This semester, I learned a lot about healthcare. After learning about the healthcare system, healthcare reform, how the profession came about, costs, medical training, medicalization, over diagnosing, and under treatment, I admit, that I have completely lost faith in our current system. The U.S. healthcare system does well when it has to deal with acute illnesses, but terrible with chronic diseases. Healthcare is closely regulated and guarded by those who practice it, making it almost impossible to enact policies that will actually help us. Their focus on making money is very concerning. Healthcare should be about making people who are sick feel better. And if it can’t make us feel better, then it should help us to feel comfortable when dying. The system is completely backwards, worrying about maximizing profit instead of maximizing health.
The most impactful subjects for me were the social determinants of health and end of life care. The big impact of socioeconomic status on health is astonishing. It is just another way that society seems to be punishing those with low SES, watching them die out while doing very little to stop it. End of life care also made a huge impact on me. It has definitely pushed me to start the conversation with my parents about what they would want when the time comes. It also has me concerned about costs and how to pay for their care. If social policies aren’t enacted to help out and if healthcare costs keep going up, I shudder to think about the limited options that I will have to choose from.
The healthcare seems like a system that exploits the sick in order to make money. We can see an example of this in the end of life care. Before, we talked about how people were undergoing medicalized deaths because families were not having conversations about what they would want. Thus, because of uncertainty, families and loved ones erred on the side of more treatment rather than sitting around, doing nothing. Now, we see from the New York Times article “Fighting to Honor a Father’s Last Wish: To Die at Home,” even those who choose a non-medicalized death and want to die at home are facing troubles in having their wishes met. Reading this article left me feeling both frustrated and angry. Mr. Andrey spent the last few years of his life in and out of nursing homes that cared for him poorly. His daughter couldn’t find any options for home care services that allowed her father to live at home because his condition was too advanced. Why aren’t there programs for elder care for those with advanced diseases? What social policies can be enacted to help families with elder care? How can we pay for such programs? How can we improve the conditions of nursing homes?
As with everything else, we can see that only those with high income will be able to afford quality elder care. Why is long term care so expensive for the elderly? Can we think of ways to finance nursing homes so that residents don’t have to become impoverished trying to pay for care? What are some of the positive and negative aspects of long-term care insurance? Do you believe that long-term care insurance is the answer for paying for elder care? If not, what do you believe is the answer to this dilemma?
FDA Targets Inaccurate Medical Tests, Citing Dangers and Costs
Inaccurate, unreliable tests promote unnecessary medical interventions, causing medical costs to increase. This is a threat to Obama’s plan of “personalized medicines,” a new way of treating patients based on their genetic characteristics. This approach relies on diagnostic tests. Thus if the tests are unreliable, the treatments could be ineffective. Currently, diagnostic tests are regulated differently depending on where they were developed and manufactured. “Commercial test kits,” those sold to multiple labs are typically reviewed by the FDA before going on market, and there are protocols in place if a product proves to be defective or unreliable. The problem lies for tests that are manufactured and used within a single lab, as there are no actively enforced regulatory requirements. This has become a problem now because their products are being used just as much as the commercial tests; they are no longer just a small portion of goods produced. Thus, it’s important to make sure that the tests do what they are supposed to do.
It’s scary to think that these independent manufacturers weren’t being tested and regulated before. If a patient’s sample is being sent to a lab, doctors should know for sure that the instruments that they use are accurate. It’s sad that it has taken a large volume of independently designed and manufactured products to be sold in the market for the federal government to decide to finally step in and get involved. As with any argument about federal regulation, there are two sides to it: those who oppose and those who are supporting the decision. It is not at all surprising to me that the medical profession is against it. The article sites one of the representatives, who also happens to be a physician, concerned that “regulation will stifle medical innovation and open the door to federal regulation of the practice of medicine.” The medical profession seems to favor autonomy more than the health of the people they supposedly serve. Medical innovation is important, and the government not being involved in regulating it is important. The fact that inaccurate test results that lead to treatments that could lead to more harm than good for a patient is not so important.
I think the most shocking thing to me about this article was that patients vanish as participants in their own care when they enter the ICU. They vanish as people, instead becoming their disease. Logistically, this makes sense. The ICU is set up to deal with life threatening circumstances. The doctors have comprehensive knowledge and are often following a course of treatment to save their patients’ lives. For doctors to do their jobs, they should be looking at the patient’s chart, to get the whole story. However, they often focus on the numbers. This is understandable, as patients aren’t always forthcoming with pertinent information, and the data is more reliable.
