As we finish off this course, I realized I have developed a new perspective and outlook on the entire medical system of the U.S.. Having grown up in another country for most of my life, I have always known my own country’s medical system (Taiwan) and thought everything should be like that as it would make things much easier. I also thought in a more than naive way that the U.S. would have a similar system. This course helped me shine a light on what is wrong with the entire medical system of the U.S., but also gave me hope for what little hope there is left. It allowed some thoughts of reform and of change, which provided a rather bleak life with a sort of hopeful outlook. Even as we ended the class talking about end of life care, we managed to squeeze in some happy notes by explaining what we could be doing instead of what we are doing now. In that sense, I don’t see this class as teaching new material as a typical class does, but rather provoking conversations and viewing the world from an outsider view. Instead of teaching the basics, we learned to question the society we live in and what can we do as individuals to improve it. After all, we are going to be future doctors which will have a major impact on the medical field. If we can bring what we learned in this class to our future careers, maybe we really can bring change to the medical field and possibly reform it completely.
In terms of actual teaching, I think Dr. Guseva did a great job explaining many of the past concepts in lecture. She brought her own point of view as well as explained the current trends, and allowed us to think about what we should do to contribute, such as conversations about death. I think discussions were helpful as well, but I would’ve preferred if they went a little faster or more in depth into the lectures that we went over in class. We usually went over the readings which were helpful, but were something we really could’ve done in our own time.
To bring it all into context with what we have been learning about for the past few weeks, I think we really should bring all of what we learned into context to be change, however slight, in the world and change perspectives of how we view healthcare, illnesses, and death. What is rather stigmatizing to think about should not be so, and should be more talked about as the more we stigmatize them, the less we treat people with these certain conditions. This course really has brought a lot of new thoughts to my mind about healthcare and I’m glad I took this course to discuss these thoughts!
Through the last view lectures, we learned many aspects of end of life care, such as being in the intensive care unit, in nursing homes, and in hospice care. The main overall view we can get from these aspects is we need to change our view of death, and make sure the patient gets what they want or deserve. Maybe they would not prefer treatment and rather die in the hands of their loved ones or near them, therefore sending them not to ICUs but rather to hospice facilities or just the comfort of home. Maybe the old would rather be living their own lives, like those in the neighborhood for the elderly, instead of being monitored for their own health. This would lead us to believe that we need a change in how we view death and aging.
Whereas death may be viewed as a terrible thing and prevented, we should treat is as an inevitable situation and have the patient be the one in control when it is their own death. Death should not be a taboo subject, but again it should be embraced when the time has come. In this state, the most optimal thing to do would be allowing the patient the most comfort they can afford. Aging should be viewed in a similar fashion. People who are aging should not be viewed as feeble or fragile and have to be looked for (unless they have to due to a condition such as Alzheimer’s) but rather looked as capable individuals who have their own wants or needs. Rather then confine them because they are close to death, allow them to do whatever they want because they almost have no more life to live. There is a shift toward this view, but a lot more thought would be needed to fully push the view toward the main picture and have it embraced by everyone. At this point, will we be able to actually conquer death: when we accept it and gain a sense of comfort from it.
In this article, Patrick Hardison, a firefighter, undertook an extensive face transplant. It started when he entered a burning house for a rescue search, but had the roof collapse on him, burning the firefighter’s mask into his face. A donor however was found for him and they were able to give him a full face transplant, as well as 70 other surgeries, for 850,000 to 1 million dollars paid for by NYU. This shows the extent to which medical technology has advanced to the point where almost any type of transplant is possible with the right amount of money.
The extent of medical technology to be able to repair an entire face is absolutely astounding. This article reminds me a bit of Frankenstein, how they were able to piece together dead body parts and bring it alive. In a way, we are moving closer to what we thought was purely science fiction, with the extent to which we complete transplants nowadays. It also raises many questions for where medical science is to go from here and how will it improve even further. It almost seems quite surreal how we are now able to fix any broken limb or organ just with a transplant whereas a few years ago we were lacking all sorts of technology. Could it be possible that we move from a time where we can fix any body part to curing any disease? Whatever path or direction we take for medical science, it will only bring further better outcomes for the whole of society.
