1. HOSPITAL SOCIOLOGY
Kingsuk Sarkar, MD
Asst. Professor
Dept. of Community Medicine
DSMCH

2. • Modern hospital is a
social universe
• Multiplicity of goals
• Profusion of personnel
• Fine division of labor
• Patient is hospital‟s client

3. Structure:
- Dynamic in structure & function
- Consistent with changes in
community
- Evolution of hospital: from a
charitable institution to take
last refuge, to take last breath
Institution concerned with
active medical treatment in
liaison with modern medical
sciences
- Provision of teaching to
medical & nursing personnel

4. - Research activities
designed to increase
medical knowledge
- Hospital today function
as : Hotel, School,
Laboratory, A large set
up for treatment
- Administrative
machinery runs the
hospital & tries to diffuse
conflicts between
administrative &
professional staff

5. - Democratic ideals not
has been achieved in
hospital structure:
wards, semi- private,
private rooms
represents class division
- Each patients expects
TLC from hospitals
- Each hospital has its
ambience, work-culture,
emotional atmosphere,
staff patterns,
community served by it

6. - An occupational group
- Distinguished by certain
characteristics
- Professional body controls the right to
practice
- License to practice embodied in
legislation
- Awarded to those with a certain level
of competence
- Indian Medical Council Act passed on
1933, revised 1956

7. - Maintenance of all India
registrar
- State Medical Councils
controls the right to practice
- Certain standards of practice
& personal conducts are
imposed
- Professional misconduct→
rights to practice medicine is
withdrawn

8. o Traditional Physician: self
employed small
businessman having “solo-
practice” & charging fee
o Development of diagnostic
& therapeutic techniques→
involvement of skilled
manpower & large scale
investment→ large non-
medicos involved

9. o Longstanding practice of subsidizing
medical education & medical care
o Rapid development of insurance &
other prepayment financial facilities
o Demand for provision of best possible
health care for all irrespective of
financial status
o Medical education with knowledge,
experience, dedication may lead the
way to develop better future

10. o Many recognized specialties &
sub-specialties
o Less interpersonal contact
between doctor & patient
o ↑jurisdictional disputes
between specialties, between
specialist & generalist
o Specialization→ divides doctor
& patient, de-personification,
social role of medicine is
forgotten, lopsided
development of health
sciences, strained traditional
doc- pt relationship

11. o Doctor possesses technical
superiority, knowledge, skill
o Doctor exercises authoritative role
over patient
 Levels of Communication between
doctor & patient:
i. Communication on emotional plane:
ii. Communication on cultural plane:
awareness on culture & social
organization of the community
iii. Communication on intellectual
plane: reduction of social distance
between doctor & patient

12. o Doctor‟s ability to communicate
patients on all three planes brings
out maximal psychological
satisfaction to the patient
 Qualities sullying reputation of a
doctor:
- Lack of sympathy
- Unfriendly
- Greedy
- Differentiating between rich & poor
 Patient not behaving up to doctor‟s
expectation→”un-cooperative”

13. o Medicine & Nursing share common goal
o preservation & restoration 0f health
o The primary role of medicine →
diagnosis & treatment ═ cure
o The primary role of nursing →care
↔caring, helping, comforting, guiding
o Doctor assumes authoritarian role→
role of nurse get unnoticed
o Nurses to take up more instrumental
role pertaining to treatment &
diagnosis

14. - a sub-discipline of social work
- also known as “Hospital Social Work”
- Began in 1895 in England through
Almoner
- Main technique- “case work”
- Finds out social background of illness,
helps doctor in social diagnosis,
treatment, concluding prognosis
- Main purpose→ to help sick people,
through best use of patient‟s
capabilities & community resources
- Personal & social adjustments in the
community through rehabilitation

15. o A paramedical worker who has been
trained in in social case work &
interviewing
o MSWs are employed in hospitals, tb
clinics, cancer control centers, family
planning clinics; fields of mental
health, maternal & child welfare,
school & university health services
o typically work on an interdisciplinary
team with professionals of other
disciplines such as medicine,
nursing; physical, occupational,
speech and recreational therapy, etc.

16. o Visits the family & probe into the
personal, economic, & social cause of
illness & collect social history to supplement
medical history
o In chronic debilitating illness
(tb, leprosy, polio) MSW aids in
rehabilitation
o Medical social workers play a critical role in
the area of discharge planning. One
responsibility of medical social workers is to
collaborate in the development of a
discharge plan that will meet the patient's
needs and allow the patient to leave the
hospital in a timely manner.
o Essential professional colleague of doctor in

17. o Ancient codes on medical ethics:
Hippocrates, Indian, Chinese;
based on patient‟s welfare
o Modern codes have an added
social dimension, responsibility for
health & concern for justice
o HFA 2000 emphasized on social
justice with equitable distribution of
resources by sharing of
responsibilities on health by
individual & community
o Progress in medical biotechnology
o Progressing social changes

