This article examined a new plan in medical school training that would get medical school graduates working as physician sooner. Grads would skip residency and go straight to treating patients. This new model would help the physician shortage and get physicians into areas with not enough physicians. Residency programs have limited space so many med school graduates are left with the qualifications, but without residency experience, creating a bottleneck effect. However, people argue that medical school is not intended to prepare you to go into practice, that is what residency is for. Some states are trying to implement a position called a “physician in training” or an “assistant physician” (different from a physician’s assistant) who are people who have graduated from med school, but not completed residency. The job allows them to provide primary care services as long as they are supervised by a physician. These new rules and positions are not planned to take effect until fall 2016. Continue reading “New Medical Training”
How pertinent is it know about the exact way you’re going to die, if it’s inevitable anyway? Some cultures find that telling you these *minor* details may not be the most necessary thing, and that’s just the way it plays out, living your life out in the form of a cancer-ridden body while you don’t know what exactly is going on. People take care of you, and you know you’re sick, and yet even you accept that no one is going to say anything about the matter. I’m not sure if telling my grandmother was the right thing to do, nor does it matter anymore, but how would it have changed things? Is it right to withhold this kind of information from someone, or better yet, if someone came up to you and described the way you were ultimately going to die would you want them to tell you? It’s the same thing…right?
This past week in class, we’ve finally come to what seems the perfect ending of such a class, looking at the care of those who are elderly or coming to the end of the their life. And yet, similar to many other age groups there appears to be a plethora of issues that are involved in this group as well. So considering the breadth of the issues we’ve discussed in this class, who deserves the most help? Is it those who are less affluent since they seem to be at a disadvantage compared to those who are able to receive more benefits based on their income? Or rather should we help the elderly since their age is also coupled to a need for stability, which inevitably needs some care? Should the government help anyone at all? Maybe a better question to consider is what can we do that will help the most amount of people in the long run? No answer is really the right one to any of these, yet the matter can’t be left unresolved.
In Tip-Toeing Toward Conversations About Death, the article talks about multiple health organizations attempting to “start” conversations about end-of-life treatment and what to do in those situations. Due to the general trend of most american, who tend to shy away from and avoid the topic death, end-of-life care becomes problematic for patients and their families, as they are left unprepared and not knowing what to do in the situation. Illness can appear unexpectedly and these unprepared families would not know how the patient, who could possibly be unable to respond or make decisions themselves, would want to be treated. The article states that the department of health has begun drafting a law to spread information, pamphlets on end-of-life care, in hopes to start the conversation. Other organizations, such as Harvard Vangard and Dana Farber Cancer Institute are also forming ways to help patient’s create a end-of-life plan. Continue reading “Mandatory Counseling”
On the review sheet that was passed out in discussion today, there was a question about death brokering. After reading Timmermans’s abstract I still don’t quite understand what it is. How or why are social movements challenging the institutionalization and why does it affect the professional legitimacy of forensic science other than the fact that it intertwines the legal system and medicine? Isn’t the point of forensic science to just found out the cause and time of death? I can understand how this would affect the professional legitimacy but not this whole idea of death’s existential ambiguity.
In the documentary we saw today in lecture, Florence Wald mentioned in her closing comments that she would someday like to see all medical students or residents spend six weeks in a hospice care facility before entering medical practice. My initial thought when I heard her say this was that six weeks was overkill-wouldn’t doctors learn how to deal with death and dying once they were put in their residencies? But as I considered her proposition I began to realize the many ways that experiencing care in a hospice setting would be beneficial for new doctors. What, aside from how to address death, could hospice education offer young doctors? How would giving medical students this experience change the way they interact with patients? Do you think that if medical education incorporated more aspects of the hospice model into their curricula the profession would begin to shift their ideas about emotional disconnectedness and the need to care for the whole person?
After reading about the extreme mistreatment Mr. Andrey endured, it seems that he would have been better off anywhere but a nursing home. Were his healthcare providers seriously concerned with his health or were they more concerned with the money his stay in these facilities would bring?
How can healthcare providers force the elderly to remain in their treatment facilities against their will? The treatment Mr. Andrey endured was inhumane. Why isn’t the government stricter with laws that prevent experiences like this from happening?
Would forcing people to make decisions regarding their long term care improve the quality of care in the long run? Or reduce it?
In the long run, is it more expensive to die in a nursing home facility or at home? What is one sacrificing by choosing one or the other? Does being a country that steers away from having conversations of death affect the state of elderly care? If so, in what ways?
Within the article “Fight to Honor A Father’s Last Wish: To Die At Home,” it was mentioned that “most developed countries spend much less on medicare, but twice as much on social supports.” Thus, I wonder how end-of-life care is structured and regulated in other countries? Is nursing home abuse as rampant and overlooked? What checks and balance do they have in place to ensure the people’s best interests? Is the cost much higher in comparison to the US?
The New York Times article “Fighting to Honor a Father’s Last Wish: To Die at Home” is a heartbreaking story about Ms. Stefanides and her dying father’s fight with a healthcare system that seems a little inept in end of life care. Ms. Stefanides could not afford to pay out of pocket home health care costs and although her father was more than qualified for insurance, the health care system could not grant Mr. Andrey’s wish to die at home. Ms. Stefanides knew firsthand about the horrible conditions some nursing homes could be, having already experienced the emotional trauma with her mother. Unfortunately, with the healthcare system we have today, Mr. Audrey’s choices for end of life care were very slim. His doctor’s pushed Ms. Stefanides to disregard his wish to die at home.
This makes me wonder if there should be more regulated rules about a doctor’s role in end of life care. Is it not a human right to decide where and how you want to spend the last day, months or even years of your life? Or should doctors have a final say in what they believe is best for the patient?
After reading the article “Tip-Toeing Toward Conversations About Death,” I was glad to see the encouragement towards end-of-life care planning. While steps are being made to expand the guideline of the “appropriate” patient for end-of-life care planning with their primary care providers, issues still remain with the end-of-life training program. Take for instance the MOLST form. Though the pamphlet cements in writing the desires of the patient the medical steps they would like to be taken in their case, it still has certain limitations. Where the patient would like to be taken or housed in solely designated by two options: transfer to a hospital or no hospital transfer. Should not the option of deciding for or against nursing home care and or home-care be designated as well on the form? Some, like Andrew Stefanides from the article concerning a father’s dieing wish, would probably have benefited greatly for such an option. What other possible limitations are there with the MOLST form? Does giving out a form as simple as this display insensitivity to the patient? Are their better methods with which to initiate the discussion of end-of-life care?