Process reflection 3

What interests me most throughout the course is how actors such as big pharma, insurance companies, medical providers, policy makers and consumer groups influence the medical landscapes today on a macro level. Unlike most of the premed students in the classroom who resonate with the medical professionals more often, as a business major student I think more about the regulatory environment and sustainable growth for the companies (outside the limitation that defining ourselves by our majors, I surely learned a lot from my classmates and adjusted my opinions along the course). Not surprisingly, the mainstream sentiment in the teaching materials is the anger towards almost all the for-profit entities. But since further commercialization is inevitable in our social development, we need to shift from being angry to collaborating with the businesses with new corporate social responsibilities to create a better healthcare system. Furthermore, policymakers have huge power to allocate the interests among different groups thus shifting the whole landscape. For example, the coverage change in Medicare can transform the model of nursing homes, create a new industry such as Hospice, or significantly impact the life of certain population such as people diagnosed with cancer. Those topics are probably outside the scope of this course, but they could be very good extensions and leave questions for further research. Besides, I have only been in this country for about four months, so all the assumed knowledge towards US healthcare system is very new to me! Therefore, this course has been very eye-opening and rewarding.

How much control should a doctor truly have over a dying patient?

In the New York Times article “Fighting to Honor a Father’s Last Wish: To Die at Home”, we are introduced Ms. Stefanides and her dying father, Mr. Andrey, and their battle with the healthcare system. Unfortunately, Ms. Stefanides could not afford out-of-pocket home care, and though her father qualified for both Medicaid and Medicare, “the flow of money seemed to bypass what he actually wanted at the end of life”. In addition to emphasizing that Mr. Andrey couldn’t even be granted his basic wish to die at home, the article further talked about all the abuse that occurs at rehabilitation homes that care for the elderly. Ms. Stefanides recalled her own mother’s month-long abuse and eventual death in the hospice, and refused to subject her father to that kind of tragedy. Unfortunately her options were incredibly slim, and she felt that the doctors were “bullying her to disregard her father’s wishes”, and they basically wanted him sent somewhere else to die.

This incredibly touching and sad article sheds light on the difficult position many are faced with due to a failing healthcare and abusive system. One must wonder if all of this heartache for Ms. Stefanides and her father were worth it, and if his dying wish should’ve been granted in the first place. This brings up the issue of the doctor-patient relationship, and how invested a doctor should truly during a patient’s final years. And so I ask – Where do we draw the line to how much say a doctor has during a patient’s time for his/her death? Should the patient have full ownership over their body and where they will rest during their final time, or does the doctor know what is best?

Where are the primary care doctors?

The declining salary cut for primary care physicians has snowballed into a potential healthcare crisis within the next twenty years. As medical students choose to specialize within a specific field of medicine, there has been a significant decrease of primary care doctors around the United States. In response, the federal government has provided special bonuses for these physicians in an attempt to garner more medical students. The bonuses were directed towards Medicare patients who often use primary care practitioners. In 2012, approximately $664 million was allocated among 170,000 doctors. However, as funds begin to dwindle and the bonus reward program sees its end, some doctors will likely see a small reduction in salary compared to previous years. Many are worried about the potential impact in the cutback, but others are confident the end of the program will not affect a majority of the doctors. It is believed that these primary care doctors will continue to see Medicare patients regardless of the bonuses that were enacted few years ago.

Although these salary cuts may not seem to be an immediate problem, there will certainly be long-term effects for the occupation. For example, research shows that primary care physicians earn much less than their specialist counterparts. The drop in the number of primary care physicians may cause Americans healthcare users to wait months for a simple appointment and pay much more for their medical bills. The discrepancy between primary care doctors and specialists has been known for decades, but the problem has not been tackled. The potential problem will be even worse for towns in rural areas where the number of primary care physicians is already small. The government must approach the situation as soon as possible before the shortage of primary care doctors takes a toll on the American people.

Article: http://www.npr.org/sections/health-shots/2015/11/28/457148697/end-of-medicare-bonuses-will-cut-pay-to-primary-care-doctors

Medicare Encourages Patient Voice in End-of-Life Care

In the New York Times article, “A Quiet End to the ‘Death Panel’ Debate,” Paula Span draws attention to the recent change in Medicare policy that reimburses physicians for holding end-of-life discussions with patients; this policy change thus promotes an important conversation that can ultimately help alleviate issues for the patient, their loved ones, and the nation’s budget. Over the years, medical care and its professionals have evolved to focus on “curing” a patient of their condition often irrespective of the patient’s comfort and quality of life, and this tendency of health care providers to order more tests and procedures rather holding a transparent conversation with the “nearing-the-end” patient has contributed to a less compassionate health care system and increased health care expenditures. Encouraging a discussion of end-of-life options for a patient and not a declarative “death-panel” respects the wishes of patients and their loved ones, improves communication in an egalitarian doctor-patient relationship, and ultimately reduces the need for unnecessary scans, tests, procedures that contribute to elevated health care costs.

Continue reading “Medicare Encourages Patient Voice in End-of-Life Care”

The High Cost of Dementia

Gina Kolata wrote an article about the cost of dementia care and why it is so high compared to other diseases. According to the article, the three diseases that are the leading killers of Americans are heart disease, cancer, and dementia. Heart disease and cancer seems like they would be the most expensive diseases out of the three but dementia is the most expensive. The article states that “the average total cost of care for a person who died of heart disease over those five years was $287,038,” for a heart disease patient it was $175,136, and for a cancer patient it was $173,383. The reason the cost of dementia is so high is because “patients need caregivers  to watch them, help with basic activities like eating, dressing, and bathing, and provide constant supervision to make sure they do not wander off or harm themselves” and these cost are not covered by Medicare. Medical cost also skyrocket when a dementia patient in a nursing home gets a fever or gets ill. The staff would call 911 and the patient would go to the hospital and there the patients may have complications. Going to the hospital and these complications makes medical cost rise. Finally Medicare covers medical services like office visits and acute care but it does not cover the cost of nursing homes or full-time care. Continue reading “The High Cost of Dementia”

Income Inequalities With Old Age

On the very first day of lecture, we learned in class that there is a difference between sociology in medicine and sociology of medicine. The former means that we accept the basic principles of medicine, but the latter means that we are analyzing medicine from outside the medical system and challenging accepted beliefs and ideas claimed in this complex field. In this article titled “Income Inequality Grows With Age and Shapes Later Years,” the writer tells a story of two senior women who both grew up in frugal households but lived very different lives throughout their adult and elderly years. Continue reading “Income Inequalities With Old Age”