Blog #4: Do Doctors Judge Patients Based on their Color and Ethnicity?

After reading the article titled, “Does your doctor judge you based on your color?” written by Elizabeth Cohen, I questioned myself and wondered if physicians and health care professionals judge their patients based on their color or ethnicity. The story starts with John Reid, a retired African-American businessman going to the emergency room in New York City because he had an infected toe. He claimed that the doctor’s immediate solution was to order an instant amputation. They even explained to Reid that they were going to be able to schedule him for an immediate surgery right then and there.

Of course, Reid did the smart thing to get a second opinion from another senior doctor who simply “prescribed a long-term regimen of intravenous antibiotics and physical therapy” (Cohen, 2009). Despite the fact that this treatment was a lot more expensive and a lot of more time consuming, in the end, it did indeed save him from having to amputate his entire toe.

With this particular case, it makes patients wonder if an individual gets treated differently based on their color or perhaps the language that they speak, or where they are from. Professionals at times take advantage of a patient’s ignorance on the field of health care and choose to disrespect one because they are considered a minority. It can be said that health care professionals sometimes assume that minorities cannot make a competent medical decision on their own. Studies do now indicate that white and black patients are treated differently not just in the health care facility, but in everywhere else. Throughout the decades, many aspects in regards to race and ethnicity have changed. Nevertheless, there is still much more to come.

In 2005, studies indicate that “African-American cardiac patients were less likely than whites to receive a lifesaving procedure called revascularization, where doctors restore the flow of oxygen to the heart,” (Cohen, 2009). This is just one out of the many different case studies that have been conducted in regards to racial profiling. The most unfortunate part remains on the fact that the quality of care of such patients is to a certain extent limited. Racism and stereotype is a very common experience that patient’s with different races and ethnicity feel. All there is to do at the moment is to tell such individuals to go seek health care services with another doctor… a doctor that does not discriminate nor stereotype.

• Reference
• Cohen, Elizabeth. "Does your doctor judge you based on your color? - CNN.com." CNN.com. 26 July 2009. Web. 28 July 2009.

Blog #3: Patient's Perspective

To begin, I would like to take the opportunity to define adverse event as the following, “an injury caused by medical management rather than the underlying condition of the patient” (Kohn et al., -----). I do believe that the perspective of the patient is the most important determinantas to whether an adverse event has occurred. It can be said that at times, an adverse event may not have occurred; nevertheless, as health care practitioners abide by the law of ‘duty to care’, it is important for them to acknowledge the current situation. The term ‘adverse event’ in itself is stating that a condition has been brought upon that is out of the reach of the patient. In other words, the error derived from the health care organization. To prevent lawsuits and liabilities and to satisfy legal criteria, a patient’s perspective must be considered an important determinantas to determine whether or not an adverse event has truly occurred. If health care organizations choose to refuse a patient treatment or refuse to prioritize such an event, then it falls upon the facility/hospital that has failed to provide and to meet a reasonable standard of care for the patient in question.

As a health care professional, the patient’s point of view is extremely important. Without the patient’s opinion and information based on how they currently feel, a proper medical diagnosis cannot necessarily be provided. Personally, I believe that regardless of how big or how small an issue truly is, the patient always comes first and they should be treated, or at least stabilized. Working at the Community Living Center at the Orlando VA Medical Center, often times we see patients who fear to acknowledge a problem that has occurred or something that they are currently feeling. In reality, I believe that patients should share their perspective when an adverse event has occurred. After all, they are the ones who have truly been affected. If health care physicians and medical personnel have committed an error, whether by carelessness or mistake, I personally believe that they should seek a solution to the adverse event and realize what the problem is. If not, this act of negligence will indeed repeat itself.

I try to think about this particular situation this way… imagine someone dialing 9-1-1. Now imagine them not being acknowledged because the representative on the other line ‘believes’ or ‘assumes’ that it is truly not an emergency. If the issue is put to the side, regardless of whether there is truly an emergency or not, something has to be done. This is just to avoid bigger issues and to take the proper precautionary actions to prevent an adverse event in the near future. In the end, the primary goal of any health care organization is to ensure the patient’s safety. Therefore, it can be said that the perspective of a patient is essential to ensure the quality of care provided by physicians and medical personnel.

