Final Process Reflection

Sociology of Healthcare has opened my eyes to the many multifaceted  problems within the healthcare system, especially in the United States. As a developed country, one would expect the best quality care and equality for all its citizens. This is clearly not the case. Our current system has been  and is continually hesitant to change.

Traditional medicine and practices are not always the answer to good care. Some major takeaways from this class are equity and access to care and the importance of a universal healthcare system. There are large disparities in health among racial and ethnic minorities. These disparities create major spikes in healthcare costs and promote a continual decline in health that impacts the overall health of the United States. There are more problems to consider such as doctors and feeling, and how it affects the patient and health outcomes. The lack of feeling and emotion in healthcare overlooks patient needs. This leads to a poor experience and in some cases poorer health outcomes. If doctors would take the time to get to know their patients, they would be better able to address their problems (some that may not be easily identified in a healthcare setting).

In the end, it is crucial for the individual to be the focus in healthcare. At the end of the day, we are caring for people not human bodies. Access to quality care is a must to promote healthy lives at all stages of life.

November Posting

http://www.nytimes.com/2015/11/18/health/prostate-cancer-studies-find-declines-in-screening-and-early-detection.html?ref=health

Studies Find Declines in Screening and Early Detection of Prostate Cancer

The article, “Studies Find Declines in Screening and Early Detection of Prostate Cancer,” by Denise Grady discusses the findings of two studies published in the AMA journal that suggest that prostate cancer screenings are happening less and less for men. The reason for the decline in screenings is that “there is less effort to find it” and by a  “recommendation….made in 2012 by the United States Preventative Services Task Forces”. The Task Force’s reason for this decline in screening is that the “risks outweigh the benefits” and with more testing “there is unnecessary surgery and radiation” involved.

I believe that this article highlights the importance in identifying the conundrum that the healthcare system has in providing good care and services to people without providing too much or too little. Overutilization is a real problem in the healthcare system. There is a chance that testing can cause more harm than good. However, there is also a chance that we may not be doing enough in preventative care for chronic diseases. If zero men are being screened then there is likely a higher chance of prostate cancer cases being missed or not diagnosed.

The article suggests that less testing correlates with less cases of prostate cancer, but this statement is not verified. I doubt whether there is enough evidence or research to make this conclusion. There could be other reasons for less cases such as environmental factors.

Grady suggests that “better ways to screen [are] needed.” Screening can be both cost effective and preventative. If doctors can narrow down “high risk” patients they will be more successful in finding prostate cancer. Unnecessary screening can be avoided and necessary screening can be administered.

Ultimately, I think there is much need for an overhaul in the way we provide healthcare to patients. Problems with preventative testing does not just affect men, but it also affects women. Some women are required to have annual mammograms to screen for breast cancer or suspicious tumors. Does the radiation from this screening cause more cancer cases? When is preventative care too invasive and harmful? How can we tell? Further research needs to be conducted to determine the effect of this relationship.

How have hospitals changed throughout history and what implications do these changes have on care?

In Charles Rosenberg’s  piece, “The Rise of the Modern Hospital,” he discusses the  transformation of the hospital throughout history and the implications that have resulted from this change. In the early 1800s, care was typically seen in the home. Hospitals were more like wards that provided “room and board” type services for the poor who did not have a home or family caretakers to give them care. As hospitals transformed in the 1900s, care in hospitals was no longer an outlet for the poor. This has had extreme implications today since we now see a significant problem with providing access to healthcare to the poor. In the 1920s, hospitals determined admission based on social position, diagnosis, and therapeutic capacity. Hospitals became an institution and a marketplace where providing care meant maximizing on income from those who could afford care. This meant that more people were now unable to afford care at hospitals and they were “unwilling to enter charity wards in voluntary hospitals” (Rosenberg). This was a “failure to provide optimum care at a reasonable cost”(Rosenberg).  This also meant that chronic care was ignored and acute care was pursued. If healthcare has progressed in research and in technology why is quality of care still so poor? Why are we ignoring the poor and why are we so fixated on financial reimbursements? How do we find ways to fix this problem when it is so deeply rooted in our history?

Why aren’t we teaching doctors how to think?

