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Biomedical subjects

H Waitzkin

Publications and source records attributed to H Waitzkin.

At least 73 records · Page 4Linked to original sources
PubMed1981

The social origins of illness: a neglected history.

Although interest in the social origins of illness has grown recently, the sources of this concern in Marxist thought have received little attention. Friedrich Engels, Rudolf Virchow, and Salvador Allende made important early contributions to this field. Engels analyzed features of the workplace and environment that caused disability and early death for the British working class. Virchow's studies in "social medicine" and infectious diseases called for social change as a solution to medical problems. Allende traced poor health to class oppression, economic underdevelopment, and imperialism. These analysts provided divergent, though complementary, views of social etiology, multifactorial causation, the methodology of dialectic materialism, an activist role for medical scientists and practitioners, social epidemiology, health policy, and strategies of sociomedical change. The social origins of illness remain with us and reveal the scope of reconstruction needed for meaningful solutions.

Chile↗
PubMed1979

Physician stereotypes about female health and illness: a study of patient's sex and the informative process during medical interviews.

Three hundred and thirty-six tape recorded interactions between a stratified random sample of physicians and a sample of their patients are analyzed in order to compare male and female information-seeking behavior in the medical interview and to contrast the response of doctors to male and female requests for information. Some of the underlying attitudes on the part of the physicians that may affect the information-exchange process are discussed.

Attitude of Health Personnel↗
PubMed1979

A Marxian interpretation of the growth and development of coronary care technology.

Cost containment efforts will fail if they continue to ignore the structural relationships between health care costs and private profit in capitalist society. The recent history of coronary care shows that apparent irrationalities of health policy make sense from the standpoint of capitalist profit structure. Coronary care units (CCUs) gained wide acceptance, despite high costs. Studies of CCU effectiveness, using random controlled trials and epidemiologic techniques, do not show a consistent advantage of CCUs over non-intensive ward care or simple rest at home. From a Marxian perspective, the proliferation of CCUs and similar innovations is a complex historical process that includes initiatives by industrial corporations, cooperation by clinical investigators at academic medical centers, support by private philanthropies linked to corporate interests, intervention by state agencies, and changes in the health care labor force. Cost-effective methodology obscures the profit motive as a basic source of high costs and ineffective practices. Health-policy alternatives curtailing corporate involvement in medicine would reduce costs by restricting profit.

Academic Medical Centers↗
PubMed1979

Homes or hospitals? Contradictions of the urban crisis.

Medical expansion is threatening to eliminate many urban residential areas, despite criticisim that argues for comprehensive planning, reduced costs, less concentrated power in the health sector, and a reversal of "medicalization." Our research on expansion, which grew partly from personal participation in a local struggle against expanding institutions in Boston, revealed certain tensions in combining sociomedical research with concrete political practice. From events in Boston and from an exploratory review of periodicals, we recognized that medical expansion and community conflict occur frequently in cities throughtout the United States. Based on general theoretical perspectives from organizational analysis and political economy, we made several hypotheses that we tested through a questionnaire sent to all hospitals in the 20 largest cities of the United States and through other data available on the same hospitals. In large part, this empirical study confirmed our theoretical expectations that (a) larger medical centers show a greater tendency toward territorial growth than smaller hospitals; (b) bureaucratic and administrative dynamics lead to facilities that do not necessarily enhance patient care; (c) despite short-term cycles of expansion and contraction in public hospital growth, expansion projects are widespread and generate considerable political conflict; (d) because of the state's contradictory roles in regulation and social capital expenditures, opposition to medical expansion comes more from community organizations than from governmental monitoring or planning bodies; and (e) the needs of capital determine that medical expansion has a more detrimental impact on housing than on commercial or industrial facilities. Future expansion of private medical facilities is more likely than that of public facilities, although much private expansion may receive public subsidization. As ideologic patterns are demystified, the contradictions between medical expansion and housing needs can provide a focus for successful community organizing.

Boston↗
PubMed1978

A Marxist view of medical care.

