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Hospital Sociology:
Social structure of a hospital:
- Hospitals are among the most complex organizations in
modern society.
- Hospitals are dynamic organization( not static) , change
according to change in the community.
- In the past ( before100 years ago), hospitals were more
nearly a place of refuge for the sick and homeless rather
than a place for medical treatment, It was an institution
where one went to die rather than to be cured, and they
were occupied by poor and old people.
- In contrast, hospitals now are concerned with active
medical treatment using the latest medical advances to
cure the patients. They are occupied by all classes of
people.
* Now there is an increasing demand for higher academic
qualifications, and no doctor today can provide singlehanded all the skills and facilities needed for treatment.
Functions of hospitals:
1. Pace for the diagnosis, treatment and rehabilitation of
sick people.
2. Teaching either medical or nursing personnel.
3. Areas for medical researches to increase medical
knowledge.
4. Are places for employment of huge no. of medical and
paramedical persons.
* The hospital today is a system of increasing complexityit is a hotel and a school, a laboratory and a stage set for
treatment and employment.
The hospital is like a federal system with several •
departments each having a special system of its
management.
The great challenge is one of coordination between
different parts of the hospital, it requires an administrative
machinery to run the hospital smoothly and to avoid
conflicts between administrative and professional staff,
because if large portion of a group is dissatisfied , the
whole system of the hospital will break down.
* Each hospital has a " personality" of its own. The nature
of the staff relationships will influence the staff-patient
relationships and consequently the outcome of therapy, It
is for this reason there are different atmospheres in
different hospitals, some have a good name, others a bad
name.
The democratic ideal has certainly not yet been achieved •
in medicine because of the followings:
1. The structure of the wards, semi-private and private
rooms in hospitals is an obvious reflection of class lines.
2. The service of the doctor in his private chamber tends to
differ from that given in a public chamber, not only in time
spent for examination but in interpersonal attitudes.
3. Bureaucratic authority still the characteristic feature of
the doctor's communication with patients, doctors, and
other medical and paramedical personnel, because there is
no communication skills curricula in medical teaching till
now in many medical schools.
Medical profession:
Medical profession like any other occupational group is
distinguished by certain characteristics, and because this profession
(medical) is concerned with the health of human it should be
controlled by:
- Professional body which controls the right to practice.
- The license to practice is embodied in the legislation ,
and is given to those have reached a level of competence
that is considered minimum.
- There must be a State Medical Councils, to control the
right to practice, and to determine certain standards in
practice.
- The confidentiality and the right to practice medicine is
withdrawn if there is professional misconduct.
- In summary, the state must control the relationship
between medical professionals and the clients.
Some of the possible conflicts in the medical profession may •
happen from the rules and regulations to which they are bound, as
e.g. the abolition of private practice by Government doctors.
Medical care- an Industry?
In the past, the traditional physician was a self-employed
small businessman, with many of the same problems,
goals and attitudes as other small businessman. His
practice was solo-practice based on "fee-for service".
Now, significant changes have taken place, in the
practice of medicine, The development of new
diagnostic and therapeutic techniques requires not only
large capital investment but also skilled team of
personnel.
Sociologically speaking , medical care has the features
similar to, big industry.
Specialization:
The vast increase of medical knowledge during the 20th
century has contributed to specialization in medicine.
There are at present now not less than 20 recognized
specialties and many more subspecialties. A specialist is
defined as " one who learns more about less and less" he is
concerned with one part or organ in the body as opposed
to the traditional practitioner or " family doctor" who is
concerned with the " whole person" or even the family.
The problems here are:
- Specialists do not establish effective and close doctorpatient relationship.
- Specialization encourages jurisdictional disputes
between one specialist and another and between specialist
and generalist.
Doctor- patient relationship:
It is one of the important part of Medical knowledge,
skills and attitudes that doctor must has in order to be a
good doctor and to provide the best heath services to the
patient.
