Discrimination in the E.R.

In Nicholas Bakalar’s NYTimes article, “Minorities Get Less Pain Treatment in E.R.” he discusses recent study findings from the Centers for Disease Control and Prevention (CDC) regarding treatment in the E.R. for patients of various racial and ethnic backgrounds. This nationwide study was conducted over a four-year period using “a sample of 6,710 visits to 350 emergency rooms by patients 18 and older with acute abdominal pain.” Despite the fact that severe pain frequency was equal across all patients at 59 percent, Black patients and those of other minorities “were 22 percent to 30 percent less likely to receive pain medication” than White patients. In addition, they were “less likely to receive pain medicine if they were over 75 or male, lacked private insurance or were treated at a hospital with numerous minority patients.” The article ends with some remarks from the senior author of the study, Dr. Adil H. Haider of Brigham and Women’s Hospital in Boston. His remarks were as follows: “It may be that different people communicate differently with their providers. If we as providers could improve our ability to better communicate with patients so that we could provide more patient-centered care, we’ll be making several steps toward reducing and hopefully eliminating these disparities.”

Continue reading “Discrimination in the E.R.”

Extent of Medical Technology and what’s to come

In this article, Patrick Hardison, a firefighter, undertook an extensive face transplant. It started when he entered a burning house for a rescue search, but had the roof collapse on him, burning the firefighter’s mask into his face. A donor however was found for him and they were able to give him a full face transplant, as well as 70 other surgeries, for 850,000 to 1 million dollars paid for by NYU. This shows the extent to which medical technology has advanced to the point where almost any type of transplant is possible with the right amount of money.

The extent of medical technology to be able to repair an entire face is absolutely astounding. This article reminds me a bit of Frankenstein, how they were able to piece together dead body parts and bring it alive. In a way, we are moving closer to what we thought was purely science fiction, with the extent to which we complete transplants nowadays. It also raises many questions for where medical science is to go from here and how will it improve even further. It almost seems quite surreal how we are now able to fix any broken limb or organ just with a transplant whereas a few years ago we were lacking all sorts of technology. Could it be possible that we move from a time where we can fix any body part to curing any disease? Whatever path or direction we take for medical science, it will only bring further better outcomes for the whole of society.

 

http://www.cnn.com/2015/11/15/health/face-transplant-firefighter/index.html

How much treatment do ICU physicians really provide?

In Zussman’s article “The patient in the intensive care unit, Zussman discusses how medical providers in the intensive care unit focus solely on physiology alone rather than looking at the external psychological or acute problems the patient may have. It makes sense to a certain extent that this would be the main focus of treatment since the medical crisis at hand usually centers on the physiological the patient has endured. However, what stood out to me after reading this article was the account of the treatment of a patient who tried to commit suicide. This eighteen-year-old patient had overdosed on drugs and was taken to the ICU, where the physicians focused solely on his liver damage. They were not at all concerned about his psychological damage however, or the underlying problems that had caused the liver damage in the first place. In cases like this, the patient’s underlying problem may not be as immediately dangerous as their physiological problem but is the cause of their physiological problem and may be even more dangerous in the long run. Is this underlying problem addressed after they leave the ICU? Do the physicians in the ICU at least acknowledge the underlying problem to the extent that they will refer the patient to a psychologist or another physician that focuses more on treating said underlying problem? Or are the ICU physicians so focused on getting the patient out of the hospital with minimal physiological damage that they simply feel as if this is not their responsibility? How much treatment is really being provided if the underlying problems are not being addressed at all and may cause the patient to end up in the ICU again with a worse medical crisis due to this underlying problem?

Social Viability in Resuscitation

In Timmerman’s “ Social Death As Self-Fulfilling Prophecy”, Timmerman describes the impact of social value on the fervor and vigor in which resuscitating techniques are applied to a patient. Certain positive characteristics contribute to the patients presumed social viability such as age, social importance, and identification with the patient. Negative characteristics include seriously ill or older patients and addicts, who have less effort put into their resuscitation. In terms of seriously ill patients, less effort is put into resuscitation because the medical staff sometimes believes that sudden death is not the worst possible end of life and these patients may be in significantly more pain living. However, Timmerman does not mention the impact physical manifestations of defects would have on an individual’s social viability. Are those with genetic disorders or birth defects who exhibit these disorders/defects also viewed as less socially viable even though they are not seriously ill? For example, would someone with Down syndrome have less of an effort put into resuscitating him or her even though they may be perfectly healthy and happy in life otherwise? Additionally, would someone exhibiting a physical birth defect but otherwise healthy have less vigor put into his or her resuscitation? What is the impact of disorders and defects on resuscitative efforts?

Does the Way a Doctor Phrases a Question Affect the Response from a Patient?

In Groopman’s book How Doctors Think, he harps on an important concept that I though was similar to a main point in the ted talk. In his description of the case for the patient Anne Dodge, Groopman quotes the doctor who solved her case, Dr. Falchuk. Dr. Falchuk explains how even though he received a patient who has seen many other doctors, he started from scratch and let her talk freely. The doctor allowed her to begin from the start of her condition, even though it was something that had been going on for 15 years. Dr. Falchuk asked an open ended question, which influenced his patient to answer more openly, which in turn, helped lead to a correct diagnosis.

Does the way a doctor phrases a question (open ended/ closed ended) affect the response that the doctor gets from the patient? Do open ended questions take up too much of a doctors time? Do open ended questions lead to an over diagnosis of a patient?

