Communicating prognosis

This article called “Communication of Prognosis in Palliative Care” discusses the ways in which the news about their situation should be delivered to patients and the importance of healthcare that is not only based on cure. As we have discussed in the lectures, the profession of medicine is centered about curing disease, which leaves terminal patients and patients with chronic diseases without the same level of care. While acknowledging the significance of end-of-life care in medicine, the article highlights the importance of communication between the physician and the patient as well as their families.

One of the key points in the article is that good communication is very likely to increase the quality life for patients and help alleviate the pain of their loved ones. One would think that delivering a prognosis or a diagnosis should be straightforward, but the example in the article states an opposing finding: “In a study of 1193 patients with metastatic lung and colorectal cancer, 69 percent of those with lung cancer and 81 percent of those with colorectal cancer did not report understanding that chemotherapy was not at all likely to cure their cancer”. From this, it can be inferred that communicating with patients in palliative care is more sensitive than one would imagine.

The article suggests several reasons for the presence of ambiguity and confusion in communication when it is with patients who are in end-of-life care. One explanation is that the patients are in shock, possibly in denial, or hopeless to hear or process information about their terminal illness. The same thing goes for the families. Another point made in the article is this: “Clinicians may be reluctant to discuss prognostic information because they are concerned it will negatively affect the patient-doctor relationship, or the patient’s psychological state. Clinicians frequently articulate the concern that discussing prognosis will “take away hope.””

One other thing discussed is the precision and the uncertainty of the prognosis. The article talks about the online tools that can approximate how much a person has to live based on their symptoms, disease, or other biological factors–possibly better than doctors would. While such a tool might be useful, it is accessible to everyone and it feels inhumane to find out how much more one is likely to live from a website. These findings altogether emphasize the significance and indispensibility of the human element in medicine, just like how the human touch is a miracle for some patients.

If obesity is a disease, then what?

This news article is in the form of a discussion about the medicalization of obesity. In the lectures, we have talked about how the medicalization of a condition can be stigmatizing or de-stigmatizing, and in this case, people who participate in this discussion argue that it can be both. Some think that while obese people will be no longer viewed as deficient or incapable because they have the medical condition to blame. But others think that the medicalization of obesity as a disease leads to serious body image issues because it labels being overweight as something to be seriously looked down on.

Another point made about obesity is that it is medicalized (or should be medicalized) as a predisease, since it does not kill anyone but it leads to higher morbidity and mortality. Being obese increases the risk of coronary artery disease for example, but no one has ever died from obesity itself.

While this argument is valid, it does not contribute to the question of whether obesity should be medicalized or not. Labeling obesity as predisease is in itself another debate, because many conditions, deviances such as some values that are higher than normal, are labeled as predisease and cause lifelong use of some medications.

One point that I found very interesting and thought-provoking was that whether the medicalization of obesity makes a difference in “recovery”. The article shows data that “no more than 5 to 10 percent of obese people succeed in losing weight and keeping it off”. This suggests that even with the application of some medications, the number of people who can stop being obese is surprisingly low.

“The “significant negative consequence” they foresee, however, is thus put in a different light: Most of the already obese will not be able to lose weight, and any relief from societal stigma will be valuable.”

This statement from the article thus highlights the pointlessness of many forms of medicalization. If a medicalized condition that is major like obesity can do no good in public health, then there must be many more conditions whose medicalization is more harmful than beneficial.

Transparency in Healthcare Costs: Benefit Value Advisor?

Consumerism is a rising concept in today’s healthcare system. Patient-centeredness and so called “independence” increase the patients’ responsibility in their healthcare demands and choices for treatment and hospital visits. However, as the article states, the healthcare market is not like the others: patients “consumers find it very difficult to assess the relative value (quality versus cost) of the different care options and providers that are available to them”. Because unlike simple markets,”health care marketplace generally lacks price transparency”.

Acknowledging the difficulty of measuring healthcare quality vs the cost, the article proposes a solution or an idea to overcome the ambiguity in the healthcare market, or at least for what patients are actually paying for. The rising costs and overutilization still remain a problem in consumerism because “more healthcare is thought to be better healthcare”. But if patients were aware of the raw costs of their treatment, they would realize that what they were paying for is actually mainly for the profit of the hospital. Therefore a transparency in hospital bills or other healthcare costs is necessary to inform the patients, since in today’s individualist world they hold more responsibility in their expenses. The article highlights such a demand:  “A growing number of employers are asking for tools to help members in their health-benefit plans gain insight into prices and quality so that they can become more informed consumers of health care.” It also presents a tool called “Benefit Value Advisor” to inform the employers or healthcare “consumers” about the true value or true cost of the treatment they are getting as well as the median value of the treatment, so that they can compare the value given to them and be more eligible to make a decision about their “consumption”.

Such a system is necessary because in a healthcare system where patients carry the burden of being true consumers, they must be given the actual rights to act like one. That is, they should know the variety of options to choose from, as well as getting access to a maximixed quality with minimized cost. However, even though such a tool can be standardized, the healthcare is still in essence very different from other markets because it is mankind’s utmost right and need. So what will fight the rising costs in the first place, and how will people get the “highest-value option” in an emergency?

Consumerism and healthcare costs

With the rise of consumerism, patient independence increases; and with the internet, patients have more access to knowledge, so they have the conception that they become able to self-diagnose and even self-treat. And with the availability of medications over the counter, why doesn’t this result in decreased visits to the hospital and decreased costs in healthcare?