Technological Advances in Healthcare

The world is very different now. For man holds in his mortal hands the power to abolish all forms of human poverty, and all forms of human life. -John F. Kennedy

It's no secret that technology has significantly advanced in the healthcare industry. We have robots that can perform surgery. We have machines that can let us see inside the body. We don't have paperwork filling up doctors' offices; we have all the information stored inside the computers. With technological advances, there are benefits and disadvantages.

I have noticed, personally, that a lot has changed in my own healthcare experiences. When I was a child, my pediatrician always came in with a file folder full of papers. Now, when I visit my doctor, the nurse just finds my name in a computer system, enters my vital information, and leaves it for my doctor to make notes on. When I was in the hospital having my daughter, they brought me a tablet and I used a stylus to sign my name on the screen, instead of using a pen and papers. All of these things have been very interesting to see. I never know what is going to be new and exciting at my next visit.

One problem I have faced as a patient is the higher price of technology-based healthcare. Last year, I had a great primary care physician who was helping me find the right medication for my depression and ADHD. I saw her at least once a month to follow up. One day, I saw signs that said they were switching to digital health records. All of my paperwork was now in a computer, and I had to sign a form to acknowledge this change. I thought it was a great advancement for the office. My previous primary care physicians had already switched over to computer-based records and I found it to be much quicker and more convenient. However, about 2 or 3 months after my doctor's office switched to electronic records, I was informed that they would be shutting down the office in a few weeks. The costs ended up being too high, and my doctor could not keep up with the increasing costs. I was forced to find a new physician at a moment's notice. This is the only "inconvenience" I have personally faced, though. However, I can see that technology could potentially cause some other problems.

Of course advances in technology result in an increase of healthcare costs. Hospitals are faced with the need to "keep up" with all of the new technology and bring in the "latest and greatest" devices in order to compete with other area hospitals. There is also the chance of electronic devices "crashing" or losing information, as well as failure to work properly. However, I do believe that technology could bring our healthcare system to amazing advances and has the potential to do great things for the overall health of our world.

Any sufficiently advanced technology is indistinguishable from magic.-Arthur C. Clarke

Sick Around America

This week I had the opportunity to watch a video for the second time around, PBS Frontline's "Sick Around America". The more times I watch this particular episode, the more frightened I am about the current state of our health care system. The stories that you hear from patients and families really make you think about what needs to change in our current system.

In my opinion, the health insurance companies in our country today, are incredibly unethical. Personally, I feel that they are more concerned about profits than they are about people who really need them to survive.  Karen Pollitz describes the current health insurance system: "like having an airbag in your car that's made out of tissue paper: I'm so glad that it's there, but if I ever get in a crash, it's not going to protect me." 

These days, without a good job, it's insanely hard to get good health insurance. Without health insurance, healthcare is very expensive and many times impossible to receive. How is this ethical? 

I'd like to share a personal story about my fiancé. His name is Daniel, and since he graduated high school, he hasn't had any health insurance. In 2009, he fell down the stairs in our apartment and broke his neck. Because he didn't have insurance, he decided to just deal with it through the day. He did not know at the time that his neck was broken, just that he was really sore and had a terrible headache. After working all day, I finally called my friend to take him to the hospital. When he arrived, they were very concerned and put a neck brace on him immediately. After several tests they determined that he had a grade 3 concussion and a broken neck. He was very lucky to have survived. The hospital bills were insane, though, and we couldn't pay. A few months later, he started having seizures, major mood changes, and terrible headaches. After a few more hospital visits, he found out he had developed epilepsy as a result of multiple head injuries. Now, he has a chronic condition. He worked from 2009 until this year with a company who didn't offer any health insurance. Since his injury, he has built up thousands, maybe even millions, of dollars in medical bills. There's no way he can pay for these. And because of his chronic condition, no individual insurance companies will help him. Now, he is looking for a new job with a reputable company so he can receive a good health insurance package. But, because of the state of the economy, and the high costs of healthcare, there are far fewer companies offering full-time employment with health insurance. I work for Disney, and they've even stopped hiring full-time employees for many positions. The only reason I get full-time hours there is because I am an intern, and they don't have to offer me health insurance. 

