Medicalization–is it a bad thing?

What’s the problem with medicalization? If people with anxiety are better able to live their lives with medication that they’re given once they’re diagnosed with SAD, then what’s so bad about it? Shouldn’t the greater fear be that there are people who aren’t getting treatment because their symptoms aren’t recognized?

At the very least, how can doctors and healthcare providers draw the line between medicalization and overdiagnosis or even misdiagnosis?

Fighting Overtreatment

http://www.nytimes.com/2015/10/18/business/a-small-indiana-town-scarred-by-a-trusted-doctor.html?ref=health&_r=0

Overtreatment in the United States has been an issue pushed to the forefront of health care debate in recent years. Overtreatment is defined as providing unnecessary health care, whether it be invasive procedures or prescribing medicine, to a patient by a doctor who more often than not is incentivized by money. A New York Times article written by Julie Creswell examines the issue of overtreatment in a small Indiana town.

Continue reading “Fighting Overtreatment”

Could the concept of “Overkill” go as far as performing an open heart surgery just for the profit?

I read a news article recently about a woman in a small town in Indiana who found out about her doctor being sued for performing unnecessary operations. This woman had been going to this cardiologist for more than 30 years. When she was 27 years old, she first came to this doctor regarding an abnormality in her heartbeat, and the doctor told her that an open heart surgery would be necessary to fix this problem. She did not question the procedure at the moment. However, a number of patients of this town have recently filed lawsuits against this doctor and two other physicians that work with him. In response to these lawsuits, it was discovered that these doctors received nearly $5 million in Medicare reimbursements, making them the most reimbursed cardiologists in Indiana.

This article reminded me about what we have been talking about in class about the “Overkill” idea and how the payment method in the US promotes that doctors prescribe more medications, more treatments, and more surgeries. I find this incident very worrying because of the lack of professionalism of such doctors in treating their patients. While some people might argue that patients should be aware of this trend and be knowledgeable about their health, so they can avoid this over diagnosis, I personally believe that this is a “Band-Aid” solution to the problem. While it is true that patients should be involved in their medical appointments and their treatments, it should not be the patient’s concern to investigate whether or not the treatment they are receiving is actually necessary, or just a way for doctors to earn more money. Patients are not supposed to have the academic and clinical experience that a doctor has; after all, this is why they come to the doctor to begin with. Rather, the system should be settled in a way that doctors are not rewarded for doing this.

http://www.nytimes.com/2015/10/18/business/a-small-indiana-town-scarred-by-a-trusted-doctor.html?ref=health&_r=0

Process Reflection 1

One thing that I found surprising is how our healthcare system compares to other countries’. The U.S. spends the most money on healthcare than any other country but our life expectancy and infant mortality rate is worst than every other well developed nation. I use to think that the U.S. had one of the best medical research centers and that our healthcare was one of the best in the world. One of the reasons I used to think that was because the United States is one of the most powerful nations in the world so consequently I thought that the healthcare system would be the best. Someone would think that with all the money the U.S. spends on healthcare, it would be the best in the world. Continue reading “Process Reflection 1”

ADHD and the Elderly

Symptoms of forgetfulness, misplacing items, and trouble following and remembering conversations may not just be signs of old age; grandma or grandpa may have ADHD.

In the New York Times article “Is it Old Age, or A.D.H.D.?” by Judith Berck, she talks about the emergence of ADHD in the elderly population. She posits that this is a disease that is now being understood in the elderly population, and is not just for children and adults. In fact, this is a disease that lasts a lifetime. Thus, it is imperative to get the diagnosis correct: are the above symptoms a disease or just a consequence of aging?

This raises questions of both over diagnosis and under diagnosis of ADHD as a disease. The over diagnosis as it relates to the older population because it puts pressure on people to get tested for ADHD. It’s also emotional as loved ones will want to make sure that their loved one is suffering from an actual disease that can be managed with medication.

Under treatment also exists because many won’t go to the doctor for yet another medical diagnosis. The elderly population already suffer from various diseases. Some may not want to go in and find out what else is wrong with them. Not to mention the costs associated with seeing a psychologist and the price of the test. The diagnosis itself is murky. There is no physical test that confirms or denies the ADHD diagnosis. Rather, it is a clinical diagnosis and is at the discretion of the doctor that is seen.