• References
• Kohn, L. T., Corringan, J., Donaldson, M. S., & Institute of Medicine (U.S.) Committee on Quality of Health Care In America. (2000). To Err Is Human: Building a Safer Health System. New York: National Academies P.

Blog #2: After-Hours Health Care Centers: A Way to Improve Quality Health Care

It has been estimated that over half the visits that individuals pay to go to the emergency room can be avoided or handled at an urgent after-hour health care center (Tama, 2005). The quality of care provided in emergency rooms will most definitely improve if individuals, along with their families, can gain access to an after-hour health care center near their neighborhood. Recently, I stumbled upon an article published on June 11, 2009 titled “After-Hours Doctor Calls Save Holland Money” written by Patti Neighmond. The extract briefly describes United States’ current health care system with the Netherlands. Nowadays, there has been an outrageous amount of Americans that are either underinsured or uninsured. To break it down into further discussion, this means that a great proportion of the U.S.’s population do not have a primary physician or a primary care provider in which they visit on a regular basis.

When something abrupt occurs out of the norm, a lot of people end up in their nearest hospital emergency room. Two different common scenarios occur over and over again at the emergency room. Scenario one: half of the visits from individuals going into the ER are categorized as non-urgent. This clearly means that patients could have been treated effectively in a regular doctor’s office or a neighborhood clinic in the first place. Scenario two: costs for emergency room visits has been increasing more and more over the past few decades and a lot of ERs nationwide “have had to close their doors or limit their hours as a result of out of control, burdensome costs” (Neighmond, 2009).

After-hour health care centers provide services to individuals and families who have medical situations and issues that are not considered an emergency, but still require some form of an immediate attention. The health centers, for the most part, are open beyond their normal business hours of 8:00am to the standard 5:00pm Monday through Friday. Some health care centers provide flexible hours of operation to help working families visit the hospitals or clinics after 5:00pm either on a walk-in basis or with a scheduled appointment. Neighmond points out that in the Netherlands, there are primary health care providers that are available 24 hours a day and 7 days a week for their citizens. The United States health care system needs to quickly adopt such methods as well. In the short run, it may not be as effective because not a lot of people are aware of the after-hour health care centers. Nevertheless, in the long run, not only will individuals reduce the costs of their ambulance fees, but they will also receive better quality of care with friendlier physicians who can spend more time really focusing on the issues at hand. Eventually, this will be better for any individual’s health care budget. Emergency rooms can provide better services to patients who are really either in danger or in the need of immediate attention.

Currently, there are many children that end up in the emergency room with a condition that is clearly not classified as an ‘emergency’. It is not hard to understand why parents end up taking their children to the ERs. First of all, parents can take their children to the hospital without waiting for an appointment. Second, the ER is open 24 hours a day and 7 days a week. Parents are not aware that there are cheaper alternative health care services for their children during the weekday and on the weekends. The American health care system must educate parents about after-hour health care center’s availabilities. Perhaps they may have to provide such individuals and families with an incentive to use such after-hour clinics, instead of having them turn to emergency room visits for common services that are not considered an emergency after all. With after-hour health care centers, patients will receive better quality of care regardless whether the visit is done on a walk-in basis or with a scheduled appointment. Patients will still be seen by a board-certified doctor or by a primary care physician. Treatments, for the most part, are available for patients of all ages. If additional medical assistance is required beyond the expertise of the primary care physician, the proper referrals will be made to the right specialist. If an immediate life threatening situation occurs, the majority of the after-hour health care centers will arrange a form of transportation for patients to the nearest emergency room around the community.

Some of the following common services listed below demonstrate what an after-hour urgent care health center can handle:

-Minor asthma-related symptoms
-Minor cuts
-Minor skin rashes
-Animal bites with controlled bleeding
-Minor sunburns or burns
-Broken bones or sprains
-Earaches and ear infections
-Coughs or sore throats
-Fever
-Illness related to nausea, vomiting, and/or diarrhea
-Bladder infections
-Minor upper respiratory problems
-Insomnia

After-hour health care centers will dramatically improve the quality of health care provided to many individuals and families residing within the United States. This will prove itself especially useful and functional for individuals and families who work during the normal business hours. These centers are continually expanding; however, it is essential that such health care centers are made accessible for the majority of the population.

