DEVTOME.COM HOSTING COSTS HAVE BEGUN TO EXCEED 115$ MONTHLY. THE ADMINISTRATION IS NO LONGER ABLE TO HANDLE THE COST WITHOUT ASSISTANCE DUE TO THE RISING COST. THIS HAS BEEN OCCURRING FOR ALMOST A YEAR, BUT WE HAVE BEEN HANDLING IT FROM OUR OWN POCKETS. HOWEVER, WITH LITERALLY NO DONATIONS FOR THE PAST 2+ YEARS IT HAS DEPLETED THE BUDGET IN SHORT ORDER WITH THE INCREASE IN ACTIVITY ON THE SITE IN THE PAST 6 MONTHS. OUR CPU USAGE HAS BECOME TOO HIGH TO REMAIN ON A REASONABLE COSTING PLAN THAT WE COULD MAINTAIN. IF YOU WOULD LIKE TO SUPPORT THE DEVTOME PROJECT AND KEEP THE SITE UP/ALIVE PLEASE DONATE (EVEN IF ITS A SATOSHI) TO OUR DEVCOIN 1M4PCuMXvpWX6LHPkBEf3LJ2z1boZv4EQa OR OUR BTC WALLET 16eqEcqfw4zHUh2znvMcmRzGVwCn7CJLxR TO ALLOW US TO AFFORD THE HOSTING.

THE DEVCOIN AND DEVTOME PROJECTS ARE BOTH VERY IMPORTANT TO THE COMMUNITY. PLEASE CONTRIBUTE TO ITS FURTHER SUCCESS FOR ANOTHER 5 OR MORE YEARS!

Medicine’s Illness (A multiple part analysis of medical treatments)

Obsessive-compulsive disorder is commonly, and jokingly, referred to as “OC Disorder”. Reflective of the current wave of hypochondriasis and increasing dependence on medical practitioners, wealthy housewives all over the world rush to their local doctors to get diagnoses and prescription drugs for their “migraines” from loud children, and their “compulsive” need to have the potpourri in the living room be lavender scented. Likewise, doctors are now more and more unable to fully interact with their patients due to an aging population and decrease in general practitioners. Patients are rushed in and out of medical offices after a quick checkup and diagnosis, and some go off to larger facilities to receive the treatment the doctor had quickly prescribed. This lack of communication between doctor and patient leads to medical paternalism, which at best allows the doctor to provide the treatment that can most effectively restore the patient’s health, and at worst puts the patient through unnecessary and painful treatments without consulting the patient first. Medical paternalism fails to take the emotional conditions of the patient into consideration and violates their freedom of choice; this not only creates a relationship between the doctor and patient based upon mistrust, but also a medical and social tradition in which doctors are given power and authority to facilitate social roles. Medical paternalism, according to Goldman in his paper “Medical Ethics: The Goal of Health and the Rights of Patients” is the fairly common practice of doctors making decisions for their patients. This ranges from not only which treatments a patient can receive, but also the information that the patient is allowed to know. Since physicians and surgeons are far more knowledgeable than patients are in terms of knowing how to properly restore health in a patient, many patients feel like it is best for the doctor to make the decisions. Likewise, many doctors believe that their medical education and expertise make them best suited to make the decisions that can benefit the patient the best, especially when it comes to prescribed medication. Currently, many pharmaceuticals available on the market have addictive qualities, such as vicodin, or ambien. The doctor, in this case according to Goldman, should be able to control how much and what kind of medication is given to the patient. If patients are given the right to choose, then they would most likely continue prescribing themselves the medication that makes them feel the best, even though that certain drug may be harmful to their bodies (1 Goldman 190). Also, Goldman points out that doctors are expected to share the same values as their patients do, which include eliminating pain, prolonging life, and returning the patient to normal functioning (2 Goldman 179). However, Goldman states that physical concerns are not always at the top of a patient’s list of priorities. While the medical practitioners may know best when it comes to which treatments are appropriate for certain diseases, they do not fully understand the emotional condition of the patient, nor are they capable of making the decision that would make the patient the happiest. Not every patient considers prolonging life, or eliminating pain the most important value. Goldman points out in his article that although doctors are knowledgeable about which medical treatment is the most effective, these treatments are not always the best when taking the patients’ emotions into consideration (3 Goldman 169). He gives the example of suicide, or when the patient does not wish to go through treatment. In this case, the most valued treatment is not one that will prolong the patient’s life, but one that will allow the patient to live the rest of their life as comfortably as possible without suffering (4 Goldman 201). If the doctor withholds information about the patient’s diagnosis in this case, then the patient’s desire to not go through a long and painful treatment is not respected, thus forcing the patient to live the rest out of their life in pain and forgo the things they wished to do before death. The patient loses out on the opportunity to write wills, or make amends with family members or friends before they die. In this case, the death is abrupt, and the patient, along with their family, is not emotionally prepared for the death (5 Goldman 208). Another issue is that when the patient is withheld knowledge about their condition and options, it prevents the patient from choosing the course of treatment that would suit them best (6 Goldman 219). Although in some cases chemotherapy may be the most effective for treating certain types of cancer, patients may choose surgery instead because they do not wish to suffer from the horrible side effects of radiation.

