MEDICAL SOCIOLOGY: PRINCIPLES, PRACTICES, AND PUZZLES SYO 4402, Section 02, Spring 2014 Monday & Wednesday, 12:30 pm - 1:45 pm, Room 214 HCB Instructor: Xan Nowakowski, PhD, MPH E-mail: xnowakowski@fsu.edu Office: College of Medicine, Room 3300D Phone: (850) 645-7396 Office Hours: Tuesday 10:00 am – 12:00 pm OVERVIEW The concept of “patient-centered medicine”—health care that embraces patients as complete people—has gained prominence in many parts of the world. Why is how we think about “patients” so important? What does it mean to provide “quality” medical care? What constitutes a good health outcome or a bad one? How do people develop health conditions in the first place? How do they experience these changes on a personal level? Health care requires just as much attention to social factors as it does to clinical ones, yet researchers have only recently begun to examine how these forces work together to produce or diminish well-being. “Medical sociology”—the study of social causes and consequences of health—is an exciting and rapidly growing discipline that is changing the way people think about health in multiple domains. COURSE GOALS This course will orient you to the field of medical sociology, and give you practice in using the fundamental tools of the discipline. Specifically, it will help you develop basic knowledge about key medical sociology topics, expose you to current research studies and findings, help you understand how and when to apply specific sociomedical concepts and models, and encourage you to think critically about course material. It will also help you synthesize concepts to think creatively and strategically about central social issues in health and medicine. These include patient-provider communication, social support, stigma management, medical ethics, health and wellness measurement, social determinants of health, medical care delivery, paying for health care, and health disparities. We will explore two broad questions: (1) How do social factors cause different health states? (2) How does society respond to different health states? COURSE OBJECTIVES By the end of the semester, you should be able to: Describe different types of health care organizations, insurance, and financing. Differentiate individual, group, and institutional influences on health. Articulate how elements of health and medicine are measured and tracked. Explain why and how social inequality affects health, and vice versa. Compare and contrast the attributes and challenges of different health care settings. Summarize major concepts and theories on important medical sociology issues. Find and interpret news coverage of current issues in medical sociology. 1 Apply sociological concepts and models to health, illness, and disability. Write basic, brief critical responses to course readings. Generalize your knowledge about medical sociology to other topics, where appropriate. Approach learning new material strategically—in medical sociology and other areas. I teach new concepts by relating them to what you already know, and by helping you organize information into categories that make sense to you. I emphasize applying and challenging knowledge so that you can participate actively in class meetings and take full advantage of your unique strengths as a learner. As Mark Twain once said, “Never let your schooling interfere with your education!” REQUIRED READINGS No textbook is required. All of the following pieces are posted on Blackboard. Adler, Nancy E. and Joan M. Ostrove. 1999. “Socioeconomic Status and Health: What We Know and What We Don’t.” Socioeconomic Status and Health in Industrial Nations: Social, Psychological, and Biological Pathways 896:3-15. Akers, Aletha Y., Melvin R. Muhammad, and Giselle Corbie-Smith. 2011. “‘When you got nothing to do, you do somebody’: A community’s perceptions of neighborhood effects on adolescent sexual behaviors.” Social Science & Medicine 72:91-99. Burdette, Amy and Terrence Hill. 2008. “An examination of processes linking perceived neighborhood disorder and obesity.” Social Science & Medicine 67:38-46. Bury, Michael. 1991. “The Sociology of Chronic Illness: A Review of Research and Prospects.” Sociology of Health & Illness 13:451−468. Busfield, Joan. 2006. “Pills, Power, People: Sociological Understandings of the Pharmaceutical Industry.” Sociology 40(2):297-314. Butterfoss, Frances Dunn, Robert M. Goodman, and Abraham Wandersman. 1993. “Community Coalitions for Prevention and Health Promotion.” Health Education Research 8(3):315-330. Charmaz, Kathy. 