I would like to address how undervalued preventative health care is and how many strategies pertaining to basic patient education could save lives in the short and long term. If we consider the top 10 leading causes of death in the United States, heart disease has remained at the top of the list for a number of years. Factors contributing to this are unhealthy diet, lack of exercise, lack of patient education, and lack of accessibility to health foods. Of course, there are genetic susceptibilities within certain patients that make them more at risk for the development of heart disease, but this is no excuse to undermine the importance of lifestyle changes. Along with this, many chronic disease states exist that are brought forth or exacerbated by preventable diseases, such as obesity. In my opinion, the US does not effectively provide the necessary information for its citizens to live happy and healthy lives. I must reflect on my upbringing to illustrate this point more clearly. I grew up in a family with 8 children and ate a typical, westernized diet for most of my life. I had no idea what was and was not healthy for me, what portion sizes to eat during meals, and never really challenged the idea of eating pizza and fast food on most nights. This was the case for each of my siblings as well. I entered middle school and had a culinary arts class. This first thing we made was rice crispy treats, using as much butter and sugar as we wanted, then made apple pie under the same circumstances. This trend continued until the semester was over. I am fond of these memories but cannot help but reflect on how nonexistent basic nutritional education was. I believe it to be partly due to this that many of my family members suffer from chronic illnesses such as diabetes, hypertension, and obesity, among many other diseases that one can take preventative measures for. As much as I love drug therapy, I do not want to see patients on medications that may not be necessary with the right precautions taken. In recent years, it seems that the US is making some advancements in promoting patient health education, for example, under Michelle Obama's "let's move!" initiative, but I believe that more can be done.
I wanted to tackle the debate of whether healthcare is a right or privilege. I had heard of the debate but never really investigated the arguments on both sides; I just always thought that anyone that believed it was a privilege was selfish. After our discussion and a little more thought, I am still very much of the opinion that healthcare is a right. The main argument for those that believe it is a privilege is that making it a right imposes a duty on others such as doctors and healthcare systems as well as a monetary duty on the public. To that, I say of course it is a doctor’s and health system’s duty to provide healthcare- that’s literally their job. As for a monetary duty on the public, while it may be harder to accept, it is in the best interest of the individual to help promote a health society. The evidence is clear, a sick society is an unproductive society. Just like people pay taxes for smooth roads and clean water, which everyone agrees is a right because it directly benefits them, money that goes towards universal healthcare is just indirectly benefiting them. Seeing healthcare as a right is such a critical step in the path to proper healthcare reform. Continuing to view it as a privilege, as the United States does now, will continue to result in a system that is clearly broken.
It is evident that there are many issues in our healthcare system that I'm afraid we won't see a plausible resolution to. I am a strong advocate for early prevention of disease. It's so important to endorse things such as exercise, diet, etc., however there may be barriers for those that unfortunately don't have access to healthy food options, don't live in a safe area to exercise outside, or have to focus their funds elsewhere rather than on a gym membership. I recall in pharmacy 503 we watched a video about how general insurance doesn't typically include dental insurance, however dental health is vital to overall health and can contribute to various disease states. Having more access to preventative care rather than focusing on treating a problem after it exists could make a huge impact on our healthcare system because it would drastically reduce healthcare costs and of course result in less hospital visits and overall healthier people. If we could shift the mindset of Americans to focus on their health and wellness early on, we could potentially make a true difference in our healthcare system.
The COVID-19 pandemic exposed many of the flaws of our current healthcare system. From overcrowding of hospitals to creating a strong public divide, the pandemic has brought forth many issues and the need for change. Throughout the pandemic and the emergence of different variants, various waves have caused overcrowding of hospitals. Images were shown of people waiting in hospital beds in hallways just to get a room. Not only did this have a negative impact on those getting treated for COVID-19, but hospitals still had to treat individuals experiencing any other health condition. Many grew fear of going to the hospital as it would be a place to potentially contract the virus and would avoid going. Even doctors’ offices limited the amount of in-person appointments they had, really creating problems for those with chronic disease who require frequent monitoring. In response to the demanding hours and increasingly difficult work conditions, many health care workers begin to feel the effects of burnout. As many of us worked in pharmacies throughout the pandemic, we are able to relate to the increased demands with no/little increase in incentives. In a time where many other fields were transitioning into remote work, a majority of health care workers were forced to increase their in-person work hours. Early on the pandemic, there was shortages of PPE, adding to the stress and increasing the worry of contracting the virus for healthcare workers. Health care workers also would often isolate from their families and friends in an effort to minimize the spread. This lack of support and connection with loved ones only furthered the problem. Many Americans rely on receiving healthcare benefits through their employer. Due to the shutdown of many businesses or the inability to move to remote work, many individuals lost their jobs. While options are available for the unemployed, it can often times be difficult to afford these with no source of income and take time to be approved for different plans. This adds to the fear of getting the virus and negatively impacts quality of life. In a time that potentially could have been uniting politically, the pandemic created further divide in our country regarding science and healthcare. Even during a pandemic, healthcare is heavily politically debated, rather than viewed as a human right. Misinformation regarding treatments and the virus itself were able to spread very quickly. Such a divide was created, that even once a vaccine was developed many remained strongly against its use. A distrust of many Americans in the scientific community will only complicate our healthcare system divide even more. Despite the many negatives that have been brought to light during the pandemic, positive changes have been implemented. For example, telehealth has become extremely popular throughout the pandemic. Telehealth can increases the efficiency and accessibility of healthcare and hopefully will continue past the pandemic. The pandemic has also allowed for expanded roles for many healthcare providers. For example, pharmacist have been able to provide more vaccinations as well as provide more patient counseling through virtual settings.
Finding a healthcare professional that listens to your needs as a patient can be challenging. This is a common issue within the scope of gender & women's health, which demonstrates unnerving trends of this patient population feeling dismissed by their providers. A patient case presented by the Katz Institute for Women's Health details a 50 y.o female presenting with a chief complaint of chest pressure and difficulty maintaining exercise endurance. The patient's gynecologist and internist assured the patient to not worry, as it was a combination of her perimenopausal symptoms and heavy workload as an attorney. However, a second opinion with a cardiologist revealed early coronary artery disease.
