End-of-semester thoughts

The primary reason why I took this class is because I realized that I knew close to nothing about how the healthcare system works in this country. I moved to the US three years ago and, thankfully, I have not had any health related issues or complications in the past years of me living here that have obligated me to go to the doctor for an emergency, have surgery, or anything similar. Therefore, I feel like for a long time I have had this perception about health in this country being extremely expensive, but never really knew why that was.

I really appreciated how the topics in the class were structured because they went from the very broad problems, to the more specific events in the history of the development of the current healthcare system. This organization of the topics allowed me to understand the concepts more clearly and allowed me to make connections as we moved forward in the content.

Looking at everything we have learned in this class in perspective, I think what is still surprising and baffling to me is the fact that the US, being the country that it is, still does not guarantee health for their citizens. I think this is something that I did know before, but this class made me see things in perspective for the first time, because it specifically compares the US with many other countries in the world. It is one thing to know that healthcare is particularly expensive in this country, but to actually look at an illustration of how much more expensive it is compared to other peer countries was something that amazed me.

I believe this is an important class for people to take, even if they are not involved or plan to be involved specifically in the healthcare field. These ideas, in my opinion, are important for everyone that lives in this country to keep in mind, because any of us could potentially be involved in a situation regarding a medical issue at some point in our lives.

Thoughts about end-of-life care: importance of starting this conversation

I believe the focus of the article “Tip-Toeing Toward Conversation About Death” by Martha Bebinger shows some of the attempt that are currently being made to encourage people to start a conversation about end-of-life experiences. One of the points she makes, which we have discussed in class, is that by starting this conversation, people might actually be able to die in a way that is comfortable to them, according to their wished, instead of dying in a hospital in a very debilitating state. Babinger says that by starting this conversation, these personal choices can be more accurately followed.

I believe that the option about the end-of-life counseling can be a good initiative to first start that initial conversation. It is likely that the majority of people will find difficult to bring up this subject with their families, especially if there is no particular tragic event occurring at the moment However, if this is an alternative that is offered by doctors to the patient, I believe the likelihood of sparking this conversation is higher. Furthermore, I personally think that the initiative about reaching out to people is settings other than hospitals (such as churches, synagogues, etc) is an additional opportunity for people to start thinking about this topic and how important it is to discuss it with their families.

By increasing the awareness of how important this topic is for every family, we might eliminate, or at least diminish, the “taboo” there is towards talking about this subject. If people are encouraged to have this conversation as part of their normal discussion to have as a family group, it is likely that this become the rule and not the exception for families dealing with end-of-life care.

Thoughts about the lack of patient’s “personhood” in the ICU

I believe the argument about the lack of patient personhood in the ICU described in the article “The Patient in the Intensive Care Unit” by Zussman is due to a combination of factors, rather than to a single cause.

This article explains how physicians that work in the ICU usually are not aiming to solve the underlying cause of the patient’s disease. It seems to me that these physicians are concerned with a specific set of symptoms, or problems that are immediate and urgent, and are not necessarily concerned with the “broader picture” of the patient’s condition.

I do not necessarily think that doctors in this case do not care as much about their patients, or have been de-sensitized to dealing with patients everyday; I believe that each branch of medicine and medical care is to be dealt with in a different way. In the case of the ICU, patients are there because they most likely are suffering from an acute problem, that is usually the result of an existing condition or disease. Doctors in the ICU are looking to save the patient from this acute/sudden problem, so that the patient can leave the ICU alive. I can imagine how this area of the hospital can be extremely stressful to doctors, as well as to the patients and their families. Therefore, I do not think that doctors in the ICU (or at least not all of them) have become careless about their patient’s background and overall health condition, or that they want to take away the patient’s personhood; rather, I think this attitude is a product of the mindset they are obligated to be in, which is saving the patient and getting them out of the ICU alive. This is not to say that this is the right approach to patient care necessarily, but it is a consequence of how the system is set and what the expectations of the doctors in the ICU are, in my opinion.

Detrimental effects of the concept of “social death”

The study of Passing On, by David Sudnow mentioned in Timmermans’ “Social Death as a Self-Fulfilling Prophecy”, argues that a patient’s social value is what determines how the healthcare staff will administer their care giving to that patient. According to Sudnow, some of the characteristics that define the social value of a patient are the age, the “moral character” and their clinical teaching value. According to this theory, these aspects would determine if a patient would be treated as already being dead, even when they are still alive biologically. Furthermore, Sudnow argues that this social death is able to predict the actual (biological) death on individuals; this means that there was a higher chance of death in people that were thought of as socially dead by the staff.

