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The origins of a sociology of medicine can be traced back to German physician Rudolf Virchow, who maintained that medicine was a social science and should be used to improve social conditions. Many years ago, medical historian Henry Sigerist (1946: 130) advocated incorporation of social science into medical curricula, arguing that ”Social medicine is not so much a technique as rather an attitude and approach to the problems of medicine.”
While there is a growing awareness that patient care decisions are not purely medical, the coming together of sociology and medicine remains elusory. There seems to be little application of social knowledge, despite the fact that sociology clearly can inform the clinician’s view of the problem. However, applicable sociology still largely is thought to be too abstract and uncertain to be helpful.
Although we know much about the volume and cost of medical care utilization, there is less explanation of its cause and variation. The relationship between patients’ health and their use of medical services is influenced by class, race, and other social variables.
Previous work mostly includes ”users” of health care services when testing health care-seeking patterns. But this means that studies focusing on only users of health services are really measuring frequency of use rather than the broader issue of who is using and not using health services. The decision to go to a doctor is the result of an interpretive process, taking place within the social structural parameters. Factors other than need are important in health care utilization.
Health behaviors are ultimately influenced by how people think about their health. Individuals who place greater value on health potentially have different utilization patterns than those who attach less value. Indeed, individuals with greater confidence in their ability to influence their own health and those who are somewhat skeptical of medical science or distrust doctors are less likely to consult professionals. Moreover, sociological studies have primarily utilized self-reported measures, which may or may not correspond with actual health behavior. The latter is an important area of future inquiry.
Material considerations such as socioeconomic status and the lack of access to care that attends particular class strata are critical for understanding contemporary health disparities. But also, symbolic and cultural definitions of health are salient and vary by social structural context such as race and class. These too are critical to understanding how patients and providers do or do not connect and in turn to understanding differences in health perceptions, behaviors, and care. The presentation of health information must take into account patients’ knowledge and values or it may create misunderstandings about treatment and prevention strategies. Moreover, patients may further aggravate their health by failing to follow treatment plans.
We may expect to see increasing use of home health care services as the ”baby boomer” generation ages. This will necessitate the integration of formal and informal health care structures. Home-based formal support services may be the critical link to reducing burden of family members, but such services should also enhance those informal support systems. Formal care providers may have to take responsibility for what goes on outside the clinic. Current drives for universal health care are based on the premise that traditional biocentric medicine must expand its domain to include health promotion and prevention to be effective. Similarly, the scope of services can be broadened to include meaningful assistance to informal care-givers.
Proponents of alternative orientations toward the practice of medicine (and medical sociology) would like to see the emergence of new approaches and broadening conceptualizations of health and medicine, based on both traditional scientific methodology and new ways of knowing. Sociology can be at the center of an integrative network of health and illness. However, it will fall on sociologists to find ways of dealing with differences in our conceptual languages in order to infiltrate medicine and other physical and mental health settings, since invitations are not abundantly forthcoming.
- Sigerist, H. E. (1946) The University at the Crossroads. Henry Shuman, New York.
- Clair, J. M. & Allman, R. M. (eds.) (1993) Sociomedical Perspectives on Patient Care. University Press of Kentucky, Lexington, KY.
Cockerham, W. (2007) Medical Sociology. Prentice Hall, Upper Saddle River, NJ.
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