Personal anecdote: I've had several, notable experiences much like the story above. Recently, I was at my IPPE and started to get a severe (8/10 pain) headache on the left side of my head. My left eye turned bright red, I saw some strange rainbow streaks in my vision, and then the vision in my left eye went black for an hour. Not only was I nauseous, but I was terrified I was about to experience permanent blindness. I was worried it was glaucoma, since I had been so stressed & drinking plenty of coffee during the day. Eventually my vision recovered, I finished up my IPPE, and I went to the ED. Upon presentation and describing my symptoms, no matter how hard I pushed, I got a diagnosis of pinkeye. It felt juvenile and very dismissive; my vision went out for an hour and the best diagnosis is pinkeye? I didn't settle on this diagnosis, and visited an outpatient ophthalmologist for further evaluation; eventually, it turned out to be ocular migraines.
But why do these experiences and health disparities occur for women? Dr. Powell indicates that "health care providers may have implicit biases that affect the way women are heard, understood and treated." Furthermore, Dr. Gupta indicates that women may have a harder time speaking up because they have been taught to "rationalize warning signs of physical or mental health problems" since a young age. A study conducted by Lichtman et al. (2015) indicated that women hesitated to seek help for a suspected heart attack out of fear of being labeled as a hypochondriac.
However, changing implicit biases in healthcare providers will require extensive work. Certain medical schools are already beginning to address these issues in their curriculum, but perhaps this is not enough. For patients, being direct with their healthcare providers, and seeking multiple opinions can begin to bridge the gaps in these disparities. Public figures such as Serena Williams have helped elucidate the difficulties that women, especially women of color, have faced within the healthcare system. During an interview, Williams revealed that her nurse had incorrectly assumed she was confused as a result of her opioid medications, when she was actually experiencing a VTE.
My dad brought up an interesting point when we talked a few weeks ago. He asked "When is someone in authority going to tell us: 'From here on out, we're treating COVID like the Flu. Stop masking, stop socially distancing, go back to work, get your vaccine, and move on with your lives.'?" The only answer I could come up with was "When everyone, or enough people, get vaccinated." I think the underlying problem is: people in this country absolutely abhor being told what to do. A while ago I heard a very applicable analogy to our current situation: when seat-belt laws were being proposed. None of us millennials, or gen z'ers, have known a life without seat-belt laws, so we may not really understand the comparison. But until 1968, seat-belts were optional. In fact, seat-belts weren't even invented until 1959. It was 9 years before they were a required inclusion in vehicles. From talking to my dad, I've learned that a substantial number of people were extremely opposed to their inclusion being required by law, and in fact, he doesn't remember my grandparents once using them. In my opinion, Americans are acting in the exact same fashion now about vaccine mandates as they did in the 60s when seat-belt laws were being proposed.
Now I understand that there are differences between these instances. For example: seat-belts aren't injected into your body. The COVID-19 vaccine, however, only bothers most patients for about a day, and is completely free. Car manufacturers certainly had to increase prices to help pay for the seat-belts they were forced to include in their vehicles. Not to mention the fact that the seat-belt is always there to annoy you.
Personally, I believe that a federal law requiring the vaccine, or proof of allergy to an ingredient, is necessary to achieve the utopia of viewing COVID-19 in the same ballpark as the flu. Perhaps breaking this law could impose an income-based fine, so that people who absolutely insist on distrusting proven science can still do so.
I recently dislocated my shoulder over the summer while vacationing in Miami. Most insurances unfortunately only cover a certain geographical area. And mine, the Health Alliance Plan, which covers exclusively the Henry Ford Hospitals in Detroit, did not. However, every insurance has to cover any urgent care or emergency care all over the world. By law the hospitals are supposed to provide you a service if you come in injured but the problem is if the hospital is not part of your insurance plan, the payment systems aren't linked and those exorbitant hospital bills add to the stress of the patient. Post surgery, my parents and I had to take calls from insurance to see if the relocation procedure was justified expense because I had spent too much time getting to hospital after the accident to qualify as emergency use and they suspected there was possibility I could have flown back to Michigan to get the procedure done. Then we told them to call the hospital to negotiate with provider because they informed us the price for the relocation surgery was higher than it would have been in with Henry Ford. I felt like some of the costs could have been on them if they were a higher class facility, some of them could have been on me for waiting too long and causing nerve damage or being a heavier set individual, I couldn't tell you because the patients aren't a part of these price negotiations to give our input. What happens instead is that it falls on us to create reconciliation and just facilitate negotiations when we really don't want to be bothered by all this while recovering. Even though my arm hadn't fully healed yet the insurance didn't give me any more days after 4 months from surgery for rehabilitation. There is a lot of issues doing it this way because a) I already needed 2 months for my shoulder to heal post operation and b) I was living in Ann Arbor where there weren't many places that accepted HAP, so I spent 2 weeks looking until I found Med Sports facility in Domino Farms. I was left asking my doctor for more rehab days, but their graces could only get me one more. That's when I learned insurance plans really try to limit your benefits. Among the insurances, Blue Cross Blue Shield is generally considered the best because they are largest but often expensive so patients end up paying higher premiums. Alternative ones like HMOs pre-negotiate with doctors and only offer to pay for those in their plan but are used regionally. I use an HMO, HAP, and another issue I've seen is that patients cant see a specialist directly, you have to get referrals from a primary care first. You can go to a larger insurance to avoid this but you will have to pay more. Medicare/Medicaid are different because government set limits on how much each procedure or drug costs and providers can decide whether or not they want to be a part of that. I think a lot of times they don't use them because they would be accepting a huge new customer base for subpar reimbursements; but a new clinic or failing clinic could benefit from them because they can handle that capacity for the elderly and indigent. Finally because we recently did a project on herbal and alternative medicines, for certain narrow specialists or experimental drugs, you have to pay out of pocket unless your insurance makes an exception. Pharmacists are uniquely positioned to work in both the health provider settings and insurance settings, so we can provide solutions to make insurances more patient friendly.
