Semester Reflection

As the semester comes to a close, I’ve realized just how aware I’ve become of the issues in the U.S. healthcare system. I remember coming to the first lecture not having any concept of the Affordable Care Act, but can now discuss it in a constructive and analytical manner with my peers. I didn’t know that our healthcare system was so multi-faceted and had so many contributing parties, especially in terms of deciding the cost of care. As a student interested in becoming part of the healthcare system as a physician, I was reminded of the importance of empathy and emotion in the medical field. The moving films we watched in lecture really opened my eyes to how important a stable healthcare system is and has inspired me to take initiative in actively reshaping our overpriced and inefficient system. “The Importance of Touch” really helped me understand that healthcare is more than just providing a solution to a disease, but nurturing and developing connections with others. A lot of the semester was spent hopelessly reading articles about the horrible consequences of a dysfunctional system, but the last lectures on hospice care have reassured me that with passion and initiative, we can find a way to organize and establish healthcare as a basic human right. I am curious as to what we can do right now as students and future leaders of the healthcare system. I cannot wait to see the progress we make as a generation on the medical field!

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ObamaCare News

Hey everyone, just one last quick question regarding some interesting news I heard about this week about ObamaCare. It seems that ObamaCare enrollees will be paying even higher premiums next year, even though the number of applicants has skyrocketed this year. Does anyone have any insight as to why these premiums are rising? I read that the Cadillac Tax is getting cut, which is meant to expand healthcare to those who cannot afford care, so with that tax getting cut and rise of premiums, where is that extra money going?

Solving the Case of the Vanishing Patient in the ICU

After reading “The Patient in the Intensive Care Unit” for class, a few questions came to mind as I thought about the experiences associated with being in the ICU. It seems that most of the experience is extremely dehumanizing, and although recent changes in some hospitals allow family members to be with their loved ones in the ICU, many hospitals (including the one I regularly volunteer at) prohibit families from visiting for longer than an hour and force them to wait in another room. A lot of these dehumanizing aspects of an ICU stay simply require a change of policy, but how does one go about changing these policies? Is there any way to make ICU patients less of a “science project”? Furthermore, is it a good idea to keep family members in the room with the patient for as long as they would like to stay? I wonder where it is safe to draw the line, since form one perspective patients should be surrounded by loved ones in such a critical time, but this could pose as a distraction to the professionals working the unit. What are your thoughts on this? Should we make these critical (and potentially last) moments meaningful with family, or do everything possible(even dehumanizing) to save the patient?

Is internet-based diagnosis helping or hindering the patient experience?

 

http://www.newstatesman.com/2015/11/dr-google-will-see-you-now

An article from earlier this month titled “Dr. Google Will See You Now” which overviews how search engines “enhance” your healthcare experience. The article claims that patients who look up their symptoms and do outside research before talking to their physician can make better decisions about their health. Millenials are the most popular users for search engines, and in most cases, are more likely to consult a website or form of media instead of their own physician. On the other hand, the elderly are more likely to consult their doctor before engaging in any other type of medical consulting. Some statistics show that even though search engines produce articles and results that may not be credible, a high percentage of users refer to only the most credible sources. Internet-based “research” and apps seem to be dominating more and more of healthcare, putting patients in what seems to be more control and “expertise”.

This article takes a step back into consumerism and healthcare, where the patient seems to have more of a say in what he or she thinks is right for his or her health. The professional dominance dynamic shifts once again as the internet and apps that check your vitals for you become more and more popular. The article makes the argument that “As technology improves so, too, will the quality of the information available to both patient and doctor, and the benefits of online health-care information and self-diagnosis tools will be felt more widely”, but personally, I think the power of touch and interaction is still missing in this practice, which defeats the purpose of medicine. In many ways, we seem to trust ourselves more than licensed medical practitioners, which creates a barrier in the patient-doctor relationship. Using the internet as the first step to diagnosis can be the start of a dangerous path, causing patients to have a predisposition to their diagnosis and may even refuse treatment if it does not “match up” with their own personal research. New connected devices like health watches allow us to be aware of our vitals, which can especially be useful during exercise. However, it seems that we rely on these technologies even more and even replace them with traditional healthcare practices.

 

Consolidation of Big Pharma Companies

I recently came across an article about two major pharma companies, Pfizer and Allergan to consolidate as one large pharmaceutical company.

http://asia.nikkei.com/Business/Deals/Pfizer-buying-Allergan-to-goose-growth-as-patents-expire

After talking about the relationship between Big Pharma and government policy in lecture, I started to wonder what would happen if big companies like this got even bigger. How do you all feel about this? Do you think this will make healthcare, or at least pharmaceutical care even less accessible to the population that can’t afford drugs? It seems that a lot of the discussion has been centered around the tax benefits and creation of new jobs, but not much commentary on how this will impact the pharma industry in general. Also, other past consolidations such as Pfizer/Astra and AbbVie/Shire were both huge deals, but fell through owing to competition concerns and moral questioning. Why is it that this deal seems to not have any moral concern? Any comments/other questions are welcome!