I personally believe there is still some truth in this statement, especially when a patient is suffering from a terminal or incurable disease. As we have been talking about in class, patients that have terminal diseases are sometimes not given the appropriate care they deserve, a lot of this being related to the lack of training that medical students get regarding care of terminally ill patients.

I find this theory extremely worrying because it raises an important question: is it possible that these patients that are catalogued as having a “low social value” are loosing their chance of living as a consequence of this label? I guess it is hard to dissect these two aspects. That is, are patients becoming “socially dead” because they are dying, or are they dying as a consequence of being marked as such?  In any case, I think it is important for healthcare providers and all the staff members of medical settings to have this in mind and understand that patients’ health is deeply affected by the way they are treated and the way they are perceived by society.

Is autism spectrum disorder increasing in the US?

This recent news talked about whether the number of cases of children with autism in the US have increased, or if it was a matter of better case reporting in the last few years.

According to the Center for Disease control and Prevention, the number of cases of children with autism spectrum disorder has increased by 30%, compared to the number of cases in 2012.

Turns out that, starting in 2014, the survey given to parents who were asked about autism symptoms in their children was slightly changed. Researchers repositioned the questions regarding autism at the beginning of the survey, whereas other questions about other developmental disorders were located at the end of the survey. They realized that, coincidentally or not, the number of reported cases of autism went up, and the number of reporter cases of other developmental disorders went down.

The fact that autism is a complicated disease to diagnose only makes things trickier. There is no blood test that can confirm the presence of autism. The Center for Health Statistics found that 13% of the children who were first diagnosed with autism obtained a different diagnosis later, after further examinations. This just goes to show how complicated it can become to obtain data for such disorder.

I personally think that the issue regarding the design of the survey for parents is true not only for autism, but for other conditions as well. For example, in the field of epidemiology, researchers pay special attention to the order of the questions in a survey, particularly if these are questions with certain stigmas embedded in them. Turns out that people is more likely to answer honestly when these questions are in the middle of the survey, as opposed to the beginning. This is because, if this question were to be the first one, it would be more obvious to other individuals around what their answer was. In this particular case, researchers were not attributing this to social stigma related to autism; however, it goes to show how the method of data collection can have an important impact on the results obtained.


The effect that social factors and stigmatized views have on the development of illnesses

Conrad et al. in “Construction of Illness: Key Insights and Policy Implications” I find it interesting that the concept of social constructionism addresses the fact that the same disease can affect people is different ways, depending on their culture and social systems.

I remember reading another article a few months back that compared the rate of breast cancer recovery in members of families from different cultures. The study found that members of Hispanic families who suffered from breast cancer had a higher chance of recovering and overcoming this disease that patients who belonged to other cultures. This made me think about the concept of the Hispanic paradox that we have been talking about in class. I honestly do not know how reliable this study is, because I think many other variables should have been taken into account. However, I think it is an interesting example of how cultural factors (in this case, family support) can affect the disease of a person.

This week’s article also mentioned how in some cultures there is a stigma to some diseases, such as HIV/AIDS. Talking from my personal background, I grew up in a Latin-American country where I believe this disease is still a “taboo” subject to talk about. I agree with the article when it says that it is more difficult in these scenarios for patients to get access to treatment; there is shame and embarrassment associated with the disease, so the patients are less likely to tell others and/or seek for help. I wonder about if, in the case of HIV, patients are even more immunocompromised because of the stress generated by living in countries/societies where this disease is more stigmatized.

Could the concept of “Overkill” go as far as performing an open heart surgery just for the profit?

I read a news article recently about a woman in a small town in Indiana who found out about her doctor being sued for performing unnecessary operations. This woman had been going to this cardiologist for more than 30 years. When she was 27 years old, she first came to this doctor regarding an abnormality in her heartbeat, and the doctor told her that an open heart surgery would be necessary to fix this problem. She did not question the procedure at the moment. However, a number of patients of this town have recently filed lawsuits against this doctor and two other physicians that work with him. In response to these lawsuits, it was discovered that these doctors received nearly $5 million in Medicare reimbursements, making them the most reimbursed cardiologists in Indiana.