The pandemic has brought health to the forefront of many people’s daily lives. While it has demonstrated some of the most positive aspects of our healthcare system, such as the resilience of our healthcare workers and the dedication of the scientists responsible for developing the vaccines, it also has exposed some of the weaknesses of our system. One particular weakness is our current treatment of mental health. The inadequacies of mental health treatment in the US predate the pandemic, but the spread of the virus brought those inadequacies into sharp focus. During the pandemic, feelings of stress, isolation, anxiety, and depression rose dramatically among the population. The number of individuals reporting symptoms of anxiety or a depressive order increased substantially from 1 in 10 adults to 4 in 10 adults. Additionally, approximately a third of individuals reported indicators of negative effects on their mental well-being, such as difficulties sleeping or eating, and approximately 10% reported increases in alcohol consumption or substance abuse. With a decrease in peoples’ mental well-being came an increased demand for mental health services, and that demand continues to be poorly met.
Even before the pandemic, the resources available to those struggling with mental health issues was limited. While insurance companies are usually more than happy to pay for a Prozac prescription every month, they have been much less keen on offering comprehensive therapy, even though outcomes are known to be significantly better when pharmacotherapy is accompanied by talk-based therapy. Patients seeking help are limited by their choice of therapists that are considered in-network, the frequency of visits that are covered, and the type of therapy offered. On top of this, they are also dealing with the cost of therapy and a demand that exceeds supply, a situation which has been amplified dramatically by the pandemic. Patients that should really be seen weekly for individual therapy are often being relegated to group therapy or to individual therapy on a bi-weekly or once monthly basis, and for many the wait for their first appointment after making the choice to seek help can take a month or more. Effective therapy requires trust and comfort between the patient and therapist, and finding the right “fit” is an integral part of treatment. With extended wait times for appointments and lack of consistency of treatment, it can be many months before those seeking help can even start to receive it. Couple that with the fact that it can take a month before patients even known if their antidepressants are working and may have to cycle through multiple antidepressants to find one that does actually work, and it is clear that the needs of this patient population are in no way being adequately met in a timely manner. While we may one day be free of considering sars-cov-2 as a significant risk to our physical health, the impact that it has had on our mental health may carry long into the future, and as of now there’s no vaccine for that.
I want to tackle a more controversial topic as it is very relevant to our current situation. Let's talk about COVID vaccine mandates! First, I want to clear up a few things before getting into the thick of it. Being in the field of pharmacy we all have a better understanding of the kind of research and regulations that went into making these vaccines. We are also professionally obligated to promote the use of the vaccine and encourage everyone to get it. We know that they are safe and effective and currently our only defense against the SARS-CoV-2 virus. Another thing we must acknowledge is that we give up some rights choosing to enter the field of healthcare, being required to be up to date on all vaccines (including the COVID vaccine) is one such example. I want to bring up the discussion of the COVID vaccine being mandated, other than for healthcare worker, in any area it may be brought up (schools, private business, public areas, international travel, etc.) My opinion: I understand and support the mandate for healthcare workers, it makes sense that considering the patient populations we may deal with that we would be required to be vaccinated just like we already are. I would even say that it is reasonable to mandate it for public schools, teachers in particular, however mandating it for children is where I think it gets muddy, mostly due to the process of how it was approved for <18. Before we can vaccinate children I think we need just a little more time, owing to long-term data, especially given the downward trajectory of the virus as of late and the fact that children are very unlikely to suffer much from the virus. As for the private sector I am against a government mandate. I think this brings up a fundamental philosophical question, which is more important? freedom or safety? Yes the vaccine helps protect everyone and decrease the chance of those at risk of death from contracting it. However, there is a line that must be drawn when allowing the government to force people to put something into their body. For me the matter is more of how much control will we let the government have. The third point I want to touch on with this is vaccine requirements for international travel. This one I'm honestly not to sure on. I think each country has their own decisions to make on this but if you have proof that you aren't infected via a negative test than the necessity of the vaccine becomes more of a debate than I would care to go into.
In summary, yes the vaccine is safe and effective (as far as we know for short-term). It is reasonable to require healthcare workers to be vaccinated and even teachers and students to an extent. As for the private sector I am in general more the view of the government being hands off. At the end of the day we have to acknowledge that while this is a deadly disease there are fairly specific populations that are at risk, and in general the average healthy person will not be too harmed by the virus. Does this level of lethality justify government mandates for every person to get the vaccine? It's hard to say. But in America where the fundamental answer to the philosophical question is freedom>safety I think that question is answered.
One thing really stood out to me on Monday's lecture that ... why do we spend so so much money on military instead of other areas like housing, education, or research (i.e., research)!?! Please don't get me wrong here -- I have a tremendous respect for all my military friends and their sacrifices for this country; however, there are many different areas that we, as a country, still need to work on. We are spending about 16.2% of the mandatory budget on defense/security, whereas we are only spending about 3% of that "juicy" budget on education. Nelson Mandela once said, "Education is the most powerful weapon which you can use to change the world." It does not seem like the case in the US, whatsoever. Education oftentimes links with science or health research, where most extraordinary discoveries had taken place from. And yet the government decides to only spend about 1% of the whole budget for research/science. I genuinely believe research in healthcare is very important because it is one of a few ways to fight against chronic illnesses and/or rare diseases. One may argue that there are many foundations out there that can help fund the research; however, those are so scarce for such high demand like research. And just forget about asking the NIH for funding because it is so competitive. Only if the government can split just that 0.2% from homeland security funding for research, then I strongly believe that this funding can help someone's research come to the finish line. We never know because someday the research can become helpful in fighting a rare disease like COVID.
Medical procedures in the United States tend to be extremely expensive. It is often difficult for an American family to pay these expenses alone. Therefore, insurance companies offer healthcare to help cover these expenses. However, often times the prices to purchase health insurances are also expensive and require a lot of copay and deductibles that must be made, prior to the insurance covering the medical procedure. This has also made it very difficult for the average American family to opt into purchasing a healthcare plan. The result? No healthcare and limited money to pay for their expensive medical procedures.
Unfortunately, healthcare in the United States has been controversial. Nowadays, the country is very divided, and the issue regarding healthcare is not different. This topic is very heated when it comes to both political parties in the United States – the Republican and Democrat parties. While the majority of one party are big proponents of Medicare for all and universal healthcare, the other party is completely against it due to the high price it comes with. One of the arguments from the left is that healthcare is a human right, and every American should have access to good, quality healthcare. In contrast, the right believes that socialized healthcare comes with a huge price-tag and don’t want to eliminate private insurances, through free universal healthcare.