Managing Emotions in Medical School

In Managing Emotions in Medical School: Students’ Contacts with the Living and the Dead, Smith and Kleinman analyze the view our culture has on the emotions expressed by medical students and also how important a role those emotions have in the students’ and even the professional’s care. An important point they make that is easy to see first hand with almost any sort of doctor’s visit is that the current view of doctors is that they are desensitized to the illnesses or traumas of their patients. I think that this poses a conundrum in the medical field because this often leads to patients feeling dehumanized and dissatisfied with their care. Continue reading “Managing Emotions in Medical School”

Teen Health Study Shows There’s Not Enough Screening for Depression

http://bringmethenews.com/2015/10/31/teen-health-study-less-than-half-are-being-screened-for-depression

The article “Teen Health Study: Less Than Half Are Being Screened For Depression” reminds us about the importance of screening for depression, and sheds light on the issue of inadequate screening for depression. A recent health study in Minnesota concluded that less than half of teenagers are being adequately screened for depression. The analysis focused on patients aged 12-17, and highlighted that Minnesota health clinics are failing in their job to accurately test for depression. The study found that “only 40 percent of those teens received a mental health screening” (Sommers, par.3). The health department emphasized the importance of mental health screening, “since half of all cases of mental illness begin showing up by age 14” (Sommers, par.6). Even concerned parents emphasized there disappoint in Minnesota health clinics, with one parent stating the how effective adequate mental health screening can be. The Minnesota Department of Health is working on a solution to this problem, one of them being that they developed a “standard set of criteria to measure the quality of health care providers across the state” (Sommers, par.12). They are hopeful that they can fix this problem, in order to more accurately inform patients about their mental health status.

I think this article does a great job in emphasizing the importance of mental health status. It is very encouraging that the state of Minnesota recognizes their inadequate mental health screening, and work on a solution to fix this problem. Depression is a major mental health issue in the United States, and many patients often go untreated or undiagnosed. Accurately diagnosing someone with depression can cause a lot of relief for the patient, and as we discussed in class, can help with de-stigmatization. Diagnosing someone with depression, or any other mental illness, can help decrease the blame that person gets for being the way they are. Having a medical label justifies that they cannot perform in the level that they are expected too, so the blame is no longer on them, but on their condition. The article is definitely encouraging, and I truly hope they find the solution they need in order to fix this problem, as it could help a lot of teenagers overcome the obstacles that come with mental diseases.

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?

New WHO HIV Treatment and Prevention Guidelines

In an article entitled “Millions More Need H.I.V. Treatment, W.H.O. Says,” NY Times writer Donald G. McNeil Jr. explains the implications of the new WHO HIV Treatment and Prevention Guidelines. Previously, those living with HIV were put on antiretroviral therapy (ART) once their CD4 cell count, which is essentially used as a measure of the strength of one’s immune system, declined to a certain level. Now, the new guidelines recommend ART to everyone who is HIV positive, regardless of their CD4 cell count. In addition, the guidelines recommend that more people use a daily oral pre-exposure prophylaxis (PrEP) as a preventative measure. PrEP reduces the chance of acquiring HIV even in the case of exposure to the virus. Therefore, PrEP is highly recommended to those who are at a higher risk of being exposed to HIV, such as gay men, sex workers, and people who have HIV positive partners. The new guidelines recommend this preventative measure to more people than did the previous guidelines, including African women and children. Under these new guidelines, nine million more people should be treated with ART and “untold millions” more should use PrEP.

These new guidelines are backed up by a substantial amount of evidence that they will prove to be effective. According to the WHO, there have been numerous clinical trials, observational studies, and other research released since 2013 that back up both the earlier initiation of ART and the success of PrEP as prevention. In addition, HIV/AIDS experts, such as Dr. Mark Dybul (executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria) and Dr. Deborah L. Birx (the United States global AIDS coordinator and head of the President’s Emergency Plan for AIDS Relief), support the new guidelines. The Centers for Disease Control and Prevention (CDC) is also a strong source of support for the treatment and prevention combination, and some North American cities have implemented this combination before, to great success.

McNeil raises salient questions throughout his article: how much will it cost to implement these new guidelines? How will those costs be paid? He points out that, not only are the drugs themselves expensive, but a substantial amount of money must go into the health care systems needed to administer those drugs. According to the article, there have not yet been any widely accepted estimates of the cost of these new guidelines; however, some say that current HIV treatment costs would at least triple, with prevention likely costing exceedingly more.

I agree with McNeil. These new guidelines sound wonderful. This combination of ART for treatment and PrEP for prevention has been proven to work, so I would not classify this as excessive treatment or prevention. This is especially true for the treatment: according to the WHO, initiating ART earlier results in better clinical outcomes for HIV positive patients than waiting for their CD4 cell counts to get low enough to start treatment. Recommending that African women and girls use PrEP as a preventative measure is also extremely important, as they are a major at-risk population for HIV infection. That said, before these new guidelines are fully implemented, the issue of cost must be thoroughly examined, and, according to the article, that issue is being largely ignored presently. In countries without universal healthcare coverage, people living with HIV often cannot afford their medications without sufficient health insurance, and that may apply to those at risk for contracting HIV, especially if their insurance provider deems them “not enough at risk” and denies coverage. Even countries with universal healthcare must grapple with the higher bill, and we all must consider where payment will come from in the case of low- and middle-income countries that cannot afford the medications on their own. With these new guidelines, everyone involved with healthcare and the HIV/AIDS epidemic, including governments, organizations like the Global Fund, insurance providers, patients, etcetera, all must closely examine the major problem of cost in this situation.

http://www.nytimes.com/2015/10/01/health/millions-more-need-hiv-treatment-who-says.html

http://www.who.int/hiv/pub/guidelines/earlyrelease-arv/en/

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?