• References
• Neighmond, P. (2009, June 11). After-Hours Doctor Calls Save Holland Money. In National Public Radio. Retrieved June 11, 2009, from http://www.npr.org/templates/story/story.php?storyId=92606938
• Tama, M. (2005, March 26). Emergency room visits reach record high. In MSNBC. Retrieved June 11, 2009, from http://www.msnbc.msn.com/id/7995137/

Black Women who are Refusing Breast Cancer Treatments...

An article titled “Many Black Women Refuse Breast Cancer Treatments” written by Steven Reinberg was published last week on May 22, 2009 stating that nearly 25 percent of the black women population within the United States have been diagnosed with advanced breast cancer yet choose to deny chemotherapy and radiation treatments. Despite the fact that black women residing within the U.S. have a lower chance of developing breast cancer compared to white women, their cancers, when diagnosed, are at an advanced stage with higher risks that requires more aggressive treatments (Phend). I personally decided to choose this article because I find it very worrisome that the black population, which has almost “twice the rate of advanced breast cancer” when compared to white women, are choosing to diagnose and check themselves when the tumor has already progressed profoundly. The worst part is that the black women, who know about their condition, choose to refuse any form of treatment.

Reinberg points out that Dr. Monica Rizzo, an assistant professor of surgery at Emory University School of Medicine in Atlanta, has lead a team into conducting research in regards to this particular issue. Dr. Rizzo’s team was able to conclude that out of 107 women diagnosed and reported with breast cancer within the years of 2000 to 2006 in an inner city hospital, 87 percent of the women were black, and 20.5 percent of such population refused any form of chemotherapy and 26.3 percent of the patients refused radiation treatments. With such statistics that are provided within the tip of our fingers, I believe that the society truly needs to start making some awareness programs that drastically targets the black population. At times, it is made apparent that certain issues such as cultural and social differences come into the picture. For example, studies have shown that black women fear the medical system and a lot of them cannot afford to get time off from their own work to go to the hospital to get treatment. Religion can also play a major role in this particular situation as black women may have misconceptions about breast cancer itself and become hesitant about seeking medical assistance and treatment. Reinberg does mention that Dr. Rizzo’s team has started a community outreach program; nevertheless, a lot more has to be done from this point forward. The black community does play a major role within our economy and within our society. It is very important for the U.S. to educate and to inform all women, about the potential hazards and treatments that are made available to breast cancer victims, especially among the black women population. If this issue becomes a continuous trend, then outcomes will definitely be affected. This is something that can be detected and treated, but only with the effort of the community as a whole. Education, persistency, and support is a start to help women with breast cancer, especially for black women.

• References:
• Phend, C. (2009, March 25). Triple-Negative Breast Cancer Rates Higher in Black Women. In BreastCancer.org. Retrieved May 26, 2009, from http://www.breastcancer.org/symptoms/new_research/20090325.jsp
• Reinberg, S. (2009, May 22). Many Black Women Refuse Breast Cancer Treatments. In Forbes.com. Retrieved May 26, 2009, from http://www.forbes.com/feeds/hscout/2009/05/22/hscout627351.html

Daniel Hauser rejecting Chemotherapy: Parental Medical Negligence

After following up with the headlines for consecutive days, I have to say that one of the most alarming cases that I found very interesting yet worrisome is Daniel Hauser’s mother refusing chemotherapy for her son. To begin, let me briefly give you a recap of the headline. Daniel Hauser is a 13 year old boy from Minnesota who has been diagnosed with Hodgkin’s lymphoma. Around the first week of May, oncologists have claimed that, “given his state and type of tumor, he could normally expect at least an 85% chance of surviving and perhaps even greater than 90%... without therapy he is certain to die of his disease, barring a rare spontaneous remission” (Orac, 2009).

Daniel’s mother, Colleen Hauser, has refused chemotherapy treatment for her son. The Hauser’s have been taken to trial. Written in a 58-page ruling, Brown County District Judge John Rodenberg has issued an arrest warrant for Colleen due to the fact that Daniel has been medically neglected when there is a clear cure for his illness. Judge Rodenberg has stated that Daniel can remain in the custody of his parents, Colleen and Anthony Hauser, if they get an updated x-ray and select an oncologist for him by May 19th.