While both parties have valid reasons, I believe there is a middle ground that can be reached as many Americans are in dire need of some sort of healthcare reform. Healthcare is a human right; everyone should have access to free healthcare, and I think this can be achievable. As a country, much of the American taxpayer’s money is used foolishly by congress, in my opinion. I believe that cutting down on this wastefulness of our taxes would be able to afford basic healthcare for all Americans. We do have the money to afford it, probably without raising taxes; we just need to allocate the taxpayer’s money more properly.
In regard to eliminating private insurances through Medicare for all, I believe that this can be overcome. I think one of the other issues Republicans are hesitant to vote for a platform such as universal healthcare, is that they want Americans to be able to buy their own insurance as they are against the so-called, poor quality government programs tend to offer. I don’t think having socialized health care and private insurance companies are mutually exclusive. There can be free basic universal healthcare for everyone; and if the “wait times” and “poor quality” is true, there can also be an option for Americans to be able to purchase healthcare by their own private insurances.
Overall, I believe healthcare is a must have for everyone and it should be affordable. We live in a currently divided country and it is extremely difficult- almost near impossible- to have one or the other. By allocating taxes and keeping private insurance companies, universal healthcare can happen in the United States.
Something that concerns me regarding current drug discovery methods is the number of medications that have been pulled from the US market with time. One example of this (Happy MedChem studying) is troglitazone, which was removed from the market after the discovery of a hepatotoxic quinone metabolite. Routine post-marketing surveillance of medications has resulted in many cases similar to this. It seems counterproductive to me that companies spend a decade developing a drug, utilizing their time and resources only to find out that their drug has unintended consequences and needs to be withdrawn. And then the cycle repeats!
It does worry me as a future pharmacist to think that any medication I will dispense has the potential to cause harm. I think back to the tragic and often life-long effects that thalidomide and diethylstilbestrol (DES) had on children and their families. Despite the medical community's best efforts to help people, there is always risk involved with treatment. On a brighter note, I’m hopeful that modern technological advances in healthcare can help to reduce the risk of human error in ways not previously achievable.
I would like to think that in America, everyone cares about the health of other people. Whether it's physical, mental, or emotional, I prefer to look at the good of people and the good of things. Life is too short to focus on the negativity, but I sometimes find myself struggling to see the good in America's healthcare. I have been blessed with having top healthcare my entire life from my father's job, so I have never had to experience some horrors millions of Americans can experience daily. Coming to UMich, however, opened my eyes quickly about the status of our country's healthcare. The challenges so many of us may face is indescribable and leaves my heart emptier every time I learn more.
At a glance, one might assume we have excellent indicators in our country because of how much of our country's GDP we spend on healthcare. Not to say that our healthcare is the worst globally, but it surely isn't where it should be. It also isn't where it can stay. The USA is a constant outlier in comparison to other "fully" developed countries: whether it is spending around double per person compared to other nations, having significantly higher maternal mortality ratios, or simply comparing average life expectancy, America continues to disappoint. It would be one thing if the amount of money we spent produced results; however, we are spending at an unsustainable rate, with little results to show for it. Yet, it would be naïve of me to say that healthcare (access, guidelines etc.) is the only contributor, when many other systemic issues hurt our country as a whole. But it plays a part and needs to be addressed.
In America, we frequently try to find pride in ourselves and our country. But I constantly ask myself, how much is there currently to be proud of with our healthcare? Does our current healthcare show ourselves that we honestly CARE about those in our society? These questions often leave me with doubt. But then I try focus on the good of the situation... that for around a century, expanding healthcare and improving it has been a focus of many leaders in our country. Although minimal ideas have stuck, I am still hopeful that enough people care and wish to better our country. I choose to believe that small strides will continue to be made as wins for EVERYONE in America throughout my lifetime.
The illegal practice of patient dumping occurs when hospitals discharge patients to bus stops, shelters, or other hospitals prematurely. Research indicates that low-income patients face unequal treatment in emergency care and patients who are poor, uninsured, or covered by Medicaid are more likely to experience patient dumping. Additionally, victims of patient dumping tend to be homeless, undocumented immigrants, and have mental health issues.
Patient dumping isn’t new! President Truman attempted to address it with the Hill Burton Act of 1946, but it was vague and largely unenforced. President Regan signed The Emergency Medical Treatment and Active Labor Act (EMTALA) in 1986 to prevent this practice in Medicare participating hospitals. EMTALA states that hospitals can be penalized for engaging in dumping. Fines depend on the size of the hospital and ranges from $50,000-$100,000 per violation. In certain cases, patients can sue for damages and hospitals who believe they received an illegal patient transfer can report this to the Center for Medicaid Services as an EMTALA violation.
One particularly disturbing example of patient dumping occurred in January 2018 when Rebecca Hall was removed from the University of Maryland (UMD) Medical Center Midtown on a cold night. Four male guards escorted her to a bus stop wearing only a hospital gown and socks. Rebecca fits the profile of a likely victim of patient dumping as she struggles with mental health, is a minority, and is homeless. UMD Medical Center CEO agreed that it was wrong to discharge Rebecca in that manner but defended the care provided by emergency room staff.
Rebecca’s mother feels that many people failed her including case managers, emergency responders, and hospitals and I agree. I feel that this issue could be addressed by applying SDoH. Rebecca seems to be impacted by economic stability, education, community and social context, and health care system. I appreciate Michigan Medicines stance on SDoH and feel that Rebecca could benefit from the services MM Social Workers and physicians provide such as housing assistance and effective mental health treatment.
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ReplyDeleteI would like to address how undervalued preventative health care is and how many strategies pertaining to basic patient education could save lives in the short and long term. If we consider the top 10 leading causes of death in the United States, heart disease has remained at the top of the list for a number of years. Factors contributing to this are unhealthy diet, lack of exercise, lack of patient education, and lack of accessibility to health foods. Of course, there are genetic susceptibilities within certain patients that make them more at risk for the development of heart disease, but this is no excuse to undermine the importance of lifestyle changes. Along with this, many chronic disease states exist that are brought forth or exacerbated by preventable diseases, such as obesity. In my opinion, the US does not effectively provide the necessary information for its citizens to live happy and healthy lives.