This article reminded me about what we have been talking about in class about the “Overkill” idea and how the payment method in the US promotes that doctors prescribe more medications, more treatments, and more surgeries. I find this incident very worrying because of the lack of professionalism of such doctors in treating their patients. While some people might argue that patients should be aware of this trend and be knowledgeable about their health, so they can avoid this over diagnosis, I personally believe that this is a “Band-Aid” solution to the problem. While it is true that patients should be involved in their medical appointments and their treatments, it should not be the patient’s concern to investigate whether or not the treatment they are receiving is actually necessary, or just a way for doctors to earn more money. Patients are not supposed to have the academic and clinical experience that a doctor has; after all, this is why they come to the doctor to begin with. Rather, the system should be settled in a way that doctors are not rewarded for doing this.


The impact of SES and social inequalities in health

I thought that the theory about the association between socioeconomic status and mortality presented in this week’s reading was accurate in some aspects, but somewhat unrealistic in their expectations.

This theory basically seeks to understand why there is still an association between SES and mortality as there use to be. They state that, in the past, this difference in mortality rates was due to the fact that people with higher SES was able to be protected (because of their access to resources) against infectious diseases, fever, tuberculosis, and other conditions that by now have been pretty much eradicated. Therefore, this theory suggests that the fact that this difference still persists even now suggests that we might be missing a broader, more general problem that accounts for the difference in mortality rates.

I personally believe that the main reason why this difference still persists is because, in spite of the fact that these diseases previously mentioned have been eradicated, many other factors have come into play in the current society that still causes people with higher SES to have a lower mortality incidence. In the globalized society we are currently, people have probably higher levels of stress, which is known to be the underlying cause of many diseases. People of lower SES usually are under higher levels of stress, which puts them more at risk of developing these diseases.

The theory also talks about the fact that a way to eliminate this difference is to minimize the extent to which socioeconomic resources buy a health advantage. However, how can this be feasible? Even if new intervention strategies are developed, as they mention in the article, how will this be available equally to all people, regardless of their economical status? I feel like the disparity would only be accentuated because people of lower SES would not be able to access this resources.

Thoughts about medical tourism + feasibility of changing the US healthcare system

As someone that grew up outside of the US, I feel this class have helped me to begin to understand how the healthcare system works in this country. I feel like I have always heard how medicine in the US is so expensive, but I have never really understood why this is the case. I even have family members that have lived in this country for many years and they still travel home sometimes to get certain medical procedures done; kind of the “medical tourism” we have mentioned in class. I am from Venezuela, and it seems ironic to me that these family members would travel to a South American country, which most certainly does not have the technology or medical equipment that the US has, to get a procedure done, simply because medicine in this country is so hard to afford.

One of the harder concepts for me to grasp about the topics we have been discussing in class has to do with the fact that, in almost all of the statistics that we have looked in class, the US seems to have its own category. No other countries seem to be even close to paying what US citizens pay for healthcare.

I understand (and it was not surprising to learn) that many other people are actually getting benefit from the fact that this healthcare system is so expensive. However, I would have thought that the number of people that is negatively affected would be a lot higher. If that is the case, then how come there has not been a switch in the system? If there are so many victims of this system, it is hard to think that there has not been a more drastic change in order to regulate some of the costs of medications. Is it that maybe some people have just resigned to paying that much money for healthcare?

The possible consequences of Republican states not accepting the Medicaid expansion

When reading the New York Times article “Millions of Poor Are Left Uncovered by Health Law”, I found it ironic that precisely those states with more than half of the impoverished population of the country are the ones that are not accepting the Medicaid expansion.

Giving that people are not insured and they are getting sicker because they cannot afford medicines that they would need to take daily, such as high blood pressure medications, wouldn’t it be more costly for these states, in the lung run, to have an overall sicker population? In other words, wouldn’t the decision of not expanding Medicaid be more detrimental, economically wise, for these states?

If such an important percentage of these states are impoverished people, this suggests that, if they are uninsured and they found themselves in a situation where they have to pay for a certain medical procedure, they would not be able to do so. Wouldn’t these people end up in medical bankruptcy if something like this where to happen to them? Is that even beneficial for such states? If it is not, then what reasons are outweighing the fact that these states could end up with a more sick and bankrupt population?