Social science & medicine
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Social science & medicine · Jan 1983
Tips, status and sacrifice: gift giving in the doctor-patient relationship.
This study examines the gifts physicians receive from their patients. Internists in a hospital-based group practice kept diaries of gifts received and were interviewed about their responses and the reasons which they ascribed to the patient's gift-giving. ⋯ Patient gifts are found to be reciprocations for some action on the part of the physician, which the patient, in turn, perceives as a gift. Three categories of gifts, according to their nature and timing, are: (1) gifts as 'tips', given to promote personalized service, to assure the continued interest and the tolerance of the physician; (2) gifts to address the status imbalance in the doctor-patient relationship, either by imposing a non-professional identity on the physician or by redeeming status lost in the sick role; (3) gifts as a sacrifice to the physician who exercises his power on the patient's behalf.
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Social science & medicine · Jan 1982
The basis of privacy and autonomy in medical practice. A model.
Most of the medical literature concerned with privacy seems to be based on the implicit assumptions that there is such a thing as right-to-privacy and that privacy is a worthwhile end unto itself. This paper develops a model which should permit a better and more pragmatic understanding of the moral, ethical and psychosocial bases of these assumptions. Arguments are offered that privacy is, indeed, not mainly an intrinsic value but is more of an instrumental value. ⋯ The model is developed which states: the analogy of a person is as a unit consisting of a matrix which is unique and autonomous because of its separation from other units by means of a wall-of-privacy; the relationship between persons is measured by their social distance. Derived from this is the 'equation', A approximately equal to (P)(D). Intimacy, substitutive judgement, confidentiality and patient-physician relationship are conceptualized within this model.
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Most economists have suggested that the growing presence of insurance, including Medicare, Medicaid, Blue Cross and the commercial insurers, is largely responsible for the rapid rise of health care costs in the United States. It is the contention of this paper, however, that the insurance industry in the private sector in the United States may help in the effort to contain costs rather than solely stimulating rapidly increasing costs. ⋯ It is cautioned, however, that although health insurer cost containment efforts will continue to expand in the future, perversities in the U. S. tax laws, potential provider opposition and the complexities of medicine will continue to make cost containment a difficult task.
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Social science & medicine · Jan 1982
Clinical Trial Historical ArticleHuman experimentation in historical and ethical perspectives.