Hospital Sociology: Social structure of a hospital: - Hospitals are among the most complex organizations in modern society. - Hospitals are dynamic organization( not static) , change according to change in the community. - In the past ( before100 years ago), hospitals were more nearly a place of refuge for the sick and homeless rather than a place for medical treatment, It was an institution where one went to die rather than to be cured, and they were occupied by poor and old people. - In contrast, hospitals now are concerned with active medical treatment using the latest medical advances to cure the patients. They are occupied by all classes of people.

* Now there is an increasing demand for higher academic qualifications, and no doctor today can provide single-handed all the skills and facilities needed for treatment. Functions of hospitals: 1. Pace for the diagnosis, treatment and rehabilitation of sick people. 2. Teaching either medical or nursing personnel. 3. Areas for medical researches to increase medical knowledge. 4. Are places for employment of huge no. of medical and paramedical persons. * The hospital today is a system of increasing complexity- it is a hotel and a school, a laboratory and a stage set for treatment and employment.

The hospital is like a federal system with several departments each having a special system of its management. The great challenge is one of coordination between different parts of the hospital, it requires an administrative machinery to run the hospital smoothly and to avoid conflicts between administrative and professional staff, because if large portion of a group is dissatisfied , the whole system of the hospital will break down. * Each hospital has a " personality" of its own. The nature of the staff relationships will influence the staff-patient relationships and consequently the outcome of therapy, It is for this reason there are different atmospheres in different hospitals, some have a good name, others a bad name.

The democratic ideal has certainly not yet been achieved in medicine because of the followings: 1. The structure of the wards, semi-private and private rooms in hospitals is an obvious reflection of class lines. 2. The service of the doctor in his private chamber tends to differ from that given in a public chamber, not only in time spent for examination but in interpersonal attitudes. 3. Bureaucratic authority still the characteristic feature of the doctor's communication with patients, doctors, and other medical and paramedical personnel, because there is no communication skills curricula in medical teaching till now in many medical schools.

Medical profession: Medical profession like any other occupational group is distinguished by certain characteristics, and because this profession (medical) is concerned with the health of human it should be controlled by: - Professional body which controls the right to practice. - The license to practice is embodied in the legislation , and is given to those have reached a level of competence that is considered minimum. - There must be a State Medical Councils, to control the right to practice, and to determine certain standards in practice. - The confidentiality and the right to practice medicine is withdrawn if there is professional misconduct. - In summary, the state must control the relationship between medical professionals and the clients.

Some of the possible conflicts in the medical profession may happen from the rules and regulations to which they are bound, as e.g. the abolition of private practice by Government doctors. Medical care- an Industry? In the past, the traditional physician was a self-employed small businessman, with many of the same problems, goals and attitudes as other small businessman. His practice was solo-practice based on "fee-for service". Now, significant changes have taken place, in the practice of medicine, The development of new diagnostic and therapeutic techniques requires not only large capital investment but also skilled team of personnel. Sociologically speaking , medical care has the features similar to, big industry.

Specialization: The vast increase of medical knowledge during the 20th century has contributed to specialization in medicine. There are at present now not less than 20 recognized specialties and many more subspecialties. A specialist is defined as " one who learns more about less and less" he is concerned with one part or organ in the body as opposed to the traditional practitioner or " family doctor" who is concerned with the " whole person" or even the family. The problems here are: - Specialists do not establish effective and close doctor-patient relationship. - Specialization encourages jurisdictional disputes between one specialist and another and between specialist and generalist.

Doctor- patient relationship: It is one of the important part of Medical knowledge, skills and attitudes that doctor must has in order to be a good doctor and to provide the best heath services to the patient. Levels of communications: 1. Communication on an emotional plane: The doctor must give a sympathetic ear to the complaints made by the patient and his relatives and treats the patient as human not as a case " the uniqueness of every patient". 2. Communication on a cultural plane: The doctor should be aware of the general concepts of culture and social organization of the community with which he is dealing. 3. Communication on an intellectual plane: The doctor must reduce the social gap between him and illiterate patients and make the patient talks freely with him.

Doctor- Nurse Relationship: Medicine and nursing have common goals→ preservation and restoration of health. Yet their roles in achieving that are different. Primary role of medicine → diagnosis and treatment ( cure process). Primary role of nursing → caring, helping, comforting and guiding ( care process). * Physicians because of authoritarian role tend to be autocratic and look upon the nurse primarily as their helper, following their orders and carrying out whatever they choose to delegate. This in a whole → conflicts in nursing duty, and finally lead to that many of patient's psychological needs persist unidentified and unmet.

The guidelines for good doctor- nurse relationships are: 1 The guidelines for good doctor- nurse relationships are: 1. The doctor should regard the nurse as a member of medical team and not like only a helper for his duty. 2. The doctor should maintain good communication skills with all medical and paramedical staff in addition to patients. 3. The doctor should take the nurse's notes regarding patient emotion and conditions seriously in order met patient's psychological needs. 4. The doctor should usually educate the nurse medically as much as possible.

Medical Social Work: Medical social work has grown into an important field of social work and an integral part of medicine. Medical social works uses " case work" as its main technique to find out the social background of illness, this information helps the doctor in arriving at a social diagnosis, treating illness and estimating the prognosis. The purpose of medical social work is to help sick people – individuals by individual . the person who best can do this is one who had special training in social case work " medical social worker".

Employments of medical social worker: 1. Hospitals. 2 Employments of medical social worker: 1. Hospitals. 2. Tuberculosis clinics. 3. Family planning clinics. 4. Cancers control centers. 5. Mental health centers. 6. Maternal and child welfare. 7. School and university health services. Medical social worker forms a link between medical institutions and the community, visit the family and search for best solution for patients through their social situations. His importance as the importance of nurse for the doctors.

From Medical ethics to social ethics: Along the whole medical history , there are three main stages which represent the relationship between medicine and humanity: 1. Stage of Hippocrates ideal: At the beginning of human history, physicians treated patients with the primitive medicine based on humoral physiology but with very effective communication skills ensuring the uniqueness of the patient and the doctor at that time act as a servant or barber. 2. Stage of medical advances: begins in early 19th century up to middle of 20th century, Where medical advances were huge , medical knowledge was not subjected to suggestions, doctors became highly authorotized over patient, and patients became treated as cases or even as lab animal.

3. Stage of human rights: begins from middle of 20th century till now, after recognition of human rights and freedoms, and of individual autonomy. Many medical choices can no longer be made on the basis of medical science. The patient now can share in medical decision , even replace his physician if not believe in him. In 1948, The General Assembly of the United Nations adopted The Universal Declaration of Human Rights. * Researchers have a particular ethical responsibilities to safeguard the rights of people and to observe the ethical principles benefits, avoidance of harm and justice.

Consumer Protection Act: Over the centuries, the medical profession has been accorded respect by the society. Since last decade or so , increasing commercialization of the profession has eroded this faith. The patient can now claims the doctor or the health institution in the court for bad treatment. COPRA is a piece of comprehensive legislation and recognizes 6 rights of the consumer, namely:

1. Right to safety. 2. Right to be informed. 3. Right to choose. 4 1. Right to safety. 2. Right to be informed. 3. Right to choose. 4. Right to be heard. 5. Right to seek redress. 6. Right to consumer education. * Although the medical community is fighting against the inclusion of medicine under COPRA, it is here to stay. The medical profession can not wish it away. * It is found that by new researches that 90 to 95% medical malpractice claims can be avoided only by good communication skills with patients even when severe complications after medical treatment have been made.