Basic Concepts and Ideas Flashcards
Proponents of truth-telling:
- basics of respect
- undermines trust and support in patient-physician interactions
Opponents of truth-telling:
all in the patients interest!!
some patients cannot handle the truth of life threatening illnesses
justifications of lying:
-discretion; doctors shouldn’t be forced to report just facts –> there is an emotional aspect into it as well!
-lying might benefit patient –> physician-patient relationship may give doctors understanding to what may cause patient undue stress
-some patients cant even fully understand the truth
justifications of truth-telling:
idea that patients understand themselves more than doctors
enhances patient-physician relationship and builds trust and legitimacy
consensus on truthtellign
most patients want to be told the truth
confidentiality
patients count physician not to share personal information with others
NOT ABSOLUTE
importance of confidentiality
more people inclined to seek treatment (safety in secrecy)
patients more inclined to provide MAX info
trust with physicians is enhanced
justifications for refusing treating patient
excessive risk
questionable benefits –> is it really going to help them in the long run
obligations to other patients/self/family
justifications to treat regardless of risk
inherent part of profession –> its the job
apart of social contract and expectation of job
patients depend on doctor!
AMA stance on treatment of patients (risk-wise)
expresses duty to treat regardless of risk BUT offers easy exemptions
AMBIGUOUS
Healthcare costs covered by
employers
family/individual
government
third party payer (insurance companies)
1 payer for medicare and medicaid
government
1 payer for obamacare!
third party payer
trend of healthcare costs
increase with stagnation of real wages
why healthcare costs increase?
new medical technology
increased life expectancy –> more care needed to chronic and acute illnesses
medical wastes
larger corporate profits
exorbitant salaries and compensation packages
high administrative costs –> advertisement, marketing, etc
medical fraud/malpractice
do companies want federal/national healthcare?
YES - would reduce overall costs; would make less demands by employees for more costly benefits and insurance packages
private company health care expenditures:
mostly spent on health insurance
accompanied by higher employee contributions
CHIP
wants to DECREASE number of children without insurance
MD facilites:
tend to do procedures that have higher fees
tend to pass recommended to places and areas with mutual monetary interest
what is specifically not address in healthcare refomr
malpractice
what industry is growing to be the most profitabel
pharmaceuticals
healthcare delivery system
hospitals
freestanding ambulatory units
surgical care sites
nursing homes
hospice care facilites
1700s-1800s state of hospital care
volunteer staff, treated mostly people without family/money
*hospice-like treatment
*end of life treatment
1900s
admited mostly sick people with curable illnesses
alternate care for elderly and homeless
BY 1920
hospitals became primary center for acute treatment
included nursing services, auxillary services, surgical stuff, etc.
churches actually funded a lot of this!
as hospital sizes grew…
need for mroe adminstrative services to control it all grew as well
management!!
more money was given towards medicine and hospitals after
WWII
criticism for for-profit hosptials
profit maximizations
catering to rich patients
providing little to no care for those that cant pay
cheaper alternatives to normal hospital car e
increased use of ambulatory care
urgent cares services used more by poor people for urgent events
retail stores (walgreens cvs!), ambulatory surgical centers, public health center
physicians work in group/office like relationships
work cash deals based on patient ability to pay
patient dumping
ILLEGAL - still happens - when they just dump a person on streets when they cant pay
epicenter of pandemic
nursing homes
primary concerns for nursing homes
neglect
abuse
accidents
high price of care
staff shortages
technology innovations and advancements
INCREASED
benefits of tech
more accurate diagnoses –> leads to increase in diagnoses
quicker diagnoses
INCREASED effective treatments
INCREASED life expectancies
negatives of tech
increased costs
unequal access
some technological advances FAIL –> can be harmful in long run
ethical issues –> my body, my choice
dependence on technology may lead to loss of motor skills in physicians
social effects of technology
- new more options for people
- laters human relationships –> people live longer, increase in social pools
- can affect healthcare system –> cause displacement of certain people
-greater reflection of value of this –> consquences?
-more social policy questons –> vaccine mandates, abortions? etc.
Top Advances in Technology
-cardiac technology (pacemakers, defibrillators)
-critical care management (ICU,etc)
-medical imaging (MRI, CT)
-genomic medicine (genetic mutations,etc)
-telemedicine (online medical info )
distance between patient and physicians with technology influence
increased distance
1991 self determination act
all health care providers have to inform patients about their rights under law to prepare living will
1st to talk about patients right to privacy and can refuse treatments EXTENDING to competent and incompetent peoples
supports of doctor assisted suicide
-consistent with right of self determination
-most deaths in hospitals occur from preliminary discussion and agreement to not prolong life –> DO NOT REUCITATE
opponents on doctor assisted suicide
-patients too sick to think straight
-inconsistent with idea that doctors should sustain life and relieve stress
consensus on doctor assisted suicide
most people are in favor of this
organ donations in US
voluntary by nature
United Network of Organ Sharing
helps find potential donors and people in need of transplants; healthcare providers have to notify patients and families about donations
strong market approach –> organ donation
individuals or next of kin can auction off organs to highest bidder
spending for best treatment options
fed gov and private corps say that they cant afford to fund this for EVERY person
curative care spending
-end of life spending
-newborn with lfietime care needs spending
increased healthcare based on income and wealth for life expectancy
categories of healthcare performance
-preventative healthcare –> access to healthcare, diet, safety check ups etc.
-healthcare use and services –> using healthcare resources, access to healthcare`
-availability of top care tech
-mortality
-healthcare system responsiveness –> addressing needs of pop
-stability per capita spending in relation to national income –> willing and able to spend for people
influences on healthcare systems
-physical, historical and situational events
-cultural norms and values
-structural norms and values
*US has rugged indiviudalism cultural tendency –> less likely to react well to government handouts
private insurance
private entrepreneurial services; for profit! ex: US
types of national insurance
- with private regulated services –> canada, germany
-with public regulated services –> great britain
-socialized system –> cuba, china
