Social medicine

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This article or paragraph presents the situation in Germany . Help us to describe the situation in other countries.

Social medicine describes and analyzes the diverse interactions between health and illness, their risks and protective factors on the one hand and social facts on the other, from an etiological , preventive , rehabilitative , expert , care law and economic perspective. To this end, it deals scientifically and practically with the state of health of the population and its determinants, the organization of the health system , social security and the political determinants of health as well as the effects and costs of medical care. According to Diehl , Gebauer and Groner, social medicine is not only a cross-sectional subject within medicine, but also a “bridging subject to other specialist disciplines - above all social law, sociology, social work, psychology, statistics and health economics”.

Field of activity

In social medical research, for example, the causes of illness and disability caused by the social environment as well as the interaction between social class ( social structure ) and health are examined. The further development of health care organizations and social security institutions are also important socio-medical research areas.

The specialist in social medicine with the additional qualification of social medicine prepares his reports in the area of ​​tension between the partially justified (in the case of a disability), partially unjustified (pension request without sufficient illness) interests of the individual on the one hand and the interests of the solidarity community (i.e. the contributors) on the other. For this he must not only have sound medical knowledge (6 years of medical studies, 5 years of specialist training, additional training in social medicine) to assess the extent of impairment due to the disease, but also sufficient knowledge of the legal situation and current case law (additional training in social medicine).

Typical questions to be assessed in social medicine relate, for example, to statements on the extent and expected duration of incapacity for work , positive and negative performance (such as only 3 to 6 hours of work ability per day, lifting or carrying a maximum of 5 kg, no activities in constrained postures such as crouching), on restrictions on the ability to work, on the need for care or on the requirements for recognition of a severe disability .

Specialists with an additional qualification in social medicine (see under further training) typically work at the MDK / MDS , the statutory pension insurance , the social medical service of the Federal Miners ' Union, the pension funds or also in rehabilitation facilities.

classification

In medical studies, social medicine is part of the ecological field in the clinical study section. The ecological material area includes:

Social medicine is also taught in the social work , health promotion and management and social economy courses .

Definition of terms

Social medicine, as a term coined in 1848 by the surgical orthopedic surgeon Jules René Guérin and dealt with in more detail in the monthly for social medicine founded by M. Fürst and K. Jaffé in 1903 , is to be distinguished from medical sociology , medical behavior and health behavior in a social context considered. Robert Straus reduced this difference to the following formula: “Sociology of Medicine” = medical sociology and “Sociology in medicine” = social medicine. This distinction is based on the ambiguity of the genitive object in English and German. In making this distinction between a medical sociology in the sense of an externally applied science on the “object” of medicine, Straus emphasizes its “organizational structures, role relationships, value systems, customs and functioning of medicine as a behavioral system”. Johannes Siegrist points out the importance of a research approach that makes medical action itself the subject of investigation and "thereby identifies a number of disease conditions and therapeutic results as iatrogenic products". The currently rather controversial cooperation between established social medicine and medical sociology can only be viewed as a task of case-related, concrete discussions and is therefore reserved for future development in scientific and systematic terms. The aim of medical sociology partially coincides with the → sociology of  science , see below, chap. Criticism of social medicine . According to Klemperer, the disciplines of social medicine, public health and health sciences cannot be clearly demarcated from one another.

further education

Since the resolution passed at the 87th German Medical Congress in 1984 to include social medicine in the further training regulations, doctors have been able to acquire the additional title of social medicine. The additional training in social medicine includes, according to the current model training regulations of the German Medical Association, "in addition to specialist medical expertise, the assessment of the type and scope of health disorders and their effects on performance in the professional and social environment, including the classifications of functionality, disability and health, their classification in the framework conditions the social security systems and advising social service providers on questions of medical care. "

Scientific society

The German Society for Social Medicine and Prevention (DGSMP), a member society of the Working Group of Scientific Medical Societies in Germany ( AWMF ), sees itself in Germany as the scientific society for issues relating to social medicine. There are also scientific activities in the social insurance institutions themselves. These are coordinated by the Professional Association of German Social Insurance Physicians (BSD).

International

From an international perspective, however, there are very large differences between the various countries. In the Netherlands, for example, social medicine is an umbrella term that includes occupational medicine , insurance medicine and public service doctors. Insurance doctors from the UWV (the Dutch social insurance), for example, must complete their own 4-year specialist training. In Austria, on the other hand, the social medicine specialist works purely in science and has more to do as a Master of Public Health (MPH). The Austrian colleague has no patient contact. However, there are very few specialists there and the specialist medical profession threatens to die out.

criticism

Criticism of social medicine is only rudimentary in Germany. It is stated that social medicine was essentially shaped by the JF Lehmanns Verlag , known in the Third Reich , which operated under the same name until 1998. Coming to terms with the murders of the sick during the Nazi era also started late.

Since the social medical assessment initiated by health and long-term care funds and carried out by the medical service of the health insurance is part of public law under the Social Code , the protective regulations of the European Convention on Human Rights do not apply here . Criticism of the current practice of socio-medical assessment is also expressed under the aspect of power of interpretation .

See also

Individual evidence

  1. ^ Rainer G. Diehl, Erika Gebauer, Alfred Groner: course book social medicine - text book for the curriculum of the German Medical Association. Foreword, Deutscher Ärzteverlag 2011
  2. ↑ uinsome.files.wordpress: Social medicine in Europe and Sweden: an historical perspective .
  3. ^ Walter Artelt : Ernst Georg Short 1859-1937. [ Lecture given on October 1, 1963 at the annual meeting of the German Society for the History of Medicine, Science and Technology e. V. in Schaffhausen and dedicated to my teacher Paul Diepgen on his upcoming 85th birthday on November 24, 1963. ] Senckenberg Institute for the History of Medicine at the University, Frankfurt am Main 1963, p. 8.
  4. ^ Robert Straus : The Nature and Status of Medical Sociology. Amer. Sociol. Rev. 22 (1957) pp. 200-204, citation reproduced here p. 203.
  5. ↑ Johannes Siegrist : Textbook of Medical Sociology. Urban & Schwarzenberg, Munich 1977, ISBN 3-541-06383-1 , p. 8ff.
  6. ↑ David Klemperer. Textbook Social Medicine - Public Health - Health Sciences. 3rd edition. Hogrefe Verlag 2015
  7. ^ Rainer G. Diehl, Erika Gebauer, Alfred E. Groner: Course book social medicine - text book on the curriculum of the German Medical Association. Chapter 1.1.3 Basic , advanced and advanced training in social medicine and rehabilitation. P. 14, Deutscher Ärzteverlag, 2011.
  8. ↑ (Sample) Further Education Regulations 2003 ( Memento from January 21, 2012 in the Internet Archive ) on bundesaerztekammer.de (PDF; 759 kB)
  9. ↑ Sigrid Stöckel, ed. Heidelberg: The “right nation” and their publisher. Politics and popularization in JF Lehmanns Verlag 1890-1979. Lehmanns Verlag, 2002, 328 pages, ISBN 3-931253-98-8 .
  10. ↑ Publisher JF Lehmann as Promoter of Social Psychiatry under Fascism on peter-lehmann-publishing.com (English)

Web links

Wikisource: The social medicine and social hygiene (1914)  - essay on the development in Germany