ReplyDeleteI must reflect on my upbringing to illustrate this point more clearly. I grew up in a family with 8 children and ate a typical, westernized diet for most of my life. I had no idea what was and was not healthy for me, what portion sizes to eat during meals, and never really challenged the idea of eating pizza and fast food on most nights. This was the case for each of my siblings as well. I entered middle school and had a culinary arts class. This first thing we made was rice crispy treats, using as much butter and sugar as we wanted, then made apple pie under the same circumstances. This trend continued until the semester was over. I am fond of these memories but cannot help but reflect on how nonexistent basic nutritional education was.
I believe it to be partly due to this that many of my family members suffer from chronic illnesses such as diabetes, hypertension, and obesity, among many other diseases that one can take preventative measures for. As much as I love drug therapy, I do not want to see patients on medications that may not be necessary with the right precautions taken. In recent years, it seems that the US is making some advancements in promoting patient health education, for example, under Michelle Obama's "let's move!" initiative, but I believe that more can be done.
I wanted to tackle the debate of whether healthcare is a right or privilege. I had heard of the debate but never really investigated the arguments on both sides; I just always thought that anyone that believed it was a privilege was selfish. After our discussion and a little more thought, I am still very much of the opinion that healthcare is a right. The main argument for those that believe it is a privilege is that making it a right imposes a duty on others such as doctors and healthcare systems as well as a monetary duty on the public. To that, I say of course it is a doctor’s and health system’s duty to provide healthcare- that’s literally their job. As for a monetary duty on the public, while it may be harder to accept, it is in the best interest of the individual to help promote a health society. The evidence is clear, a sick society is an unproductive society. Just like people pay taxes for smooth roads and clean water, which everyone agrees is a right because it directly benefits them, money that goes towards universal healthcare is just indirectly benefiting them. Seeing healthcare as a right is such a critical step in the path to proper healthcare reform. Continuing to view it as a privilege, as the United States does now, will continue to result in a system that is clearly broken.
ReplyDeleteIt is evident that there are many issues in our healthcare system that I'm afraid we won't see a plausible resolution to. I am a strong advocate for early prevention of disease. It's so important to endorse things such as exercise, diet, etc., however there may be barriers for those that unfortunately don't have access to healthy food options, don't live in a safe area to exercise outside, or have to focus their funds elsewhere rather than on a gym membership. I recall in pharmacy 503 we watched a video about how general insurance doesn't typically include dental insurance, however dental health is vital to overall health and can contribute to various disease states. Having more access to preventative care rather than focusing on treating a problem after it exists could make a huge impact on our healthcare system because it would drastically reduce healthcare costs and of course result in less hospital visits and overall healthier people. If we could shift the mindset of Americans to focus on their health and wellness early on, we could potentially make a true difference in our healthcare system.
ReplyDeleteThe COVID-19 pandemic exposed many of the flaws of our current healthcare system. From overcrowding of hospitals to creating a strong public divide, the pandemic has brought forth many issues and the need for change.
ReplyDeleteThroughout the pandemic and the emergence of different variants, various waves have caused overcrowding of hospitals. Images were shown of people waiting in hospital beds in hallways just to get a room. Not only did this have a negative impact on those getting treated for COVID-19, but hospitals still had to treat individuals experiencing any other health condition. Many grew fear of going to the hospital as it would be a place to potentially contract the virus and would avoid going. Even doctors’ offices limited the amount of in-person appointments they had, really creating problems for those with chronic disease who require frequent monitoring.
In response to the demanding hours and increasingly difficult work conditions, many health care workers begin to feel the effects of burnout. As many of us worked in pharmacies throughout the pandemic, we are able to relate to the increased demands with no/little increase in incentives. In a time where many other fields were transitioning into remote work, a majority of health care workers were forced to increase their in-person work hours. Early on the pandemic, there was shortages of PPE, adding to the stress and increasing the worry of contracting the virus for healthcare workers. Health care workers also would often isolate from their families and friends in an effort to minimize the spread. This lack of support and connection with loved ones only furthered the problem.
Many Americans rely on receiving healthcare benefits through their employer. Due to the shutdown of many businesses or the inability to move to remote work, many individuals lost their jobs. While options are available for the unemployed, it can often times be difficult to afford these with no source of income and take time to be approved for different plans. This adds to the fear of getting the virus and negatively impacts quality of life.
In a time that potentially could have been uniting politically, the pandemic created further divide in our country regarding science and healthcare. Even during a pandemic, healthcare is heavily politically debated, rather than viewed as a human right. Misinformation regarding treatments and the virus itself were able to spread very quickly. Such a divide was created, that even once a vaccine was developed many remained strongly against its use. A distrust of many Americans in the scientific community will only complicate our healthcare system divide even more.
Despite the many negatives that have been brought to light during the pandemic, positive changes have been implemented. For example, telehealth has become extremely popular throughout the pandemic. Telehealth can increases the efficiency and accessibility of healthcare and hopefully will continue past the pandemic. The pandemic has also allowed for expanded roles for many healthcare providers. For example, pharmacist have been able to provide more vaccinations as well as provide more patient counseling through virtual settings.
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ReplyDeleteFinding a healthcare professional that listens to your needs as a patient can be challenging. This is a common issue within the scope of gender & women's health, which demonstrates unnerving trends of this patient population feeling dismissed by their providers. A patient case presented by the Katz Institute for Women's Health details a 50 y.o female presenting with a chief complaint of chest pressure and difficulty maintaining exercise endurance. The patient's gynecologist and internist assured the patient to not worry, as it was a combination of her perimenopausal symptoms and heavy workload as an attorney. However, a second opinion with a cardiologist revealed early coronary artery disease.
