Hope for Our Nation? (Process Reflection)

As I look back on this semester, my thoughts toward our health care system have changed. To be honest, I enrolled in this class because I needed an elective for my public health minor. I did not have any expectations coming into this course as I thought it would be just like my previous healthcare course I took in Sargent. At the end of the day, I learned so much from this class and I hope to use this knowledge and understanding as I pursue my career in the health care industry.

Conversations About Death

The article “Tip-Toeing Toward Conversations About Death”, explains that a state law earlier this year was passed to encourage more people to make preparations about how they want to die. I had several questions regarding this article. First they mentioned that “Sixty-seven percent of people want to die at home and only 24 percent did”, is this because they simply never made arrangements for this death or did this data include sudden deaths such as heart attacks, car accidents, etc.

To add on, doo you think the Department of Public Health should broaden the qualifications of an “appropriate” patient like what Harvard Vanguard did in the attempt to promote end of life arrangements? Should these arrangements just be simple conversations with family members or are these patients suppose to set up meetings with lawyers and have written requests? Lastly, the article mentions that the law wants doctors to hand out pamphlets to patients. I believe that this is a very ineffective tool to encourage end of life talk. Many people do not read pamphlets and throw them away immediately. Obviously, face-to-face communication between the doctor and patient would be the easiest and an effective form of urging an end of life talk but what are other effective ways that can encourage these talks? Media usage? Ads? Should the doctor talk to family members before the patient about end of life talks?

Video: Medicaid Gap

Link: https://www.youtube.com/watch?v=5d3nASKtGas

I found this video on YouTube of John Oliver on his show Last Week Tonight. He discussed the current elections and how this effects the Medicaid gap in the country. These upcoming elections may determine whether many Americans will receive health insurance or not. He talks about Obama’s initial “ObamaCare” plan with the focus on providing everyone with healthcare. But, after the Supreme Court didn’t approve of the entire health care bill, which then gave states the option to choose whether or not they want to expand Medicaid. States that did expand Medicaid showed a decrease of uninsured Americans in their state. I thought this was an interesting video and adds a lot of humor with this current situation.

How Do We Improve Elderly Care in Nursing Homes?

In the article, “Does Investor Ownership of Nursing Homes Compromise the Quality of Care?”, the authors notes that 2/3 of nursing homes are investor owned. They investigated whether or not investor ownership affected the quality of care in these nursing homes. After examining about 14000 nursing homes, they found that investor-owned nursing homes did in-fact provide worse care and less nursing care compared to non-profit and public homes. I wonder if there are any set regulations, rules or guidelines that these medical homes have to obey in order to remain running? If this study was known to more people, do you think other people will take this into consideration and send their loved ones into certain homes? Would they do further research in order to secure better care for their loved ones? Or would they just want to send them anywhere in the means to “get rid of them or let someone else take care of them”. If consumers do realize that for-profit homes provide worse care, do you think the owners of these homes would try to fix it and focus more on improving patient care? How do we ensure that the elderly get the best care possible? As mentioned before, do we need to set rules, regulations, and/or qualifications of care givers?

Massachusetts Look to Raise the Legal Age for Buying Cigarettes to 21

Tobacco use is one of the largest preventable cause of death and disease in the United States. According to the Centers for Disease Control and Prevention (2015), cigarette smoking kills more than 480,000 Americans each year, with more than 41,000 of these deaths from exposure to secondhand smoke. To add on, several studies suggests that about 90% of daily smokers first used cigarettes before the age of 19. Thus, Massachusetts’ lawmakers are weighing the possibility to raise the legal age for buying cigarettes and other tobacco products from 18 to 21.

Patient Care in the ICU

In Zussman’s article, “The Patient in the Intensive Care Unit”, he explains how patient’s are losing their autonomy and personhood in the ICU. Doctors in the ICU are not aiming to solve external and underlying problems of the patient’s disease or illness. The doctors in the ICU overwhelming are starting to lose their empathy towards their patients as there are many people coming in and out constantly. But, is it the doctors fault that they are not merely concern about “patient care and feelings” as their job is to save and preserve the life of their patients? There are only a certain amount of physicians within an ICU and they have to treat everyone in a small time period or it could be costly to one’s health. Others may argue that the patients autonomy and feelings should be a big part of their experience in the ICU. But does patient autonomy matter when it involves life or death? Is the patient being selfish for asking more out of the doctors time as they may be risking the life of another person in the ICU?