However, ICUs have more fatalities than good outcomes. There should be no reason why the patient has been stripped of all humanity such that the patient is just a set of numbers, stats, and symptoms and then discharged with no thought of how patients need to handle their care. Doctors are essentially only treating the immediate problem and sending their patients home. This tunnel vision approach is dangerous to the health of the patient. There has to be a way to balance medical care and patient care, despite the condition the patient is in. Something about the system needs to change. What measures can we enact within the ICU so that admitted patients don’t lose their personhood, and are treated for the range of conditions that they suffer from, not just the ones that have landed them in the ICU?
It’s great that there is an option to go abroad for more affordable care. However, this is only reserved for those who can pay for travel to another country and have jobs that give them such luxuries as taking 2 weeks off to get a procedure done and to recover. You can choose to go to another country and get your vacation and medical needs taken care of at the same time. While medical tourism is certainly an option for those who can pay to do it, there is still a large majority of those who can’t because they are too poor. The future modern hospital will continue to deny care to those who can’t afford it. We need to make some serious reforms to our current health and hospital care system domestically, not encouraging people to go to another country for treatment because it is cheaper. Aside from the monetary incentive to do so, is there a benefit for medical tourism? Are people really getting better care for such low prices? How can the system be tweaked so that even those with low socioeconomic status can also benefit?
In their article, Smith and Kleinman argue that medical students adopt emotion management strategies. These strategies affect the medicine that they learn as well as their well-being as individuals. In using these strategies, they are reproducing medicine’s professional culture.
The strategy that most stood out to me was empathy. Patients associate doctors as caring for their patients. However, they are trained to be empathetic. Excessive concern is bad, but moderate concern allows them to manage their feelings and do their job taking care of the patient. How can empathy be possible if the doctors are also dehumanizing them by making jokes and viewing their body as an object that is separate from the person? Is this part of emotional management? Convincing the patient that you really do care about what is going on with them, but not necessarily meaning it?
Other things that stood out to me was this emphasis on isolation and contact avoidance. Students learn to keep feelings to themselves and not discuss them either with faculty or other students. Their feelings are meant to remain private. Do you think that this is another tool used in reinforcing emotional management? Is it a way of sweeping this issue under the rug, as the subject of emotional management is considered taboo in the medical profession? Medical students have the opportunity to avoid kinds of contact that might make them uncomfortable. In fact, faculty do not supervise the students’ contact with patients (65). How can doctors do their jobs if they avoid contact? Could the over use of imaging technology be an indirect result of lack of contact? Contact wasn’t stressed as part of their education. Newly developed technology provides an excuse to keep avoiding touching the patient.
The authors argue that Western culture emphasizes rationality and scientific objectivity. That the mind is superior to the body, thoughts superior to feelings (67). Has Western society cultivated inhumanity? To what extent do you believe that Western culture is responsible for the emotion management problem? Why do you think that there is this belief that for doctors to be able to do their jobs, they need to distance themselves from their feelings?
As a final note, doctors have gotten so good at emotion management, that some fear that this newly developed skill will start to leak into their personal lives in unhealthy ways. They are essentially learning how to be desensitized. How can the system be modified so that practicing medicine doesn’t have a negative impact for both the patient and the doctor?
Dr. Jack Yanovski has been studying the BDNF gene to understand how it works. Previous studies have shown that this gene may lead to weight gain and obesity. But what was not known until recently is how. BDNF protein adjusts satiety cues and promotes feelings of fullness. The recent study shows that minor variations in the gene can alter the BDNF protein levels in the brain, which can lead to obesity. Thus, if an individual has lower levels of BDNF protein, they have a higher risk of becoming obese. In their study, they found that African Americans and Hispanics are more likely to having to this gene being modified. More tests need to be done, but the hope is that by understanding BDNF, drugs can be developed to help stabilize BDNF levels.
There are two main ideas that this article brings up that I will critique: racial/ethnic disparities and medicalization of obesity.
