Final Process Reflection

Before taking Sociology of Health Care, I knew very little about our health care system. This class has been very informative. The lectures, and readings gave me a chance to learn about all different aspects of health care. Ranging from the business side, to the patients needs. The discussion section allowed me to further explore my classmates and my own ideas. I really enjoyed how this class was structured. I believe the frequent assignments helped me further understand what was going on in class. I always enjoyed the fact that the assignments were not just busy work, they correlated directly to what we were doing in class.

The most surprising thing I learned in this class was about the charge master. I am still baffled that our health care system allows for such arbitrary prices. Learning about this has motivated me to try to make a change once I have a career in health care. This class has made me view health care in a different way. Which ultimately has provided me with an understanding of what type of doctor I would want to be. I have learned that it is easy for doctors to put business priorities over their patients wants and needs. After taking this class I will make sure to never become a doctor who does that.

I have fully enjoyed every aspect of this class. The environment in which Professor Guseva and Rebecca teach is a very welcoming one. This made it much easier to discuss some of the controversial topics we did this semester. This class is very beneficial for anyone who is interested in health care, pre-med, or even politics. I believe that this class, the professor, and the TF are shaping undergrad pre-med students into become much better doctors then they once would have been.

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Health Care & Death

In the article, “Tip-Toeing Toward Conversations About Death”, by Martha Bebinger, the evolvement of health care in regards to death is discussed. Bebinger stated that a new law in Massachusetts was passed, “urges more of us to make preparations for these wrenching experiences by requiring that doctors offer information on end-of-life care to “appropriate” patients.” This is a huge step for health care. Most of the time doctors only focused on saving patients lives, not making them comfortable for their death.

This huge step in health care is really important because families and patients should be able to live the last days of their lives in a way that makes them the most comfortable. I fully support this new law. However, it brings about a few questions. With this new evolvement in health care will assisted suicide soon be legalized in Massachusetts and other states?

Empathy Over Quality?

In the article, “The Patient in the Intensive Care Unit,” Robert Zussman states that patients who are place in the ICU end up losing their individual characteristics and becoming only a set of symptoms and numbers. Zussman seems to be blaming the doctors who work in the ICU for being less empathetic towards these patients. I believe that if doctors are being less empathetic is is merely because of the time sensitiveness of the cases that usually bring a patient to an ICU. With this said, do patients and their families value a doctors empathy over their quality of care? Has the view of health care altered in a way that a nice caring doctor is valued more then one who can perform much better? and is it fair to judge these doctors who are simply trying to save lives?

Loneliness: A New Silent Killer?

http://www.npr.org/sections/health-shots/2015/11/29/457255876/loneliness-may-warp-our-genes-and-our-immune-systems

In the article, “Being Lonely Can Warp Our Genes, And Our Immune Systems”, by Angus Chen, Chen discusses the different ways in which being lonely has been found to affect the human body. Chen even states that loneliness has been linked to diseases such as heart disease, Alzheimer’s disease, cancer. Chen explains that researchers have found that immune systems of lonely people work differently then immune systems of people who are not lonely. Chen states that, “Lonely people’s white blood cells seem to be more active in a way that increases inflammation, a natural immune response to wounding and bacterial infection. On top of that, they seem to have lower levels of antiviral compounds known as interferons.” Chen also states that loneliness causes a higher level of inflammation which could lead to many of these diseases. Steve Cole, a genomics researcher at the University of California backs Chen’s argument, “That explains very clearly why lonely people fall at increased risk for cancer, neurodegenerative disease and viral infections as well.”

Chen goes on to explain how and why loneliness can change our bodies. Cole explains how he tracked 141 people over five years, by measuring how they felt and by drawing their blood. He found that, “In a life-threatening situation, norepinephrine cascades through the body and starts shutting down immune functions like viral defense, while ramping up the production of white blood cells called monocytes.” Cole agreed with this, “”It’s this surge in these pro-inflammatory white blood cells that are highly adapted to defend against wounds, but at the expense of our defenses against viral diseases that come from close social contact with other people.” Chen also explained that during this process lonely people shut down genes that make their body sensitive to cortisol, which lowers inflammation.