The Modern Hospital

After watching the video in discussion on Bumrungrad International Hospital, I began to realize just how dramatic the environment of hospitals has shifted from philanthropic to business oriented. It seems that traveling all the way to Thailand provides a cheaper way of receiving medical care, but it doesn’t seem that Medical Tourism really solves any issues within the healthcare system we have today. Even though the price of care is 1/8 of that in the U.S., medical tourism remains an out-of-reach option for any people below the upper-middle class socioeconomic level. The gradual absence of the middle class in our system leaves two categories of people: those who can afford to travel to get care and those who simply cannot. This once again leaves a large group of people that cannot receive the care they need because it is simple too expensive, even if not provided in the U.S. It seems as if the modern hospital is becoming an overpriced hotel stay, completely overlooking the large population of people that simply just need medical help, not some sort of glamorous experience. At what point do we draw the line and focus on the medical aspect of a hospital stay and stick to the very basics of medicine, rather than try to cultivate some sort of elaborate business idea? If this trend continues, what will hospitals become and will they even be accessible to the poor?

The Case of the Elderly Orphan

Perhaps a recent and increasingly critical issue arising in the United States healthcare system is the lack of end-of-life care and elderly care. In Anna Medaris Miller’s article titled “No Spouse, No Kids, No Caregiver: How to Prepare to Age Alone,” Miller highlights steps that the elderly can take in order to avoid being helpless when they need assistance. Without family members or caregivers, elderly people virtually have little to no way to be cared for by the American healthcare system, leaving most elderly patients to be orphaned with no one to provide them with the care that they deserve. Miller names these patients “elder orphans”, and mentions that “Elder Orphans come in with horrible cases of malnutrition, bedsores, depression and attempt suicide, feeling hopeless that no one can help them”. However, in order to prevent poor ageing environments, Miller suggests that the elderly make connections with friends and reach out to others when they need help. She also suggests that appointing a proxy and moving to a more elderly-friendly city will make being alone much easier as an elderly person.

Although Miller does propose some good solutions to elderly “orphans” that will need to eventually seek help for their medical needs, there doesn’t seem to be any systematic solution for this. Miller simply indicates how to deal with the current situation the American healthcare system is in regarding care of the elderly but fails to acknowledge that the healthcare system itself needs revising in terms of providing care for the elderly that do not have family or financial sources to care for them. In Holly Holder’s article titled “Japan’s solution to providing care for an ageing population”, Holder illustrates what makes Japanese healthcare so effective for the elderly. Japan’s long-term care insurance plan, which wasn’t introduced until 2000 since it was believed that caring for the elderly is the sole responsibility of the family, provides the elderly with publicly-funded institutional and community-based services. Japan’s reform for the elderly has provided social care that is needed for its large ageing population, and could even explain why the life expectancy is so high in Japan.

Holders’s article seemed to provide insight to the problem highlighted in Miller’s article, since the responsibility for taking care of the elderly couldn’t possibly be placed on family members if the elderly person does not have any family members or children that can take care of them. With the increasingly ageing population in the United States, the number of elderly orphans is increasing, leaving a large number of people that need care but simply can’t get it. Although Medicare does provide some care for the elderly, healthcare may be inaccessible entirely for elderly patients that can’t even find the help to make it to a doctor’s appointment. Creating communities for these elderly people would allow them to connect and avoid isolation, which would prevent depression and make a healthier life more accessible to them. Expanding programs such as meals-on-wheels for the elderly would especially help this sort of scenario and cutting the costs of such programs would benefit elderly orphans as well, since it would become more affordable and less daunting. This way, end-of-life care can take small steps to becoming a more stable and useful part of our healthcare system.

Article Links:

http://health.usnews.com/health-news/health-wellness/articles/2015/10/26/no-spouse-no-kids-no-caregiver-how-to-prepare-to-age-alone?page=2

http://www.theguardian.com/social-care-network/2014/mar/27/japan-solution-providing-care-ageing-population

How Mental Health Awareness Can Provide Better Health Care

Last week, I came across an interesting article by Dr. Ed Jones, vice president of strategic planning for the Institute for Health and Productivity Management, regarding behavioral health in the United States. Perhaps one of the most overlooked areas in healthcare is mental healthcare, especially since regular behavioral health has only recently become a major topic in medicine along with other medical concerns. It seems that the only way to be provided with quality mental health care is to develop a mental illness and find help once a problem has developed, rather than obtain regular behavioral check-ups as one would for physical check-ups.

Jones proposes that the main culprit behind this problem is the underfunding of primary care, which ultimately leads to a lack of structure in primary care. Primary care physicians (PCPs, for short), are essentially the first set of eyes to analyze a patient, leaving PCPs with a lot to look into, but little training to do so properly. PCPs not only deal with ordinary physical illnesses, but are involved in the psychosocial issues of the patient as well.

In order to correctly address the patient’s emotional problems and provide the care that they deserve, PCPs need proper training in order to work with the “chronic medical conditions that drive more than half of the medical costs in the U.S.”. Addressing mental health concerns as early as a primary care physician visit can improve the overall quality of care that each patient receives and will reduce the overall price of the cost of his or her care. As Jones mentions, primary care needs to be led “head first,” focusing on behavioral health, especially since 70% of PCP visits stem from behavioral health problems. However, this cannot happen without the current lack of funding for PCP training in this field.

I found this article very enlightening in terms of finding a way to make PCP visits more valuable financially and health-wise. It seems that a PCP visit is always a very ambigious analysis of health, but with the proper training, PCPs could be more critical of the psychoscocial issues of patients. Although I agree that the funding must be improved in order to provide training for PCPs to tackle such issues, I am confused by Jones’ solution for training. It seems to me that team training only fixes the dynamic between doctors, rather than improving the dynamic between an individual patient and doctor. I think team planning/training is a strategic plan for other fields, but does not seem beneficial for medicine. The negative social stigma for mental illnesses must also be changed in order for patients to view behavioral health to be just as important as any other type of care.

Link to article: http://www.behavioral.net/article/how-behavioral-health-can-advance-better-model