Month: August 2020

Unit 4 Journal Entry

Healthcare and Sicko

Imagine your fictional character is in need of medical care. Consider their social and economic situation and the likelihood of them having insurance. Be very specific as you determine not only whether they have medical insurance but also what that coverage encompasses. Think back to the movie as well as the lecture on healthcare delivery… does insurance guarantee that one can access medical care? What about rising copayments, employer and employee contributions? As you think about your character trying to access care, consider, too, their experience of healthcare in the United States.

Now imagine your character is visiting another country, or perhaps they even live there. You may choose any country to focus on… preferably one showcased in the film. What is your experience? How does it differ from your experience in the United States?

                Sam has already had some experiences with the issues of the high cost and availability of healthcare. He has seen how the high cost of health care has affected his family. His mother had been diagnosed with leukemia about five years ago. She had received chemotherapy at that time and had been in remission for almost three years. Sam’s family had significant struggles to obtain coverage for many of the treatments his mother had received and they are still paying for co-payments and fees that were charged at that time. During a doctor’s visit about a year ago it had been found that her cancer had returned. She is receiving more chemotherapy and she is on the waiting list for bone marrow treatments. Sam had health care coverage from his father’s health plan through his father’s small business. When the costs of his mother’s care became to great his father had to drop Sam’s coverage. Sam had to pick up coverage under the ACA program.

Under the ACA Sam has some basic health care coverage. He has however found that he had to change his primary care provider (PCP) as the doctor he had previously been seeing had changed to a managed care system and would not accept patients with ACA insurance. Sam did find it difficult to get an initial visit with a PCP as many offices that he called were booked a few months ahead.  Sam is also struggling to pay his portion of the costs for the ACA coverage. He works part time so his earnings don’t always meet all of his expenses. His employer does not provide any health care benefits to people who work less than 30 hours per week. Sam is required to have health care coverage though in order to attend classes at the community college.

Sam has been able to have a routine checkup through his current PCP and his overall health has generally been good. He did recently seek treatment from a practitioner of acupuncture for some chronic headaches. This treatment was recommended by his PCP after Sam had experienced some side effects from taking medications. Sam had also talked about this option as he had a good experience with trying acupuncture during a college health fair that he had attended. Sam does have to pay out of pocket for the acupuncture as this service id not covered under his ACA plan.

            About a year ago Sam had been visiting a college friend in Canada. The friend had a minor bicycle accident while they were out riding on a trail near where the friend lives. Sam had helped his friend to get to the hospital and had waited there with him. Sam was surprised that the care there was, from what he saw very efficient. His friend was seen in the emergency room after about a half hour wait, he received an x-ray for his ankle injury, he had been evaluated by the doctor and had received an ankle support and a prescription for some pain medication. When Sam talked with his friend afterward, he asked what it would cost for the friend’s hospital bills. His friend explained that everything was covered under the national health plan. Sam was a bit shocked that it was so easy for his friend to get the care he needed, as his personal experiences were quite different.

Unit 3

Journal Entry

Francis DeMers

Imagine that you are a patient being treated by Dr. House. Consider an illness that your fictional character is likely to have, and outline House’s approach in treating it. Does he listen, is he interested in you, do you think he considers some of the limitations associated with biomedicine? Given DTC advertising what are your expectations around treatment?

Sam has booked an appointment at the hospital’s free clinic. He has been having chronic headaches and neck pain, he is starting to get tingling and numbness down both of his arms. He has had some trouble sleeping, although he is not sure if it is due to the headaches. Sam is examined by Dr. House. Sam is somewhat offended by House’s brusque manner and apparent lack of empathy.

Dr. House conducts a routine exam and has bloodwork drawn for analysis. He asks several somewhat obscure questions, asking if Sam has been out of the country recently “No, I can’t afford to travel is Sam’s reply.” Has anyone you live or work with traveled out of the country? “Not that I know of? “Have you been swimming in the last several weeks?  “I swam in a friend’s pool about two weeks ago.”  Was the water clean?  “As far as I could tell, there was a lot of chlorine in the water.” Dr. House continues to ask questions, but doesn’t really seem to pay much attention to Sam’s answers. He does examine Sam’s skin very closely, but he gives no indication of his findings. 

                Dr. House tells Sam that he would like to admit him to the hospital for further testing. He is recommending a CT scan and an MRI along with other tests. He tells him that he believes Sam might possibly have picked up a viral infection from the pool water. Sam tries to explain that he really can’t afford to take time off from school or work right now and he asks, “Can’t you just give me some pills for the pain?”  Dr. House responds “When did you get your medical degree and what makes you think I’m going to give you pills, when I don’t know what’s wrong.”  Once again Sam is taken back by Dr. House’s manner and he asks if he can be seen by another doctor. Dr. House replies: “Oh of course you know better than I do what is wrong with you!” Sam is now offended and he says that he is going to leave and go somewhere else.