When headlines blew up about Daniel and Colleen’s disappearance, my interest towards this case immediately increased. Days after their run, Daniel and Colleen did voluntarily return back to their home. They did after all decide to follow the court order. Daniel’s parents initially decided to withdraw their son from treatment after he had attended one round of chemotherapy session. The parents claimed that the side effects were too strong and devastating. The Hauser’s wanted to find another treatment plan for the remedy of their son’s illness (Harkness, 2009). I personally believe that it is outrageous for the parents to even considering finding a treatment plan that consists of herbal supplements, vitamins, and ionized water, when oncologists are providing a substantial amount of medical evidence claiming that the chemotherapy can indeed prove a 90 percent success rate!

Ethical values do come into the picture as the public attempts to rationalize Daniel’s parents’ actions. Negligence is presented as the parents allege that medical alternatives should be sought due to their religious beliefs (Dailey, 2009). As the x-rays report, the tumor has grown since the first time his parents chose to disregard and forgo chemotherapy. I strongly believe that Child Support Services and the Minnesota Legislature have taken the proper steps towards bringing this case into the court’s hands. In Judge Rodenburg’s ruling, he indicated that the “state’s interest in protecting the child overrides the constitutional right to freedom of religious expression and parent’s right to direct a child’s upbringing” (CBS Broadcasting, 2009).

This case continues to be very controversial and it captivates my attention as the state attempts to intervene the Hauser’s method of upbringing their 13 year old son with Hodgkin’s lymphoma. The public, the health care system, numerous states, and the Nation itself have different opinions about this headline story. What makes the Hauser’s case even more notorious are the ongoing debates about whether the government should have the right to intervene and have the judicial system protect Daniel from medical negligence.

Currently, the judge has ruled the case and ordered Daniel Hauser to undergo his chemotherapy treatment. Colleen has agreed to take her son to the chemotherapy sessions. The oncologist has also agreed to allow other safe alternative treatments to be provided to Daniel in addition to the chemotherapy. It is chaos that this particular situation had to reach the hands of the judicial system. It is hard enough to be a teenager fighting with lymphoma, let alone have parents that are generating so much publicity into this particular case. Daniel truly needs to focus on battling with his cancer and regain his health and strength again.

• REFERENCES:


• CBS Broadcasting. (2009, March 15). Minn. Judge Orders Parents to Treat Son's Cancer. In CBS5. Retrieved May 31, 2009, from http://cbs5.com/national/chemo.therapy.ordered.2.1010515.html


• Dailey, K. (2009, March 19). Parents' Rights, Judges' Rules: in the battle between families and the courts over medical treatment for kids, who has the last word? In Newsweek. Retrieved May 31, 2009, from http://www.newsweek.com/id/198397


• Harkness, K. (2009, May 19). Judge rules family can't refuse chemo for boy. In MSNBC. Retrieved May 31, 2009, from http://www.msnbc.msn.com/id/30763438/


• Orac. (2009, May 12). Daniel Hauser and his rejection of chemotherapy: Is religion the driving force or just a convenient excuse? In ScienceBlogs. Retrieved May 31, 2009, from http://scienceblogs.com/insolence/2009/05/daniel_hauser_and_the_rejection_of_chemo.php

BLOG #1: What Does Quality Mean to You?

Who determines the amount of quality that one receives? Do we all want quality? Do we all know what quality means? All these questions come about when the term ‘quality’ is mentioned. Just by going into the Marriam-Webster dictionary online, readers can view that there are 8 different definitions for the word ‘quality’ (‘quality’, 2009). To describe quality, an individual must be able to differentiate the category in which the word falls under. For instance, when speaking about quality, the word can be referred to an economic, environmental, social, or a service related problem. Specifically targeting the quality within the health care arena, I believe that quality improvement and management has to be strictly enforced.

I believe and I hope to see that all providers pursue quality as equally important in all sectors of the health care facility. Based on the behaviors and the actions provided by medical personnel, quality can be determined based on the cost and the effectiveness of the services that are provided. Personally, I believe that quality of care is not so much about how long I wait to see a doctor, but instead, the quality of care that I receive from the doctor who treats me. There was a reason why I asked ‘Who determines the amount of quality that one receives?’ A continuous trend can be seen that the higher an individual lies within a social network and class, the more likely they will be seen and treated faster in a hospital visit. This lies within the mere fact that the more money a patient possesses, the better the quality of service they will receive. Unfortunately, this is a very disturbing statement, but it is nothing but reality. The statement has been made in numerous books, such as in Money Driven Medicine written by Maggie Mahar and in Your Money of Your Life: strong medicine for America’s Health Care System written by David Cutler.

