Home Health Care Management & Practice
2005; 17; 146
Home Health Care Management Practice Yu Xu
U.S. Healthcare Systems: A Critical Critique http://www.sodocs.net/doc/82e740d8a58da0116c1749ce.html
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U.S. Healthcare Systems: A Critical Critique
Yu Xu, PhD, RN, CTN
H aving lived in the States for more than13
years,I have had the desire to write my obser-
vation and thinking on the pros and cons of the health care systems in the United States for some time.Because I came from another country and my doctoral major was comparative study(http://www.sodocs.net/doc/82e740d8a58da0116c1749ce.htmlpara-tive education to be exact),I have gotten into the habit of viewing what I see through a comparative lens.The observations and thinking that follow are based on per-sonal experience primarily.The intent is to provide food for thought rather than to reach any definitive conclusions.
EMERGENCY DEPARTMENT (ED) EXPERIENCE
By definition,medical emergency in the United States is defined as a health problem or situation that demands immediate attention.However,what a client views as an emergency may not be perceived the same by health providers.The general public does not understand the professional definition of emergency.To them(except those who use—in fact abuse—the ED as a convenient means of accessing treatment of minor conditions such as a cold),their situation is an emergency;otherwise they would not be there.However,to the ED health professionals,only life-threatening conditions consti-tute real emergencies.The discrepancies in the percep-tion between the suffering clients and health profes-
sionals often create tension,misunderstanding,and perceived treatment delays.Consequently,waiting for hours,suffering from the wait in the ED,and negative outcomes such as alienation are the expected norm rather than the exceptions.That was the reason my friend reminded me to bring a book or game whenever going to the ED.
The public understands that health professionals in the ED have to prioritize different cases.In addition, they understand that the increasing paperwork required by governments and agencies takes more and more time.However,it appears that the wait is too long,to the point of being unbearable,and is getting longer and longer.Consequently,one has to ask the serious ques-tion:Is it worth going to the emergency room if the con-dition is not life threatening?
PAPERWORK AND DEPENDENCY
ON TESTS AND TECHNOLOGY
Paperwork is eating away valuable time physicians and nurses can spend with their clients and is identified as one of the contributors to skyrocketing health care costs.To a considerable extent,this is a response to increasing regulations in health care as well as a natural outcome of the practice of defensive medicine to avoid
Author’s Note:Correspondence regarding this article should be sent to Dr.Yu Xu,University of Connecticut School of Nursing,Storrs,CT 06066; e-mail: yu.xu@http://www.sodocs.net/doc/82e740d8a58da0116c1749ce.html
Home Health Care Management & Practice/February2005/Volume17,Number2,146-147
?2005 Sage Publications
Key Words:health care, systems, critique
lawsuits.However,such a trend is not in the best inter-ests of either patients or society.
It appears that many U.S.physicians cannot function without lab tests,very often labs are drawn on daily basis causing added anxiety and suffering.Such dependency can also be attributed to the training of U.S.physicians where empirical evidence is empha-sized.Make no mistake,I have no intent to discount the scientific and diagnostic value of lab tests.My point is that these tests should be used as tools rather than ends in themselves,and lab tests should be combined with common sense,intuition,and critical thinking in diag-nosing and treating patients.As we all know“technol-ogy is wonderful when it works.”In no circumstances should technology replace professional judgment based on critical thinking.In addition,I wondered if some of those tests could be reduced without affecting treatments.
FRAGMENTATION OF TREATMENT
Increasing specialization in health care has lead to increasing regimens by specialists.Unfortunately,with this specialization,treatment and care tend to become fragmented,and the holistic focus tends to be lost.To some degree,this is an inevitable outcome;however, the downside of specialization should be and can be minimized.Moreover,the higher the level of special-ization,the stronger the need of integration and synthe-sis.On the other hand,the emphasis on specialization reflects the differences in medical philosophy between East and West because Eastern cultures tend to be holistic whereas Western cultures tend to be analytical.
SYNTHETIC MEDICATION VS.
Every medication has side effects.Research (Kudzma,1999,2001)has demonstrated that our bod-ies are made unequal and minorities are at risk of devel-oping untoward reactions when the standard dose of medication is given.For example,Asians may achieve the therapeutic effect of Valium at one half of its stan-dard dose.The primary reason is believed to be that the standard dose was normed on majority participants dur-ing clinical trials before federal agencies mandated inclusion of minorities,women,and children in feder-ally funded pharmaceutical studies.The National Insti-tutes of Health did not have such a mandate until1994 (Office of Extramural Research,National Institutes of Health).In contrast,alternative and complementary therapies are flourishing among the general public, primarily because of their limited and minimal side effects.
From a comparative perspective,the strengths of the U.S.health care system are surgery,technology,and efficiency(from a technological vantage point).How-ever,its flip sides are also associated with those strengths:lack of effective treatments for chronic ill-nesses,fragmentation of treatment and care,and inade-quate attention given to clients as people.The principle of“high-tech high touch”is true more than ever.I believe that health care systems in the East and West can learn from and complement each other to better serve human health needs.
Kudzma,E.C.(1999).Culturally competent drug administration.American Journal of Nursing,99(8), 46-51.
Kudzma,E.C.(2001).Cultural competence:Cardiovascular medications. Progress in Cardiovascular Nursing,16(4), 152-160, 169.
Office of Extramural Research,National Institutes of Health.(1994).NIH guidelines on the inclusion of women and minorities as subjects in clinical research.Retrieved September7,2004,from http://www.sodocs.net/doc/82e740d8a58da0116c1749ce.html/grants/ guide/notice-files/not94-100.html
Yu Xu,PhD,RN CTN,is an associate professor at University of Connecticut School of Nursing in Storrs, Connecticut.
Xu / U.S. HEALTHCARE SYSTEMS147