As we finish off this course, I realized I have developed a new perspective and outlook on the entire medical system of the U.S.. Having grown up in another country for most of my life, I have always known my own country’s medical system (Taiwan) and thought everything should be like that as it would make things much easier. I also thought in a more than naive way that the U.S. would have a similar system. This course helped me shine a light on what is wrong with the entire medical system of the U.S., but also gave me hope for what little hope there is left. It allowed some thoughts of reform and of change, which provided a rather bleak life with a sort of hopeful outlook. Even as we ended the class talking about end of life care, we managed to squeeze in some happy notes by explaining what we could be doing instead of what we are doing now. In that sense, I don’t see this class as teaching new material as a typical class does, but rather provoking conversations and viewing the world from an outsider view. Instead of teaching the basics, we learned to question the society we live in and what can we do as individuals to improve it. After all, we are going to be future doctors which will have a major impact on the medical field. If we can bring what we learned in this class to our future careers, maybe we really can bring change to the medical field and possibly reform it completely.
In terms of actual teaching, I think Dr. Guseva did a great job explaining many of the past concepts in lecture. She brought her own point of view as well as explained the current trends, and allowed us to think about what we should do to contribute, such as conversations about death. I think discussions were helpful as well, but I would’ve preferred if they went a little faster or more in depth into the lectures that we went over in class. We usually went over the readings which were helpful, but were something we really could’ve done in our own time.
To bring it all into context with what we have been learning about for the past few weeks, I think we really should bring all of what we learned into context to be change, however slight, in the world and change perspectives of how we view healthcare, illnesses, and death. What is rather stigmatizing to think about should not be so, and should be more talked about as the more we stigmatize them, the less we treat people with these certain conditions. This course really has brought a lot of new thoughts to my mind about healthcare and I’m glad I took this course to discuss these thoughts!
This course has been eye-opening for me. The most interesting idea I have learned is the correlation between socioeconomic status and health outcomes. The Whitehall studies in England produced a result I did not expect. Prior to the course I would have expected wealth to correlate with health but I would not have expected race, education or stress to correlate with health as well.
Another topic I found very interesting was the need for the medical profession to focus on care and the quality of patient life as well as curing the affliction. This idea is one that I have seen in the past when dealing with family members in the hospital. However, I was not aware that the quality of life is not always the primary concern of doctors. This realization had a large impact on me.
A final topic was shown to me in the analytical postings, but I wish it was discussed more in class. Mental health infrastructure is a serious problem that has been around for far too long. A large percentage of the population experiences some form of mental health issue, and there is very little infrastructure to support these patients. Moreover, the majority of homeless people and a large portion of the prison population suffer from a mental illness. I feel that, in the context of a course that is teaching students to address societal medical issues, this would have been a great topic to study in depth.
This class has been enlightening and has inspired me to think of health care, doctors, hospitals and our systems in the United States in new ways. One interesting thing I want to share relates to the topic of discussing end of life care with family members. My mom is an elderly care lawyer so she is around people in this type of situation every day at work. I haven’t ever really talked to her about end of life care before.
Over this thanksgiving break my grandparents and my stepfather’s parents both were visiting and staying in our house. One morning, I walked into the kitchen to get breakfast and I overheard my mom talking to my step dad telling him that he needed to have this conversation with his parents while they were visiting. She had printed out forms that my step dad and his parents needed to sign, which would give him authority over making decisions about their care, if and when the time came. I stopped what I was doing to listen and watch. My step dad seemed anxious and acted as if he was trying to avoid the conversation. However, my mom eventually convinced him that it was the necessary thing to do.
Later that day I talked to my mom about what she did that morning and I told her how we had just talked about that material in this class. She told me that it was part of her every day duties to inform people about end of life care decisions and she always encourages people to have these discussions with their families, especially on holidays such as Thanksgiving! I thought it was interesting how timing worked out and I wanted to share this story. To rap up my final post I would like to say thank you for a great class, I’ve learned a lot and would recommend this class to any premedical student.
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.
Imagining a family member dying is something nobody wants to do. However, death is one of the few things that is guaranteed in the world. Many times, a person’s loved one will die or be put on life support unexpectedly, and it is the duty of their closest loved one to make all the big decisions… whether to resuscitate, pull the plug, or perform a risky procedure. This stressful decisions can be alleviated by having an “end of life” talk in which you talk to family members and loved ones about what action they would prefer to be taken if they are ever in such a dire situation. Many families are encouraged to have this talk, and my question is, what are the benefits to having this talk? Are there consequences? When is the best time to talk about this?
Through the last view lectures, we learned many aspects of end of life care, such as being in the intensive care unit, in nursing homes, and in hospice care. The main overall view we can get from these aspects is we need to change our view of death, and make sure the patient gets what they want or deserve. Maybe they would not prefer treatment and rather die in the hands of their loved ones or near them, therefore sending them not to ICUs but rather to hospice facilities or just the comfort of home. Maybe the old would rather be living their own lives, like those in the neighborhood for the elderly, instead of being monitored for their own health. This would lead us to believe that we need a change in how we view death and aging.