In the book “How Doctors Think”, Groopman introduces us to a woman named Anne Hodge who had a long history of illness. She has visited doctors regularly for years but still saw her health deteriorating. Many of these doctors diagnosed Anne with different ailments but nothing seemed to alleviate the pain and nothing got to the source of her illness. No doctor communicated with her effectively or listened to her. With this case, Groopman discusses the nature of thinking and how a doctor comes to his conclusions. Groopman believes that future generations of doctors are being “conditioned to function like…computers” (Groopman, p. 6). Future doctors should not only focus on scientific aspects of disease and illness but also the physical and social implications they present. Groopman discussed Anne Dodge’s visit with her doctor, Dr. Myron Falchuk. Instead of just looking at scientific factors he looked at her as a person and what he saw on the outside was highly telling. She was “suffering” (Groopman, p. 11) immensely and her symptoms weren’t adding up. Dr. Falchuk was able to give her the proper diagnosis and Anne was finally able to get relief from the disease. It is astonishing that it took 15 years to help this poor woman. My question is why are we still using and teaching old practices or methods of finding and curing disease when they are simply not working or do not target the problem? Groopman suggests that “open ended questions” (Groopman, p.18) are necessary to allow the patient “freedom of speech” (Groopman, p.18). Why aren’t these practices taught or utilized in today’s medical training? Why isn’t this a focus? Why aren’t we teaching doctors how to think?

Gender Creates Inequalities

In discussion, we talked more about the nature of gender inequalities and the disparities among health outcomes. I thought it was very interesting to see how social institutions, stigmas,  and our history, affect health outcomes. I once read an article that discussed children born to mothers who were in New York City during the time of the 9/11 terrorist attack. Research found that these children were more prone to developing anxiety since their mothers experienced severe stress while they were in the womb. Women seem to have more health problems than men, is this disparity directly related to the social oppression seen in women’s history?

Is health dependent on more than race and socioeconomic status?

In class, we have watched several short films that suggest that socioeconomic status and an individual’s environment play a large role in determining health. What struck me was the last piece of information we looked at in class on Tuesday; the Hispanic paradox. This paradox seemed to suggest that even though Black and Hispanic Americans are both minorities who share lower socioeconomic statuses in our country, there is an alarming difference in the health of African Americans and Hispanics. On average, Hispanics tend to be healthier. This has nothing to do with race, African citizens from Africa tend to have better health in Africa than most Blacks here in the United States. The short film we watched suggested that culture and interpersonal relationships had something to do with determining health. I found this very interesting because there are theories in sociology that discuss the nature of individuals who are isolated from a community and how it affects them. Hispanics have a tight knit culture and often times older family members stay with their children rather than being left alone or forced into nursing homes. Other than strong social bonds, how else does Hispanic culture compared to African American culture tie into health? What other differences affect African Americans?

Why can’t we adopt a different healthcare system?

The film in class allowed me to view other countries’ healthcare systems and compare them to our own here in the United States. I was surprised to find that even though we are a well developed country, we still struggle to give people access to healthcare, as well as,  lower our healthcare spending. The UK has a system that is funded by tax revenue and Japan is somewhat similar except there are competing players. Why can’t the US adopt a similar plan that allows access to all Americans regardless of age, employment status, or income but still keep the market open? The US spends more than any other nation on healthcare costs alone. Why have other nations figured it out when we are moving slowly to change? A hospital president in Japan even commented on the high medical costs in the US by saying “being put in debt because of healthcare is unheard of.” This is astounding because in the United States, there are many people who are suffering from debt due to hefty medical bills. Japan also has regulated costs. These medical prices cannot be raised for no reason.

Process Reflection 1

The Sociology of Healthcare class and the materials covered have opened my eyes to the corrupt and unjust nature of the United States Healthcare system. Before taking this class, I was not very familiar with the healthcare system or all of the different types of coverage or even the history of healthcare or insurance policy. Today, I have a better understanding of the healthcare system and the way it is organized. After reading about different healthcare plans and different experiences in the system,  I often look back at my own healthcare experience for context. However, I feel that I am unique in the sense that my coverage is provided by the government; specifically the military. This system is not perfect by any means but I have not had a problem gaining access to healthcare and have never had to pay any off the wall charges. For instance, I had a thumb surgery for a tumor removal. The bill came out to $6,000 but my family only had to pay a small copay of about $40.

