QUIZ 4 Medical Education and Physician Training

QUIZ 4 13 December 2024 22:02 QUIZ 4- Study guide Medical Errors o What are the majority of errors caused by? Medical Education and Physician T...

QUIZ 4 13 December 2024 22:02 QUIZ 4- Study guide Medical Errors o What are the majority of errors caused by? Medical Education and Physician Training – Progression to Capitalism - Faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent Flexner Report o Personal vs. Systems Approach and Failure - Conducted by Abraham Flexner - Personal approach: assign blame and shames individuals - the report revolutionized medical education by closing substandard schools - Systems approach: recognizes ppl make mistakes, improving and promoting rigorous scientific training processes - three categories: Johns Hopkins, inadequate/improvable, substandard/shut - Systems approach failure: faulty health systems and processes, poor down working conditions - Set Johns Hopkins as the gold standard and emphasized the biomedical o Z-DoggMD – Nurse RaDonda Vaught video model ▪ He lists a whole list of stressors for all health care professionals NYT - Black American Deaths, and a Paper from 1910 - RaDonda was nurse- had to override med becuz Vanderbilt was - Disparities in healthcare outcomes for Black Americans- die at higher rates having EHR systems issues - Showed systemic issues in education and healthcare accessibility dating back - Highlights the immense stress healthcare workers face, including to early 20th century policies understaffing, EHR challenges, and emotional tolls White Privilege in a White Coat: How Racism Shaped My Medical Education Trends (multihospital chains/systems & medical practices) - Racial inequities in medical education- white physicians & patients favored - MHCs: consolidation of healthcare entities increases costs and reduces - Racism has shaped professional norms and restricted opportunities for competition; more clout to negotiate w health insurance, supplies, etc. underrepresented minorities in medicine What is the take home message of Sutter Health (How Sutter Health Grew Slides summary to Gain Market Power and Drove up California Health Care Costs - 60 - MARKET: market forces influenced rise of medical profession, industrial rev, Minutes segment in a transcript) physician benefit if they control - Sutter Health (hospital chain) became too big & monopoly in COVID- - PHYSICIAN CONFLICT AND CONSOLIDATION: feuds b/w physicians, 1847- ravaged CA- consolidation leads to higher costs AMA formed, urbanization and specialization led to acceptance - Sutter’s market power in California led to inflated costs without improving - PARALLEL EDUCATION: university affiliated (non-profit, expensive & outcomes exclusive); independent (for profit, inferior, mostly blacks & women); licensure Cross-National Comparisons of Health Care - LATE 19th CENTURY: increased rigor, stricter standards, teaching hospitals - PHYSICIANS: didn't want hierarchical control; doctors succeeded in avoiding Four models of care and the countries that have adopted them hierarchical subordination (relationship w patient) - Beveridge (UK, NZ): National Health Service Model, universal coverage, - POSTWAR POLICY: advance medical research and hospitals, NIH grants, new fully govt funded, free at point of service med schools- increased specialization, distancing research and clinical - Bismarck (Germany, France): shared financing, employer-sponsored services insurance, govt doesn't own hospitals, regulated prices, multi-payer - STUDENTS TODAY: common curriculum req, lawsuits - Patients sue less often when they feel heard and understood (high U.S. Health Care System & Reform satisfaction) Physician and patient expectations and attitudes regarding race History of repeated failures (for universal healthcare) - Physicians may subconsciously underdiagnose or undertreat minority - Attempts since WWI have been stalled by ideological divides, lobbying, patients and systemic inertia - Blacks and low SES were perceived as less favourable than whites and high Why Socialized Health Care is Unjust SES patients in study by Ryn and Burke (2000) - individual liberty, fear of government overreach, and inefficiencies Health outcomes between black and white doctors There is Never A 'Free Market' In Health Care - Black patients have better health outcomes with Black physicians due to - Healthcare operates under constraints like regulation, market failures, and improved communication and cultural competence third-party payers Age bias The Three “isms” soc of med Page 1  Health outcomes between black and white doctors There is Never A 'Free Market' In Health Care - Black patients have better health outcomes with Black physicians due to - Healthcare operates under constraints like regulation, market failures, and improved communication and cultural competence third-party payers Age bias The Three “isms” - Physicians may stereotype older patients as frail or cognitively impaired, - Federalism (individualism), capitalism (market forces), socialism (NHI is leading to under-treatment or neglect slippery slope) - Not all older people are the same Medicare history Race and Ethnicity Systemic assumptions that affect physician – patient - Govt coverage for elderly, leverage social security, incrementalism interactions (restricted to elderly), AMA opposition - Assumptions about pain tolerance or compliance affect treatment Medicaid: for the poor, cost sharing b/w federal govt and states - Institutional biases perpetuate disparities What has stopped true health care reform EHR/Use of scribe - Distrust of government, powerful interest groups, don't like taxes, - Heavy reliance on Electronic Health Records decrease patient satisfaction ideological divides, fear of socialism and limits face-to-face interaction (under ACA) Individual Mandate – why is it important - Scribes help maintain patient engagement - Req most americans to have health insurance mp3 file (approx 2:40) Black Americans Expect to Face Racism in the Doctors - Ensures risk pooling and prevents adverse selection, stabilizing insurance Office KFF Survey Finds markets - Explored perceptions of systemic racism in healthcare. Achievements & Limitations of ACA (Obamacare) - Many Black Americans anticipate bias during doctor visits. - Achievements: Expanded coverage, protected pre-existing conditions, Getting to Know Our Patients more access at lower cost - Personal connection improves outcomes and trust. - Limitations: High deductibles/ out-of-pocket, still many uninsured, less - Focus on holistic care and understanding cultural contexts. out-of-network coverage Women Are Calling Out ‘Medical Gaslighting’ The Moral Crisis of America’s Doctors This was only recommended, but I - Many women feel dismissed or misunderstood in clinical settings. want you to read this. - Calls for greater awareness and training in gender-sensitive care - burnout, ethical dilemmas (patients face high costs), job dissatisfaction and alienation from profession Providers & Teams The video on *United Health Care that was in the lecture, as well as the Vox videos The criteria for nursing that do and do not constitute a profession - corporate influences on healthcare costs and systemic inefficiencies - Meets criteria like specialized knowledge, training, and altruism - but lacks 2 characteristics: full autonomy and authority, remaining subordinate to physicians Nurses: lack of full autonomy, subordination to physicians - Despite critical roles, nurses have limited decision-making power, reflecting historical subordination - Florence nightingale: founder of nursing profession & first school, civil war displaced nursing effectiveness Differences between nurse practitioners and physician assistants - NPs: Higher autonomy, often focus on primary care, poor pay - PAs: Work under physician supervision with broader scopes, better pay Article: Commentary on ‘The Changing Medical Division of Labor’ - Evolving roles of healthcare workers- nurses expanded their influence and understand patients better - Challenges like role ambiguity and scope conflicts Complementary and alternative medicine practitioners - Chiropractors, acupuncture, diet supplement, yoga, meditation Ways that teams can improve care - Emphasize collaboration, clear goals, multidisciplinary expertise, coordination on floor and off floor Team roles and responsibilities - Evaluate condition, treat, and manage patient care effectively Characteristics of effective teams, outcomes, barriers - Clear goals, strong communication, measurable outcomes, and shared responsibility - Outcomes: improved care to patients; effective use of resources; improved recruitment & retention - Barriers: changing roles, hierarchies, unstable teams, individualism soc of med Page 2