Our health insurance system is failing us, and we need a change immediately. 

Euthanasia

This is probably the hardest topic to write about. Is it right to say when a patient should die? Is it okay to give consent to taking a family member off of life support? Is it okay to "play God" in these situations? It's a really hard thing to think about. Decisions like these are made everyday, but I honestly have no idea how I'd ever make such a decision. 

I feel that we're all here for a reason, and that we'll die when the time is right. I agree with many of the doctors in the Frontline video-that we should always offer treatments. At the point where there's nothing left to do, except keep the patient on a ventilator and/or feeding tube, that's the time when the family needs to make a decision. Personally, if I were in the situation, I'd want every treatment done. No matter how much it hurts, no matter how much pain or agony it causes, if there's any sort of chance that I'll improve afterward, I want it done. At the point where the doctors say, "She's going to be on life support. There's no further treatments we can do.", that's when I'd give the okay to let me die. But never before. I feel that allowing someone to die, without doing something that might have a chance of helping, is unfair. There are so many instances in which someone who's given 2 months to live makes it  several more years. The advances in medical technology are moving so quickly! If we were to allow everyone to die after we try one thing, we wouldn't learn much about medicine. It's those people who defeat the odds that help us advance medicine. As Jerome Groopman, M.D. said, "There's very stark and important advances that have occurred by very much chasing that tail end of the curve. Severe diseases like leukemia, initially treated with chemotherapy, might have a 5 percent or a 10 percent improvement. Some people might say, "Well, that's meaningless." Of course for the individuals in that 5 or 10 percent, it's 100 percent. But it's not only to help patients, which of course is the primary goal, but it's to learn from that and try to build on it and expand, and then move to 15 percent or 20 percent, because generally in medicine, progress, advances occur incrementally, in small steps. There's rarely a eureka moment with this dramatic breakthrough that just shifts the paradigm." 

I'd have to say that I agree very strongly with what David Muller, M.D. said in the interview on the "Big Issues" page of the website (Link below): "So that if you take someone who's 20 and has acute leukemia and is going to die, and you've got to look at them in the face and say, "Look, I've got a therapy, but it's very, very dangerous, and the percent of people who die from it is a high percent, 10 to 20 percent, which is very, very high," I think that's an easier discussion for doctors to have, and for many patients, an easier decision to make, because they've got a shot and they've got a long life ahead of them, and in a sense, the potential benefit is worth the risk.

If you have someone who's 70 or 80 or 90, and it's not just age that has to do with it; it's everything that we talked about that comes with it -- chronic illness, frailty, dependence in a lot of different ways -- and that person has leukemia, maybe not acute leukemia, maybe it's chronic, and they need to have an intervention that's very, very aggressive and might bring them to the brink of death, it's a different kind of discussion to have. But I don't think that it's about the therapy and how dangerous it is. I think it's about the context in which you have that discussion." 

So, basically, I feel that we have a responsibility as health care providers to offer any treatments necessary. But when you get to a certain point, where there are no other options, that's when it's time to discuss with the family what to do.

To me, this topic could go so many different ways. I don't have a strong opinion one way or another. It is really dependent on a case-by-case basis and what the individual wishes. It's ultimately up to the patient or the family members to make decisions. It is up to the health care provider to offer any available treatments. Personally, as a health care professional, I would never EVER give someone a lethal injection or push them to the point of death for any reason. I would take them off life support at the wishes of the patient or family, but I would never push that point of death on purpose. 

"This life in us; however low it flickers or fiercely burns, is still a divine flame which no man dare presume to put out, be his motives never so humane and enlightened; To suppose otherwise is to countenance a death-wish; Either life is always and in all circumstances sacred, or intrinsically of no account; it is inconceivable that it should be in some cases the one, and in some the other." -Malcolm Muggeridge


Links:
http://www.pbs.org/wgbh/pages/frontline/facing-death/interviews/
http://www.pbs.org/wgbh/pages/frontline/facing-death/