I do not pay for individual visits to see a healthcare provider and medications are also covered under my insurance. I simply cannot imagine being an individual who does not have insurance or who is denied coverage. Why is it so difficult to convert to an overarching system that provides access and care to all people regardless of income or age? If it is costing us billions of dollars each year then why can’t we find any cheaper alternatives or stop over-utilizing and wasting money on unnecessary procedures and tests? This fact alone makes me think that the healthcare system is not in the business of making people better but instead is in the business of profiting from illness. For example, the article that struck me most was the article that discussed the “chargemasters” payment system. This was a database that determined cost of services from surgeries performed and down to the instruments being used.  It surprised me that this database basically came from no where. It was based on theory and had no real context. This makes me question who really determines cost? Why is there so much inflation?

Our healthcare system needs a serious overhaul.  Who or what will change it? Only time will tell.

September Posting

How the High Cost of Medical Care Is Affecting Americans

By ELISABETH ROSENTHAL

http://www.nytimes.com/interactive/2014/12/18/health/cost-of-health-care-poll.html

The article “How the High Cost of Medical Care Is Affecting Americans” by Elizabeth Rosenthal is an small dent compared to that of larger investigation much of which  that delves into the United States healthcare system and the unbelievable costs it generates. Rosenthal discusses the results of a poll taken by New York Times in the summer of 2014. These series of polls cover different healthcare topics that touch our society. The polls suggest that there is an issue with cost versus actual treatment received. This poll suggest that many times individuals go to receive medical care when they are completely unaware of the healthcare charges. Many times a bill will show up from no where with costs never discussed with the patient by the doctor or provider. The article comments on the fact that asking a provider for healthcare costs is simply “taboo” in this country. But, why does it have to be this way? Why is there not a system in place that goes about explaining costs and even allowing consumers to pick their own services. By hiding costs away from patients, the healthcare system appears to be an evil car salesmen. One who hides the fact that the used car you want to buy is a complete lemon. The polls also suggest that there is an overwhelming interest in these inflated costs. Many patients are concerned about their costs but many are unwilling to step up to the plate to fix anything or question anything. By reading this article, I also found that Americans are not insured properly and most go to great lengths to receive care that they can afford. Some even go to other countries for care. For instance, a man who needed a new hip went to a European country to receive care because the cost in the United States was just too high to manage.

There is a huge problem with our healthcare system in the United States and there is no real solution out there. Healthcare reform is a hopeful idea but when hospitals turn into market sellers and patients are merely consumers, it is harder to reverse the roles of this industry when they are already set in place and rooted so deeply. The rich will only get rich, and the poor will get poorer.

Why are medical bills so outrageously high? Who comes up with these high “charges”?

                In the article ““Bitter Pill: Why Medical Bills are Killing Us,” Steven Brill discusses the outrageous cost of hospital bills and the large disparity between healthcare costs in the US versus other countries. The prices that hospitals set in place for various services appear to be arbitrary in nature and lacking context. The name of this so called database of charges is called the “chargemasters”. I have honestly never heard of such a system. Who is in charge of establishing these costs and why are they so abnormally high? According to Brill’s research,  it appears that the hospital system is charging patients way above market price and, in turn, receiving a significant revenue while putting most of its patients into debt. Brill even comments on the fact that nonprofit hospitals make millions in revenue while their presidents make a hefty salary. To account for the revenue, Brill states, “the hospitals improve and expand facilities (despite the fact that the U.S. has more hospital beds than it can fill), buy more equipment, hire more people, offer more services, buy rival hospitals.” But what about quality of care for the patient? Despite, a large revenue we don’t seem to care about making the efficiency of the healthcare system better. We continue to struggle with problems of over utilization. Brill discusses the issue of overuse of CT scans for people who don’t always need it. Is this done for the purpose of avoiding lawsuits of malpractice and making sure that all the bases are covered or is this to help pay for the cost of the machinery since these CT scan machines can be very expensive?

Whatever the case may be, the healthcare system is a current mess and chivalry does seem dead.