical witnesses had become costly and often counterproductive, and an ever-increasing number of malpractice suits had intensified physicians' aversion to the courts. In short, the system we have taken largely for granted throughout the twentieth century had been established. Doctors and the Law is a penetrating look at the origins of our inherited medico-legal system.




The Good Doctors


Book Description

In the summer of 1964 medical professionals, mostly white and northern, organized the Medical Committee for Human Rights (MCHR) to provide care and support for civil rights activists organizing black voters in Mississippi. They left their lives and lucrative private practices to march beside and tend the wounds of demonstrators from Freedom Summer, the March on Selma, and the Chicago Democratic Convention of 1968. Galvanized and sometimes radicalized by their firsthand view of disenfranchised communities, the MCHR soon expanded its mission to encompass a range of causes from poverty to the war in Vietnam. They later took on the whole of the United States healthcare system. MCHR doctors soon realized fighting segregation would mean not just caring for white volunteers, but also exposing and correcting shocking inequalities in segregated health care. They pioneered community health plans and brought medical care to underserved or unserved areas. Though education was the most famous battleground for integration, the appalling injustice of segregated health care levelled equally devastating consequences. Award-winning historian John Dittmer, author of the classic civil rights history Local People: The Struggle for Civil Rights in Mississippi, has written an insightful and moving account of a group of idealists who put their careers in the service of the motto “Health Care Is a Human Right.”




Doctors and Demonstrators


Book Description

Since Roe v. Wade, abortion has continued to be a divisive political issue in the United States. In contrast, it has remained primarily a medical issue in Britain and Canada despite the countries’ shared heritage. Doctors and Demonstrators looks beyond simplistic cultural or religious explanations to find out why abortion politics and policies differ so dramatically in these otherwise similar countries. Drew Halfmann argues that political institutions are the key. In the United States, federalism, judicial review, and a private health care system contributed to the public definition of abortion as an individual right rather than a medical necessity. Meanwhile, Halfmann explains, the porous structure of American political parties gave pro-choice and pro-life groups the opportunity to move the issue onto the political agenda. A groundbreaking study of the complex legal and political factors behind the evolution of abortion policy, Doctors and Demonstrators will be vital for anyone trying to understand this contentious issue.




A New Medical Pluralism


Book Description

First published in 1998. Routledge is an imprint of Taylor & Francis, an informa company.




The Future of Public Health


Book Description

"The Nation has lost sight of its public health goals and has allowed the system of public health to fall into 'disarray'," from The Future of Public Health. This startling book contains proposals for ensuring that public health service programs are efficient and effective enough to deal not only with the topics of today, but also with those of tomorrow. In addition, the authors make recommendations for core functions in public health assessment, policy development, and service assurances, and identify the level of government--federal, state, and local--at which these functions would best be handled.




Conflict of Interest in Medical Research, Education, and Practice


Book Description

Collaborations of physicians and researchers with industry can provide valuable benefits to society, particularly in the translation of basic scientific discoveries to new therapies and products. Recent reports and news stories have, however, documented disturbing examples of relationships and practices that put at risk the integrity of medical research, the objectivity of professional education, the quality of patient care, the soundness of clinical practice guidelines, and the public's trust in medicine. Conflict of Interest in Medical Research, Education, and Practice provides a comprehensive look at conflict of interest in medicine. It offers principles to inform the design of policies to identify, limit, and manage conflicts of interest without damaging constructive collaboration with industry. It calls for both short-term actions and long-term commitments by institutions and individuals, including leaders of academic medical centers, professional societies, patient advocacy groups, government agencies, and drug, device, and pharmaceutical companies. Failure of the medical community to take convincing action on conflicts of interest invites additional legislative or regulatory measures that may be overly broad or unduly burdensome. Conflict of Interest in Medical Research, Education, and Practice makes several recommendations for strengthening conflict of interest policies and curbing relationships that create risks with little benefit. The book will serve as an invaluable resource for individuals and organizations committed to high ethical standards in all realms of medicine.




