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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Excerpts from “How Doctors Think”

In the NPR broadcast that included excerpts from Jerome Groopman’s “How Doctors Think”, Groopman talks about the nature of rounds with medical students. When he was a medical student, rounds was a time to learn not only diagnostic information but also a time to observe their superiors and how they conducted themselves. Now that Groopman is the one conducting the rounds, he has seen a shift in the purpose of rounds. The old way of conducting rounds was criticized and therefore the way Groopman conducts rounds now is solely focused on diagnostic information. Students are taught to follow a set of algorithms and practice guidelines organized into decision trees. Groopman draws attention to this issue because the consequences it has for patients with issues that do not fit into these decision trees. This shift in focus made me think of how this might impact how a condition may become medicalized. If a condition isn’t recognized as a part of one of these decision trees, how could it ever become medicalized? For a condition to be medicalized it has to be excepted by a medical profession as legitimate but these decision trees only allow for a finite amount of diagnoses and treatments.

Medicalization: A Way for the Health Industry to Stay Strong?

As we learned in class earlier this week, medicalization is the process of making non-medical conditions medical and through this there is some sort of social control. We learned that through this that the medical profession, pharmaceutical companies, and the public themselves all use this to raise awareness to certain symptoms and how pharmaceutical companies might use to promote certain new drugs. I thought we could relate this to why the medical industry has stayed as powerful as it has despite the changing economy: medicalization. With research for both the medical profession and the pharmaceutical companies, new diseases or illnesses are being discovered at a rapid pace with only the medical profession with the help of the pharmaceutical companies to solve them. With the pressure of wanting to be normal and the medical profession and pharmaceutical company both defining what is normal, the doctors and drug companies will always stay in power as they are constantly setting new guidelines of what is healthy. Through this process, as well as the influence of mass media on the public, the medical industry will never falter until something takes away that power from them. So could medicalization be not only a means of social control but a way to maintain dominance in our current economic system?

I’d Like To Nominate…

In The Social Construction of Illness: Key Insights and Policy Implications, Peter Conrad and Kristin K. Barker explore the origins of the belief that illness is a socially constructed phenomenon. Near the end of this publication, they discuss policy implications related to this phenomenon and future directions it may take us in. Something I found extremely interesting in this section was the mention of the Internet and how it has radically changed the social construct of illness.

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Doctor vs. Guardian: Who Should Have More Power?

When addressing sociology in medicine, statistical evidence is a useful tool in identifying specific problems in our healthcare system. While these “numbers” may give us a general, objective perspective, medicine is often not an objective subject. Medical treatment deals with the emotions and relationships between doctors and patients that cannot be overlooked. Within these relationships, there is also a struggle for power between the two parties. For example, in the video “Money and Medicine”, a son looks over his dying mother who is unable to do anything independently. She must be fed, bathed, and watched at all times by either the son or medical staff. She is unable to breathe on her own and her condition has been worsening for the past 8 months. The doctors have advised the son to “pull the plug” and let the mother pass in peace. However, the son’s religious beliefs and confidence in miracles have compelled him to continue his mother’s treatment. The hospital bills have summed up to $5 million. In this situation, the doctors have no power unless they are able to persuade the son that keeping his mother in a minimal conscious state would be undesirable. At what point should the doctor’s decision override the guardian’s? Should the doctor have any power to override the decision at all?

Healthcare as a Government Run Entity or Privately Owned Business?

In the video we recently watched “Money and Medicine, we were shown the conundrum of maintaining life for an expensive price and with many different methods. They essentially show the struggle between extending life and the price of extending life of such patients. The increasing price of healthcare is only going to increase as time goes on and mainly this is due to the unregulated costs of healthcare. I did further watching through YouTube videos and found two sources that proved quite informational. One video was of John Green talking about healthcare and it’s rising cost due to the lack of a government entity controlling the costs. The overall cost of healthcare would be run and regulated by the government in other countries and therefore decrease the price as healthcare businesses would have no control. In the U.S. however, healthcare businesses have almost total control of the cost and therefore can control it as they please due to their monopolistic control.

In a second video I found, Hank Green experienced such an event as the cost of his medicine rose 1200%, rising from $50 to $627 in a night. He originally thought that the cost would be cheaper than his previous medication, that being $300 before the drug company dramatically increased the price. This further illustrates that there is no real government regulation on the price and that a more efficient healthcare system would have this regulation.

The question then becomes whether healthcare should be regarded as a right or a benefit? Should we have the power to choose whether we want to be healthy or not and continue to let healthcare be privately run? Or should we let the government finally take the reins and be the more dominant power in healthcare, regulating the care for the U.S.?

Links are provided down below:

John Green’s View on Healthcare

Hank Green’s Experience with Rising Costs

Could cultural changes help bridge a medical gap

Chapter 9 discusses the possibilities of why the U.S. Health Care system is less effective than other systems, it does well to explain that malpractice insurance, an aging population, overuse of advanced technologies, and the increased use of care do not fully explain the differential. Continue reading “Could cultural changes help bridge a medical gap”

Should Medical Professionals Have So Much Authority?

In Paul Starr’s article, “The Growth of Medical Authority,” he explains that medical professionals gained their current level of authority through a combination of different factors, including scientific and technological advances, urbanization, the standardization of education and licensing requirements for medical professionals, the rise of hospitals, and the connection between medical approval for treatments and procedures and insurance payments for those interventions. In the nineteenth century, many people relied on their families and their communities in times of ill health, with medical professionals competing with each other to keep the patients that they did have. As a result, their authority was compromised and they were unable to unite with other medical professionals. As the above factors came into play, however, medical professionals gained more authority, both as individuals and as a united profession. As Starr states, “laymen have become more dependent on professionals, professionals have become more dependent on each other” for “referrals and access to facilities” (558, 561).

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