2003. “Experiencing Chronic Illness.” Pp. 277−292 in Handbook of Social Studies in Health & Medicine, edited by G. Albrecht, R. Fitzpatrick, and S. Scrimshaw. Thousand Oaks, CA: SAGE Publications, Inc. Cockerham, William. 2007. Medical Sociology, 10th Edition. Upper Saddle River, NJ: Pearson Prentice Hall. Conrad, Peter and Valerie Leiter. 2004. “Medicalization, Markets, and Consumers.” Journal of Health and Social Behavior 45 (Extra Issue):158-176. Chrisler, Joan and Paula Caplan. 2002. “The Strange Case of Dr. Jekyll and Ms. Hyde: How PMS became a Cultural Phenomenon and Psychiatric Disorder.” Annual Review of Sex Research 13:274-306. Ferraro, Kenneth and Tatyana Pylypiv Shippee. 2009. “Aging and Cumulative Inequality: How does Inequality get under the Skin?” The Gerontologist 49:333−343. Freese, Jeremy. 2008. “Genetics and the Social Science Explanation of Individual Outcomes.” American Journal of Sociology 114 Suppl.: S1–S35. 2 Freund, Peter, Meredith McGuire, and Linda Podhurst. 2003. Health, Illness, and the Social Body: A Critical Sociology, 4th Edition. Upper Saddle River, NJ: Prentice Hall. Iglehart, John. 2010. “The Political Fight Over Comparative Effectiveness Research.” Health Affairs 29:1757-1760. Institute of Medicine. 2001. Committee on Quality of Health Care in America. Crossing the Quality Chasm: A new health system for the 21st century. Washington, DC: National Academies Press. Gawande, Atul. 2009. “The Cost Conundrum: What a Texas town can teach us about health care.” The New Yorker 85(16):36-44. Geronimus, Arline T., Margaret Hicken, Danya Keene, and John Bound. 2006. “‘Weathering’ and Age-Patterns of Allostatic Load Scores among Blacks and Whites in the United States.” American Journal of Public Health 96: 826-833. Groopman, Jerome. 2007. “What’s the Trouble? How doctors think.” The New Yorker 29. Hafferty, Frederich. 1988. “Cadaver Stories and the Emotional Socialization of Medical Students.” Journal of Health and Social Behavior 29:344-356. Henderson, Gail et al. 2007. “Clinical Trials and Medical Care: Defining the Therapeutic Misconception.” PLoS Med 4(11): e324. Hummer, Robert. 1996. “Black-White Differences in Health and Mortality: A Review and Conceptual Model.” The Sociological Quarterly 37:105−125. Josefsson, Ulrika. 2005. “Coping with Illness Online: The Case of Patients’ Online Communities. The Information Society: An International Journal 21(2):133-141. Karp, David. 1996. “Illness and Identity.” Pp. 50-77 in Speaking of Sadness. New York: Oxford University Press. Link, Bruce G. and Jo Phelan. 2010. “Social Conditions as Fundamental Causes of Health Inequalities.” Pp. 3−17 in Handbook of Medical Sociology, 6th Edition, edited by C. Bird, P. Conrad, A. Fremont, and S. Timmermans. Nashville, TN: Vanderbilt University Press. Matcha, Duane. 2000. Medical Sociology. Needham Heights, MA: Allyn and Bacon. Nowakowski, Alexandra C.H. 2010. “More Options for Treating Pain.” Hospitals & Health Networks Weekly. 2 February 2010. Pearlin, Leonard I. 1989. “The Sociological Study of Stress.” Journal of Health and Social Behavior (1989):241-256. Pescosolido, Bernice A., Steven A. Tuch, and Jack K. Martin. 2001. “The Profession of Medicine and the Public: Examining Americans’ Changing Confidence in Physician Authority from the Beginning of the ‘Health Care Crisis’ to the Era of Health Care Reform.” Journal of Health and Social Behavior 42(1):1-16. Rieker, Patricia, Chloe Bird, and Martha Lang. 2013. “Understanding Gender and Health: Old Patterns, New Trends, and Future Directions.” Pp. 52−74 in Handbook of Medical Sociology, 6th Edition, edited by C. Bird, P. Conrad, A. Fremont, and S. Timmermans. Nashville, TN: Vanderbilt University Press. Rier, David A. 2000. “The missing voice of the critically ill: a medical sociologist’s firstperson account.” Sociology of Health & Illness 22(1):68-93. Rosenberg, Charles. 2002. “The Tyranny of Diagnosis: Specific Entities and Individual Experience.” The Milbank Quarterly, 80:237-260. 3 Rosich, Katherine and Janet Hankin. 2010. “Executive Summary: What Do We Know? Key Findings from 50 Years of Medical Sociology.” Journal of Health and Social Behavior, Extra Issue, 51:S1-S9. Ross, Catherine and John Mirowsky. 1989. “Psychiatric Diagnosis as Reified Measurement.” Journal of Health and Social Behavior (1989):11-25. Ross, Catherine and John Mirowsky. 2000. “Does Medical Insurance Contribute to Socioeconomic Differentials in Health?” The Milbank Quarterly 78:291−321. Shea, Christopher. 2000. “Don’t Talk to the Humans: The crackdown on social science research.” Lingua Franca 10(6):26-34. Smith, Allen and Sherryl Kleinman. 