Prolonging Life vs. Improving Life for ICU Patients

In Robert Zussman’s excerpt, “The Patient in the Intensive Care Unit,” the issue of patient dehumanization in the U.S health care system is especially prevalent in hospital intensive care units (ICU). Zussman argues that the dehumanization of the patient results from the disease endured but also at the hands of the practice of health care professionals. Many of the people that are admitted into a hospital’s ICU with unstable vitals, but ICU doctors and nurses often work tirelessly to stabilize a patient’s heart rate, blood pressure, respirations at the expense of the patient’s personhood. Zussman made the shocking comparison of ICU medicine to veterinary medicine suggesting that there is no longer any doctor-patient communication and that the “treatment” does not require thinking of the patient at the contextual level; diseases and conditions reduce people to intubated and unresponsive vessels hooked up to organ-pumping machines. Zussman also argues that because of the lethal nature of the patient cases that they treat, ICU doctors are often less thorough in their patient’s physical examination and are less empathetic health care providers than doctors in other hospital departments. This distinct difference in treatment is demonstrated in ICU doctors coining the term “GOMER” to describe undesirable ER patients and the reduced use of talking and touch when diagnosing an unresponsive patient.

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How have hospitals changed throughout history and what implications do these changes have on care?

In Charles Rosenberg’s  piece, “The Rise of the Modern Hospital,” he discusses the  transformation of the hospital throughout history and the implications that have resulted from this change. In the early 1800s, care was typically seen in the home. Hospitals were more like wards that provided “room and board” type services for the poor who did not have a home or family caretakers to give them care. As hospitals transformed in the 1900s, care in hospitals was no longer an outlet for the poor. This has had extreme implications today since we now see a significant problem with providing access to healthcare to the poor. In the 1920s, hospitals determined admission based on social position, diagnosis, and therapeutic capacity. Hospitals became an institution and a marketplace where providing care meant maximizing on income from those who could afford care. This meant that more people were now unable to afford care at hospitals and they were “unwilling to enter charity wards in voluntary hospitals” (Rosenberg). This was a “failure to provide optimum care at a reasonable cost”(Rosenberg).  This also meant that chronic care was ignored and acute care was pursued. If healthcare has progressed in research and in technology why is quality of care still so poor? Why are we ignoring the poor and why are we so fixated on financial reimbursements? How do we find ways to fix this problem when it is so deeply rooted in our history?

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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The Modern Hospital

In “The Rise of the Modern Hospital”, Charles Rosenberg describes the growth of the modern hospital. Rosenberg states that beginning around 1910, the hospital became a national institution in which it was respected by many Americans. Previous to the 20th century, hospitals only served those who were homeless/did not have the resources to care for themselves. Rosenberg writes that the concept of a hospital flourished when new technology, such as  the x-ray, were created.

To what extent does the creation of new technology still impact our view of the hospital today? Does society gain more trust/respect for hospitals and doctors when cutting edge technology is released? Is there a limit to the high-tech equipment in regards to gaining patient trust?