In Wennberg’s study “AHCPR and the Strategy for Health Care Reform”, he discovers that the course of treatment regarding prostate cancer tests and removal vary greatly amongst different hospitals and states (7 Wennberg 308). Hospitals that accepted mostly patients on Medicare were less likely to perform surgeries than those with wealthier patients. In another part of the study, he discovers that when the male patients were fully informed of their treatment options, very few actually chose to go through with surgery, even though hospitals with patients that were mostly on HMO prescribed surgery at a rate far higher than what the patients would want (8 Wennberg 324). While Wennberg concludes that more research needs to be done to determine which is the more effective method of treatment to reduce practice variation, his study also points out that doctors often pick treatments that go against the wishes of the patient. In the cases of the hospitals the accepted mostly HMOs, the course of treatment was not even decided based which treatment would be the most medically beneficial for the patient.

Groopman’s account in “True Hope, False Hope”, provides a far more emotional and intimate insight of the issue of medical paternalism than Goldman is able to provide. In this chapter from his novel The Anatomy of Hope, Groopman is a recent resident graduate seeking to supplement his fellowship stipend by working with Dr. Keyes, a fairly well known oncologist in the rural part of Southern California. While working with Dr. Keyes, Groopman meets Frances and Sharon Walker. Frances, a middle-aged African-American woman, visits Dr. Keyes for a consultation regarding her colon cancer. During the appointment, Dr. Keyes informs the Walkers that chemotherapy will be able to take care of the small spots of the tumor still left on Frances’s liver and lymph nodes, thus allowing her to live much longer, and automatically signs her up for chemotherapy the following weekend (9 Groopman 362). However, Frances’s colon cancer had progressed to Stage D, which was rarely curable. Chemotherapy in her case, would simply slow the growth of the malignant cells, and prolong her life for a year or two in exchange for several months of toxic side effects (10 Groopman 363). When Groopman asks Keyes how the Walkers should be informed, Keyes states that for people like the Walkers, ignorance is bliss (11 Groopman 364). Telling them the truth would only make Frances’s remaining time more miserable, and could cause Sharon to do badly in school.

Unaware of the true state of her condition, Frances begins chemotherapy and suffers heavily from the side effects. Three months into the therapy, a CAT scan reveals that her deposits have begun shrinking, and Keyes, finally telling her the truth, informs her that the response could indicate a partial remission. However, after further radiation therapy, Frances’s tumor became resistant to the treatment and began growing again, causing her belly to distend. Rather than informing Frances of the truth, Keyes brushes off these symptoms as mere side effects, in order to provide her hope for a few more weeks (12 Groopman 368). Over the passing weeks, as Frances’s condition worsens, Dr. Keyes begins to see the Walkers less and less, causing Groopman to have consultations with them by himself. Eventually, Groopman gives the Walkers the true statistics of the chance of chemotherapy working, and arranges for Frances to be sent to hospice care. He is then confronted by Sharon, who wonders aloud that perhaps doctors like him and Keyes did not think that people like them, African American women, were strong or intelligent enough to handle the truth (13 Groopman 372). Stunned and ashamed, Groopman awkwardly attempts to explain that they did what they thought was best, and goes home overwhelmed by guilt.

Although Dr. Keyes had hidden the truth from the Walkers to spare them misery, Groopman realizes that through deception, they had abandoned the Walkers. Of course, chemotherapy is the medically most efficient course of treatment for Stage D colon cancer, but it was not the best treatment option for the Walkers. The Walkers were not given the option to opt out of chemotherapy because they were not told the entire truth about its chances of remission, nor were they told that the chemotherapy wasn’t working when Frances’s tumor began to resist radiation. Instead, Frances was essentially forced to live the last few months of her life suffering through the painful side effects of radiation, rather than enjoying it with her daughter and family. Had she been informed from the beginning, she might have chosen instead to travel, or cross a few items off her bucket list. After her death, Groopman realizes the error of providing his patients false hope the way Dr. Keyes had for the Walkers. Although the illusion of hope can provide joy and happiness for the few months that it is available, eventually it must be shattered when the impending death of the patient can no longer be ignored. When this inevitable occasion finally comes around, the patient is left feeling alienated and bitter, unable to trust the doctor ever again.