1989. “Managing Emotions in Medical School.” Social Psychology Quarterly, 52:6-69. Street, Debra, Stephanie Burge, Jill Quadagno, and Anne Barrett. 2007. “The Salience of Social Relationships on Resident Wellbeing in Assisted Living.” Journal of Gerontology 62B (2):S129-134. Taylor, John and R. Jay Turner. 2002. “Perceived Discrimination, Social Stress, and Depression in the Transition to Adulthood: Racial Contrasts.” Social Psychology Quarterly 65:213-25. Taylor, Miles G. 2008. “Timing, Accumulation, and the Black/White Disability Gap in Later Life: A Test of Weathering.” Research on Aging: Special Issue on Race, SES, and Health 30: 226-250. Thoits, Peggy A. “Stress, coping, and social support processes: Where are we? What next?” Journal of Health and Social Behavior (1995): 53-79. Tiefer, Lenore. 2006. “The Viagra Phenomenon.” Sexualities 9:273-294. Topo, Päivi and Sonja Iltanen-Tähkävuori. 2010. “Scripting Patienthood with Patient Clothing.” Social Science and Medicine, 70:1682-9. Ueno, Koji. 2010. “Mental Health Differences Between Young Adults With and Without Same-Sex Contact: A Simultaneous Examination of Underlying Mechanisms.” Journal of Health and Social Behavior 51(4):391-407. Wallis, Anne Baber, Peter J. Winch, and Patricia J. O’Campo. 2010. “This Is Not a Well Place: Neighborhood and Stress in Pigtown.” Health Care for Women International, 31:113130. Williams, Robert L. and Kim Yanoshik. 2001. “Can You Do a Community Health Assessment without Talking to the Community?” Journal of Community Health, 26(4):233247. Woolhandler, Steffie, Terry Campbell, and David U. Himmelstein. 2003. “Costs of Health Care Administration in the U.S. and Canada.” New England Journal of Medicine, 349:768775. Zola, Irving Kenneth. 1991. “Bringing Our Bodies and Ourselves Back In: Reflections on a Past, Present, and Future ‘Medical Sociology’.” Journal of Health and Social Behavior 32(1):1-16. 4 COURSE CONTENT AND OUTLINE WEEK 1 (January 6 & January 8) Getting oriented: introductions, course overview, syllabus review Reading: Course syllabus (available on Blackboard) Support for a sociology of health and medicine Reading: Humberstone 2007 Reading: Rosich and Hankin 2010 *** Bring syllabus to class on first day! *** WEEK 2 (January 13 & January 15) Foundational concepts and terms Reading: Cockerham 2007 Reading: Matcha 2000 Biomedical, biopsychosocial, and sociological health models Reading: Freese 2008 Reading: Pearlin 1989 WEEK 3 (January 20 & January 22) Social and organizational changes in medicine Reading: Weiss 2009 Reading: Cockerham 2007 Assignment 1: Available on Blackboard, complete over next week *** No class on January 20 (Martin Luther King Day) *** WEEK 4 (January 27 & January 29) Epidemiology: transitional patterns and social approaches Reading: Freund, McGuire, and Podhurst 2003 Reading: Geronimus et al. 2006 Introduction to theories of health inequality Reading: Link and Phelan 2010 Reading: Ferraro and Shippee 2009 *** Assignment 1 due by 11:59 pm on January 29 *** WEEK 5 (February 3 & February 5) Social patterning of health and illness Reading: Adler and Ostrove 1999 Reading: Burdette and Hill 2008 Measures of health and functionality Reading: Taylor 2008 Reading: Taylor and Turner 2002 5 WEEK 6 (February 10 & February 12) Dynamics and causes of health inequality Reading: Hummer 1996 Reading: Rieker, Bird, and Lang 2010 Strategies for mitigating health disparities Reading: Ueno 2010 Reading: Akers, Muhummad, and Corbie-Smith 2011 Assignment 2: Available on Blackboard, complete over next week WEEK 7 (February 17 & February 19) People becoming patients and patients managing emotions Reading: Charmaz 2003 Reading: Bury 1991 Coping: types and social resources Reading: Josefsson 2005 Reading: Thoits 1995 *** Assignment 2 due by 11:59 pm on February 19 *** NB: February 21 is the last day to drop a course without receiving a grade. WEEK 8 (February 24 & February 26) History of diagnosis and treatment Reading: Weiss 2009 Reading: Rosenberg 2002 Experience of illness: navigating medical systems Reading: Groopman 2007 Reading: Rier 2000 Exam I: Available on Blackboard, complete over next week WEEK 9 (March 3 & March 5) Biomedical models of illness: problems and alternatives Reading: Conrad and Leiter 2004 Reading: Chrisler and Caplan 2002 Medicalization and its consequences Reading: Zola 1991 Reading: Mirowsky and Ross 1989 *** Exam I due by 11:59 pm on March 5 *** *** SPRING BREAK is the week of March 10! Get some rest! *** 6 WEEK 10 (March 17 & March 19) The pharmaceutical industry Reading: Tiefer 2006 Reading: Busfield 2006 Sociomedical research: ethics, review, and funding