As the class has gone by, I have seen manifestations of the health care issues we’re learning about in my own home and family. The day before the sociology midterm my mother had to go to the emergency room. There I was, observing exactly how they were treating her and what kinds of tests doctors were ordering. It was honestly the best form of studying. My mother had countless blood tests, was seen by too many doctors, was there for over 12 hours, and had her blood pressure checked every half hour. But, what did they forget to give her? They forgot to give her a place to rest and some food. I felt like I was standing in the intersection of so many of the issues that we’ve talked about; as though this was the perfect example of how systematic healthcare issues manifest themselves on an individual basis.
November analytical posting
In her article “A Quiet End to the ‘Death Panels’ Debate,” Paula Span touches on many important points regarding how there are structural and systematic procedures put in place that allow for poor handling of end-of-life care in the USA. Span discusses how the fee-for-service policy pushes for more tests rather than conversations between doctors and patients. Because of this, patients’ death is extended in the ICU with expensive tests and procedures unnecessarily. The article presents the new incentive coming for doctors that will allow more conversations to be happening: Medicare will now be authorizing payment for end-of-life discussions. Doctors will now be paid $86 for the first half-hour of conversation with their patients, and $75 for each additional half hour.
In class, we talked about “The Conversation Project,” an initiative that pushes families to talk about their end-of-life decisions. The project stresses that by shifting cultural norms within families to begin talking about death, we can then change the system where palliative care will be better carried out according to the patient’s wishes. This initiative came to mind as I was reading the article “Watching Brian Die: The Rhetoric and Reality of Informed Consent,” by Rose Weitz. According to Weitz, doctors often will push off references from families about having these conversations with the patients beforehand, coining them as “kitchen table discussions,” and regarding them as irrelevant in the emergency situation. The result is that doctors do not tell family members enough and ultimately coerce the situation to disallow family from making decisions.
My question is, if doctors in the end are the ones making the decision, are initiatives like “The Conversation Project” that believe they can change the system by shifting cultural norms fooling themselves? This is not to say that the Conversation Project is unimportant. I think that it is essential to have conversations with families about end-of-life decisions so that families can have a larger voice in influencing the doctor. However, how can we really create a structural shift in this way? Do we need more aggressive initiatives that target doctors rather than families and that create an environment for doctors to have the conversation with patients? Will initiatives that stop policies like “fee-for-service” allow the structural shift more effectively towards less intervention and more end-of-life care? What other kinds of initiatives can really create this structural shift more effectively than shifting the cultural norm?
In Charles Rosenberg’s “Rise of the Modern Hospital,” we learn about how the hospital setting has not always been the way we see it now. In the 1800’s hospitals were unimportant in terms of care, and only after the development of technologies and scientific theories, which allowed for things like surgeries and x-ray machines, were hospitals brought more into the public sphere. The issue, however, is that they were brought in such a way that created a system of bureaucracy, efficiency, and un-accountability. All of these changes, as Rosenberg says, were easily and quickly made due to interest from various groups, including doctors and patients.
My question is, how did people begin to feel very comfortable in hospitals so quickly? It seems to me that these changes all occurred very fast due to all of these advances, and I wonder how so quickly societies and communities were able to adapt to completely changing the way they understand health, disease, the doctor-patient relationship, and expectations. After all, there were only two hospitals in the USA in 1800. Was it propaganda from interest groups such as the AMA, the media, or the patients themselves that allowed for this type of adaptability? Which was the highest contributing factor?
In Patricia Rieker’s article “Understanding Gender and Health: Old patterns, New Trends, and Future Directions,” readers are forced to confront how men and women differ in health in terms of not only life expectancy, but also prevalence and onset of various mental and physical diseases. She argues for a constrained choice model in health, a model that illuminates how individual responsibility in health is actually a shared decision by makers such as family, community, and policy makers. Thus, according to the article, individual choices, these other makers, and biological processes all contribute together to differences between women and men in health.
