Wednesday, March 24, 2010

After Reading Chapter 3:


Dr. Nolen describes treating wealthy patients differently than poor, indigent, alcoholic ones. This is a problem with our health care system. What do you think could remedy this situation so that all patients are treating fairly and equally?

31 comments:

  1. I'm not sure that this problem will ever go away, because there are certain people who donate money to hospitals, and get new wings named after them, however I think the treatment of the poor, indigent, alcoholic patients should improve so these patients get treated more equally. They should have a standard at which to care for their patients and if their patient happens to be the rare patient who donates a million dollars to the hospital. These poor, indigent, alcoholic patients should receive the same treatment as the average person, who is not necessarily rich (but they aren't poor) or an alcoholic or indigent.

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  2. I think there is no way to ensure that all patients are treated equally. Despite the government's or hospitals' wishes to give all patients fair and equal treatment, there is such a contrast between the hospitals, facilities, doctors and resources in poorer areas and richer areas, and patients at these different locations will be treated differently. The only way to insure equal treatment to all patients would be to nationalize and equalize all hospitals and health care. By providing each hospital and medical center with equally competent doctors and equally good facilities, all patients would be treated similarly. But the nationalization of our country's medical system is a long way off, and this would create a great problem for people who feel like they should be able to pay more t ensure better medical treatment. So I think there is no real tangible way of guaranteeing that all patients, regardless of their social standing, will be given equal treatment.

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  3. This problem is very hard to fix. People, and doctors of course, want money, and it is only human to attend to the high-paying patient better in order to get that money. The doctors can’t really be to blame (unless a doctor treats a wealthy patient really terribly), for this is completely natural and therefore terribly hard to correct.

    The only true way to combat this situation is strict regulations and enforcement of the quality of care of the poor, indigent, alcoholic patients. There could be a person in hospitals, watching and asking patients, who monitors how well the poor patients are treated by doctors and enforces rules that the doctors must follow, for example.

    -- Ian R.

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  4. I think that it will always be difficult to assure that all patients are treated equally, regardless of their wealth or medical conditions/habits. I believe that the government could work to provide more medical treatment opportunities to the poor, and perhaps set up more clinics that are well-furnished by the government and available only to the needy, so that there is no competition for doctors' attention. Also, maybe if there were some way for a patient's privacy, (in terms of whether or not they are wealthy or using government aid to pay for doctor's visits), to be maintained then possibly doctors would treat patients in a more equal manner. Ultimately though, it is hard to create a completely equal environment. Often times it is not the wealth of the patient, but the medical conditions of the patient (such as if they are an alcoholic or drug addict) that determine how a doctor behaves, and thus there are some aspects of patient-doctor relationships that cannot be regulated.

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  5. The only way we can change our health care system is if all the patients either pay or do not pay to get treated.

    It is only natural that the doctors would spend more time for the people who are paying. Although it is necessary to treat the poor people who are actually very sick, it is unfair to both sides to have poor people playing the system and getting purposely ill to get free food and lodgings. Super sick poor people get more treatment that's logical. Kind of sick people, who could be deceiving the hospitals and are not paying for care, not getting treatment, that is pretty reasonable. If those 'fakers' are getting the same treatment as the paying people how is that fair?

    To achieve fair treatment in hospitals we should either all pay or all not pay.

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  6. This is Connor Townsend.

    It doesn't seem like it's possible to ensure that everyone gets fair treatment. People who pay for treatment will always get better service because the doctors need money. They aren't working at a charity, and they'll probably always help those who can pay more. The only way to ensure equality would be to have nobody pay at all, or to only admit those who pay. I really doubt the first route would work for obvious reasons. And if the second route was taken, then alot of poor people would be left without any kind of medical care.

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  7. I'm not sure how the disparities between the treatment of wealthy patients and poor patients can be fixed in the current structure of our society. Not allowing patients to pay for whatever medical care they choose would be incredibly unpopular and difficult to implement. A more realistic solution would perhaps be to make a concerted effort to improve the quality of healthcare offered to the poorest patients and offer that medical care to all citizens. Eliminating private hospitals entirely is simply not feasible, but bringing other medical care closer to those standards would be an improvement.

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  8. The solution to the disparity in quality of care given to rich and poor patients is to nationalize healthcare. Hospitals are businesses, and businesses need money. However, it doesn't matter where the money comes from, whether it's from the patient himself, a private insurance company, or the government. There will still be cushier hospitals for richer patrons, and that’s fine; rich people get nice things. As long as the government makes sure that everyone gets comprehensively adequate care, the top one percent can have all the gold-plated heart valves (no, not literally) they want.

