Final process reflection

Dr. Martin Luther King Jr. once stated “Of all the injustices in the world, injustice in health care is the most shocking and inhumane.” Equitable civil rights not only exist at the forefront of medical practice, but just living as a whole. Sociology of Health Care lectures throughout the semester have made it clear that care quality is highly variable between the sexes, races, and financial sectors of society. While I aim to touch the lives of each patient I have the opportunity to treat, I would like to also influence the medical community as a whole in a lasting manner. As such, I would like to begin further study in the field of health policy while I continue my education in medical school. Personally, the most influential lectures were those that spoke of fundamental causes of disease and the social factors affecting health, namely SES, race, and gender. Too often health policy is instated by those who lack understanding in the biological/social factors that affect illness. As I am already well equipped in this regard due to past enrollment in numerous basic science courses, I must gain fluency in the nuances of social justice regarding healthcare. SO 215 has started me on the path towards it.

Additional questions to be asked during end of life counseling

In “Tip-Toeing Towards Conversations About Death,” it is notes that 67% of individuals want to die at home, but only 24% do. I would like to know what constitutes dying at home in terms of these statistics. For example, does an individual dying away from home include an individual that has experiences complications from their terminal illness at home, calls emergency services, and then dies shortly after in the ambulance or hospital? If this is the case, would emergency services be forbidden from removing the individual from their home, or delivering care in general even though they were called by the patient him/herself? Emergency intervention options such as this need to be included in the conversation with the patient as well, rather than simply those relating to treatments received during prolonged unconsciousness.

Do physicians reserve the right to refuse continuation of treatment?

It is noted in “Watching Brian Die” that conflict between the physician and family often arise when the former sees no benefit, or even trauma/harm, in continuing aggressive treatment, but the latter supports its continuation. If said physician feels morally compromised by this, is he warranted to refuse continuation of the treatment and request being replaced by a different caretaker? If no other physician is available or none feel comfortable taking over said treatment, should the initial physician or caretaking organization be liable for death of the patient?

November Analytical Posting: Effects of the compassionate care revolution

A godsend to the medical profession is the expansion of compassionate care. Often students and physicians lose sight of the ultimate goal, delivering quality and equitable care to all patients. I have had first hand experience with its importance via witnessing compassion personified by the physicians treating my ill father prior to his passing. The article to which I am responding analyzes how leadership is attempting to integrate empathic care into common medical practice and the resulting effects.

Early on it is written, “…hospitals that promote compassion, especially with rewards, are more likely to have higher patient satisfaction scores.” Thus it is financially beneficial for the healthcare organization to promote compassionate care in practice as increased satisfaction undoubtedly correlates with willingness of a patient to return for follow up appointments and future issues. However the benefits go much further. “If patients feel their doctors genuinely care…they’re more likely to take medications and comply with recommendations.” By making this statement, the author claims that increased care quality due to physician compassion stems from increased patient adherence to prescribed drug intake and treatment suggestions. Increased compassion correlates with a deeper therapeutic bond, and thus increased confidence in physician competence. As a result, there is a lower likelihood of noncompliance for reasons other than eventual treatment ineffectiveness or side effect. The article additionally brings to light an effective method of employing compassionate care. Both the Cleveland Clinic and University of Rochester Medical Center provide their physicians with reports containing patient feedback at regular intervals. I believe this method to be highly effective as it draws attention to the areas in which physician bedside manner can improve that may otherwise not be noted. It creates the ability to measure physician compassion, and that which is measured improves. However I believe the effects of compassionate care may delve even deeper. A recurring theme in Bernard Lown’s The Lost Art of Healing: Practicing Compassion in Medicine is that patients are more likely to divulge highly personal medical histories when in a “safe” environment, such as the office of a compassionate doctor rather than an austere one. Though this is likely unimportant for the diagnosis of common illnesses such as the flu, it may be pivotal in the early detection and treatment of more critical ones. Thus care effectiveness is once again directly affected by physician emotional support, rather than simply patient comfort.

As a brief aside, I would like to mention that it is not simply the patients who benefit from empathic care. A study, for which the link is provided, states that 87% of 2,608 polled physicians who reported a newfound lack in enthusiasm in medical practice attribute it to stifling of compassionate care in their work. Though this may seem trivial as the physicians themselves are not medically compromised, I believe that it is quite dangerous. In order for one to perform to the best of their ability, they must be passionate about the work they carry out. Can a physician truly diagnose and treat to the best of their ability in the absence of this drive? I think not. Thus not only is the patient now more likely to be displeased with their care due to a lack of empathic support, they may also be at risk of low-quality care by apathetic professionals.

In conclusion, the compassionate care revolution is a needed and effective method of revolutionizing modern medical practice. Not only does it increase patient comfort, but also care quality in terms of patient compliance and meticulous diagnosis and treatment by a passionate physician. Compassionate care will continue to revolutionize health care.