Today I read a disturbing article by Maggie Fox called “Black Kids Get Less Pain Medication Than White Kids in ER.” It specifically addresses appendicitis, a common emergency surgery for many teenagers. Even though painkillers are strongly recommended in any appendicitis surgery, only about half of African American children are given painkillers. Not only that, but the article discusses how black patients with severe pain are less likely to be given opiods, even though this painkiller treatment is routinely given to white patients during post-surgery pain management. However, this is not because doctors perceive African Americans as having pain; in contrast, according to the article, research has found that clinicians do indeed recognize pain equally for all groups—clinicians are simply less inclined to give black patients proper pain treatment and management.
Even though I found this article disturbing, I did not find it shocking. The USA has a long history of discrimination and systematic racism against African Americans, whether it be in the healthcare system, in the prison system, in education, in housing, or in the welfare system. Thus, racist biases from clinicians are not surprising, but rather, are unfortunately nothing short of expected. Nonetheless, this article and other articles that stress these racist biases need to be more publicized in the media to allow greater awareness about the continuing injustices Blacks continually face.
The article “Understanding racial-ethnic Disparities in Health: Sociological Contributions,” by Williams and Sternthal stresses four points. It challenges the biological understanding of race, it emphasizes how social structure determines racial differences in disease, it discusses how racism affects health, and finally it discusses how immigrant status can play a role in healthcare quality.
Specifically, in the section on Racism and Health, Williams and Sternthal discuss how segregation has played a role in minorities’ health, especially African Americans. Additionally, this section also discusses discrimination, but only generally, and not in the context of a healthcare setting.
Thus, this article leaves out some of the medical sociology factors, like racism and discrimination by health care professionals. Therefore, I question and wonder about how quality of care after one has access to and can afford the healthcare varies for different minority groups. How does discrimination by doctors and other healthcare professionals affect the health of these groups? What research has been done to challenge this and bring it to light?
The article “Social conditions as Fundamental Causes of Health Inequalities: Theory, Evidence and Policy Implications,” (Phelan and Link) discusses how socioeconomic status has a large impact on health on an individual and community level. They argue that money, power, knowledge, prestige and beneficial social connections all play a role in giving people with high socioeconomic status better health.
This got me wondering, which kind of existent healthcare system in the world today is most effective at dealing with this issue? In class, we have learned about many different types of systems: single payer in Canada, Taiwan and Great Britain, employer and community based in Japan, social insurance in Germany and private insurance in Switzerland. Thus, I am wondering if there is any research out there about which healthcare system works best for people with low socioeconomic status. Is it one that emphasizes primary care more like Great Britain? Would that allow patients with low socioeconomic status to receive better preventative care that they miss out on due to their lack of knowledge and power? Or is it one that has no waiting time like Taiwan that makes it more convenient for patients to go to the doctor without having to worry about not going to work that day?
Now that the affordable care act has brought health care insurance coverage to millions of people, another issue prevails for the US healthcare system: the rising costs of drug prices. In response, front-line presidential candidates are proposing plans to change the way drugs are sold and financed. A recent New York Times article discusses Hilary’s plan to cap patients’ drug prices to 250/month, to require most drug makers to spend a portion of profits on research, and to discount the price of drugs sold to the federal government. In contrast, Bernie Sanders is pushing for a more radical change: a Medicare for all single payer system – a plan that pushes the US to catch up to peer countries that provide guaranteed healthcare.
I consider myself a baby activist. Each day that I grow to understand more about the world’s injustices and systematic oppression towards marginalized communities I find myself engaging more in conversations with fellow activists, and my instinct is always to think of what direct action needs to be taken. I have been engaged in conversations about the LGBTQ community, about the privatization of prisons, about the Black lives matter movement, about income inequality — all issues that are at the forefront of political campaigns that exist today. But I have never had a drive to become an activist in the healthcare system, or to think about how to advocate for the healthcare and wellbeing of Americans because I was never introduced to how inefficient and oppressive the healthcare system is until I entered this class. I was shocked to learn about the ignorance I had about the privatization of the healthcare system, about the fee-for-service policy that opens the opportunity for overtreatment and mistreatment, and about the historical significance of stakeholders’ power in shaping the healthcare system as a way to aid healthcare professionals but not patients. I take my own health for granted, and was never asked to engage in this conversation within the activist communities I am in because these topics were never talked about.