The film The Doctor provides some insight on the roots of medical paternalism by presenting the experience of Dr. Jack Mckee, a successful surgeon who becomes a patient when he is diagnosed with throat cancer. In the beginning of the film, Jack treats his patients as merely part of his business, and casually performs open-heart surgery while dancing to his favorite tune (14 Haines). However, after his diagnosis, he finds out that his status as an attending surgeon at the hospital does not earn him any special treatment. Instead, he is forced to deal with the bureaucratic system of the hospital, as he constantly fills out the same forms over and over again, and is forced to wait when the doctor arrives late. The ENT he sees does not include him in the discussion about his course of treatment until he asks her to be (15 Haines). His radiologist tells him not to argue with his treatment plan and tells Jack, much to his displeasure, that his diagnosis and current condition has been discussed amongst other doctors already. Jack finally quits and seeks out a surgeon he personally knows to perform his operation when his current doctor refuses to allow him to choose his surgery time, telling him that since she is the doctor and he is the patient, only she has a say in when she can perform surgery on him.

During his radiation sessions, Jack begins to empathize with patients and meets June Ellis, a young woman with an inoperable brain tumor. He informs her that her tumor could have been detected early on and treated, but she had been denied a life-saving MRI in order to save the hospital a thousand dollars (16 Haines). The two become close friends and rely upon each other for emotional support, and Jack is devastated when she passes away. Appalled by the institution’s impersonal treatment of him and June, Jack resolves to become closer to his patients, and to teach his attendees to do the same.

Although The Doctor points out that the flaw with medical paternalism is that it stems from doctors and hospitals becoming too detached from their patients, the Ehrenreichs, in their essay, “Medicine and Social Control”, expands on June’s experience by pointing out that medical paternalism exists primarily as a function of social control. Society ignores the visible abuses by medical practitioners – discrimination, racism, sexism, profiteering, using the poor as teaching material – and holds that the field of medicine is politically neutral (17 Ehrenreich 54). However, the medical institution, much like many other modern institutions that rely on cash to function, work to maintain capitalist social roles and relations. In their essay, the Ehrenreichs indicate that although sickness is a disease, being sick is a social role that gives people certain rights and privileges (18 Ehrenreich 56). Since the sick role provides benefits and preferential treatment, much like how early diagnoses would have allowed June to receive surgery and extend her life, only doctors can decide whether or not a patient is admitted to that role.

Like all social roles, there needs to be certain rules to which people can be admitted or not, leading to disciplinary and cooptative social control. Disciplinary measures occur when the patient is excluded from the sick role, often due to discrimination, monetary issues, or impersonality on the part of the doctor (19 Ehrenreich 62). This ensures that not the wrong people are admitted into the sick role, such as the lower class that are needed to constantly work at their low-wage jobs. On the other hand, cooptative control welcomes large amounts of people into the sick role, preferably those also belonging to the social role of an upper class woman. Over-diagnosis in this case, keeps these women in their place by creating countless “diseases” that would discourage them from attempting to enter the working role, and condemning those who sought work outside the home as sick (20 Ehrenreich 65). However, society also encourages this type of authoritarian control because it is simply easier to place the responsibility of their problems in the hands of medical professionals (21 Ehrenreich 74).

Although Jack’s view that the medical institution has lost touch with their patients is correct, it is not due to forgetfulness, but rather that doctors have overstepped their roles as healers, and became figures of social authority instead. When a doctor allows a patient to choose, the doctor must become closer to the patient, and thus incapable of using the patient for selfish means such as profiteering or medical studies. Understanding that a stress could result from a horrible boss rather than anxiety disorder would mean lower profits for Xanax. Society’s complete and utter dependence on medical professionals to treat their each and every need gives the medical institution the power to control determine and facilitate social roles, which leads to a further reliance or complete rejection of medicine.

When considering the issue of medical paternalism, it’s important to not only think about what kind of relationship should be established between doctor and patient, but also what kind of social relationships a medical system should foster, and if the medical system has any role outside of treatment alone. Medical paternalism not only violates the patient’s freedom of choice by allowing the doctor to pick the course of freedom, but it also creates a vast distance in terms of communication and trust between the doctor and patient. The combination of dependence and impersonality then gives the medical system the authority to make decisions that affect social relationships. Although ideally it would be best to enact a sweeping law that imposes limits upon the institution itself, reform must start at the roots through the promotion of better communication and relationships between doctor and patient.

References

  • 1. Medical Ethics: The Goals of Health and Rights of Patients - Goldman
  • 2. AHCPR and the Strategy for Health Care Reform - Wennberg
  • 3. True Hope, False Hope - Groopman
  • 4. The Doctor, a movie.
  • 5. Medicine and Social Control - Ehrenreichs

QR Code
QR Code medicine_s_illness (generated for current page)
 

Advertise with Anonymous Ads