Dissociation in medical practice: Social distress and the health care system

The average physician has developed several different heads, each representing another self on the same body. One is that of the conventional, ethical professional who wants nothing more than to improve mankind's health and well-being, the standard model. Another is the scientist who intends to be perceived as calculating, cold, and factual in determining what will or will not assist the ailing patient (Uexkull & Hannes, 1986). His tools are drugs, surgery, and hospitalization for presumed physical and mental ills. The third, and the one that concerns us the most, is what I will call the neo-capitalist professional hero (Lifion, 1971). This persona is an evolution of our American dominated international culture which the medical profession as a group has honored by honing and polishing with extraordinary skill, second only to politicians and bankers, maximizing it to the further detriment of the entire society. Though the body needs all three to function, none of these heads willingly acknowledges or supports the importance of the others. In what follows, a variety of media, journals, professional books, and a survey are referred to in documenting data about ethical laxity and fraud in the medical profession. Institutional, social concepts are developed that explain the data, and revealing how social distress is the embodiment of the neo-capitalist professional hero. There are also suggestions for remedies in what follows, which are presented without realistic hope for implementation very soon, unfortunately, since they involve deep changes in established social institutions. However, the country at large has developed some awareness of a problem which has reached epidemic proportions in the medical profession. Further increments in awareness promise to tip the balance into positive government action.     

"Macho men" and preventive health care: implications for older men in different social classes

The gender paradox in mortality--where men die earlier than women despite having more socioeconomic resources--may be partly explained by men's lower levels of preventive health care. Stereotypical notions of masculinity reduce preventive health care; however, the relationship between masculinity, socioeconomic status (SES), and preventive health care is unknown. Using the Wisconsin Longitudinal Study, the authors conduct a population-based assessment of masculinity beliefs and preventive health care, including whether these relationships vary by SES. The results show that men with strong masculinity beliefs are half as likely as men with more moderate masculinity beliefs to receive preventive care. Furthermore, in contrast to the well-established SES gradient in health, men with strong masculinity beliefs do not benefit from higher education and their probability of obtaining preventive health care decreases as their occupational status, wealth, and/or income increases. Masculinity may be a partial explanation for the paradox of men's lower life expectancy, despite their higher SES.     

Quality of medical care by central government health scheme--a study

This study reports findings on the time spent by CGHS medical officers per patient in different medical care activities for 2,115 patients, as obtained by time study technique. This study was conducted during the year 1976-77. The average observed time spent by the medical officer per patient was found to be 117.15 seconds per patient. The medical officers elicited only main complaints without asking past and family history in 84.44 per cent of patients and the average time spent on history taking was 42 seconds per patient which also included examination of identify card, recording of name, age and sex of the patients. Physical examinations were conducted in only 23.88 per cent of patients and the time spent per patient was 45.93 seconds. The advice for investigations was imparted in 2.60 per cent of patients, though the facilities for routine laboratory examinations were available in the dispensaries. Advice to the patient regarding dietary instructions and general advice was exclusively given in only 5.20 per cent of cases whereas the family planning/health education advice to the patients was given only in 0.76 per cent of patients. The medical officers are aware of the inadequate quality of medical care provided to the beneficiaries and they felt they should at least spend 6.83 minutes for an old patient and 12.42 minutes for the new patient. Probably they are not able to do so because of long queues in the dispensaries during peak hours. Hence, to improve the overall medical care and provide comprehensive care to the beneficiaries it is suggested that the medical officers can be given certain beneficiary population and made responsible to them.     

Behaviorally caused loss of health and the use of medical care

This paper extends the analysis of the demand for medical care to an aspect which has previously been ignored: variations in expected, as opposed to experienced, cause of losses of health and the current use of medical care. Losses of health which cannot be prevented by the prior use of medical care are hypothesized to decrease the use of medical care by reducing the rate of return to investments in health, ceteris paribus. The reduction in the rate of return occurs both because these losses curtail the length of the stream of benefits to the use of medical care and because prior use of medical care is not effective in reducing the occurrence of these types of loss. Empirical findings support this hypothesis. Results suggest that differences in expected losses may account for some of the differences in utilization of medical care by sex.     

A joy or a hassle: child health care in a multi-ethnic society

SUMMARY. This paper draws on data from a qualitative study carried out of 33 households and 28 health visitors to explore mothers' perspectives on childcare. The sample of mothers reflects the multi-ethnic character of the inner London area they live in. The paper explores the extent to which these women, from a wide range of backgrounds, shared common priorities, concerns and perspectives on childcare and childhood; and examines differences between groups of women and factors associated with patterns of difference. It concludes with the challenge this sample of women presents to social attitudes, policies and practices in the UK     

The use of injections for treating childhood diseases: determinants and consequences for preventive health care in developing countries