With everything I read in the article it seems as if you are a lonely person then your health will suffer dramatically. The evidence that is provided in the article makes sense, however I feel as if it is exaggerated. I feel like this is just another attempt to medicalize a condition to raise profit for a particular group. If everyone who feels lonely read this article they would automatically become panicked and would try to find a solution. Solutions could include medication to stop inflammation, or therapies to become less lonely. This would raise profit for pharmaceutical companies and for psychiatrists, and therapists. I feel that eventually every human emotion and natural response will be medicalized in some way to increase the profit of various parts of health care. Articles like this one are the start to that medicalization process.

In ” The Rise of the Modern Hospital”, Charles Rosenberg discusses the drastic evolution of hospitals. Prior to the 1920s hospitals were a place where only the poor would go. Anyone who had any social standing had their care given to them at home. Hospitals did not have a business stand point at all. The patients went to receive care, food, and shelter, and the doctors and nurses used the patients as a learning opportunity. After the 1920s this dramatically changed. With new technology hospitals flourished and were no longer thought to be reserved for the poor. Now hospitals are so expensive that many people go bankrupt after visiting them.

In class we watched a video about Bumrungrad International Hospital. This is the most “modern hospital” I have ever seen. The patients are considered to be guests in a hotel. You can even pay for your check up with frequent flyer points. Even with all of this luxury Bumrungrad care cost one eighth of the price of an US hospital, and the hospital still makes a very good profit off of the care.

The dramatic differences in what a hospital once was and what it is today brings about a lot of questions does advanced technology create more patient trust? If both the Bumrungrad and US hospitals have licensed experienced doctors what makes US health care prices justifiable? Are luxurious hospitals like Bumrungrad pushing health care even further into commercialism, and consumerism?

Managing Emotions linked to loss of human touch?

In the article, “Managing Emotions in Medical School” by Allen C. Smith, III and Sherryl Kleinman, the authors discuss how various medical students learned how to deal with their emotions when dealing with patients. One part that I found particularly interesting was when they were talking about how when they are examining patients they tend to think of the patient as an inanimate object, or think of the anatomy and take away the personal aspect. This was very interesting to me because when we watched the Ted talk in class the doctor explained how the human touch has been lost in medicine and that it was so important because of how personal it feels to the patients.My question is if medical students are trained in a way that physical examinations are not meant to be personal then why is the loss of human touch a big deal? And why would the medical society try to take away the personal aspect of a physical exam when they know how important it is to the patient?

The Pressures on Health Care Providers

In the article, “Health providers pressured by insurance, drug costs” by Tom DiChristopher, DiChristopher discusses how the financial pressures from high drugs costs, and negotiations with insurance companies effect the health care provider. This is a point of view that is not often discussed. The typical discussion that people have is about how the cost directly effects the patients. The article states that health care providers are trying to deliver high quality care at a much lower price. Health care providers are struggling with how to do this.

The biggest issue I have with health care providers trying to limit their care by how much things cost is I worry that patients will not be receiving as high quality care as they may have in the past. I believe it is not a health care providers responsibility to worry about how much things cost while they are trying to save someones life. Health care providers are trained to save lives not save money. I believe the real problem is why health care cost so much in the first place. In the article it discusses how one of the biggest problems is how much medication costs. I believe this is the core of the issue. If the pharmaceutical companies are not forced to lower their prices, health care professionals may be forced to treat patients in ways that are not as efficient. In the article it is argued that the price is justified because of the amount of research that goes into the product and they believe if they produce a life saving product they should receive a profit. I agree that there is a substantial amount of research that goes into these products, and that the scientist and pharmaceutical companies should be rewarded, however, if the product is too expensive for the patients who need it, the purpose has been defeated. Health care should put their patients first not their business.