18. o Recognition of human rights &
freedom, individual autonomy
o Balance between patient‟s interest
with those of society
o Explosion of expensive medical
technologies & consequent rise in
people‟s expectation→ problem of
best use of scarce resources
o Policy makers under pressures:social,
economic, political, technological
o Potential of modern biotechnology:
organ transplantation, infertility,
combating hereditary disease,
postponing death, manipulating
genetic makeover

19. o Modern days patient exercise
autonomy & informed consent:
whether or not to accept or continue
with treatment, to participate in
research, to permit use of personal
health data, stand for or against pre-
conceptional research, organ donation,
withdrawal of life support system
o Researcher has special responsibilities
to safeguard the rights of deprived &
oppressed, those subjected to
drug/vaccine trials & epidemiological
studies

20. o The Act on 1986, paved way for speedy
redressal of grievances of consumer
o Medical profession was kept into its
ambit
o Rapid commercialization has gradually
eroded the faith & respect of society
towards medical professionals
o A quick, efficacious, economic remedy
o If a patient or relations feel suffering or
death of the patient is because of
negligence of either concerned doctor
or health facility, they can complain to
the MCI or Consumer Court

21. o Medical council can only cancel the
registration of the concerned doctor
but cannot punish him or award a
compensation
o Consumer courts can only provide
compensation based on opinion or
expert certificate from doctor of
concerned specialty
o Courts can be: District Consumer
court, State Commission, National
Commission

22. I. Right to information on healthcare services, availability,
diagnosis & treatment
II. Right to have information about professionals involved in care
III. Right to safety from errors & malpractice
IV. Right to confidentiality & privacy
V. Right to have prompt treatment in an emergency
VI. Right to get copies of medical records
VII. Right to informed consent
VIII.Right to refuse to participate in human experiment & research
IX. Right to be informed about the rules & regulations of the
hospital applicable to the patient & facilities to be obtained by
patient
X. Right to choose & to seek 2nd opinion about the disease &
treatment
XI. Right to complain & have compensation within reasonably shor

24. o Secure information through face to face
interaction & hence obtain the picture of the
complete personality, wide enough to
encompass the social & psychological
background of the concerned
o To formulate hypothesis
o To collect personal data for quantitative
purposes
o To collect data from persons regarded as
secondary sources of information

25. a) Direct/Structured: a schedule containing a set
of predetermined question is administered by
the researcher into to without any alteration
b) Non-directive/Unstructured: no predetermined
sets of questions are asked instead free
discussion with subject is allowed to narrate
his/her own story along with her own
opinion/reaction
c) Focused Interview: used to study social &
psychological effects of mass communication
regarding experience, attitude & emotional
response
d) Repetitive interview: used to the gradual
influence of any social or psychological process

26. 1. Establishment of contact
2. Commencement of an interview
3. Establishment of rapport
4. Recall
5. Probing
6. Encouragement
7. Guiding the interview
8. Recording
9. Closing
10.report

27. :
• Exploring the problem:
• Psychological support
• True perception of the problem
• Summarization of the problem
• Modification of the environment
• Partialisation of the problem
• Recording

28. • Reserved vs. Outgoing personality
• Less intelligent vs. More intelligent
• Emotionally Unstable vs. Emotionally
Stable
• Assertive vs. Humble
• Expedient vs. Conscientious
• Tough vs. Tender/Feeble Minded
• Forthright vs. Shrewd
• Undisciplined vs. Controlled
• Placid vs. Apprehensive
• Relaxed vs. Tensed

29. o May be defined as the application of scientific
methods of investigation to the study of complex
human organization or services
o a discipline that deals with the application of advanced
analytical methods to help make better decisions
o Sociological science
o Concerned with the team/group working together to
introduce beneficial changes
o It aims to ensure optimal utilization of resources in
men,material & money to the service of the community
o It strives to develop new knowledge about existing
program, institution,use of facilities, about people
working there, about beneficiaries( individuals &

30. • Problem formulation
• Data collection (sampling if necessary)
• Data Analysis & Formulation of
Hypothesis
• Deriving solution from
hypothesis/„Model‟
• Choice of Optimal solution & Forecast
Result
• Testing of Solutions
• Implementation of Solution in the whole
system

31. • varies with type of work
• Minimum composition in a
social medicine application:
- Public health administrator
- Epidemiologist
- Statistician
- Social scientist
- Ancillary workers:
clerks, peons, field workers
- Headed by
director, responsible for

32. A. Part Problem
B. Whole Problem
o Finding out optimal size of area/population
to be covered by midwife/basic health unit
o Ideal vehicle for local health worker
o Problems of queue in OPDs & waiting lists
in hospitals
o Architectural design of hospitals & health
centers
o Study of bed-load & nursing services in
teaching & non-teaching hospitals

33. o Length of stay in hospitals &
length of absence due to
sickness
o Extent to which the stated
objective of the program have
been achieved
o Quality of medical care
services
o Outbreak investigations
Observation & Classification
social medicine
OR
Discovery & Recommendation