HOSPITAL SOCIOLOGYKingsuk Sarkar, MD

Asst. Professor

Dept. of Community Medicine

DSMCH

• Modern hospital is a social universe

• Multiplicity of goals• Profusion of personnel• Fine division of labor• Patient is hospital’s client

Structure:- Dynamic in structure & function- Consistent with changes in

community- Evolution of hospital: from a

charitable institution to take last refuge, to take last breath

Institution concerned with active medical treatment in liaison with modern medical sciences

- Provision of teaching to medical & nursing personnel

- Research activities designed to increase medical knowledge

- Hospital today function as : Hotel, School, Laboratory, A large set up for treatment

- Administrative machinery runs the hospital & tries to diffuse conflicts between administrative & professional staff

- Democratic ideals not has been achieved in hospital structure: wards, semi- private, private rooms represents class division

- Each patients expects TLC from hospitals

- Each hospital has its ambience, work-culture, emotional atmosphere, staff patterns, community served by it

Role of Medical Profession

- An occupational group- Distinguished by certain

characteristics - Professional body controls the right to

practice- License to practice embodied in

legislation- Awarded to those with a certain level

of competence- Indian Medical Council Act passed on

1933, revised 1956-

- Maintenance of all India registrar

- State Medical Councils controls the right to practice

- Certain standards of practice & personal conducts are imposed

- Professional misconduct→ rights to practice medicine is withdrawn

Evolution of Healthcare Industry

o Traditional Physician: self employed small businessman having “solo-practice” & charging fee

o Development of diagnostic & therapeutic techniques→ involvement of skilled manpower & large scale investment→ large non-medicos involved

o Longstanding practice of subsidizing medical education & medical care

o Rapid development of insurance & other prepayment financial facilities

o Demand for provision of best possible health care for all irrespective of financial status

o Medical education with knowledge, experience, dedication may lead the way to develop better future

Fields of specialization:o Many recognized specialties &

sub-specialtieso Less interpersonal contact

between doctor & patiento ↑jurisdictional disputes

between specialties, between specialist & generalist

o Specialization→ divides doctor & patient, de-personification, social role of medicine is forgotten, lopsided development of health sciences, strained traditional doc- pt relationship

Doctor- Patient Relationshipo Doctor possesses technical

superiority, knowledge, skillo Doctor exercises authoritative role

over patient Levels of Communication between

doctor & patient:

i. Communication on emotional plane:

ii. Communication on cultural plane: awareness on culture & social organization of the community

iii. Communication on intellectual plane: reduction of social distance between doctor & patient

o Doctor’s ability to communicate patients on all three planes brings out maximal psychological satisfaction to the patient

Qualities sullying reputation of a doctor:

- Lack of sympathy- Unfriendly- Greedy- Differentiating between rich & poor Patient not behaving up to doctor’s

expectation→”un-cooperative”

Doctor-Nurse Relationshipo Medicine & Nursing share common goal

o preservation & restoration 0f healtho The primary role of medicine →

diagnosis & treatment ═ cureo The primary role of nursing →care

↔caring, helping, comforting, guidingo Doctor assumes authoritarian role→

role of nurse get unnoticedo Nurses to take up more instrumental

role pertaining to treatment & diagnosis

Medical Social Work- a sub-discipline of social work- also known as “Hospital Social Work”- Began in 1895 in England through

Almoner- Main technique- “case work”- Finds out social background of illness,

helps doctor in social diagnosis, treatment, concluding prognosis

- Main purpose→ to help sick people, through best use of patient’s capabilities & community resources

- Personal & social adjustments in the community through rehabilitation

Medical Social workero A paramedical worker who has been

trained in in social case work & interviewing

o MSWs are employed in hospitals, tb clinics, cancer control centers, family planning clinics; fields of mental health, maternal & child welfare, school & university health services

o typically work on an interdisciplinary team with professionals of other disciplines such as medicine, nursing; physical, occupational, speech and recreational therapy, etc.

o Visits the family & probe into the personal, economic, & social cause of illness & collect social history to supplement medical history

o In chronic debilitating illness (tb, leprosy, polio) MSW aids in rehabilitation

o Medical social workers play a critical role in the area of discharge planning. One responsibility of medical social workers is to collaborate in the development of a discharge plan that will meet the patient's needs and allow the patient to leave the hospital in a timely manner.

o Essential professional colleague of doctor in analysis & correction of social & emotional factor

Medical Vs. Social Ethicso Ancient codes on medical ethics:

Hippocrates, Indian, Chinese; based on patient’s welfare

o Modern codes have an added social dimension, responsibility for health & concern for justice

o HFA 2000 emphasized on social justice with equitable distribution of resources by sharing of responsibilities on health by individual & community

o Progress in medical biotechnologyo Progressing social changes

o Recognition of human rights & freedom, individual autonomy

o Balance between patient’s interest with those of society

o Explosion of expensive medical technologies & consequent rise in people’s expectation→ problem of best use of scarce resources

o Policy makers under pressures:social, economic, political, technological

o Potential of modern biotechnology: organ transplantation, infertility, combating hereditary disease, postponing death, manipulating genetic makeover

o Modern days patient exercise autonomy & informed consent: whether or not to accept or continue with treatment, to participate in research, to permit use of personal health data, stand for or against pre- conceptional research, organ donation, withdrawal of life support system

o Researcher has special responsibilities to safeguard the rights of deprived & oppressed, those subjected to drug/vaccine trials & epidemiological studies

Consumer Protection Acto The Act on 1986, paved way for speedy

redressal of grievances of consumero Medical profession was kept into its

ambito Rapid commercialization has gradually

eroded the faith & respect of society towards medical professionals

o A quick, efficacious, economic remedyo If a patient or relations feel suffering or

death of the patient is because of negligence of either concerned doctor or health facility, they can complain to the MCI or Consumer Court

o Medical council can only cancel the registration of the concerned doctor but cannot punish him or award a compensation

o Consumer courts can only provide compensation based on opinion or expert certificate from doctor of concerned specialty

o Courts can be: District Consumer court, State Commission, National Commission

Rights of the patient:

I. Right to information on healthcare services, availability, diagnosis & treatment

II. Right to have information about professionals involved in care

III. Right to safety from errors & malpractice

IV. Right to confidentiality & privacy

V. Right to have prompt treatment in an emergency

VI. Right to get copies of medical records

VII. Right to informed consent

VIII.Right to refuse to participate in human experiment & research

IX. Right to be informed about the rules & regulations of the hospital applicable to the patient & facilities to be obtained by patient

X. Right to choose & to seek 2nd opinion about the disease & treatment

XI. Right to complain & have compensation within reasonably short time

ART OF INTERVIWING

Aim of interview:

o Secure information through face to face interaction & hence obtain the picture of the complete personality, wide enough to encompass the social & psychological background of the concerned

o To formulate hypothesiso To collect personal data for quantitative

purposeso To collect data from persons regarded as

secondary sources of information

Types of interview:

a) Direct/Structured: a schedule containing a set of predetermined question is administered by the researcher into to without any alteration

b) Non-directive/Unstructured: no predetermined sets of questions are asked instead free discussion with subject is allowed to narrate his/her own story along with her own opinion/reaction

c) Focused Interview: used to study social & psychological effects of mass communication regarding experience, attitude & emotional response

d) Repetitive interview: used to the gradual influence of any social or psychological process

INTERVIEW TECHNIQUES1. Establishment of contact

2. Commencement of an interview

3. Establishment of rapport

4. Recall

5. Probing

6. Encouragement

7. Guiding the interview

8. Recording

9. Closing

10.report

Social-Work Methodologies of Interview:

• Exploring the problem:• Psychological support• True perception of the problem• Summarization of the problem• Modification of the environment• Partialisation of the problem• Recording

Importance of psychological traits in interview:

• Reserved vs. Outgoing personality• Less intelligent vs. More intelligent • Emotionally Unstable vs. Emotionally

Stable• Assertive vs. Humble• Expedient vs. Conscientious• Tough vs. Tender/Feeble Minded• Forthright vs. Shrewd• Undisciplined vs. Controlled• Placid vs. Apprehensive• Relaxed vs. Tensed

OPERATIONAL RESEARCHo May be defined as the application of scientific

methods of investigation to the study of complex human organization or services

o a discipline that deals with the application of advanced analytical methods to help make better decisions

o Sociological scienceo Concerned with the team/group working together to

introduce beneficial changeso It aims to ensure optimal utilization of resources in

men,material & money to the service of the communityo It strives to develop new knowledge about existing

program, institution,use of facilities, about people working there, about beneficiaries( individuals & communities)

Phases of OR:• Problem formulation• Data collection (sampling if necessary)• Data Analysis & Formulation of

Hypothesis• Deriving solution from

hypothesis/‘Model’• Choice of Optimal solution & Forecast

Result• Testing of Solutions• Implementation of Solution in the whole

system

OR Team:• varies with type of work• Minimum composition in a

social medicine application:- Public health administrator- Epidemiologist- Statistician- Social scientist- Ancillary workers: clerks,

peons, field workers- Headed by director,

responsible for whole project

Application of OR in Health Services:

A. Part Problem

B. Whole Problemo Finding out optimal size of area/population

to be covered by midwife/basic health unito Ideal vehicle for local health workero Problems of queue in OPDs & waiting lists

in hospitalso Architectural design of hospitals & health

centerso Study of bed-load & nursing services in

teaching & non-teaching hospitals

o Length of stay in hospitals & length of absence due to sickness

o Extent to which the stated objective of the program have been achieved

o Quality of medical care services

o Outbreak investigations

Observation & Classification social medicine

OR

Discovery & Recommendation