Process Reflection

I took this class because my mother had struggled with insurance companies before, but since I was so little when all of it happened, I did not really understand what was going on. She had sued Blue Shield as they rejected her for some tests that the doctor had asked for and because of this, was not able to take these tests here. Her conditions grew worse and eventually while vacationing in Japan, she reached a point where she had to be rushed to the hospital.They immediately gave her and MRI where they found a brain tumor, which could have been found months earlier if Blue Shield had approved her testing. Her lawsuit was featured in a movie by Michael Moore, Sicko, which compared the healthcare system’s of several countries to the US. Since then, the healthcare system has changed a lot, especially with the passing of Obamacare, but taking this class has showed me the many more problems in our healthcare system.

In the last part of this class, we learned mostly about end of life care in nursing homes  and hospices. This is a topic that not a lot of people like to think about, though I think that it is very relevant especially to people our age because we are beginning to get older and will have to start taking care of our parents in this sense. I always told myself that I would never send my parents to a nursing home, but never really realized how expensive in home care can get. I just felt that putting my parents in this nursing home felt like I was abandoning them. In discussion, we debated about the use of cameras in the homes to be able to watch over whoever is being taken care of. Though at first I did think it was an invasion of privacy, I thought that it would give me peace of mind if I ever decided to place my parents in a home. I also did not realize the limit that insurance companies and Medicare placed on paying for end of life care. It made me realize the importance of things like a 401k plan or a retirement savings plan and the importance of family.

I think that the most challenging part of this course was thinking of actual solutions to the issues in our healthcare system. As the generation that will rise to power in the coming years, we do have some control over how things will be run, so I feel like if we were all educated a bit more in this field we can find a solution. Throughout the semester, it was hard trying to find solutions because it seemed like it was a systematic problem that could not be fixed by changing one thing. It would have to be a change in structure and policy and would have to require a lot of compromise.

I loved learning about all the parts that make up our healthcare system and I now  have a greater understand of the fight my mom was part of.

End of Life Care

Usually, end of life care can take up the last few years of a person’s life depending on the type of illness they have. In Chapter 10 of Weitz, he tells us that Medicare only pays for 6 months of end of life care in hospices. This forces the hospices to choose patients that would fit within that 6 month time span, so that they don’t need to pay out of pocket for those patients. Becoming federally funded rather than non-profit and for care caused hospices to have to adjust to these rules. Is it fair for those who do not fit in this 6 month time span to just be sent away from hospices, just because the federal government won’t pay for them? It seems like this is very similar to the time before Obamacare when insurance companies would turn down people due to pre-existing conditions that they didn’t want to, in the long run, end up funding.

Solution to Problems with End of Life Care

In the article “Fighting to Honor a Father’s Last Wish,” the main problem that seems to drag Joseph Andrey from hospital to nursing home and back, not allowing him to be at home where he wanted, was the issue of money. His daughter did not have the resources or to take care of him at home; however, all the nursing homes wanted was to make money off of him. Medicare refused to give them money to be able to have him at home, and would only pay for his stay at a nursing home. This forced his daughter to do just that. Since nursing homes have become for profit, and insurance companies worry about nothing but the money they make, is there ever going to be a way that allows us to get the end of life care that we deserve? Making patients like a source of money truly dehumanizes all of us, yet these places where the elderly spend their last years of life are doing just that. Is it possible to have a balanced system where either for-profit nursing homes and insurance companies are both happy or the nursing homes become non-profit?

Heaven over Hospital

As people get older, especially once they have acquired illness, people who work in hospitals have a harder time believing that they should be resuscitated. In Timmermans article on social death, nurses mention that they believe the elderly have lived their life and sometimes resuscitating them causes them more pain than it is worth it.

There is also sometimes much debate on whether or not it is right to let a person die, even if they ask to, if not everything has been done to try to keep them alive. The opinion about this varies depending on the age of the person, and how sick they are.

