Quiz answers

Proponents of "scientific" medicine

"Regulars"

Which of the following is NOT a task nurses are sometimes asked to do in Morris's "A Day in the Life..."

All of these are tasks nurses are asked to do.

According to Fennel & Adams, which of the following is a reason that US healthcare has become more complex?

All of these have increased complexity, according to Fennel and Adams

Which of the following is a way that Abraham Verghese discusses practicing patient-centered care in his Ted Talk?

All of these.

How did most of the women interviewed in No mas bebes find out they had been sterilized against their will?

Antonia, a lawyer, found these women in an effort to collect enough accounts to build and prepare a case. She came to these women and explained to them that they were sterilized without their consent.

The capacity of an individual to make their own choices.

Autonomy

Which of the following is TRUE of the history of medical licensing in the 19th century

Debates and action over medical licensing were slow and uneven across different states and localities.

Which of the following is NOT a way that the male nurses in McDonald's study report negotiating gender roles?

Denying that gender roles play any role in how they do nursing.

Believed that "like" cures "like," for instance that a very small dose of something that raises body temperature could cure fever.

Homeopaths

What is one thing you're looking forward to learning about in this class?

I am looking forward to learning about the US health care system from an objective and educational level. I personally am quite passionate about health care and am excited to learn the ins and outs of how health care came to be and how it is where it is today.

What kind of training might health care workers need to be better at being patient-centered? Drawing on the materials for this course, do you think professionals are getting this training?

I believe that a restructuring of the health care system's fundamental belief ideology must first be taken under severe scrutiny. The field of medicine is, and will always be, under constant revision as health care professionals, statisticians, sociologists, etc... will always find new ways to improve upon care. Berwick's analysis on what "patient-centered care" should mean posits many ideas that I almost entirely agree upon. One simple approach that Berwick suggested was for professionals to adopt a more involved position with the patient. This meant asking more questions and essentially allowing the patient to lead the examination, allowing for a more impactful and informative visit. He also suggested letting the patient be in more control by providing autonomy over medical decisions and transparency regarding procedures, finances, medications, etc... This all can be achieved through the implementation of emotional intelligence training for health care professionals. I personally suggest an "emotional intelligence" class should be implemented and required for all health care professionals. This class would focus entirely on patient-centered care where health care professionals are required to undergo proper training and adopt the appropriate languages and techniques that best fit the individual patient's best interests. From this week's materials, I would say that most professionals are lacking this training as it suites the interest of the professional, the hospital, and the entire system to remain objective, distant, and aloof while abiding by the regulations that serve to protect and enforce this impersonal belief ideology.

In your own words, what is "primary care"?

I define "primary care" as the first form of care a patient is able to receive. This is the first point of contact by which a patient's health is evaluated. This form of care is often carried longitudinally, in other words, conducted over a long period of time. This serves to benefit the overall health of the patient as a primary care physician will understand the patient's needs and symptoms better.

According to Gawande's "Piecework" how are most physicians paid?

On a fee-for-service basis.

Explain ONE of the 5 major transformations in American medicine that Starr discusses in Chapter 6, pages 229-232.

One of the 5 major transformations in American medicine discussed in this chapter was the control of labor markets in medical care. This included the introduction to medical licensing in order to create fewer competing practitioners as well as reduce the supply of cheaper professional labor for things like free dispensaries and contract practice.

Using specific examples from the readings, why is primary care so important to health care? Why not just rely on specialists?

One of the biggest points I gleaned regarding the importance of primary care was continuity. The "Primary Car Overview" document discussed the importance of this within health care. Not only does continuous care between patient and professional yield better health outcomes for the patient, it leads to higher satisfaction rates and cost effectiveness overall. Moreover, continuity of care remains a prerequisite for coordination of care. This leads to less negative health outcomes for patients such as medical errors and unnecessary repeat tests.

In your own words, what is "patient-centered care"?

To me, "patient-centered care" means a medical professional's ability to listen to and rationally cater to a patient's needs. It means eliminating the impersonal nature of the patient-professional relationship and integrating a patient-care system that places an emphasis on the patient's individual and unique needs. It means to look beyond the numbers and focus on the person. To me, patient-centered care means to adopt a humanitarian approach.

