The Social Transformation of American Medicine


Book Description

Winner of the 1983 Pulitzer Prize and the Bancroft Prize in American History, this is a landmark history of how the entire American health care system of doctors, hospitals, health plans, and government programs has evolved over the last two centuries. "The definitive social history of the medical profession in America....A monumental achievement."—H. Jack Geiger, M.D., New York Times Book Review




Social Medicine and the Coming Transformation


Book Description

Social medicine, starting two centuries ago, has shown that social conditions affect health and illness more than biology does, and social change affects the outcomes of health and illness more than health services do. Understanding and exposing sickness-generating structures in society helps us change them. This first book providing a critical introduction to social medicine sheds light on an increasingly important field. The authors draw on examples worldwide to show how principles based on solidarity and mutual aid have enabled people to participate collaboratively to construct health-promoting social conditions. The book offers vital information and analysis to enhance our understanding regarding the promotion of health through social and individual means; the micro-politics of medical encounters; the social determination of illness; the influences of racism, class, gender, and ethnicity on health; health and empire; and health praxis, reform, and sociomedical activism. Illustrations are included throughout the book to convey these key themes and important issues, as well as on Routledge’s webpage for the book, under the Support Materials tab. The authors offer compelling ways to understand and to change the social dimensions of health and health care. Students, teachers, practitioners, activists, policy makers, and people concerned about health and health care will value this book, which goes beyond the usual approaches of texts in public health, medical sociology, health economics, and health policy.




For-Profit Enterprise in Health Care


Book Description

"[This book is] the most authoritative assessment of the advantages and disadvantages of recent trends toward the commercialization of health care," says Robert Pear of The New York Times. This major study by the Institute of Medicine examines virtually all aspects of for-profit health care in the United States, including the quality and availability of health care, the cost of medical care, access to financial capital, implications for education and research, and the fiduciary role of the physician. In addition to the report, the book contains 15 papers by experts in the field of for-profit health care covering a broad range of topicsâ€"from trends in the growth of major investor-owned hospital companies to the ethical issues in for-profit health care. "The report makes a lasting contribution to the health policy literature." â€"Journal of Health Politics, Policy and Law.




Communities in Action


Book Description

In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.




The Systems Work of Social Change


Book Description

The issues of poverty, inequality, racial injustice, and climate change have never been more pressing or paralyzing. Current approaches to social change, which rely on linear thinking and traditional power dynamics to 'solve' social problems, are not helping. In fact, they may only beentrenching the status quo.Systemic social challenges produce bewildering results when we try to solve them due to their complexity, scale, and depth. While strategies to tackle complexity and scale have received significant attention and investment, challenges that arise from deeply-held beliefs, values, and assumptions thatno longer serve us well have been largely overlooked. This book draws on stories of committed social changemakers to uncover a set of principles and practices for social change that dramatically depart from the industrial approach. Rather than delivering solutions or being lured by grander visionsof 'systems change', these principles and practices focus on the process of change itself. Simple yet profound, these stories distil a timely set of lessons for leaders, scholars, and policymakers on how connection, context, and power sit at the heart of the change process, ensuring broader agencyfor people and communities while building social systems that are responsive in a rapidly-changing world.




Unequal Treatment


Book Description

Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received. In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients' and providers' attitudes, expectations, and behavior are analyzed. How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve provider-patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.




Therapeutic Revolutions


Book Description

When asked to compare the practice of medicine today to that of a hundred years ago, most people will respond with a story of therapeutic revolution: Back then we had few effective remedies, but now we have more (and more powerful) tools to fight disease, from antibiotics to psychotropics to steroids to anticancer agents. This collection challenges the historical accuracy of this revolutionary narrative and offers instead a more nuanced account of the process of therapeutic innovation and the relationships between the development of medicines and social change. These assembled histories and ethnographies span three continents and use the lived experiences of physicians and patients, consumers and providers, and marketers and regulators to reveal the tensions between universal claims of therapeutic knowledge and the actual ways these claims have been used and understood in specific sites, from postwar West Germany pharmacies to twenty-first century Nigerian street markets. By asking us to rethink a story we thought we knew, Therapeutic Revolutions offers invaluable insights to historians, anthropologists, and social scientists of medicine.




The Changing Face of Medicine


Book Description

The number of women practicing medicine in the United States has grown steadily since the late 1960s, with women now roughly at parity with men among entering medical students. Why did so many women enter American medicine? How are women faring, professionally and personally, once they become physicians? Are women transforming the way medicine is practiced? To answer these questions, The Changing Face of Medicine draws on a wide array of sources, including interviews with women physicians and surveys of medical students and practitioners. The analysis is set in the twin contexts of a rapidly evolving medical system and profound shifts in gender roles in American society. Throughout the book, Ann K. Boulis and Jerry A. Jacobs critically examine common assumptions about women in medicine. For example, they find that women's entry into medicine has less to do with the decline in status of the profession and more to do with changes in women's roles in contemporary society. Women physicians' families are becoming more and more like those of other working women. Still, disparities in terms of specialty, practice ownership, academic rank, and leadership roles endure, and barriers to opportunity persist. Along the way, Boulis and Jacobs address a host of issues, among them dual-physician marriages, specialty choice, time spent with patients, altruism versus materialism, and how physicians combine work and family. Women's presence in American medicine will continue to grow beyond the 50 percent mark, but the authors question whether this change by itself will make American medicine more caring and more patient centered. The future direction of the profession will depend on whether women doctors will lead the effort to chart a new course for health care delivery in the United States.




The Politics of Medical Encounters


Book Description

The complaints that patients bring to their doctors often have roots in social issues that involve work, family life, gender roles and sexuality, aging, substance use; or other problems of nonmedical origin. In this book, physician/sociologist Howard Waitzkin examines interactions between patients and doctors to show how physicians' focus on physical complaints often fails to address patients' underlying concerns and also reinforces the societal problems that cause or aggravate these maladies. A progressive doctor-patient relationship, Waitzkin argues, fosters social change. Waitzkin provides a pathbreaking analysis of medical encounters, applying perspectives from structuralism, post-structuralism, and critical literary theory to transcripts of recorded conversations between doctors and patients. He demonstrates how doctors unintentionally maintain dominance in their dealings with patients, encourage conforming social behavior and attitudes, and marginalize patients' concerns with social problems. Waitzkin urges physicians to attend to the social as well as the medical problems that emerge from patients' narratives and suggests ways to restructure the manner in which patients and doctors communicate with each other. Physicians and patients, for example, should work together to demystify medical discourse, should refrain from medicalizing social problems through medications or reassurances that dull socially caused pain, and should be prepared to call on advocacy organizations seeking to change the social conditions that create personal distress. This book will influence and challenge physicians scholars, and students in the social sciences and humanities, as well as anyone concerned about the present problems and future direction of medicine.




Taking Action Against Clinician Burnout


Book Description

Patient-centered, high-quality health care relies on the well-being, health, and safety of health care clinicians. However, alarmingly high rates of clinician burnout in the United States are detrimental to the quality of care being provided, harmful to individuals in the workforce, and costly. It is important to take a systemic approach to address burnout that focuses on the structure, organization, and culture of health care. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being builds upon two groundbreaking reports from the past twenty years, To Err Is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century, which both called attention to the issues around patient safety and quality of care. This report explores the extent, consequences, and contributing factors of clinician burnout and provides a framework for a systems approach to clinician burnout and professional well-being, a research agenda to advance clinician well-being, and recommendations for the field.