In this article, it explains the story of a 5 year old girl with a fatal neurodegenerative disease, which causes her muscle and movement to get weaker and weaker. This means that as she gets older, it gets more difficult for her fight off sicknesses, even those as simple as the flu. As mucus began to develop in her lungs and cause pneumonia, she kept having to return to the hospital and undergo painful procedures to have it removed and also try to cure her every time she got sick.

Eventually the pain was so much that this 5 year old girl told her mom that next time she got sick, she would rather “go to heaven” at home rather than go back to the hospital and be treated again. This raises a lot of ethical questions. As a child who is only 5 years old, is she allowed to make the decision to not be treated? Since she is still able to communicate her wants, she should be able to voice her opinion; however, as parents this would be such a hard decision to make as they don’t want to see her in pain, but she is still so young and hasn’t experienced enough of her life. Do her parents have the right not to listen to her, especially since, in the end, it is her life?

I think that this is very similar to the arguments people give for abortion. In these arguments, they say that because a baby does not have a voice, a mother does not have the right to end his/her life. So now, this 5 year old girl does have a voice and opinion, are her parents still allowed not to listen to her?

http://www.cnn.com/2015/10/27/health/girl-chooses-heaven-over-hospital-part-1/index.html

 

 

The Hospital-Patient Experience

The human touch during a hospital-patient experience is something that is almost an anomaly now. This personal touch is something that is sacrificed so that doctors can meet with more patients during the short amount of time they have. In places like Thailand and other technologically advanced hospitals, the use of robots in place of human touch is not uncommon anymore. In some cases, the surgeon actually controls a robots movements, while the machine actually performs the surgery. Robots are also used in place of custodial care for inpatients. Robots do make things in hospitals more efficient, decrease infection and contamination, and also keep movement consistent and lacking human error; however, are these advantages worth getting rid of the human touch? Will we, as possible future patients, be comfortable with robots treating us in hospitals?

The Rise of Alternative Health Care Providers

Alternative health care such as osteopathy and chiropractic has slowly gained popularity in America, with some now being reimbursed by Medicare and Medicaid. Osteopathy has become almost parallel to allopathic doctors and providers can even serve as primary care doctors. They provide a more holistic and humanistic approach to healthcare, with sometimes a lot more compassion shown that with the usual primary care doctors; however, they continue to be fought and limited based on what is considered “real medicine.” In such a diverse country, with a mix of people coming from so many difference cultures that use different methods of medicine, is it fair to limit what is considered “real medicine” especially if it is used a lot where they came from? Or does the government have the right to limit them based on if they have found scientific evidence not backing up their practices, even though patients sometimes feel more comfortable going to these alternatives?

Racism in Clinical Practice

In the article “A Silent Curriculum,” the author describes the ways she has seen racism play a part in the medical community from the medical student/doctor’s point of view. It shows that it affects how a person is treated, the amount and kind of treatment they receive, and if that person receives priority in the emergency room and during hospital stays; however, the author tells us that in med school they are told that sometimes you have to look at race when you are making a judgment call on their type of treatment, because different races are affected differently. Is this advice given in med school based on biological evidence or is it something that doctors began to assume after spending time in the field and actually seeing it in action? Or is it truly just racism causing a bias in the doctor’s decision?

Racism is also something that is ingrained in the minds of a lot of people outside the medical community. I have encountered people who do not even realize that they are being discriminatory due to their ignorance; however, lately, people have been becoming more and more aware of the blatant racism in our society and have been defending and calling people out on social media and in the news for their ignorant acts of discrimination. Is it possible that this problem of bias in the medical community can be fixed with our generation rising to med school? Or is it so deeply rooted in the mindset of society that it cannot be eradicated completely?

The Ambivalent Marriage Takes a Toll on Health

In class we discussed that usually the health of people in a married couple were much better than those who were single parents or divorced. This is probably due to the fact that the people in a marriage have constant support of their significant other, and single parents and those divorced have to deal with stressors on their own; when throwing kids into the mix, the married life becomes a little more stressful as they have to focus on working and caring for their family as well.