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  9. Unfortunately, I think that socioeconomic class will always play a large role in the treatment of patients, regardless of any government policy. People like Mr. Carlton will always receive better treatment because of their position in society. Hospitals anxious for favorable press and donations will acquiesce to the privileged client. Perhaps hospitals could set basic guidelines and standard treatments that all patients must receive from the doctor, paid for by governmental funds, while wealthier patients can pay for advanced care. Although fair treatment is ideal, doctors are also within their rights to suspect and/or deny services to the less well-off "patients" who malinger just to get a place in the hospital.

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  10. Wow, there is really no good solution to this kind of problem. Rich people will, regardless of any checks put on the system always have more money, and thus power. For example, forcing wealthy patients to be treated by the same system of public hospitals that poorer people are already subjected to, would simply cause a general decline in the quality of health care. Because of this, richer patients would still find ways to be treated in a superior fashion using the power of their money. Just like in any other industry, the paying customers in private hospitals will always receive better treatment than the non-paying customers in public hospitals. The only solution would be to staff and to fund public hospitals better so that quality of care would at least improve a little. At Bellevue inexperienced interns like Nolen are forced to work long, monotonous hours, doing complex surgeries with minimal training on just a few hours of sleep a might. No one should have to trust their life to such overworked doctors. The quality of care would almost certainly improve with more employes and better equipment.

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  11. In the ideal world, doctors would treat patients the same, regardless of their socioeconomic class and ability. I think this discrepancy in treatment comes from superficial judgement. Perhaps computerized diagnoses could be used. Before a patient goes in to see the doctor, they could fill out a scan-tron of their ailments and issues. A doctor could then pull these up and get an overview of the patient without seeing the patient first. This would rule out some of the judgement and preferential treatment

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  12. I think that something that will help with the problem is to have an equal number of both poor and wealthy patients at all hospitals.
    Rather than there being a white castle hospital for the wealthy, and a under-funded Bellevue hospital for the poor, all hospitals should
    strive to be in-between. Ofcourse there is the problem that hospitals make more money by catering to rich patients, but this problem could be solved if the state paid the hospitals rather than the clients.This way, the wealth of a hospitals patients will be of no difference to doctors who will all be making the same amount anyways. In such a situation, patients who are easy to get along with will be favored rather than rich patients who can be obnoxious (such as Mr.Carlton),which is a much better situation.

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  13. I don't think that it is possible, or even necessarily the best solution for all patients to receive the exact same medical care. True, I believe that there should be a standard for the minimum level of care all patients should receive, but its almost always going to be the case that wealthier patients will be able to afford more expensive treatment, while other patients might only get as much as their health insurance covers.

    As long as a patient is treated with respect so that they are able to receive enough care so that they recover from their illness or receive enough information so that they can prevent future sickness, I'm fine with using money as the determinant for the level of treatment a patient provides. If the hospital were paid the same amount for each patient by some third party, it would leave too much opportunity for patients to be treated on the basis of doctor preferences or biases. Although it would be nice to generalize and say that patients who are poor and would receive relatively worse treatment today would be treated better in a world where wealth doesn't determine treatment, doctors may just treat wealthier patients better because they are cleaner, or more educated, or maybe even because they like their shampoo smell better. Although money is a cold determinant to use when deciding something like patient care, it might just be the most reliable factor as well.

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  14. Unfortunately I don't think there is a way to ensure that all patients will receive equal care in hospitals. It wouldn't make sense to go to one extreme or the other (by having everyone pay for their medical or having everyone not pay for their medical care) so I think it would be best to settle for something in the middle. I think one of the more realistic solutions would be to improve places like Bellevue and create more of them. Hopefully with more clinics, more doctors, more/better supplies, better conditions overall etc. patients could receive better quality care.

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  15. I think that in an ideal world, each person deserves equal medical care. Being healthy and getting proper treatment should not be a privilege reserved for the rich, but something that everyone can access. If health care is made public, then I believe that this would allow those who are not able to afford quality healthcare on their own income access to it. However, realistically, the people who own hospitals and the doctors who work for them often do so for profit. As such, it is hard to compensate for the imbalance between rich and poor. Even in circumstances where a doctor made desire to provide equal treatment, they may not be provided with the resources to do so in a disadvantaged hospital (like at Bellavue).

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  16. While the preferential treatment given to wealthy, powerful patients is clearly unfair, it is difficult to image how exactly this situation could be eradicated. Plus, this wasn't the only problem that Dr. Nolen describes--there are also patients who don't want to leave the hospital, drug addicts who come in too late, and many others who make doctors' lives more complicated.I think the only way this problem could really be solved is if wealthy patients develop consciences and do not attempt to receive preferential treatment. Apart from that, I don't really see any way to ameliorate the situation.