Levels of communications:
1. Communication on an emotional plane: The doctor
must give a sympathetic ear to the complaints made by the
patient and his relatives and treats the patient as human
not as a case " the uniqueness of every patient".
2. Communication on a cultural plane: The doctor should
be aware of the general concepts of culture and social
organization of the community with which he is dealing.
3. Communication on an intellectual plane: The doctor
must reduce the social gap between him and illiterate
patients and make the patient talks freely with him.
Doctor- Nurse Relationship:
Medicine and nursing have common goals→ preservation
and restoration of health. Yet their roles in achieving that
are different.
Primary role of medicine → diagnosis and treatment ( cure
process).
Primary role of nursing → caring, helping, comforting and
guiding ( care process).
* Physicians because of authoritarian role tend to be
autocratic and look upon the nurse primarily as their
helper, following their orders and carrying out whatever
they choose to delegate. This in a whole → conflicts in
nursing duty, and finally lead to that many of patient's
psychological needs persist unidentified and unmet.
The guidelines for good doctor- nurse relationships are:
1. The doctor should regard the nurse as a member of
medical team and not like only a helper for his duty.
2. The doctor should maintain good communication skills
with all medical and paramedical staff in addition to
patients.
3. The doctor should take the nurse's notes regarding
patient emotion and conditions seriously in order met
patient's psychological needs.
4. The doctor should usually educate the nurse medically
as much as possible.
Medical Social Work:
Medical social work has grown into an important field of
social work and an integral part of medicine.
Medical social works uses " case work" as its main
technique to find out the social background of illness, this
information helps the doctor in arriving at a social
diagnosis, treating illness and estimating the prognosis.
The purpose of medical social work is to help sick people
– individuals by individual . the person who best can do
this is one who had special training in social case work "
medical social worker".
Employments of medical social worker:
1. Hospitals.
2. Tuberculosis clinics.
3. Family planning clinics.
4. Cancers control centers.
5. Mental health centers.
6. Maternal and child welfare.
7. School and university health services.
Medical social worker forms a link between medical
institutions and the community, visit the family and search
for best solution for patients through their social situations.
His importance as the importance of nurse for the doctors.
From Medical ethics to social ethics:
Along the whole medical history , there are three main stages which
represent the relationship between medicine and humanity:
1. Stage of Hippocrates ideal: At the beginning of human history,
physicians treated patients with the primitive medicine based on
humoral physiology but with very effective communication skills
ensuring the uniqueness of the patient and the doctor at that time act
as a servant or barber.
2. Stage of medical advances: begins in early 19th century up to
middle of 20th century, Where medical advances were huge , medical
knowledge was not subjected to suggestions, doctors became highly
authorotized over patient, and patients became treated as cases or
even as lab animal.
3. Stage of human rights: begins from middle of 20th
century till now, after recognition of human rights and
freedoms, and of individual autonomy. Many medical
choices can no longer be made on the basis of medical
science. The patient now can share in medical decision ,
even replace his physician if not believe in him. In 1948,
The General Assembly of the United Nations adopted The
Universal Declaration of Human Rights.
* Researchers have a particular ethical responsibilities to
safeguard the rights of people and to observe the ethical
principles benefits, avoidance of harm and justice.
Consumer Protection Act:
Over the centuries, the medical profession has been
accorded respect by the society. Since last decade or so ,
increasing commercialization of the profession has eroded
this faith. The patient can now claims the doctor or the
health institution in the court for bad treatment.
COPRA is a piece of comprehensive legislation and
recognizes 6 rights of the consumer, namely:
1. Right to safety.
2. Right to be informed.
3. Right to choose.
4. Right to be heard.
5. Right to seek redress.
6. Right to consumer education.
* Although the medical community is fighting against the
inclusion of medicine under COPRA, it is here to stay. The
medical profession can not wish it away.
* It is found that by new researches that 90 to 95% medical
malpractice claims can be avoided only by good
communication skills with patients even when severe
complications after medical treatment have been made.