This article analyzes the research done with the health of married couples, who have no kids. This would mean that the effect on their health comes directly from their partner. Because testing the quality of marriages cannot be focused on one factor, this research analyzes one of the factors in a multi-dimensional point of view. They questioned each partner on the supportiveness of each other and then compared it to their relative blood pressure. It was found that those couples in “ambivalent” marriages had higher readings for their blood pressure than those who reported consistent support and low levels of negativity. When the researchers say ambivalent, they mean that though the marriage is not always bad, it is not always good either. The unpredictability of the support given to each other can cause stress in the marriage.

Though marriages seem to have a positive effect on the health of most people, this research shows that the dynamic of the relationship is also important to your health. Outside stressors such as work, children, and financial issues can cause the decrease in health, but if the relationship is not as supportive, it can affect your health just as much. I thought it was interesting that these relationships were not reported as “unhealthy” or “toxic” but ambivalent. It shows that though the relationship is not necessarily bad, the once in a while lack of support also adds to the deterioration of health. Something interesting to look at would be to compare the health of the ambivalent relationships, to those who report an unhappy marriage, to those who are divorced or single parents. That way we can see how much these ambivalent relationships are affecting health relative to other stressed relationships.

http://well.blogs.nytimes.com/2015/10/26/the-ambivalent-marriage-takes-a-toll-on-health/?ref=health

Solution to Gender Gap in Health?

In Rieker and Bird’s article, they explain the gender gap in health and mortality and the causes for this gap that occur in everyday life. Researchers have shown that most women in the world (except for the women in poorer countries) have the longevity advantage over men; however, they later explain that women are more susceptible to bad health choices such as skipping a meal to take care of family, or, if they are smokers, smoking more after a long day. They are also biologically bound to deal with stressors like pregnancies. How is it that women are still able to maintain a longevity advantage over men?

When thinking about all the different daily stressors that affect both men and women’s lives, is it even possible to fix population health and reduce the disparities between the genders? I feel like the decision-making process for these health choices are so deeply rooted in our daily routines that we would have to change our whole nature to be able to fix it. They say that in terms of priorities for parents with families paid work would be considered the first shift, then caring for family needs the second, and then self-care would be the third. These priorities can’t be helped because without money from working, the parents cannot pay for family care. And out of human nature as parents, of course they would take care of their family first before doing things like exercise or other healthy activities. So what could we actually do to change some fundamental parts of our lives in order to improve population health?

Rising Cost for Prescription Drugs is Now a Campaign Issue

Prescription drug prices have been increasing consistently yearly, with the estimated cost per capita to have increased by $100 within just the last year. Even those under the Affordable Care Act and those who are well insured find it difficult to fill a prescription due to this increase in cost. Medicare does not have a consistent price for prescription drugs but instead has different prices for individual private plans. Employees who have their insurance covered by the companies they work for have to pay high deductibles yet still have to pay out of pocket for their prescription drugs. Most of these employees don’t even get sick enough during the year to spend these deductibles on doctor and hospital visits, so in the end the cost to maintain their health is even higher, as they have to pay the full cost of their prescriptions along with their deductibles.

Though the US is a super power among many developed countries, its spending per capita on average is at least double the amount other developed countries. Why are these drug costs constantly increasing? The US allows drug makers to hold long patents on their drugs, giving them the ability to control the prices. Newer and more expensive drugs continue to be released, and are not allowing the less expensive drugs to become generic, which has shown to produce lower prices.

Bernie Sanders and Hilary Clinton are both advertising policies that will fight to keep these costs down. Among these proposals are provisions to allow American’s to import drugs from Canada, where they are significantly cheaper; requiring companies to share more information about their research and development costs and making it harder to commit fraud; and capping the amount that insurance companies can ask customers to pay for prescription medication.
It is absolutely not okay to have people, who are covered by health insurance, go to the doctor, receive a prescription, and not be able to fill it because of the expense. It is about time we are doing something about these high costs.

http://www.nytimes.com/2015/09/22/upshot/prescription-drug-costs-are-rising-as-a-campaign-issue.html?ref=policy