Pharmaceutical Marketing and Medical Decisions

In Chapter 9, Marketing, Money, and Medical Decisions, in Groopman’s book, “How Doctors Think”, he illustrates how big pharmaceutical companies influences what becomes medicalized conditions in order to profit off of consumers. These aggressive pharmaceutical marketing leads to unnecessary invasive expensive procedures and financial gain from both the doctor and patient. These pharmaceutical companies tactics include giving gifts and bullying physicians into buying their drugs.

Douglas Watson, an executive in the pharmaceutical industry for 35 years, pushed for “ethical marketing” in which the aim of marketing should be the accurate education of a physician in the side effects and potential benefits of a particular agent. But, most doctors learn about their new products (drugs) from the pharmaceutical industry. Thus, as opposed to just selling the drug, the industry should help in the physicians’ education.

Desensitizing Emotions in Medical School

In Smith’s and Kleinman’s article, “Managing Emotions in Medical School: Students’ Contacts with the Living and the Dead”, they analyze doctor-patient relationship and how medical schools try to desensitize medical students in the effort to control emotions that medical situations provoke. Medical schools want to emphasize the importance of keeping a professional relationship with their patients and not let their emotions get involved as it may cloud their clinical judgements and medical decisions.

I have shadowed many doctors before and what they thought me was to “treat the patient first, then treat the illness”. They also emphasized the point where relationship with patients is the key to gain their trust and it makes it easier to provide better care for them.  This makes me question this article as to why medical schools would want to desensitize medical student’s emotions while dealing with patients.  I understand that there still needs to be a professional relationship with your patient, but to what extend does that need to be fulfilled as to what the article was explaining? If one were to desensitize their emotions, I feel that in any given circumstance, the doctor will do whatever in their power to provide the best outcomes and quality service to their patient. My question is that do you think that keeping it “strictly professional” provides better health outcomes? Because of this, will medical professionals lose their sensitivity towards the people they serve? If it does provide better health outcomes, is it better to have better health outcomes or decrease the quality of service to their patients? When it comes to one’s health, does a professional relationship outweigh the interpersonal doctor-patient relationship?

Social Workers Greatly Reduces Emergency Room Visits and Saves Hospital Money: Solution to Overtreatment?

Overutilization and Overtreatment is a big issue in the United States healthcare debate. Many people who have access to health care and an affordable health insurance often take advantage of their coverage as they may think that “the more they visit the doctor, the more healthier they will be”.

But a Milwaukee hospital is trying a new approach to reduce the number of newly insured residents from using emergency rooms as their main source of medical care. Aurora Sinai Medical Center identified 313 frequent ER visitors (visited at least five times in four months), which these patients alone account for 1,827 ER visits in that time. Aurora Sinai started a pilot program where they placed social workers in the ER full time, selected 39 people of the 313 and spent the next eight months trying to change their habits so when they do get sick, they see a primary care physician or clinic rather than the ER

Does Race Alone Influence Health Outcomes?

In Williams’ and Sternthal’s article, “Understanding Racial-Ethnic Disparities in Health: Sociological Contributions”, they explain that factors such as race, racial discrimination, gender, socioeconomic status, and social structure all have a role in health outcomes in the United States. Although we as a country have come a long way in the fight against racial discrimination, it seems that it is still a pressing issue in today’s society regarding the media, health care, violence, etc. In regards to health care, where doctors take an oath to do no harm and what ever they can to provide care to someone, it is hard for me to agree that health outcomes are because of race alone. Sure, there will be outliers that do discriminate their patients because of race, but generally, I do not think race plays a huge role in health outcomes. I think most health disparities are due to socioeconomic status.  Socioeconomic status and race are intertwined and the go hand-in-hand. Thus, I do not think racial discrimination alone accounts for a lot of health disparities but instead I believe that health disparities are due to socioeconomic status and that those people just happen to be apart of a minority racial group.  This is the reason why people are seeing health disparities when they look at solely at racial groups.

I would love to hear the opinions of others who think similarly or that that racial discrimination in the health care settings play a major factor in health disparities. Does racism alone actually correlate to health outcomes?  Another question I want to ask is that how do these studies access racism and quality of care for someone who can afford to see a doctor among different racial groups.  If the argument against my claim holds true and that racial discrimination alone influences health outcomes, then what are the health outcomes of minorities who can afford doctors and are well off? If racial discrimination is a big influence, shouldn’t their outcomes reflect among the general population among their race or is it different?