In class, we learned today about end of life care and the procedures that go into that care. Recently in the news, I’ve also learned that physician assisted suicide is becoming gradually more accepted, giving patients the right to end their pain. Although this is a large step from the indifferent end of life care and they do get to spend their last moments with their family, it is still in the hospital: a generally more morbid and depressive setting. The first thing we learned this lecture is how many patients and people in general would prefer to die at home. Shouldn’t we grant them that very right before they die?
Instead of still having the patient hooked up until they decide they would like to die, maybe we should use tools such as fMRIs or EEGs to ask the patient if they would want to go home and live the end of their life there. By living the end of their life in the hospital setting, although they do decide to die, they end their life in the worst possible place, with sick and dying people around them. Releasing them from that setting, ultimately would grant them a little bit of happiness before they are let go with their family next to them. Death shouldn’t be as stigmatized as it is, and it only is this stigmatized because we related illness and hospitalization to death, when inevitable death should be looked as the moving on with life. It should be looked as spending time with family in a familiar setting when you move on instead of with grief and pain. So ultimately my question becomes should we release patients from hospitals and ICUs so they can die at home?
As we talked about last week in lecture, emotional labor is when you show emotion even though you may not feel the same emotion you are expressing, to provide the patient or the person who you are showing that emotion to with some relief that you care. Wouldn’t this non-genuine emotion take a toll on the doctor though? The doctor, who has to deal with many stresses and pressures, would now have to make an active effort to show a fake emotion when they are really just tired of everything. By essentially faking an emotion and not showing actual empathy, the doctor would possibly wear themselves out and in the process indirectly affect the patient by the tiredness or stress they could hear in the doctors voice. If the doctor can’t express actual sympathy for a patient and has to keep an image in order to make the patient satisfied, is that person really fit to be a doctor?
As we learned in class earlier this week, medicalization is the process of making non-medical conditions medical and through this there is some sort of social control. We learned that through this that the medical profession, pharmaceutical companies, and the public themselves all use this to raise awareness to certain symptoms and how pharmaceutical companies might use to promote certain new drugs. I thought we could relate this to why the medical industry has stayed as powerful as it has despite the changing economy: medicalization. With research for both the medical profession and the pharmaceutical companies, new diseases or illnesses are being discovered at a rapid pace with only the medical profession with the help of the pharmaceutical companies to solve them. With the pressure of wanting to be normal and the medical profession and pharmaceutical company both defining what is normal, the doctors and drug companies will always stay in power as they are constantly setting new guidelines of what is healthy. Through this process, as well as the influence of mass media on the public, the medical industry will never falter until something takes away that power from them. So could medicalization be not only a means of social control but a way to maintain dominance in our current economic system?
As we learned last week, the effects of both gender and socioeconomic status have an effect on the life expectancy and health of the individual in question. These both provide the person with opportunities they wouldn’t otherwise have if they were of a lower socioeconomic status or of an opposing genders. A recent study shows however that there might be this inequality in the hospitals themselves.
In this article, it states that women are less likely to get warned of the risk for heart disease by their doctors, due to the doctors understanding it as a “men’s” disease. Because of this, men are more likely to get treated for heart disease due to the doctor telling them beforehand and giving them prevention methods. As a result, 4.5% of women below 60 died in hospitals compared to the 3% of men below 60 due to heart diseases.