                This is my interpretation of how I anticipate a visit with Dr. House would go based upon the way I saw the character portrayed in the show. Dr. House is portrayed as a very competent physician but he is generally lacking in “people skills” and his “bedside manner” is not his strongest skill.

                The show does portray the use of often invasive and at times excessive testing and diagnostic procedures. Dr. House works with a team that tries to determine the cause, of difficult to diagnose illnesses. He does have a tendency to look for unusual or unique causes for the illnesses that he sees. I do think though that Dr. House also has a certain distrust for the “medical system” as he was a victim of a medical error. His brusque and offensive manner is also due in part to both his expertise and his personal experiences. He may have some good reasons for his typically rude behavior but he shouldn’t allow it to interfere with his treatment of his patients. Dr. House is also jaded by his work and he often allows his ego to interfere with his practice of medicine.

                As portrayed on the show Dr. House does generally follow the typical procedures of the biomedical model. He does frequently use some rather unconventional methods but he doesn’t appear to embrace any form of alternative medicine.

                I do think that Sam would expect an easy solution to his headaches, DTC advertising sells us on the answers to all of our problems being contained in a pill. Sam would probably leave the appointment feeling disappointed with his treatment and without an actual solution to his medical issues.

Unit 2 Journal

Medical Sociology

Frank DeMers

For this entry consider the social sources of morbidity and mortality. You may consider the following questions:

1. How are you (your fictional character) affected by the distribution of food? In other words, is food plentiful in your society, do you have the wealth needed to buy a healthy diet?
2. How are you (your fictional character) affected by the distribution of food? In other words, is food plentiful in your society, do you have the wealth needed to buy a healthy diet? How do cultural forces affect how you consume food? For example, how does nationality, social class, ethnic group, age, gender, and more affect how you consume food?
3. Consider a day in your life… what transport is available to you, if you’re employed what are the conditions of your working environment? At home, what sort of proximate environmental factors affect you?
4. As you consider all these points, be sure to reflect on how these material factors affect your health… are you affected in adverse or positive ways?

When considering this from Sam’s point of view, I find that he has access to sufficient sources of food. He does however face some social challenges that may cause some difficulties with obtaining food that would support a healthy diet. Sam is working part time at a grocery store so the supply of food is readily available. His income and current social status are probable contributing causes of issues with access to food.

Sam as a white twenty – year old male from a middle – class background had good nutrition through his early youth and until he had moved out from his family home. He currently has no health issues related to malnutrition or insufficient access to food.

When Sam was attending college full time, he had access to food at the cafeteria. There were many food options, but as often the case Sam would choose the foods that were readily available. He would often select food that was quick to grab so that he didn’t have to wait in long lines. In many cases this consisted of fried and fatty foods. Sam did notice that he had started to gain some weight during his freshman year so he did make an effort to increase his exercise routine and to be more selective with his food choices. Sam’s current challenges though may start to influence his health. He has a high level of stress. His income has currently been impacted by the relatively low wages he is paid and the fact that he is working part time.

            Sam is experiencing economic challenges as his part time work doesn’t cover his expenses. He has to pay rent and part of the utilities for his shared apartment, he has to pay for fuel, maintenance and other costs for his vehicle. He also has to pay for his tuition costs and when he can, he tries to help his family with bills. With all of these expenses he doesn’t have much money available for food. His roommates do sometimes go in together to buy food, but that usually consists of pizza or takeout /delivery of fast food. As with many young males of this age group alcohol consumption is also a factor. One of Sam’s roommates is over twenty -one and they all “party” at times with their peers. Sam does enjoy spending time with his friends but he really is not into the party scene.

            When Sam is working he will often pick up some food before he leaves work. He does sometimes have time concerns due to classes or when he has scheduled time to drive for Lyft. Although he is aware of healthier eating options, he does find that fresh produce, lower fat foods and healthier food options are often more expensive than prepared foods. He has also found that his roommates will sometimes grab some of his food if he leaves it. The roommates are supposed to share but they tend to buy fast food meals that are not very nutritious.

            Sam has his own car and has ready access to sources of food. His working environment is generally safe, he does stocking work, some general cleanup in the store and he is sometimes assigned to the checkout area of the store. He does have some current concerns at work due to the current Covid -19 pandemic. He is exposed to a large number of people every day. He has been taking appropriate precautions whenever possible. He wears a face mask, tries to maintain social distancing, and to follow other preventative measures.

            As Sam is now twenty he is becoming more aware of some of the current and future life challenges he may be facing. His mother’s relapse and the financial challenges his family has faced recently have both made him more conscious of his spending habits. He is trying to save money to pay for his previous student loans and to cover his community college tuition. Although Sam’s father had a steady income from his business, current circumstances have made that more uncertain. His mother had worked part time as a medical receptionist, she is currently on leave due to her illness.

            Sam has tried to be more aware of his health and of his eating habits, his level of stress though is a potential contributing factor that could begin to effect his health.