ReplyDeletePersonal anecdote: I've had several, notable experiences much like the story above. Recently, I was at my IPPE and started to get a severe (8/10 pain) headache on the left side of my head. My left eye turned bright red, I saw some strange rainbow streaks in my vision, and then the vision in my left eye went black for an hour. Not only was I nauseous, but I was terrified I was about to experience permanent blindness. I was worried it was glaucoma, since I had been so stressed & drinking plenty of coffee during the day. Eventually my vision recovered, I finished up my IPPE, and I went to the ED. Upon presentation and describing my symptoms, no matter how hard I pushed, I got a diagnosis of pinkeye. It felt juvenile and very dismissive; my vision went out for an hour and the best diagnosis is pinkeye? I didn't settle on this diagnosis, and visited an outpatient ophthalmologist for further evaluation; eventually, it turned out to be ocular migraines.
But why do these experiences and health disparities occur for women? Dr. Powell indicates that "health care providers may have implicit biases that affect the way women are heard, understood and treated." Furthermore, Dr. Gupta indicates that women may have a harder time speaking up because they have been taught to "rationalize warning signs of physical or mental health problems" since a young age. A study conducted by Lichtman et al. (2015) indicated that women hesitated to seek help for a suspected heart attack out of fear of being labeled as a hypochondriac.
However, changing implicit biases in healthcare providers will require extensive work. Certain medical schools are already beginning to address these issues in their curriculum, but perhaps this is not enough. For patients, being direct with their healthcare providers, and seeking multiple opinions can begin to bridge the gaps in these disparities. Public figures such as Serena Williams have helped elucidate the difficulties that women, especially women of color, have faced within the healthcare system. During an interview, Williams revealed that her nurse had incorrectly assumed she was confused as a result of her opioid medications, when she was actually experiencing a VTE.
Resources:
1. https://www.northwell.edu/katz-institute-for-womens-health/articles/gaslighting-in-womens-health
2. https://www.nytimes.com/2018/05/03/well/live/when-doctors-downplay-womens-health-concerns.html
3. https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.114.001612
4. https://www.vogue.com/article/serena-williams-vogue-cover-interview-february-2018
My dad brought up an interesting point when we talked a few weeks ago. He asked "When is someone in authority going to tell us: 'From here on out, we're treating COVID like the Flu. Stop masking, stop socially distancing, go back to work, get your vaccine, and move on with your lives.'?" The only answer I could come up with was "When everyone, or enough people, get vaccinated." I think the underlying problem is: people in this country absolutely abhor being told what to do. A while ago I heard a very applicable analogy to our current situation: when seat-belt laws were being proposed. None of us millennials, or gen z'ers, have known a life without seat-belt laws, so we may not really understand the comparison. But until 1968, seat-belts were optional. In fact, seat-belts weren't even invented until 1959. It was 9 years before they were
ReplyDeletea required inclusion in vehicles. From talking to my dad, I've learned that a substantial number of people were extremely opposed to their inclusion being required by law, and in fact, he doesn't remember my grandparents once using them. In my opinion, Americans are acting in the exact same fashion now about vaccine mandates as they did in the 60s when seat-belt laws were being proposed.
Now I understand that there are differences between these instances. For example: seat-belts aren't injected into your body. The COVID-19 vaccine, however, only bothers most patients for about a day, and is completely free. Car manufacturers certainly had to increase prices to help pay for the seat-belts they were forced to include in their vehicles. Not to mention the fact that the seat-belt is always there to annoy you.
Personally, I believe that a federal law requiring the vaccine, or proof of allergy to an ingredient, is necessary to achieve the utopia of viewing COVID-19 in the same ballpark as the flu. Perhaps breaking this law could impose an income-based fine, so that people who absolutely insist on distrusting proven science can still do so.
I recently dislocated my shoulder over the summer while vacationing in Miami. Most insurances unfortunately only cover a certain geographical area. And mine, the Health Alliance Plan, which covers exclusively the Henry Ford Hospitals in Detroit, did not. However, every insurance has to cover any urgent care or emergency care all over the world. By law the hospitals are supposed to provide you a service if you come in injured but the problem is if the hospital is not part of your insurance plan, the payment systems aren't linked and those exorbitant hospital bills add to the stress of the patient. Post surgery, my parents and I had to take calls from insurance to see if the relocation procedure was justified expense because I had spent too much time getting to hospital after the accident to qualify as emergency use and they suspected there was possibility I could have flown back to Michigan to get the procedure done. Then we told them to call the hospital to negotiate with provider because they informed us the price for the relocation surgery was higher than it would have been in with Henry Ford. I felt like some of the costs could have been on them if they were a higher class facility, some of them could have been on me for waiting too long and causing nerve damage or being a heavier set individual, I couldn't tell you because the patients aren't a part of these price negotiations to give our input. What happens instead is that it falls on us to create reconciliation and just facilitate negotiations when we really don't want to be bothered by all this while recovering. Even though my arm hadn't fully healed yet the insurance didn't give me any more days after 4 months from surgery for rehabilitation. There is a lot of issues doing it this way because a) I already needed 2 months for my shoulder to heal post operation and b) I was living in Ann Arbor where there weren't many places that accepted HAP, so I spent 2 weeks looking until I found Med Sports facility in Domino Farms. I was left asking my doctor for more rehab days, but their graces could only get me one more. That's when I learned insurance plans really try to limit your benefits. Among the insurances, Blue Cross Blue Shield is generally considered the best because they are largest but often expensive so patients end up paying higher premiums. Alternative ones like HMOs pre-negotiate with doctors and only offer to pay for those in their plan but are used regionally. I use an HMO, HAP, and another issue I've seen is that patients cant see a specialist directly, you have to get referrals from a primary care first. You can go to a larger insurance to avoid this but you will have to pay more. Medicare/Medicaid are different because government set limits on how much each procedure or drug costs and providers can decide whether or not they want to be a part of that. I think a lot of times they don't use them because they would be accepting a huge new customer base for subpar reimbursements; but a new clinic or failing clinic could benefit from them because they can handle that capacity for the elderly and indigent. Finally because we recently did a project on herbal and alternative medicines, for certain narrow specialists or experimental drugs, you have to pay out of pocket unless your insurance makes an exception. Pharmacists are uniquely positioned to work in both the health provider settings and insurance settings, so we can provide solutions to make insurances more patient friendly.