Marxist studies of medical care emphasize political power and economic dominance in capitalist society. Although historically the Marxist paradigm went into eclipse during the early twentieth century, the field has developed rapidly during recent years. The health system mirrors the society's class structure through control over health institutions, stratification of health workers, and limited occupational mobility into health professions. Monopoly capital is manifest in the growth of medical centers, financial penetration by large corporations, and the "medical-industrial complex." Health policy recommendations reflect different interest groups' political and economic goals. The state's intervention in health care generally protects the capitalist economic system and the private sector. Medical ideology helps maintain class structure and patterns of domination. Comparative international research analyzes the effects of imperialism, changes under socialism, and contradictions of health reform in capitalist societies. Historical materialist epidemiology focuses on economic cycles, social stress, illness-generating conditions of work, and sexism. Health praxis, the disciplined uniting of study and action, involves advocacy of "nonreformist reforms" and concrete types of political struggle.

Capitalism↗
PubMed1976

Social theory and medicine.

Three sociolgists-Talcott Parson, Eliot Freidson, and Mechanic-have explained medical phneomena within a broader theoretical framework. Although all three have made significant contributions, their conclusions remain incomplete on the theoretical level and seldom have been helpful for workers concerned with ongoing problems of health care. Our purpose here is to summarize some of the strengths and weakness of each theoretical position. Parsons has elucidated the sick role as a deviant role in society, the function of physicians as agents of social control, and the normative patterns governing the doctor-patient relationship. The principal problems in Parsons' analysis center on an uncritical acceptance of physicians' social control functions, his inattention tot the ways in which physicians' behavior may inhibit change in society, and overoptimism about the medical profession's ability to regulate itself and to prevent the exploitation of patients. Viewing medical phenomena within a broader theory of the professions in general, Freidson has formulated w wide ranging critique of the medical profession and professional dominance. On the other hand, Freidson's work neglects the full political implications of bringing professional autonomy under control. Mechanic's coceptual approach emphasizes the social psychologic factors, rather than the institutional conditions, which are involved in the genesis of illness behavior. Mechanic also overlooks the ways in which illness behavior, by permitting a controllable from of deviance, fosters institutional stability. In conclusion, we present a breif overview of a theoretical framework whose general orientation is that of Marixian analysis. Several themes recur in this framework: illness as a source of exploitation, the sick role as a conservative mechanism fostering social stability, stratification in medicine, and the imperialsm of large medical institutions and health-related industries.

Clinical Competence↗
PubMedDate not supplied

Traumatic life events in primary care patients: a study in an ethnically diverse sample.

OBJECTIVE: To examine among immigrants and others seeking primary care: (1) the prevalence, types, and predictors of traumatic life events; and (2) the relations among traumatic life events, psychiatric disorders, and utilization of primary care services. DESIGN: Survey with structured diagnostic interview. SETTING: Community-based, university-affiliated primary care clinic in southern California. PARTICIPANTS: Fourteen hundred fifty-six adult patients representing 4 ethnic groups (Mexican immigrants, Central American immigrants, US-born Latinos of Mexican descent, and US-born non-Latino whites). DEPENDENT MEASURES: Rates of traumatic events measured with the Posttraumatic Stress Disorder section of the Diagnostic Interview Schedule; psychiatric disorders identified by the Composite International Diagnostic Interview using Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria; physical functioning (Short Form Health Survey); and the number of medical clinic visits during a 6-month period. RESULTS: Nearly 10% of patients had experienced a traumatic event in the previous year, and 57% had experienced at least 1 during their lifetimes. The most common forms of trauma were interpersonal violence occurring outside the family (21%), acute losses or accidents (17%), witnessing death or violence (13%), and domestic violence (12%). When compared with the US-born non-Latino whites, Mexican immigrants were half as likely, and Central American immigrants were 76% more likely, to report having experienced a traumatic event. Married individuals were significantly less likely to report traumas. Traumatic experiences, female gender, and non-Latino ethnicity were associated with the presence of a psychiatric disorder. One-year and lifetime psychiatric disorders were associated with poorer physical functioning and an increased number of clinic visits during a 6-month period. CONCLUSIONS: Traumatic life events are common and associated with psychiatric disorders other than posttraumatic stress disorder in an ethnically diverse sample of primary care patients. Psychiatric disorders, in turn, are strongly associated with poor physical functioning and higher rates of primary care utilization. Screening for traumatic experiences should accompany assessments of psychiatric disorders to ensure adequate treatment of patients seeking primary care services.

Adult↗