 

Article: http://www.cnn.com/2015/09/13/health/doctor-empathy-increase/

Book: The Lost Art of Healing: Practicing Compassion in Medicine, Bernard Lown

Study: http://www.nejm.org/doi/full/10.1056/NEJMsr031703

Who is to blame for prevalence of the silent curriculum with regards to race

In review of the silent curriculum, seemingly the most common negative aspect relates to the disparity of care quality received between whites and minority groups. Could this be due to many physicians handling rounds and medical education being white individuals from a time when racial disparity was more prevalent across all aspects of society, and thus not disputed in medical practice? Research by the AAMC has in fact shown that a vast majority of physicians within the United States are white. If so, is it plausible to believe that after so many years of practice that we can change their treatment biases? If not, who are we left to blame for the progression of this disparity besides ourselves? I believe that we as future medical students and residents must actively combat being influenced by their silent curriculum in order to bring about necessary change with regards to varying care quality among different ethnic groups.

October analytical posting: Life expectancy disparity between males and females

What I have found interesting lately has been the disparity of morality between men and women. Statistically speaking it is even to the point that by age 85 there are six living women to every four men. From a biological standpoint this strikes me as odd as I would assume that for the most part natural selection has affected genes passed on via heredity from generation to generation roughly equally. My first thought was that possibly men were affected more so by X-linked recessive disorders or biological issues related to their sex organs and secondary sexual characteristics as gene transfer affecting these traits indeed would be different. However I do not think it possible for disease and illness due to these traits to make the expected age gap so wide. My next hypothesis is potentially the most viable, and is that, as we learned in lecture, women on average are more likely to seek health care throughout their lives. As an example, two of the top causes of death worldwide are cardiovascular disease (29.34% of deaths) and malignant cancer (12.49% of deaths). Both affect men to a larger degree; cardiovascular disease causing 916.1 deaths per 100,000 in males versus 877.1 per 100,000 for women, and cancer 126.9 per 100,000 in men, and only 101.7 for women. These health complications have a myriad of pharmaceutical drugs and medical technologies to relieve symptoms, and possibly even cure the individual. Thus preventive care and early intervention are undoubtedly pivotal in affecting survival time if and when disease onset begins, and as a result the care sought by women increases their life expectancy. However how significant is this difference between amount of health care received by men and women? In one study, for which the link is provided, 3,030 Spanish subjects ages 60 and over disclosed all information regarding medical visits from the start of the study. The results were that 41.97% of women visited their medical practitioner one or more times per month, 52.19% were taking three or more prescription medications, and 15.07% had health care providers regularly visit their homes for checkup and care. In men, these percentages were only 36.85%, 41.40%, and 9.58%. Though other factors regarding sought after care could be analyzed, I believe that the results would be quite similar. Thus health care professionals are able to more closely monitor the health of women, quickly provide needed care, and be more effective as a result. Female life expectancy is longer as a result. I would also like to note that this difference could partially explain the increased mortility seen in women. As they seek more treatment, their lives are likely extended by the roughly four-year gap been male and female life expectancies. However these years could be plagued by symptoms of the disease that would otherwise cause the death of the male. In summary I believe that very little, if any, of the age gap is a result of the innate biological factors due to genetics, heredity, and natural selection acting on ancestral men and women. It can be explained by amount of preventive care and early intervention that women seek, specifically more frequent checkups and prescription of medication.

http://www.biomedcentral.com/1471-2458/6/155

Harm stemming from disease broadcasting

In the Conrad article regarding the social construction of illness, it is mentioned several times how the affected not only suffers from the physical symptoms, but also from possible societal stigmatization. They may even experience an identity shift, in which their former self partially erodes as they take on a new persona centered around their ailment. It seems to me that this would be an unfortunate, potentially degrading experience. However on a daily basis we commercials, posters, ads, etc. all raising awareness for the illness. While possibly effective in raising support and money for research and treatment, could all of the publicity concerning the patient’s struggles largely contribute to the social construction and stigmatization of the illness? And if so, for minor ailments could all the awareness cause more harm than good?

Discussion question on gender difference affecting mortality and morbidity

The reading regarding health disparities between men and women claims that on average women have a lower mortality rate, but higher morbidity rate, than their male counterparts. It is later brought up that women are typically more likely to seek health care and intervention than men are. At first, I thought this to be odd as I expected more care and intervention for women to lower both their mortality and morbidity. However it later struck me that increased longevity experienced by women due to more care could mean that these “extra” years gained could be plagued by fighting the illness that otherwise would lead to death, as it could in the men who do not seek care. My claim also seems to be supported by the statement that “…women have…in later years a diminished quality of life.” Is this is a valid hypothesis to partially explain the lower mortality yet higher morbidity of women?