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  17. Its hard to say if there could ever be a solution to the different treatment of rich and poor patients. Hospitals, like everything in our lives, have politics that are affected by influential people. Dr. Nolen's episode with Mr. Carlton is a good example of these hospital politics. Dr. Nolen got into a lot of trouble for getting angry at Mr. Carlton because "He is an influential guy-a bastard, yes-but a high ranking one"(56). I cannot think of any solutions to the unfair treatment of influential people because, doctors and hospital owners fear the power of people like this. Doctors would have to take it upon themselves to treat every patient the same way, and not judge based on wealth or connections.

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  18. This is Jazmyne.
    Of course I think that it would be great if people from various socioeconomic classes and backgrounds received equal healthcare, but hospitals and doctors all have their priorities and many times they choose to focus on the paying patients. I believe that people should have the opportuntiy to receive good health care and access to competent doctors. Doctors and hospitals should take it upon themselves to treat every patient that walks through their doors as an important being. When it comes down to it, doctors are supposed to help save lives. The financial stability that comes from being a doctor is an extremely great asset, but they are truly meant to help people, no matter their financial status.

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  19. It is unfortunate that there is a certain dichotomy between treatment of rich and poor patients in hospitals, but it is in no way surprising. The problem is in fact twofold--not only do richer patients often receive better treatment (as in doctor-patient interaction)they also have a greater amount of physical resources available to them.

    Though doctors have a vital role in aiding their patients, they are still part of a business and have similar preferences to any other businessman, meaning they would certainly treat the richer better, as it means at the very least a bigger paycheck. Though it may not be morally optimal, it is how business and society essentially function.

    Yet measures can be taken to ameliorate this issue, most of which concern setting standards for all medical care through nationalizing healthcare. This would take care of the issue of what a patient can get once they got to the hospital (proper tests, medication, etc.). Additionally, all hospitals should improve their standard procedures and baseline requirements in treating all patients on a social/attentive level that ensures no patient is neglected, and feels comfortable and safe. The doctors and aides at every hospital should be monitored so as to make sure these regulations are followed. therefore, those with more money can get more, and those with less can get completely sufficient care.

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  20. Sadly, I don't think that any method would fully resolve this problem of class differentiation. Doctors will always foster some sort of preferential interest to their patients, whether it be because of socioeconomic class (as is prevalent in this case), gender, race or even merely personality. Although these biases may not be intentional, human nature will always cause someone to guard certain prejudices against a particular group of people. That being said, in order to lessen the magnitude of socioeconomic discrimination, perhaps hospitals could establish a system in which everyone, regardless of their economic status, is required to pay the same amount of money for the same kinds of treatment. However, even this possibility is susceptible to flaws

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  21. This is a very difficult problem to solve. For one, the question of money is very prominent: wealthier patients will pay more money to receive the best possible care, and patients from less affluent backgrounds would struggle to receive that same level of attention. The only way to completely ignore the gap between classes would be to ignore all sort of financial or socioeconomic backgrounds: each patient would not have to submit any proof of financial security of the like. Thus, by not exposing their financial situation, patients would ultimately be "the same". Still, this is still susceptible to error: doctors, just as other people, still hold prejudices that may force them to conceive certain notions about patients, whether due to their race, gender, religious, or any other sort of background.

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  22. No matter how we rework our health care system to give everyone equal treatment, there will always be the situation that some people will have more money and be willing to use it to get what they want.
    However, I think a nationalized health care system could make significant progress towards health care equality. If, like social security, everyone paid a tax that funded the system, treatment would be available to all who needed it and how much they could pay for it would not be an issue. Everyone would be offered a sufficient level of treatment; however, the private sector would still have to exist for those who wanted the "cushy" hospital experience.
    Another problem though, is the location of hospitals. Bellevue Hospital was in a neighborhood that had a high concentration of destitute people, while swankier hospitals are closer to wealthier neighborhoods. Thus there will probably always be a discrepancy in treatment at these two places because the hospitals near wealthy neighborhoods will attract the doctors and philanthropists. In this situation, assumptions would be harder to erase.

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  23. granted this is one of the most difficult challenges we are facving in our lifetime, i think we, the united states, can fix the problem of treating patients of different socio-economic class differently. we need to develop a socialist health care system where everyone can receive equal care without regard to money available. if we can enact a system with no one worrying about money then nobody will consider how much money they are receiving or spending during operations. something along these lines would also help the health of our citizens because there would be no judging of people based on their wealth or history. in this ideal health care plan everyone would be an equal and money would not interfere with how anybody is treated, people would simply be treated based on their needs at the time. this is nearly impossible to accomplish with the political system we have currently in our country... but if people could only be humane about the treatment (and pass judgement on individuals based on wealth) our health care system would be significantly better off.