Reading: Henderson et al. 2007 Reading: Shea 2000 *** Optional course evaluation survey due by 11:59 pm on March 19 *** WEEK 11 (March 24 & March 26) Health professions and physician socialization Reading: Freund, McGuire, and Podhurst 2003 Reading: Hafferty 1988 People as “cases”: physician attitudes toward patients Reading: Smith and Kleinman 1989 Reading: Topo and Iltanen-Tähkävuori 2010 Assignment 3: Available on Blackboard, complete over next week WEEK 12 (March 31 & April 2) Models of health care delivery Reading: Karp 1996 Reading: Gawande 2009 Relationships between health services and health outcomes Reading: Street et al. 2007 Reading: Ross and Mirowsky 2000 *** Assignment 3 due by 11:59 pm on April 2 Feb*** NB: April 4 is the deadline for late drop with dean’s permission. WEEK 13 (April 7 & April 9) US health care system: unique attributes Reading: Woolhandler, Campbell, and Himmelstein 2003 Reading: Nowakowski 2010 Health care reform Reading: Pescosolido, Tuch, and Martin 2001 Reading: Institute of Medicine 2001 Assignment 4: Available on Blackboard, complete over next week WEEK 14 (April 14 & April 16) Comparative effectiveness research Reading: Iglehart 2010 Reading: Butterfoss, Goodman, and Wandersman 1993 Community health assessment Reading: Williams and Yanoshik 2001 Reading: Wallis, Winch, and O’Campo 2010 *** Assignment 4 due by 11:59 pm on April 16 *** 7 WEEK 15 (April 21 & April 23) Current events in medical sociology Reading: Catch up on any readings you haven’t done yet! Activity: Find one news article related to medical sociology! Course wrap-up Exam II: Available on Blackboard, complete over next week SPOT Evaluations: Will go out over email at end of semester FINAL EXAM *** Exam II due by 11:59 pm on April 30 *** COURSE REQUIREMENTS Blackboard. You can find all of the course readings in the “Course Library” area on our Blackboard site. Please let me know promptly if you have difficulty accessing any of the PDFs! Submit your assignments and exams to Blackboard as requested—I will show everyone where to find things early in the semester. Make sure you also check Blackboard regularly to keep up with newly posted information and changes to the syllabus. Attendance. I will circulate an attendance sheet during every class period. If I take attendance and you are present for the entire class period and signed the sign in sheet I will give you an attendance point for that day. Accumulated attendance points will count as extra credit toward your final grade. You will need a valid written excuse (e.g., attending a conference, having surgery) to get attendance points for any class you need to miss. If you have an emergency and cannot attend class, please let me know ASAP (before class if possible) via e-mail, and give me whatever written documentation you can provide at the next class meeting. Note that class attendance and grades are very highly correlated, so come when you can! Class participation. Engaging our brains in discussion of course materials enhances our learning and makes the classroom experience much more fun. I keep my lecture slides general and brief because I believe students should drive our journey in the classroom. If you have a question or comment about what we are covering, signal that you would like to speak, and I will call on you. To encourage you to engage actively, I give points for class participation. This does not mean that you need to talk constantly to get full credit! Rather, I want to see evidence that you are thinking critically about the different course modules and challenging yourself intellectually. I also recognize that not every student feels equally comfortable speaking in front of others. It is perfectly okay not to speak up frequently during lectures, but I do expect every student to participate actively in smaller discussion activities. Readings. Lectures will highlight and/or build on the readings so you should finish assigned readings prior to coming to class. Being prepared for class will also enhance your learning experience and allow you to participate! The instructions for writing response papers are a great guide for active reading. Think about these topics as you read each article, and take a few notes! I personally find it works very well to create a matrix with one column for the discussion topics and another column for brief notes about each topic, but I encourage you to take notes in whatever way you find most useful. 