Process Reflection 1

Until this point in my undergrad tenure, a large percentage of the courses I have completed have been concerned with core sciences such as biochemistry and physics. For this reason, I had begun to think that this knowledge would be sufficient to critically examine medical culture. However SO 215 has been, for lack of a better term, eye opening. Specifically I have appreciated the insight I have gained into the complexities and disparities of the American healthcare system.

Personally I am awe struck that our system is still decentralized to such a degree, and that presidential reforms presented by Roosevelt, Truman, and Clinton were all met with such disdain by our nation. In review of the Timmermans and Quadagno papers, I can see how stakeholders would oppose such reform as these investors, physicians, and pharmaceutical companies have unimaginable profit stakes within the financial success of the healthcare system. However I am shocked that the public has also so often been swayed to feel that such reform would strip them of basic freedoms. Quite possibly it is due in large part to the advertising and political power that investors and pharmaceutical companies attain with their deep wallets, or that we tend to blindly trust the word of physicians within our country, believing them to be more knowledgeable on such matters than the average American. Additionally as was suggested through papers and slides, the American community values their autonomy. Thus we are likely to fear any proactive plans associated with the negative connotation bound to the words “government” and “taxes.” This again can loop back to scare tactics used by powerful opposition of reforms, as they can use their vast economic and political input to make reform and these words indistinguishable. Perhaps the simplest way to put it is that I am disappointed with the inaction of such a large part of the population. I believe it is likely that many don’t take the time to educate themselves on such matters as health care reform, myself included until recently, and are content to just support whatever movement gains the most support in fear of being stigmatized for opposition. As such, not all of the blame can be put on those entities simply trying to turn a profit, as we allow them to do so without any attempt at knowledgeable opposition. Being one that values general education and knowledge highly, I truly hope that as a whole our nation can move towards increasing public knowledge on such matters so everyone may form and express their own opinion on the matter.

My final point stems from a more emotional perspective. As Americans, we value highly our right to become as financially successful as possible, and do not believe that our wealth should be shared among the community. This stems from our highly individualistic society, whereas many other countries with centralized care stress community more so than we do. Such un-altruistic and uncooperative behavior have led to severe disadvantage of the lower class, even though the percentage of the community they make up is much larger than that of the upper classes. It seems only recently as this unfairness spread to the middle class has public opinion on need for reform in “who pays how much” been sparked. Maybe since we have begun to realize this inequality, we can begin to work together for reform that may having little or no help on an individual level, will likely benefit the community as a whole.

Health care issues faced by foster children

There are several sections of society that quickly come to mind when contemplating unequal healthcare, including financially disadvantaged families, immigrants, and ethnic minorities. However in recent research, another demographic has proven to receive insufficient treatment with regards to medical screening and treatment. For a multitude of reasons, children apart of, or recently removed from the foster care system are commonly slighted by medical professionals, and do not receive adequate treatment. First, I believe it necessary to comment on health troubles that this demographic faces. From a physical standpoint, these children are often taken from homes of abuse and neglect, and may face both physical abuse-related injuries (i.e. bruises, broken bones, etc.), as well as previously untreated illnesses/diseases. What may be even more damaging, however, is the psychological toll that living in such an environment took on them. As a result of the avoidant or disorganized care they likely received in the birth home, conditions such as social withdrawal/anxiety or stunted emotional development are more common than in the general population. Thus both drug and non-drug related therapeutic intervention, as well as physical workups such as blood/urine analysis and dental checkups should be required in order to revamp and maintain the standard of health these children experience.

 

Unfortunately this is not the case for these children. To briefly mention some statistics, the National Child Abuse and Neglect Data System recorded that roughly 27% of children of foster children have a diagnosed illness or disability, and over 80% live with a behavioral, emotional, or developmental needs that should be addressed by health care professionals. However it is the case that these children are often relocated quite some distance from their birth home, either to a foster home or adoptive family. As a result, sharing of their medical history between previous and new health care providers can often become increasingly difficult. Even more problematic is the fact that due to a neglectful upbringing, medical histories are insufficient or even absent, as caregivers did not seek health care intervention for anything short of urgent situations. Thus medical screenings should not only be carried out, but promptly so. However in a study conducted by the Administration for Children and Families of all state child welfare agencies, 30% of the sample population never even received assessment or treatment upon relocation. Though it is not intended, it seems as if the neglect concerning the health of these children is carried on.

 

In an attempt to care for these children, they become eligible for Medicaid upon entering the foster system. However for ease or profit-related reasons, physicians may not accept Medicaid coverage, leading to both a potential decrease in the quality of care received, or the promptness of it. I am not well versed in the details of Medicaid law, nor that of specific Social Security titles meant to correct these gaps in care. However if the aforementioned statistics hold true and were gathered in a correct manner, it is obvious that the health care these disadvantaged youth receive needs to be altered.

 

http://pediatrics.aappublications.org/content/109/3/536.full

http://www.hdwg.org/catalyst/fostercareCYSHCN