This raises serious issues in regards to both research and treatment. In regards to treatment, whenever a person is shown to have symptoms of anything, be it heart disease or any other disease, it is the job of the doctor to inform the patient and not act under the guise of it being a specific gender disease. It is not the patient who is at fault in situations like these, as he/she would not know they have anything wrong with them until it is too late, but rather it is the fault of the doctor. In regards to research, the very last line of the article pointed out a clear fault that we have been talking about for quite a while last week: “Officials should also enforce existing policies that require women to be included in research instead of men only, she added.”. The reasons why doctors would think this way would be because not enough research is done on female subjects so only data involving males is obtained. If we are to prevent diseases in general, we have to have research to understand both the female and male anatomy and their susceptibility to diseases or we won’t understand the entire picture of said condition.
As we learned in class, we found out about the Hispanic-Paradox and how Hispanics who come to the US have up to five years that they have better healthcare than the average American or even the wealthy Americans. This is due to their environment outside of the United States being more friendly toward all and less stress overall which increases the general healthcare of anyone there. Would this then apply to anyone else coming to the United States compared to that of an American born individual? If it is the environment affecting the health, couldn’t people from Japan or Germany who were born and raised there, come to America again with better health than the average American. If that is the case, then it really is the problem of the system and the main issues that need to change would be issues regarding the economic barriers and social statuses of people. It is not about just providing healthcare anymore, but it is also about making sure everyone has the same everyday needs as to not get infected by any preventable diseases.
Through the beginning of the semester, I really learned a lot regarding the system of healthcare and how it operates. I feel like the readings that we had helped to compliment the lecture as we learned various details such as the high costs in our healthcare system and the growth of the healthcare system throughout history. For the most part, I agreed on the issues that were raised: we definitely need to cut down the prices and de-capitalize the system of healthcare as it is right now. I found a lot of this to be not as surprising as I would’ve hoped however as this conversation has been an ongoing one for a while. While I did hope for new views on the matter, the readings and lecture broadened my view to incorporate the many people that were affected by the actions of the healthcare companies. This also raises many questions about what I think of this class in relation to the profession I am hoping to get in the future, such as what type of doctor will I be in the future or how we can maximize the patient’s comfort during their treatment without going through over-treatment.
In regards to Dr. Guseva’s teachings, I feel at times she goes a bit slow. I understand that we are getting an in-depth view of how deep this problem runs and how overlooked certain issues have become but I would prefer the teachings to be more broad on the many different aspects of the healthcare system. I’m sure we will get into it later on in the lecture, but I would hope to understand more about other countries as well. We are slowly touching on them and I hope to learn a lot more as time goes on. Overall, this class has been a really interesting and eye opening class as it is now!
Recently in the news, there has been a lot of conversation around an individual named Martin Shkreli who owns the pharmaceutical company Turing Pharmaceuticals, raising the price of Daraprim, a HIV drug, overnight by $13.50 to $750 per pill overnight. I found this article to be really interesting as it touched on what we are currently learning about in class. Instead of focusing just on Shkreli, it focused on the general picture, being that this is a custom that is done by all pharmaceutical companies. As quoted by the article, “A 2014 House of Representatives investigation found 10 genetic drugs that ranged in price increases anywhere from 420% to over 8000% of their prices just a year before”, showing that this was already a common practice. The article then goes to talk about the monopoly effect that many pharmaceutical companies have over the drugs they sell. Lastly they go into the fact that raising the price is “not illegal, just immoral”, and because it’s not a legal case but rather one of morality, little is done to change it.
I feel like this article is greatly representative of how our healthcare system is like and why there has to be a dramatic change in action. With the pharmaceutical companies having almost total control over the drug costs, doctors don’t have much negotiating power and therefore charge the consumers for the same price. By keeping our healthcare system in this state, we allow business CEOs, focused on maximizing profits, to run the state of our healthcare. I also agree with the last point that we have to make it a legal issue. The government should be able to regulate these costs as well as the overall state of healthcare as it had with Medicare. If the government can make policies around these issues, as well as regulating prices of the healthcare system, the monopoly of drugs and treatment will be drastically reduced and many will have more access to treatment.