At the end of the article Noseworthy said, “We’ve basically defunded the NIH over the last 11 years, and that’s a problem if you’re going to be the leading developer of new treatments in medicine. Our position could fall if that doesn’t turn around.” Because the United States is a leading developer in new treatments in medicine there is a lot of expectations and pressure put on us. Trying to solve the problem of high health care costs by defunded research is not the answer. They are taking the money from the wrong place. The real issue is with the pharmaceutical companies, and how the charge master prices are developed. If something doesn’t change, and health care providers are expected to deal with the business side of health care while treating patients, or high quality health care system will diminish.

Article: http://www.cnbc.com/2015/10/30/health-providers-pressured-by-insurance-drug-costs.html

Social Norm Created by Health Care

In the article, “Tall Girls: The Social Shaping of a Medical Therapy” by Joyce M. Lee, MD, MPH; Joel D. Howell, MD, PhD, the authors discuss how Estrogen therapy came about. Prior to reading this article I had never heard of Estrogen therapy being used to stunt the growth of a girl who was expected to be taller then what a medical professional deemed normal. This was very surprising to me because this seems like a very cosmetic procedure, and there was a lot of time and research put into it. In the article it states that this was such a pressing issue at the time because, “Some girls feel so embarrassed with boys shorter than themselves that they believe that their choice of male companions, both in the immediate future and as adults, will be seriously jeopardized.” Because the 1950s and 60s were a time when women worked mostly as stay at home moms, it was necessary for them to be attractive to find a male companion. I believe that part of the issue of women feeling unattractive because of their “abnormal” height is because of the social norm that was set in stone by medical professionals. Once someone with as high of ranking as a medical professional or scientist declares that being too tall is an issue then society will agree. My question is, did the medical professionals responsible for the use of Estrogen therapy to stunt growth, create the social norm of tall women being less attractive?

Socioeconomic Status and Mortality Relationship

In the article “Social Conditions as Fundamental Causes of Health Inequalities: Theory, Evidence, and Policy Implications” by Phelan, Link, and Tehranifar, the authors discuss why the relationship between mortality and socioeconomic status correlate. This article goes on to say that even though there has been dramatic changes in the disease and risk factors that previously explained the correlation, the relationship still exists.

This article goes over many of the reasons that low income people tend to have a higher mortality rate then higher income people. It lists reasons such as education, access to more care, more financial resources, access to preventative care, power, and social connections. With this said it is very difficult for a low income individual to be able to access care that is not necessary for them. Low income people often do not have the knowledge or resources to seek preventative care that could help diminish many of the diseases that they die from. This makes me question if these are such widely known facts why hasn’t our government pushed for a universal health care system that will help the poor? and why hasn’t our health care system made a bigger attempt to fix this issue?

Process Reflection 1

This class has made me realize that in some ways I have been naive about the way the health care system works. Before this class I had never questioned doctors motives or questioned why people were being charged so much for health care. So far in this class the readings, lectures, and discussions have broadened my awareness of what our nations health care system is really like. One question we were asked in class that surprised me was, are doctors business people first? I have previously learned in school that hospitals run as businesses which was fairly easy to rationalize and accept, but the idea of a doctor putting business first is very unsettling to me. As someone who wants to become a doctor I really hope that this is not true.

Another fact that we learned in class that surprised me was learning that the cost of services in hospitals came from a “charge master”. The idea of hospitals randomly creating high prices for services is baffling to me. Before learning of the charge master I always questioned why so many people go broke from hospital bills, now that I know why I am very concerned about our health care system. This class has challenged my previous beliefs, and challenged me intellectually. I found some of the language in the readings to be very challenging, but after talking through everything in discussion and lectures I feel that I have a full understanding of them. I have really enjoyed the various readings we have done. They have helped me further my knowledge. The multitude of views and options has helped me form an educated opinion on the health care system as a whole. Everything I have learned in this class has helped me to form a new perspective on our government.