Last year I did my WR 150 paper on physician-assisted suicide in the U.S., and I learned a lot about what made the public so afraid of legalizing it. Most of those who were against it stated that, while they believed in supporting their loved ones’ final wishes and their right to comfortable deaths, their hesitation was rooted in both the newness of the idea, and in the lack of preparation and regulation that the laws would require. However, the article “Tip-Toeing Toward Conversations About Death”, by Martha Bebinger, recognizes the recent advances in end of life care. With physicians now being required to discuss the options available to their patients, and families being encouraged to discuss loved ones’ wishes in advance, will the public see progress being made, and perhaps support physician-assisted suicide for willing patients with terminal illnesses?
As we have discussed, long term care for the elderly has become a major problem, and one that does not seem to have any solution in sight. With many Americans not having the time or the resources to take care of their elderly family members, many who can afford it are forced into nursing homes that are only concerned with making a profit. My question is, would eliminating for-profit nursing homes and replacing them with non-profits improve long term care for the elderly or make it worse? Yes, costs would likely be driven down, therefore allowing more people to afford it, but as nursing homes are already underfunded and understaffed, would creating a stricter budget simply make the problem even worse, causing nursing homes to be a worse option than staying at home?
In discussion, we talked about the role of emotions in medicine. We discussed how it has become commonplace for doctors to be taught to distance themselves from their patients, both to maintain their ethical integrity and professionalism, as well as to protect their own psyche. While I understand the importance of these reasons, I can’t help but feel that a lack of emotion is fundamentally detrimental to the relationship between doctor and patient. Without the doctor letting down some of their barriers, what will encourage the patient to do the same?
We also discussed a sort of spectrum, on which the varying doctoral specialties are sorted by how much of a role emotion should play. Some felt that specialists like oncologists, whose patients have higher than average mortality rates compared to many other specialties, should be more emotionally detached than others, as they are more likely to loose their patients. I disagree, as I feel that a patient’s emotional connection to their physician can be extremely important in forming a relationship in which the patient has enough trust in their oncologist to go through the extremely difficult regimen required for most treatments. Some student suggested that maybe doctors should fake emotion in order to support their patients while at the same time protecting themselves. It’s a good idea in theory, sort of a win-win, but would it be practical? Would non-genuine physicians be able to fool patients into forming relationships with them? And would that be better for the physicians, or would continuous years of lying and faking emotion be detrimental to their overall mental health?
I took sociology of healthcare because I know that there is a business aspect of the medical profession that I will eventually not be able to ignore- no matter how much I will want to. Working in a medical practice, I see the struggles that doctors face every day when it comes to dealing with insurance, and I see how costs associated with insurance can actually determine the care that patients receive.
One of the biggest themes of this class is that America is overspending on healthcare. This point has been driven home over and over again by the dozens of articles and podcasts and movies we have been assigned. And though it seems to be such common knowledge in the study of healthcare, it is still the most surprising thing I have learned. As someone who idolizes the medical profession, it is hard for me to grasp the fact that doctors would intentionally over-treat, over-test, or over-prescribe simply for the sake of monetary rewards. This fact has, unfortunately, been proven over and over again by our assignments. However, I still can’t help but feel like doctors are unaware of the effect they are having on the healthcare system as a whole. In my opinion, most doctors are simply trying to do everything they can to help their patients- both out of empathy and a desire to do right, and out of a desire to cover themselves in the case of malpractice suits.
If someone were to ask me what the biggest problem with our healthcare system was, I would answer “pharmaceutical companies” with absolutely no hesitation. Their greed has become- in my opinion- the biggest factor that is raising overall healthcare costs. The way that they extend patents so that companies making generic drugs have a more difficult time getting them to market is something that I am very passionately against. These big pharma companies are making billions of dollars in profits while patients are scraping together every last penny in order to get the medication they need to live.
About five years ago, two Harvard clinicians initiated OpenNotes, which was basically this idea of complete transparency between physicians and their patients. In a study of 20,000 patients at prominent Boston hospitals, doctors made all of their notes completely available to the patient. The study claims that there were many benefits to this note sharing, including patients being able to remind themselves of details they may have otherwise forgotten, as well as being able to find mistakes in their charts and alert their doctors of them, both of which doctors reportedly saw as helpful effects of the new system.
Even though this article highlights the benefits of note sharing, I can’t help but wonder if itsn’t actually just contributing to one of the larger problems we as a society face today. Our nation’s health care system has become an over-spending mess of tests, treatments, and demanding patients, and I feel that sharing doctors’ notes with their patients will simply exacerbate the problem. Not only could finding mistakes in their notes potentially diminish patients’ faith in their doctors, but finding a mention of a problem- even if the doctor only notes it as a possibility- will inevitably make patients worry and demand treatments they most likely do not need. This will continue to propagate the issue of over-treating, while simultaneously stressing the doctor-patient relationship unnecessarily.
I suppose the biggest question this article brings to light is whether or not the benefits outweigh the risks. Is allowing patients to be more involved in the management of their own healthcare going to create more responsible patients or more paranoid patients? Will having complete transparency between doctor and patient create more trust due to honesty or more tension due to patients knowing more “what” but not enough “why” because they lack the medical education their physicians have? The OpenNotes team is conducting more long-term studies to discover the answers to these questions, and I will be very interested in discovering their results.