8 Examinations. There will be two exams, both of which are take-home and should be submitted through Blackboard. These exams will consist of multiple choice items, with the goal of getting you to demonstrate knowledge of key concepts and think critically about course materials. You may use your notes and readings while completing the exams, but note that you will not be able to complete the exams in the required time if you have not prepared in advance. I will give extensions on exam deadlines only for emergencies or for extenuating circumstances. In such an event, you must give me a valid written excuse that I can keep for my records. For more information, please review Florida State University’s policy on final exams, which instructors and students are mandated to follow: http://undergrad.fsu.edu/Retention/exam.html. Assignments. You will complete four written assignments during the semester. For each of these assignments, you will write a short (1 to 2 pages double-spaced) “response paper” to one of the readings for that module. Each assignment will ask you to think critically about course readings and form your own positions on the content. Assignment 1: Health/illness models and social epidemiology Assignment 2: Inequality, medicalization, and coping Assignment 3: Pharma and health professions Assignment 4: Health care delivery models and systems You will have some choice in which readings you address in each assignment. You may use your notes, book, and any other resources you find useful. I also strongly encourage you to discuss the course readings with other students! However, you may not collaborate with other students to do the actual writing—all work must be completely your own. I will discuss the details of these assignments in class and will post them in advance on the Blackboard site. I will also post the standards with which I grade these assignments, so you have a clear idea of how to approach the work. If you need to submit an assignment late, talk to me beforehand (except in the case of severe emergencies, in which case you should talk to me as soon as possible). I reserve the right to deduct points for late submissions. However, I also believe that grades should reflect learning rather than ability to navigate bureaucracy. Consequently, the more important thing is to take responsibility for letting me know if you will have a problem turning in an assignment on time, and to work with me on alternative arrangements. Course evaluation. I will use Blackboard to administer a course evaluation survey about halfway through the semester. Since there is no better way for me to improve my teaching—and thus, your experience in the course—than asking for your feedback, completing this evaluation will boost your final course grade. You will receive a small amount of extra credit toward your course grade by completing this evaluation. At the end of the term, you will complete the mandatory SPOT assessment form for all FSU courses. 9 GRADING & EVALUATION Final grades will be calculated according to the following formula: ASSESSMENT Assignment 1 Assignment 2 Exam I Assignment 3 Assignment 4 Exam II Class Participation TOTAL TOPICS COVERED Health/illness models and social epidemiology Inequality, medicalization, and coping First half of semester only Pharma and health professions Health care delivery models and systems Second half of semester only Readings for each session WEIGHT 15% 15% 10% 15% 15% 10% 20% 100% I use full letter grades in this course. Cut-points for letter grades are: A = 90-100%; B = 80-89%; C = 70-79%; D = 60-69%; F < 59%. You will not receive formal letter grades for exams or assignments; I will add your points for all exams and assignments to derive your final grade for the course. To help you keep tabs on your own performance, however, I will compute percentage scores for each assessment and post these to Blackboard. You can get a bit of extra credit by attending class regularly, and by completing the optional course evaluation survey on Blackboard midway through the semester. ACADEMIC HONOR POLICY The Florida State University Academic Honor Policy outlines the University’s expectations for the integrity of students’ academic work, the procedures for resolving alleged violations of those expectations, and the rights and responsibilities of students and faculty members throughout the process. Students are responsible for reading the Academic Honor Policy and for living up to their pledge to “. . . be honest and truthful and . . . [to] strive for personal and institutional integrity at Florida State University.” (Florida State University Academic Honor Policy, found at http://fda.fsu.edu/Academics/Academic-Honor-Policy.) CLASSROOM COURTESY Basic classroom courtesy