Medical Licensing and Discipline in America


Book Description

Medical Licensing and Discipline in America traces the evolution of the U.S. medical licensing system from its historical antecedents in the 18th and 19th century to its modern structure. David A. Johnson and Humayun J. Chaudhry provide an organizational history of the Federation of State Medical Boards within the broader context of the development of America’s state-based system. As the national organization representing the interests of the individual state medical boards, the Federation has been at the forefront of developments in licensing, discipline, and regulation impacting the medical profession, medical education, and health policy within the United States. The narrative shifts between micro- and macro-level developments in the evolution of America’s medical licensing system, blending national context with state-specific and Federation initiatives. For example, the book documents such milestones as the national shift toward greater public accountability by state medical boards as evidenced by California’s inclusion of public members on its medical board, New Mexico’s requirement for continuing medical education by physicians as a condition for license renewal and the Federation’s policy development work advocating for both initiatives among all state medical boards. The book begins by examining the 18th and 19th century origins of the modern state-based medical regulatory system, including the reinstitution of licensing boards in the latter part of the 19th century and the early challenges facing boards, e.g., license portability, examinations, physician impostors, inter-professional tensions among physicians, etc. Medical Licensing and Discipline in America picks up the story of the Federation and its role in the major issue of licensing and discipline in the 20th century: uniformity in medical statute, evaluation of international medical graduates, nationally administered examinations for licensure, etc.




How Doctors Think


Book Description

On average, a physician will interrupt a patient describing her symptoms within eighteen seconds. In that short time, many doctors decide on the likely diagnosis and best treatment. Often, decisions made this way are correct, but at crucial moments they can also be wrong—with catastrophic consequences. In this myth-shattering book, Jerome Groopman pinpoints the forces and thought processes behind the decisions doctors make. Groopman explores why doctors err and shows when and how they can—with our help—avoid snap judgments, embrace uncertainty, communicate effectively, and deploy other skills that can profoundly impact our health. This book is the first to describe in detail the warning signs of erroneous medical thinking and reveal how new technologies may actually hinder accurate diagnoses. How Doctors Think offers direct, intelligent questions patients can ask their doctors to help them get back on track. Groopman draws on a wealth of research, extensive interviews with some of the country’s best doctors, and his own experiences as a doctor and as a patient. He has learned many of the lessons in this book the hard way, from his own mistakes and from errors his doctors made in treating his own debilitating medical problems. How Doctors Think reveals a profound new view of twenty-first-century medical practice, giving doctors and patients the vital information they need to make better judgments together.




Doctors' Orders


Book Description

The United States does not have enough doctors. Every year since the 1950s, internationally trained and osteopathic medical graduates have been needed to fill residency positions because there are too few American-trained MDs. However, these international and osteopathic graduates have to significantly outperform their American MD counterparts to have the same likelihood of getting a residency position. And when they do, they often end up in lower-prestige training programs, while American-trained MDs tend to occupy elite training positions. Some programs are even fully segregated, accepting exclusively U.S. medical graduates or non-U.S. medical graduates, depending on the program’s prestige. How do international and osteopathic medical graduates end up so marginalized, and what allows U.S.-trained MDs to remain elite? Doctors’ Orders offers a groundbreaking examination of the construction and consequences of status distinctions between physicians before, during, and after residency training. Tania M. Jenkins spent years observing and interviewing American, international, and osteopathic medical residents in two hospitals to reveal the unspoken mechanisms that are taken for granted and that lead to hierarchies among supposed equals. She finds that the United States does not need formal policies to prioritize American-trained MDs. By relying on a system of informal beliefs and practices that equate status with merit and eclipse structural disadvantages, the profession convinces international and osteopathic graduates to participate in a system that subordinates them to American-trained MDs. Offering a rare ethnographic look at the inner workings of an elite profession, Doctors’ Orders sheds new light on the formation of informal status hierarchies and their significance for both doctors and patients.