Nursing Homes: Friend or Foe?

In Does Investor Ownership of Nursing Homes Compromise the Quality of Care?, Charlene Harrington et al. reveal that investor-owned nursing homes deliver lower quality care than do nonprofit or public facilities and explores the factors behind this marked decrease in quality of care.

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Clueless (*As IF*)

Many Doctors Unaware of Truvada, Drug for Preventing H.I.V.

By Donald G. McNeil Jr.

http://www.nytimes.com/2015/11/26/health/many-doctors-unaware-of-truvada-drug-for-preventing-hiv.html?ref=health 

Kudos to you if you actually got the reference I was making in the title.

But in all seriousness, this article frustrates me a lot. One of my good friends from high school is a campus advocate for Truvada (a.k.a. “PrEP”, or Pre-Exposure Prophylaxis) at NYU and I can already imagine how upset the information in this article would make him.

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Great Expectations of Health Care

In the excerpt, “The Rise of the Modern Hospital,” Charles Rosenberg illustrates how hospitals have made the transition from being a “microcosm” in a 19th century community to a national institution by the early 20th century. Rosenberg also describes how this transformation of the hospital setting was driven by technological advances and rise of internal bureaucracy. He also begins to touch upon certain social determinants of healthcare, as referred to as “social location” that persisted along with the new hospitals’ development.However, the idea that “changed expectations” of the hospital setting on both the physician and patient ends had largely contributed to the transformation was a novel argument that was particularly interesting.

Rosenberg argues that as medicine changed drastically in the latter half of the 19th century, so did patients’ expectations of medicine and this thus provided “medical men” the ability to claim an identity with raised authority in social hierarchy and even over science itself. Rosenberg reiterates this notion with the statement, “The growing complexity and presumed efficacy of medicine’s tools seemed to make the centrality of physicians in decision making both inevitable and appropriate.” This must have begun the medical care norm of the patriarchal relationship between the doctor and the patient, which was a big transition from what used to be a community with diffused medical knowledge and skill and not as much power to the physician. Rosenberg concludes that the initial driving force of scientific advancements in medicine continues to raise people’s expectations of medicine while simultaneously increasing costs of medical care; however, the issues of rising health costs and persisting patient dissatisfaction does not seem possible to solve with our current health care system’s preferred aims for scientific innovation and profit maximization.

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What Goes Up, Must Come Down

In The Rise of the Modern Hospital, Charles Rosenberg discusses the “contentious present and problematic future” of the hospital and explores the factors that led to the evolution of this institution from the subpar ragtag collection of inpatient beds in 1800 to the profit-maximizing monolith of the 21st century. This reading made me reflect on the things we’ve learned throughout the course of this semester. Before this class, I knew that our health care system was flawed but I had no idea of the extent of these imperfections.

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