ensures that everyone has the opportunity to learn without distractions in a physically and emotionally safe environment. So, please refrain from having “side conversations”, answering cell phones in class, or otherwise disrupting class activities. On the other hand, asking questions and participating in class discussion is strongly encouraged! Likewise, you may use a laptop, tablet PC, and/or e-reader in class to assist you in learning and taking notes—in fact, I encourage students to avoid printing out articles if at all possible. That said, I reserve the right to take action if you repeatedly engage in distracting or disruptive behavior with any technology you bring to class. If you must have a cell phone to receive emergency calls about children or other loved ones, keep it on vibrate and step out of class to answer. Please also make a general effort to minimize noise in the classroom—for example, if you bring food to class, choose snacks that you can eat quietly. 10 Most importantly, respect your fellow students at all times. Hostile comments directed at other students or population groups will not be tolerated. I refuse to censor anyone, but consider this fair warning that if you disparage another student in any way, I will call you on it and give everyone the opportunity to discuss the incident together. I have zero interest in embarrassing or punishing anyone, so please think about the likely impact of your words before you speak. EMAIL ETIQUETTE In every email you send me, please include your first and last name, the course and the section number or date/time of our class. Generally this course has upwards of 40 enrolled students, so this is crucial to help me know who you are and how I can help you! Before asking questions about basic course information, please check the course Blackboard site and the syllabus—be a strategic learner! These skills will take you far in your future career, and in most cases, you will get the information you need much more quickly by looking at the course website instead of emailing me. AMERICANS WITH DISABILITIES ACT Students with disabilities needing academic accommodation should: (1) register with and provide documentation to the Student Disability Resource Center; and (2) bring a letter to the instructor indicating the need for accommodation and what type. This should be done during the first week of class. This syllabus and other class materials are available in alternative format upon request. For more information about services available to FSU students with disabilities, contact the: Student Disability Resource Center 874 Traditions Way 108 Student Services Building Florida State University Tallahassee, FL 32306-4167 (850) 644-9566 (voice) (850) 644-8504 (TDD) sdrc@admin.fsu.edu http://www.disabilitycenter.fsu.edu/ FREE TUTORING SERVICES On-campus tutoring and writing assistance is available for many courses at Florida State University. For more information, visit the Academic Center for Excellence (ACE) Tutoring Services’ comprehensive list of on-campus tutoring options: see http://ace.fsu.edu/tutoring or contact tutor@fsu.edu. High-quality tutoring is available by appointment and on a walk-in basis. These services are offered by tutors trained to encourage the highest level of individual academic success while upholding personal academic integrity. 11 EXCUSED ABSENCES Excused absences include documented illness, deaths in the family and other documented crises, call to active military duty or jury duty, religious holy days, and official University activities. These absences will be accommodated in a way that does not arbitrarily penalize students who have a valid excuse. Consideration will also be given to students whose dependent children experience serious illness. INCOMPLETE GRADES Missing work or completing assignments partially are insufficient reasons for a grade of Incomplete. An Incomplete grade will not be given except under extenuating circumstances at the instructor’s discretion. Note that College of Social Science guidelines require that students seeking an “I” must have completed a substantial portion of the course and be passing the course. If for any reason you do qualify for an Incomplete in this course, I will work with you to develop a plan for completing your remaining work. SYLLABUS CHANGE POLICY This syllabus is a guide for the course and is subject to change—with advance notice, of course! Class topics, assignments, reading selections, and scheduling may be modified by the instructor as circumstances dictate. I will announce any necessary changes via email and in class. 12