Navigating the Amazing Maze of Health Care.
(continued)
198 ■ Chapter 8
Class A person may be from a class that is not part of the dominant culture, limiting their ability to determine the need for health care and to understand the subtleties involved in making health care system choices.
Education A person may not know how to read and write English and may not read and write in his or her native tongue.
Gender Existing services may be limited to a specific gender or the person may be unwilling or unable to access a system that does not deliver gender-specific care.
Geography A person may not reside near a health care facility, and the costs of traveling to a facility may be unaffordable.
Homelessness A person may be homeless in a place where health care is not provided to people who are homeless, and the person does not know the ways to access the system.
Insurance A person may not have health insurance, or it may be inadequate to cover the scope of the person’s needs.
Language A person may not speak or understand English and adequate interpreter services may not be available.
Manners A person’s manners or expectations of the provider’s manners may not be congruent.
Philosophy The philosophy of an institution may not be congruent with a person’s religious or personal philosophy.
Prejudice The person seeking health care may sense the prejudice that the providers and institution exhibit.
Race There may be residuals of racial prejudice as part of the institution’s philosophy.
Racism The institution may have specific barriers in place to not treat people from other races than the race of the owners of the facility.
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Religion A patient may not desire to be treated in an institution that is not derived from his or her religious background, and there may be manifest prejudice on both sides—patient and institution.
A given religion’s teachings regarding HEALTH and ILLNESS may contradict modern health care practices.
SES (socioeconomic status)
The 2 extremes of socioeconomic status are poverty or great wealth; poverty can limit access to care; wealth may prevent people from seeking care in institutions where they prefer to not go because of the patient population served there.
Technology A person may not be able to afford or want the plethora of diagnostic tests and therapies offered to him or her.
Transportation There may be no public transportation available from where the patient resides to the institution.
■ Medicine as an Institution of Social Control The people of today’s youth-oriented, cure-expecting, death-denying society have unusually high expectations of the healers of our time. We expect a cure (or if not a cure, then the prolongation of life) as the normal outcome of illness. The technology of modern health care dominates our expectations of treatment, and our primary focus is on the curative aspects of medicine, not on prevention.
As control over the behavior of a person has shifted from the family and church to a physician, “be good” has shifted to “take your medicine.” The role that physicians play within society in terms of social control is ever-growing, so that conflict frequently arises between medicine and the law over definitions of accepted codes of behavior and the relative status of the 2 professions in governing American life. Zola (1966, 1972) uses the following examples to illustrate the “medicalization” of society.