Besides the wait time period, the medical depth of the medical diagnoses provided also determines the quality of service that a patient is receiving. For the most part, doctors speak in medical terms because of their advanced level of knowledge that they have with certain medical conditions. A health care provider that offers outstanding quality of care would take the time to have medical personnel, perhaps not the doctors themselves due to their tight schedules, explain what type of treatments, medications, and services the patient’s medical condition entails.

In a clinical setting, quality is measured based on statistics and figures retrieved on overall accidents, injuries, mortality rates, among other analysis (Beckford, 2002). To achieve the quality standards that a health care provider desires can be both time consuming and expensive. Nonetheless, ensuring consumers and patients the health care services that an individual deserves will be very rewarding. The government, major affiliations, and other medical corporations should provide incentives and a greater sense of encouragement for the health care system to constantly strive to improve the quality of care provided to individuals and families.

The attempt to improve quality of care should benefit not only the patients, but it should also promote the utmost good faith of health care providers. When medical personnel take their time towards providing efficient and effective services, they are also acknowledging their patients by being considerate, attentive, responsive, and most importantly, supportive. Quality of care, as described in The Healthcare Quality Book, illustrates the six aims and dimensions in which the Institute of Medicine (IOM) has established to improve quality of care. The six aims are the following: safe, effective, efficient, timely, patient centered, and equitable (Joshi, Nash, and Ransom, 2008).

It is essential for health care facilities to minimize the number of minor and crucial errors conducted within the medical field. Ultimately, quality of care should aim towards completely eliminating all forms of communication barriers. Patients want to know that they are the center of the attention when they are being treated. I also believe that it is very important for individuals going into hospitals to see that doctors, nurses, and other medical personnel can hold a good relationship with one another. In return, quality of service for me is also defined as one where the doctor and employees are friendly, welcoming, and want to create a special rapport with their patients to get to know them better. Perhaps if better quality of care was provided, children and other individuals will have less fear towards going to the hospital. This in return will increase the amount of visits that one would pay to go to doctor for their annual check-ups and preventive care services. One can say that the legal justice is blind and that all men and women are created equal. Nevertheless, the U.S. health care system is set up in a way where your health benefits and your social status determines the quality of care that you will receive.

• References:
• Beckford, J. (2002). Quality (2nd ed.). New York: Routledge.
• Cutler, D. M. (2005). Your Money or Your Life: Strong Medicine for America's Health Care System. New York: Oxford UP.
• Joshi, M. S., Nash, D. B., & Ransom, E. R. (2008). The Healthcare Quality Book: Vision, Strategy, and Tools (2nd ed.) (S. B. Ransom, Ed.). Chicago: Health Administration P.
• Mahar, M. (2006). Money Driven Medicine: The Real Reason Health Care Costs So Much. New York: HarperCollins.
• Quality. (2009). In Merriam-Webster Online Dictionary. Retrieved May 27, 2009, from http://www.merriam-webster.com/dictionary/quality.

Welcome to my Blog...

Hello everyone, My name is Antonio Hori and I am an 8 year Navy Veteran. I have gone through two tours to the Middle East. I have a Bachelor's Degree in Health Services Administration and I am currently pursuing my Master's Degree in Engineering Technology. I am short 2 classes for Graduation after this summer. I work at the Orlando Veterans Administration Medical Center as an Intern, working on the facility's policies, SOP's, and on the new patient software system "Vista" which will lead us to the opening of the new Hospital at Lake Nona.

After 2 surgeries and multiple endless appointments at the VA, I have come to realize that the VA is in the need of fresh and innovative ideas and a structural change on how services are truly rendered to our veterans. With that in mind, if I fully recover from my surgery and I am found fit for duty again, I see myself in 5 years as an Air Force Medevac Officer, providing logistics and Aeromedical Evacuation at one of our overseas facilities in Iraq and/or Afghanistan. My second back-up plan would include becoming the new Program Director for the Operation Iraqi Freedom and Operation Enduring Freedom Soldiers Program at the Lake Nona Hospital.

I am definitely very excited to start this new blog and hope to learn a lot throughout this course for the semester!