The implications of labelling ADHD as a lifetime disease is good business for the pharmaceutical companies. Current medication for ADHD may not work with the elderly as it may interact with current medication they are taking. Thus, this incentivizes pharmaceutical companies to research and market new drugs.

I wonder: are we medicalizing the symptoms of old age as ADHD? What is the distinction between being old and having ADHD? If the elderly have gone this long without a diagnosis, does that mean we should try to give them one now? If we do test, how can we make the tests more reliable and accurate? How would we effectively treat it if it does turn out to be ADHD? Dr. Wetzel, quoted in the article, admits that there is a terrible job being done in training professionals on adult ADHD. With this incomprehensive training, can we trust they’ll do a good job on an older population? Especially since there is very little known about how ADHD effects the older population?

Article: http://well.blogs.nytimes.com/2015/09/28/is-it-alzheimers-or-a-d-h-d/?ref=health 

Has healthcare become an industry of business, or do doctors just really, REALLY, care about their patients?

There are always two sides to every situation. On the one side, you have Dr. Atul Gawande and his article “Overkill”, in which he essentially criticizes the current healthcare situation and blames doctors for overdiagnosing and overtesting their patients. On the other side, you have doctors – doctors that are just trying to do their job. So which is it?

Indeed Dr. Atul Gawande makes incredible points, followed by his own experiences in the medical profession and the experiences of fellow colleagues. He has firsthand witnessed the detriment known as overtesting, which he says leads to overdiagnosing. Not only does he highlight the health issues that come with overtesting, but he states the obvious; it’s expensive and is costing us way too much money. “The medical system had done what it so often does: performed tests, unnecessarily, to reveal problems that aren’t quite problems to then be fixed, unnecessarily, at great expense and no little risk.”

But one could argue that doctors are just doing everything in their power to run excess test to ensure the health of their patient. People could even agree that the importance of their health far surpasses any monetary value, hence my question: Has healthcare become an industry of business, or do doctors just really, REALLY, care about their patients?

Are healthcare providers just looking to make money? Have they turned an industry based on providing and caring for people into an industry run by money? Or are these tests necessary in insuring the complete health of patients?

Preventative Care in the Health Care System

In Atul Gwande’s 2015 article “Overkill” he discusses the repercussions of over testing, over diagnosis, and over treatment. However, testing, diagnosis and treatment are taught to doctors in both medical school and residency. So why are they expected to do anything else? Public health in the form of preventative care should be more prominent in the heath care system, but in what way? Should doctors should receive extra training to avoid the need for so much testing or should public health professionals be included in the doctor patient communication?

Over-care and Over-treatment

http://www.newyorker.com/magazine/2009/06/11/overkill-atul-gawande

In his 2015 The New Yorker article Atul Gawande discusses the largely overlooked problems of over-care and over-treatment that are costing the United States billions of dollars. I was shocked to read that there is a huge portion of Medicare patients that have received care that was deemed wasteful, “no value care.” Gawande explains that often times, Medicare patients are receiving expensive tests like MRIs and CT Scans for problems that clearly indicate no need for such tests; problems like headaches and back pain where the patients records and previous diagnoses indicate no need for more than perhaps over the counter pain medication. In 2010, it was stated that upwards of $750 billion was spent on this “no value care.” Could this extreme overspending and over-diagnosis stem from corporate desire to use the new technologies and treatments developed by hospitals and their funded research? Are the patients in any way a part of the problem- could the lack of education and knowledge lead the people of the general public to seek unnecessary care? Does this mean there should be some sort of education the general public receives detailing when they should go in to see a doctor and what tests to expect during these visits?

Overdiagnosis

In Gawande’s article, “Overkill”, he writes about the incredible amount of overdiagnosis and excessive care that occurs in the US each year. How much of this overdiagnosis and excessive treatment is due to a corrupted and disorganized healthcare system, as opposed to how medical students are trained during medical school? Would the issue of overdiagnosis be solved if preventive care and public health was emphasized during med school, rather than solely treatment?