Hospital sociology

COMMUNITY MEDICINE FOR UNDERGRADUATES

1. HOSPITAL SOCIOLOGY -----ANJANA.B.S.

2. An examination from a social point of view of hospitals, of medical personnel and of the utilization of medical services. The modern hospital is a social universe with a multiplicity of goals, profusion of personnel and extremely fine division of labour. The care of the patient is the master value …..and the patient is the hospital’s client…..

3. SOCIAL STRUCTURE OF A HOSPITAL A hospital is not a static organization, subject to change in structure and function depending upon changes which occur in community. Historically, hospital was more nearly a place of refuge for the sick and homeless , than a place for medical treatment . It was a charitable institution where one went to die rather than to be cured. In the 19 th century , hospitals were occupied by poor and old patients.

4. 100 YEARS AGO…………,

5. In contrast , hospitals today are concerned with active medical treatment, mobilizing all that is latest in medical to produce a cure. Hospitals today are occupied by all classes of people. The shift in the type of patients occupying hospitals has led to a new doctor-patient relationship. There is an increasing demand for higher academic qualifications which was not typical of the earlier medical organisation of the 19 th century.

6. THE MOST MODERN………,

7. The other functions performed by hospitals are teaching either medical or nursing personnel and research designed to increase medical knowledge in which the patient is of secondary importance. The hospital today is a system of increasing complexity _it is a hotel and a school , a laboratory and a stage set for treatment – employing a large number of medical and paramedical personnel. The greatest challenge is one of coordination. It requires an administrative machinery to run the hospital smoothly and to avoid conflicts b/w administrative and professional staff and b/w professionals.

8. The service of the doctor in his private chamber tends to differ from that given in a public clinic not only in the time spent for case examination but in interpersonal attitudes. It is said that each hospital has a “ personality” of its own – a tempo of work and an emotional atmosphere peculiar to a given hospital, its traditions, its community of staff and patients. Even the nature of the staff relationships will influence the staff-patient relationships and consequently the outcome of therapy.

9. MEDICAL PROFESSION The medical profession, like any other occupational group is distinguished by certain characteristics . There is a professional body which controls the right to practice. In India, the Indian Medical Council Act was passed in 1933 to establish uniform standards of medical education in the country. A revision of the Act was made in 1956,which provides , in addition , for the maintenance of the All India Medical Register.

10. The State Medical Councils control the right to practice and certain standards of practice and personal conduct are imposed upon its members. There is great insistence of maintenance of confidentiality, and right to practice medicine is withdrawn if there is professional misconduct. In other words, the State is regulating the relationship between professional men and their clients. The abolition of private practice by Government doctors is an example of recent conflict.

11. MEDICAL CARE - AN INDUSTRY ? The development of new diagnostic and therapeutic techniques require not only large capital investment but also skilled team of personnel. There is a rapid development of insurance and other types of pre-payment . Now it is a national policy in many countries to make the best of known medical care available to all who need it regardless of economic status. Sociologically speaking , medical care has the features similar to big industry.

12. SPECIALIZATION

13. The vast increase of medical knowledge during the 20 th century has contributed to specialization in medicine . There are at present no less than 20 recognised specialities and many more sub-specialities. Specialisation has created problems for the traditional doctor-patient relationships & the specialist does not establish close relationship with patient. Besides, specialization has encouraged jurisdictional disputes b/w one speciality & another and b/w specialists & generalist.

14. DOCTOR –PATIENT RELATIONSHIP An important area of medical sociology is doctor-patient relationship in which complex social factors are implicated By virtue of his technical superiority , knowledge and skill, the doctor exercises an authoritative role and issues “orders” to his patient . Some individuals may not be prepared to invest the doctor with full authority, this may lead to conflict b/w the doctor and patient.

15. Besides technical competence, the doctor must know how to communicate with his patient and 3 levels of communication have been described: (1) Communication on an emotional plane: The doctor must give a sympathetic ear to the complaints made by the patient and his relatives. This is necessary to establish a quick rapport . The reason why folk medicine is successful is because the patient and his relatives feel they can talk more freely to a folk medical practitioner than with the modern physician. (2) Communication on a cultural plane: Secondly, the doctor should be aware of the general concepts of culture and social organisation of the community with which he is dealing. This helps to acquire certain “flexibility” in his dealings with patients.

16. The reason why the indigenous and folk systems of medicine are successful in the rural areas is because they are part of the total way of life of the people : treatment is based mostly on charity, and payment to the physician may be in kind , and the medicines are prepared from ordinary plants common to the region. Against this background, the western system of medicine is alien to the cultural patterns of the rural folk. To be successful, the modern doctor should couch his scientific advice in terms which fit an already existing cultural pattern. (3) Communication on an intellectual plane : Practitioners of modern medicine come from well-to-do-families . By their education and training, they tend to be sophisticated . This leaves a wide gap b/w the intellectual level of the practitioners of modern medicine and the illiterate masses.

17. In other words, there is an enormous “ social distance” b/w the two groups. The doctor who is able to communicate with his patient on these 3 planes is bound to give maximum psychological satisfaction to his patients. The other qualities which mar the reputation of a doctor are his greed for money , differential treatment b/w the rich and poor & lack of a sympathetic and friendly attitude. The patient can challenge the doctor’s professional adequacy if the doctor does not know how to communicate .

18. Medicine and nursing have common goals – the preservation and restoration of health. The primary role of medicine comprises diagnosis and treatment – the “cure” process. In contrast, the primary role of nursing lies in the “care” process – consisting of caring , helping. In the medical care team,the physician tends to be autocratic & looks upon the nurse primarily as his helper following his orders. Because of the physician’s authoritarian role, the role of the nurse go largely unrealized. But now as the technology is advancing , the nurse takes up tasks instrumental to diagnosis & treatment. Currently , both doctors & nurses are exploring new approaches & roles to provide improved patient care............. Doctor-nurse Relationship