The author reports findings from an assessment of the extent to which injections are used by mothers in Ghana, Kenya, Uganda, and Zimbabwe to treat cough and fever in their children as well as the factors which influence their use. Two rationales are presented for conducting the study. First, the prevalence of HIV infection in many countries and the potential for infection using contaminated needles points to the need to minimize injections except when necessary and under only the most sterile conditions. Second, participation by intended groups in immunization programs has been less than complete, partly due to mothers' fear of the link between injections and subsequent paralysis in children documented in the literature since 1950. Knowledge on which factors determine parents' use of injections for treating childhood diseases could be used to help convince parents that injections for immunization against childhood diseases are beneficial. The author applied the Andersen Behavioral framework of predisposing, enabling, and need factors to Demographic and Health Survey (DHS) data collected in the four countries during 1988 and 1989. Nationally representative sample sizes ranged from 4201 respondents in Zimbabwe to 7150 respondents in Kenya. Morbidity data were collected from the mother for all living children under five years of age using a standard questionnaire. The percentages of children reported to have had cough or difficult breathing in the four weeks preceding the survey are as follows: 20.6% in Ghana, 17.5% in Kenya, 22.2% in Uganda, and 48.0% in Zimbabwe. Children aged 6-11 showed the highest prevalence of respiratory symptoms followed by children aged 12-23 months. The prevalences of fever during the four weeks preceding the survey were 36.4% in Ghana, 42.7% in Kenya, 44.2% in Uganda, and 7.0% in Zimbabwe. The prevalence rates of fever were higher among children aged 6-11 months and markedly lower among children aged 1-5 months. Prevalences of respiratory problems and fever were both considerably higher in rural areas than in urban areas. Approximately 20% of children with respiratory problems and 30% of children with fever were treated with injections. Multivariate analyses found that the effects of predisposing and enabling characteristics upon the use of injections were consistently higher than those of the need component, suggesting the existence of great inequities in the health care system. Previous research has found that such injections are often given by various people including untrained health personnel, itinerant drug peddlers, traditional healers, and new forms of injection doctors who specialize in giving all types of injections. Such practice combined with the fact that injection drugs can be bought over the counter demands the tighter control of drug sales and drug reform in these countries. Health education programs for consumers are also called for.     

The Durham Family Initiative: a preventive system of care

This article describes the Durham Family Initiative (DFI), an innovative effort to bring together child welfare and juvenile justice systems to reach DFI's goal of reducing the child abuse rate in Durham, North Carolina, by 50% within the next 10 years. DFI will follow principles of a preventive system of care (PSoC), which focuses on nurturing the healthy parent-child relationship. A community collaborative of government agency directors has signed a memorandum of agreement to implement the PSoC principles. The researchers will use multiple methods to evaluate DFI's efficacy.     

Personal resources and depression in the transition to adulthood: ethnic comparisons

Based on a representative sample of 1,803 South Florida young adults, we examine the extent to which personal attributes mediate or moderate the ethnicity-depression relationship and condition the effects of social stress on depression. Our sample contains nearly equal proportions of African American, Cuban American, "other" Hispanic, and non-Hispanic white respondents. Findings suggest that there are ethnic variations in four of the five personal resources considered. Additionally, when accounting for ethnic differences in response tendencies and in the confounding of personal resources with depression, there is strong evidence for both direct and stress-buffering effects of personal resources. Although na?ve comparisons of within group findings imply a number of ethnic variations in those effects, few statistically significant differences are observed. It is suggested that ethnic similarities outweigh differences, at least with respect to the mental health significance of the personal resources considered. Overall, the results highlight some of the complexities inherent in making multi-ethnic comparisons.     

Personal empowerment program: addressing health concerns in people with schizophrenia

Three staff nurses in the Outpatient Schizophrenia Service of the Foothills Medical Centre in Calgary, Alberta, Canada, became concerned about the weight gain of their patients. Patients and their family members were also concerned and asking for help. Before integrating a program to address these concerns, staff first had to demonstrate that a program of this nature would be beneficial for clinic patients. Of the 75 clients screened, many presented with problems in the areas of weight, blood pressure, and fasting blood sugar and lipid levels. Although not a research study, an 8-month pilot project was implemented to address these concerns. It was hypothesized that integrating all dimensions of wellness in patient programming would have a positive effect on various defined indicators (e.g., weight, body mass index, blood pressure, and fasting blood sugar and lipid levels). Screening tests before, during, and after the 8-month project provided the physical outcome measurements. Social and psychological outcomes were described through observation and group member feedback. The positive results are significant in terms of empowering patients in the long-term management of their health.     

Mental health support needs of people with a learning difficulty: a medical or a social model?

People with learning difficulties, like all disabled people, face social oppression. Much recent policy and practice are underpinned by at least some understanding of this oppression, and the social model of disability has been influential in discussions of services and supports for people with learning difficulties. However, in the area of mental health, the picture is somewhat different. This paper argues that the medical model has predominated in discussions of mental health support for people with learning difficulties, and that a social model approach could have much to offer. The paper draws on an ongoing action research study in which service providers, families and young people with learning difficulties are working together to articulate what is needed, in order to find routes to improve the support offered to young people with learning difficulties and mental health support needs.