ReplyDeleteThe pandemic has brought health to the forefront of many people’s daily lives. While it has demonstrated some of the most positive aspects of our healthcare system, such as the resilience of our healthcare workers and the dedication of the scientists responsible for developing the vaccines, it also has exposed some of the weaknesses of our system. One particular weakness is our current treatment of mental health. The inadequacies of mental health treatment in the US predate the pandemic, but the spread of the virus brought those inadequacies into sharp focus. During the pandemic, feelings of stress, isolation, anxiety, and depression rose dramatically among the population. The number of individuals reporting symptoms of anxiety or a depressive order increased substantially from 1 in 10 adults to 4 in 10 adults. Additionally, approximately a third of individuals reported indicators of negative effects on their mental well-being, such as difficulties sleeping or eating, and approximately 10% reported increases in alcohol consumption or substance abuse. With a decrease in peoples’ mental well-being came an increased demand for mental health services, and that demand continues to be poorly met.
ReplyDeleteEven before the pandemic, the resources available to those struggling with mental health issues was limited. While insurance companies are usually more than happy to pay for a Prozac prescription every month, they have been much less keen on offering comprehensive therapy, even though outcomes are known to be significantly better when pharmacotherapy is accompanied by talk-based therapy. Patients seeking help are limited by their choice of therapists that are considered in-network, the frequency of visits that are covered, and the type of therapy offered. On top of this, they are also dealing with the cost of therapy and a demand that exceeds supply, a situation which has been amplified dramatically by the pandemic. Patients that should really be seen weekly for individual therapy are often being relegated to group therapy or to individual therapy on a bi-weekly or once monthly basis, and for many the wait for their first appointment after making the choice to seek help can take a month or more. Effective therapy requires trust and comfort between the patient and therapist, and finding the right “fit” is an integral part of treatment. With extended wait times for appointments and lack of consistency of treatment, it can be many months before those seeking help can even start to receive it. Couple that with the fact that it can take a month before patients even known if their antidepressants are working and may have to cycle through multiple antidepressants to find one that does actually work, and it is clear that the needs of this patient population are in no way being adequately met in a timely manner. While we may one day be free of considering sars-cov-2 as a significant risk to our physical health, the impact that it has had on our mental health may carry long into the future, and as of now there’s no vaccine for that.
I want to tackle a more controversial topic as it is very relevant to our current situation.
ReplyDeleteLet's talk about COVID vaccine mandates!
First, I want to clear up a few things before getting into the thick of it. Being in the field of pharmacy we all have a better understanding of the kind of research and regulations that went into making these vaccines. We are also professionally obligated to promote the use of the vaccine and encourage everyone to get it. We know that they are safe and effective and currently our only defense against the SARS-CoV-2 virus. Another thing we must acknowledge is that we give up some rights choosing to enter the field of healthcare, being required to be up to date on all vaccines (including the COVID vaccine) is one such example. I want to bring up the discussion of the COVID vaccine being mandated, other than for healthcare worker, in any area it may be brought up (schools, private business, public areas, international travel, etc.)
My opinion: I understand and support the mandate for healthcare workers, it makes sense that considering the patient populations we may deal with that we would be required to be vaccinated just like we already are. I would even say that it is reasonable to mandate it for public schools, teachers in particular, however mandating it for children is where I think it gets muddy, mostly due to the process of how it was approved for <18. Before we can vaccinate children I think we need just a little more time, owing to long-term data, especially given the downward trajectory of the virus as of late and the fact that children are very unlikely to suffer much from the virus.
As for the private sector I am against a government mandate. I think this brings up a fundamental philosophical question, which is more important? freedom or safety? Yes the vaccine helps protect everyone and decrease the chance of those at risk of death from contracting it. However, there is a line that must be drawn when allowing the government to force people to put something into their body. For me the matter is more of how much control will we let the government have.
The third point I want to touch on with this is vaccine requirements for international travel. This one I'm honestly not to sure on. I think each country has their own decisions to make on this but if you have proof that you aren't infected via a negative test than the necessity of the vaccine becomes more of a debate than I would care to go into.
In summary, yes the vaccine is safe and effective (as far as we know for short-term). It is reasonable to require healthcare workers to be vaccinated and even teachers and students to an extent. As for the private sector I am in general more the view of the government being hands off. At the end of the day we have to acknowledge that while this is a deadly disease there are fairly specific populations that are at risk, and in general the average healthy person will not be too harmed by the virus. Does this level of lethality justify government mandates for every person to get the vaccine? It's hard to say. But in America where the fundamental answer to the philosophical question is freedom>safety I think that question is answered.
Get the vaccine, but don't force it.
Theo Nguyen
ReplyDeleteOne thing really stood out to me on Monday's lecture that ... why do we spend so so much money on military instead of other areas like housing, education, or research (i.e., research)!?! Please don't get me wrong here -- I have a tremendous respect for all my military friends and their sacrifices for this country; however, there are many different areas that we, as a country, still need to work on. We are spending about 16.2% of the mandatory budget on defense/security, whereas we are only spending about 3% of that "juicy" budget on education. Nelson Mandela once said, "Education is the most powerful weapon which you can use to change the world." It does not seem like the case in the US, whatsoever. Education oftentimes links with science or health research, where most extraordinary discoveries had taken place from. And yet the government decides to only spend about 1% of the whole budget for research/science. I genuinely believe research in healthcare is very important because it is one of a few ways to fight against chronic illnesses and/or rare diseases. One may argue that there are many foundations out there that can help fund the research; however, those are so scarce for such high demand like research. And just forget about asking the NIH for funding because it is so competitive. Only if the government can split just that 0.2% from homeland security funding for research, then I strongly believe that this funding can help someone's research come to the finish line. We never know because someday the research can become helpful in fighting a rare disease like COVID.
HEALTHCARE IN THE UNITED STATES OF AMERICA
ReplyDeleteMedical procedures in the United States tend to be extremely expensive. It is often difficult for an American family to pay these expenses alone. Therefore, insurance companies offer healthcare to help cover these expenses. However, often times the prices to purchase health insurances are also expensive and require a lot of copay and deductibles that must be made, prior to the insurance covering the medical procedure. This has also made it very difficult for the average American family to opt into purchasing a healthcare plan. The result? No healthcare and limited money to pay for their expensive medical procedures.