Whereas death may be viewed as a terrible thing and prevented, we should treat is as an inevitable situation and have the patient be the one in control when it is their own death. Death should not be a taboo subject, but again it should be embraced when the time has come. In this state, the most optimal thing to do would be allowing the patient the most comfort they can afford. Aging should be viewed in a similar fashion. People who are aging should not be viewed as feeble or fragile and have to be looked for (unless they have to due to a condition such as Alzheimer’s) but rather looked as capable individuals who have their own wants or needs. Rather then confine them because they are close to death, allow them to do whatever they want because they almost have no more life to live. There is a shift toward this view, but a lot more thought would be needed to fully push the view toward the main picture and have it embraced by everyone. At this point, will we be able to actually conquer death: when we accept it and gain a sense of comfort from it.
After reading “Fighting to Honor a Father’s Last Wish: To Die at Home,” I have to wonder what could possibly be done to change our current system of elder care and end-of-life care. If the system continues to be largely run for profit, then we are never going to get to a point where we stop spending so much money on unwanted medical care and start investing more in social services. My questions revolve around that idea. What can be done to incentivize home health care and social services? For those who are truly too sick to be cared for at home, what can be done to improve treatment in nursing homes and hospitals? If these institutions are turning such a profit, why is there such a staffing shortage? Surely, they can afford to hire more staff, which is frequently stated to be a way to improve conditions in these settings. Hopefully, changes can be made soon, so that less people have to endure what Joseph Andrey did in his last months of life and more elderly people can die at home, if they so wish.
I have been lucky enough to get to know my great grand mother. As the wheel of life turns however, I also had to experience her end of life care and the approach that my family took. My parents involved me a lot into the situation even though my young age. I’m grateful since this experience opened my eyes in regard to death and the meaning that life has. At the age of 96 , after years at home, with my greatgrandmother being completely dependent onto my grandmother, my greatgrandmother, when understood that her time had come, actively decided to stop being under medications, eating and even drinking. What could my family do in front of such a strong decision? Was it right to attach her to machines and force her to a vegetative life that wouldn’t have honored the amazing woman she was and the harshness that she overcame in life. We all stayed next to her, gave all the love we could and accepted her decision if that was what she wanted to do. She looked happy serene. I remember my tears in front of her decision asking myself how a human being could be so strong to take such an approach towards death.
After reading Nina Berstein’s article I started questioning myself: “ How can the context surrounding us affect the individual’s approach to dying and the one of his family? “ In my country in fact, having a public health system, the approach to end of life care is much more different and in a way more free to follow the course of nature. Having a for-profit mechanism, as described in the article, determines how an individual has to die. What is therefore the sense of expressing your will on your death, if at the end, the envy of money of the society you live in, puts in second place the peaceful desire of his citizens, among which many of them have helped in the past make this country the place that it is now? Is an individual really free to express how he wants to die, in the for-profit system that the end of life care has become in the United States?
The article “Tip-Toeing Toward Conversations About Death”, explains that a state law earlier this year was passed to encourage more people to make preparations about how they want to die. I had several questions regarding this article. First they mentioned that “Sixty-seven percent of people want to die at home and only 24 percent did”, is this because they simply never made arrangements for this death or did this data include sudden deaths such as heart attacks, car accidents, etc.
To add on, doo you think the Department of Public Health should broaden the qualifications of an “appropriate” patient like what Harvard Vanguard did in the attempt to promote end of life arrangements? Should these arrangements just be simple conversations with family members or are these patients suppose to set up meetings with lawyers and have written requests? Lastly, the article mentions that the law wants doctors to hand out pamphlets to patients. I believe that this is a very ineffective tool to encourage end of life talk. Many people do not read pamphlets and throw them away immediately. Obviously, face-to-face communication between the doctor and patient would be the easiest and an effective form of urging an end of life talk but what are other effective ways that can encourage these talks? Media usage? Ads? Should the doctor talk to family members before the patient about end of life talks?
In many of the articles we’ve read and videos we have watched recently in class, a common theme I’ve noticed is many elderly, terminal patients wishing to die at home rather than in an institution. In Fighting to Honor a Father’s Last Wish, Mr. Joseph Andrey was shuttled around between hospital stays and different nursing homes/rehabilitation centers in the months leading up to his death. His daughter fought relentlessly to get him home and have some sort of home care/hospice to take care of him, but she had no luck. This is just one of many stories we have heard about this same type of situation, even though the vast majority of people say that they wish to die in the peace and comfort of their own homes. In Tip-Toeing Toward Conversations about Death, an expert about end-life-care states that “if patients start taking charge of their care at the end of life, the effects will ripple through the system.” But what if that is not enough? What will it take for this country to institute some sort of end-of-life care that is sustainable and will fulfill the wishes of so many Americans? Would a grass-roots movement help gain momentum, or is this an issue that only government officials can address via the passing of legislation?