Racial/ ethnic disparities implies is that there are biological differences between ethnic groups. These differences in biology would make one group more susceptible to disease than another. The problem with this argument is that it completely does not take environmental factors into consideration. Minorities have a socioeconomic disadvantage. Since they have a low SES, there are numerous factors at play regarding their health. They live in food deserts where supermarkets are hard to find. What you’re most likely to find are mom and pop stores that sell a lot of unhealthy options. Also, the lack of finances does not leave much money to actually spend on food. Unhealthy, processed and packaged food is cheaper than fresh fruits and vegetables. All these external conditions is bound to change the internal composition of the body. Genes can change over time depending on what we put into our bodies.
By medicalizing obesity, we are pointing our fingers at biology as the cause. If we blame biology and our genetic makeup for weight gain, then we have to turn to medicine to cure it. Thus, people are going to be going to the doctors for medication or other medical interventions to cure their obesity. We are no longer promoting changing eating habits, exercise, or other lifestyle changes to being healthier. It’s no longer about working hard to overcome obesity, but going to the doctor so that he or she can magically cure you.
In Chapter 7 in The Medicalization of Society, Peter Conrad talks about three factors that drives medicalization: biotechnology, consumers, and managed care.
In biotechnology, he makes the point that pharmaceutical companies are marketing diseases and then promoting drugs to treat those diseases. He uses the example of shortness drug us a medical enhancement for children. Parents who are worried their kids may not grow up tall, can go to the doctor, who can gave children hormones to grow taller. In consumers, he talks about cosmetic surgery. He makes the chilling remark that “the body has become a project, from minor touch-up to “extreme makeover,” and medicine has become the vehicle for improvement” (138). Conrad makes the comment that ADHD is “the medicalization of underperformance”. He also talks about the Internet as being a vital tool for consumers as the can now transform their illness from private to public. In managed care, Conrad talks about how managed care corporations are now covering bypass surgery for the morbidly obese in order to save money in the long run.
The height and cosmetic surgery examples were the ones that really stuck out to me. People come in different shapes and sizes, and by attacking something as arbitrary as height or the way we look has me concerned. What else about ourselves are we trying to fix? Is medicalization a response to the demands of the patient-consumer?
But the biggest question that I have is: why are we turning to medicine to solve some of these issues? Why do we keep feeding this system that cares more about making profit more than the well-being of the individual? Our solutions to some of these issues should be working on the environmental factors that perpetuates negative behavior, not trying to take the easy way of just popping a pill, undergoing an operation, or some other medical intervention to make the problem go away.
To me, it seems like we’re striving for perfection and normalcy, both physically and emotionally. If we’re not perfect, then something must be wrong with us. And if something is wrong, then we must be sick. And when we’re sick, we go to doctors so that they can fix it.
I am really enjoying the Sociology of Healthcare course so far. It has really opened my eyes to what is going on in the American health care system. I have learned about the US healthcare system and the problems that it faces with costs, over utilization, underutilization, and many more issues.
Most eye opening for me, was the description of our healthcare system as a consumer system. I went along with the system, not really questioning how things are done. People get insurance through their employers, it is part of their benefits package. When you go to the doctor, the visits aren’t free. After all, we are paying for a service. Along with understanding the consumerist nature of our health care system, learning that other countries have a universal healthcare system, that doesn’t cost its citizens as much as it does in the US was also good to see. To really understand whether the current system is working, we need to look at how other countries are doing health care and try to see if the US system can mimic them in some way.
Another eye opener for me was that we seem to be the only country where people go bankrupt from medical bills. I knew that it happened, it never occurred to me exactly how frequently it was happening. A reason why this is happening is because costs aren’t being regulated and are growing out of control. The idea that charge-masters are responsible for setting prices, that prices differ per hospital, and that the average person can’t get an exact number for the costs of certain services is absurd. It also shows that the system is majorly flawed. There is no commonality or sense to it. Not only can costs vary per hospital, per doctor, and per region, so can the quality of care. So, we are spending all of this money on doctors to get better, almost bankrupting ourselves in the process, for services that haven’t been standardized.
The final thing that shocked me was that we don’t believe that we are entitled to healthcare; it is not a basic human right. I think that once we start to define healthcare as a right, things will begin to change so that everyone is afforded that right. How that change will look like, I can’t say. But, we should start to move towards universal healthcare by taking baby steps. People shouldn’t be spending most of their income on healthcare, they should be out living life and not paying doctors to save them.