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  24. I think it is impossible for all patients to be treated fairly and equally. Every patient has different health problems, so it is hard to distinguish what fair and equality would be for all patients. For example, if there are two patients in a hospital and one has serious health problems and the other one does not, the person who needs more attention and care should receive more. However, the reality is that people who are able to pay more money will receive as much care as they need.

    At hospitals, the workers' jobs are to provide medical care for all the patients. I think it is wrong to look down on patients who are poor, alcoholics, or whatever the case may be. I have heard that sometimes doctors are annoyed when alcoholics come into hospitals because they are using up time and resources that could be used to help more deserving people who did not make the bad decision to drink.

    I can sort of understand why doctors might treat some patients worst than others. However, their jobs are still suppose to provide the best help they can to all patients. It is unfortunate how the wealthiest people are so much more respected than the others. They feel like they are entitled to everything they want, and they always get it since they can afford it. In the end, these patients are wasting time and resources too since they do not need as much care as they are receiving.

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  25. The short answer: get rid of private hospitals, put poor and rich people in the same places, and treat them according to how serious their condition is.
    This is probably impractical, and I really don't know enough about how healthcare works to answer. Perhaps having a free medical system would be best, but I don't know enough about the politics and economics of healthcare to propose a solution. Frankly, I've heard so many people going BLAHBLAHBLAH about the money involved that I've stopped caring about the economics...

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  26. This issue is an individual choice. No one will ever be able to mandate a law making people "be nice" to others. Whether an individual as the moral compass, the good nature, and a decent disposition dictates whether or not a person will be treated fairly and equally. Obviously, there are legal issues that the law can address that can ensure fair and equal rights for all, but in terms of behavior, it is up to society (as cliche as that is) to pressure a positive development of a friendly disposition.

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  27. A potential solution to this problem of inequality within the health care system would be to improve diagnostic techniques to avoid "the run-around" (41).

    I think the book includes many ways in which the doctors at Belluve have adapted (for lack of a better term..) to the relatively (to private practices with private patients) more poor, indigent, alcoholic state of its patients. For example, I imagine it would be less likely for a doctor at a private practice to know that during a suicide attempt using a knife, the "artery disappears behind the edge of the bone"(43). The private doctors would be like Mike, who hasn't seen many suicide attempts and thus assumed that the carotids where nicked. In this sense, this knowledge saved the suicide attempt guy's life.I think in this situation, the treatment is fair.

    Also, Dr. Nolen double-checks the 104 degree temperature guy because he is suspicious of his poor "type". I feel that this is within reason because he guesses correctly that the guy was faking his fever.

    Unfortunately, it is inevitable that this kind of prejudice/inequality will end up hurting some patients, but I understand that sometimes one's socioeconomic class is an important diagnostic tool.

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  28. There is no simple solution. The issues that the question asks to solve are unsolvable without a complete upheaval of society. The reality is on an evolutionary basis we have been designed to make quick assumptions. "Gut feelings" are often instinctive and subconscious bias is an adaptation of the human to avoid relation with an unsafe environment or being. While social constructs have now wrapped themselves into our subconscious we must still strive to see atleast equality and attempt to probe all people with equal skepticism.

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  29. Sadly, I don't think there's a solution to this problem. Ideally, doctors would care equally about a poor man's health and a rich man's, however, money has always talked, and a rich man has always gotten better care than a poor man. I can't even think of a possible solution to this problem; even if hospitals were integrated with wealthy and not-wealthy patients, I still think doctors would treat patients differently. It is really up to the doctor to choose how he treats a patient, and I am sure that there are good doctors everywhere who treat patients well regardless of their social class. Unfortunately, this is a problem way too big and way too old, and for that reason I don't think we can fix it.

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  30. Unfortunately, I’m not sure there is a perfect solution. The poorer patient with malnutrition or preexisting disease will most likely end up at an understaffed place like Bellevue without the equipment needed to treat them without error. However, one possible solution could be a universal form of hospital or clinic funded by the state. Poorer patients could turn to these clinics for a form of health care that eliminate the problem of the bad equipment. The problems of malnutrition and preexisting disease are harder to solve. Maybe a program that would provide regular check-ups and nutrition plans for poorer patients would help to solve those problems.

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  31. I dont believe there is a solution to this problem or at least not in the near future. It is very difficult to expect people who cannot pay, to receive the same care as people who are paying the hospital for the treatment they are receiving. It is unrealistic to assume that the government will be able to give enough money to ensure that everyone gets equal treatment. There arepeople who are willing to pay enormous amounts of money to receive the best treatment and hospitals are not going to turn this down because they are always going to need the money. I think it would be great for the government to pay for minimum care for everyone in the country though it wouldnt be logical or fair for the government to only pay for those who need it.

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