Unfortunately, healthcare in the United States has been controversial. Nowadays, the country is very divided, and the issue regarding healthcare is not different. This topic is very heated when it comes to both political parties in the United States – the Republican and Democrat parties. While the majority of one party are big proponents of Medicare for all and universal healthcare, the other party is completely against it due to the high price it comes with. One of the arguments from the left is that healthcare is a human right, and every American should have access to good, quality healthcare. In contrast, the right believes that socialized healthcare comes with a huge price-tag and don’t want to eliminate private insurances, through free universal healthcare.
While both parties have valid reasons, I believe there is a middle ground that can be reached as many Americans are in dire need of some sort of healthcare reform. Healthcare is a human right; everyone should have access to free healthcare, and I think this can be achievable. As a country, much of the American taxpayer’s money is used foolishly by congress, in my opinion. I believe that cutting down on this wastefulness of our taxes would be able to afford basic healthcare for all Americans. We do have the money to afford it, probably without raising taxes; we just need to allocate the taxpayer’s money more properly.
In regard to eliminating private insurances through Medicare for all, I believe that this can be overcome. I think one of the other issues Republicans are hesitant to vote for a platform such as universal healthcare, is that they want Americans to be able to buy their own insurance as they are against the so-called, poor quality government programs tend to offer. I don’t think having socialized health care and private insurance companies are mutually exclusive. There can be free basic universal healthcare for everyone; and if the “wait times” and “poor quality” is true, there can also be an option for Americans to be able to purchase healthcare by their own private insurances.
Overall, I believe healthcare is a must have for everyone and it should be affordable. We live in a currently divided country and it is extremely difficult- almost near impossible- to have one or the other. By allocating taxes and keeping private insurance companies, universal healthcare can happen in the United States.
Something that concerns me regarding current drug discovery methods is the number of medications that have been pulled from the US market with time. One example of this (Happy MedChem studying) is troglitazone, which was removed from the market after the discovery of a hepatotoxic quinone metabolite. Routine post-marketing surveillance of medications has resulted in many cases similar to this. It seems counterproductive to me that companies spend a decade developing a drug, utilizing their time and resources only to find out that their drug has unintended consequences and needs to be withdrawn. And then the cycle repeats!
ReplyDeleteIt does worry me as a future pharmacist to think that any medication I will dispense has the potential to cause harm. I think back to the tragic and often life-long effects that thalidomide and diethylstilbestrol (DES) had on children and their families. Despite the medical community's best efforts to help people, there is always risk involved with treatment. On a brighter note, I’m hopeful that modern technological advances in healthcare can help to reduce the risk of human error in ways not previously achievable.
By Sarah Schang
ReplyDeleteI would like to think that in America, everyone cares about the health of other people. Whether it's physical, mental, or emotional, I prefer to look at the good of people and the good of things. Life is too short to focus on the negativity, but I sometimes find myself struggling to see the good in America's healthcare. I have been blessed with having top healthcare my entire life from my father's job, so I have never had to experience some horrors millions of Americans can experience daily. Coming to UMich, however, opened my eyes quickly about the status of our country's healthcare. The challenges so many of us may face is indescribable and leaves my heart emptier every time I learn more.
At a glance, one might assume we have excellent indicators in our country because of how much of our country's GDP we spend on healthcare. Not to say that our healthcare is the worst globally, but it surely isn't where it should be. It also isn't where it can stay. The USA is a constant outlier in comparison to other "fully" developed countries: whether it is spending around double per person compared to other nations, having significantly higher maternal mortality ratios, or simply comparing average life expectancy, America continues to disappoint. It would be one thing if the amount of money we spent produced results; however, we are spending at an unsustainable rate, with little results to show for it. Yet, it would be naïve of me to say that healthcare (access, guidelines etc.) is the only contributor, when many other systemic issues hurt our country as a whole. But it plays a part and needs to be addressed.
In America, we frequently try to find pride in ourselves and our country. But I constantly ask myself, how much is there currently to be proud of with our healthcare? Does our current healthcare show ourselves that we honestly CARE about those in our society? These questions often leave me with doubt. But then I try focus on the good of the situation... that for around a century, expanding healthcare and improving it has been a focus of many leaders in our country. Although minimal ideas have stuck, I am still hopeful that enough people care and wish to better our country. I choose to believe that small strides will continue to be made as wins for EVERYONE in America throughout my lifetime.
Ronisha Kidd - 2/22/22
ReplyDeletePatient Dumping
The illegal practice of patient dumping occurs when hospitals discharge patients to bus stops, shelters, or other hospitals prematurely. Research indicates that low-income patients face unequal treatment in emergency care and patients who are poor, uninsured, or covered by Medicaid are more likely to experience patient dumping. Additionally, victims of patient dumping tend to be homeless, undocumented immigrants, and have mental health issues.
Patient dumping isn’t new! President Truman attempted to address it with the Hill Burton Act of 1946, but it was vague and largely unenforced. President Regan signed The Emergency Medical Treatment and Active Labor Act (EMTALA) in 1986 to prevent this practice in Medicare participating hospitals. EMTALA states that hospitals can be penalized for engaging in dumping. Fines depend on the size of the hospital and ranges from $50,000-$100,000 per violation. In certain cases, patients can sue for damages and hospitals who believe they received an illegal patient transfer can report this to the Center for Medicaid Services as an EMTALA violation.
One particularly disturbing example of patient dumping occurred in January 2018 when Rebecca Hall was removed from the University of Maryland (UMD) Medical Center Midtown on a cold night. Four male guards escorted her to a bus stop wearing only a hospital gown and socks. Rebecca fits the profile of a likely victim of patient dumping as she struggles with mental health, is a minority, and is homeless. UMD Medical Center CEO agreed that it was wrong to discharge Rebecca in that manner but defended the care provided by emergency room staff.
Rebecca’s mother feels that many people failed her including case managers, emergency responders, and hospitals and I agree. I feel that this issue could be addressed by applying SDoH. Rebecca seems to be impacted by economic stability, education, community and social context, and health care system. I appreciate Michigan Medicines stance on SDoH and feel that Rebecca could benefit from the services MM Social Workers and physicians provide such as housing assistance and effective mental health treatment.