In the documentary Escape Fire, Dr. Wayne Jonas elaborates on a program to improve healthcare in the US military. What is it?

A program that uses acupuncture during medical evacuations to fight pain.

In order to qualify as a Federally Qualified Health Center, a clinic must...

...serve an underserved population such as the homeless or public housing residents.

According to the CIA, as reported in the Budrys chapter, where did the US rank on health spending as a percentage of GDP in 2011?

3rd

According to the US Central Intelligence Agency, US Infant Mortality rates rank _____ out of 224.

55th

Drawing on last week AND this week, what are some ways that we see the history of health care organizations reflected in the organization of the current health care system?

Based on the readings from last week and this week, the biggest reflection of our health care history that can be seen today is the professionalization and regulation of medicine. It was fascinating for me to learn that, not too long ago, health care providers lacked any proper training, testing, and expertise. The universities that educated them relied heavily on "armchair medicine" and lacked any proper program to train the next generation of medical professionals. Due to organizations like the AMA and the Flexner report, the call for a professionalized doctor became a requirement. The health care facilities of that time also underwent radical levels of regulation in order to create a professionalized and safer environment by which better health outcomes for patients could occur.

What is "cost-shifting"?

Charging more for privately insured patients than publicly insured patients

Match the components of culturally competent communication, as described by Teal & Street, with its definition.

Communication repetoir- the set of skills and behavioral strategies necessary to communicate appropriately Situational and self awareness- the ability and mindfulness necessary to read patient cues in order to prevent misunderstandings due to patient-physician cultural differences Adaptability- the ability to adjust communication styles to accomodate the needs and characteristics of patients "Knowledge" about core cultural issues- the ability to assess core cultural issues for individual patients

What is ONE skill from the Teal & Street article would have helped avoid the tragedy described in "Hold Your Breath"? Explain your answer.

Considering the fact that the main issue in "Hold Your Breath" was cultural miscommunication, respecting diverse values could have helped avoid this issue or resolve it altogether. Health providers often work and engage with non-English speakers. Therefore, the ability to interpret cultural nuances and provide respect for diverse values is an invaluable skill to have.

Which of the following rules regarding physician consultation existed in the AMA code of ethics in the mid-19th century?

Consulting physicians must let the regular physician enter the room first Practitioners were supposed to consult on a patient in secret and present one common opinion All of the above

Why did the AMA oppose "contract medicine" (i.e. medicine performed by physicians under contract to railroad companies, businesses, social clubs, etc.)?

Contract medicine paid low wages which the AMA feared would reduce wages for all doctors.

Why does Mohammad Kochi, the patient at the center of "Hold Your Breath" refuse chemotherapy treatment?

He objected to the method of delivery (the pump) because it would interfere with daily prayers.

Which of the three hospitals would you prefer to be a patient at? Explain why, drawing on what you know about health care organizations and patient care from previous readings (1 point) and providing details and reasoning about the hospital from the Reich readings (2 points).

Despite my initial reservation regarding the organization, GroupCare seems to be the most patient-centered. From my previous readings, I am well aware that patient-centered and culturally competent care remain invaluable in the treatment of patients. The goal of GroupCare was to reduce uncertainty within the provision of care. This was executed through an extensive bureaucracy and an elaborate technological infrastructure. This involved a system operating upon prepaid group practice, meaning patients paid a monthly rate regardless of care given to them or not. Though this may not appeal to most initially (and it certainly didn't appeal to me at first) it seems as though this system has been able to bring the market into alignment with every patient's care and well-being. This is also reminiscent of the Direct Primary Care (DPC) model that I personally advocate for from last week's reading where a patient pays their primary care physician a set monthly rate directly. While the discourse between individual care and group care remains a topic of public debate, I believe GroupCare is the best option available for now.

Drawing on the readings AND your own opinion, how free should patients be to make health care decisions that are culturally appropriate, but that are not supported by scientific medicine? Does this change if parents are making decisions for children?

Drawing from this week's material, as well as my own opinion, I would conclude that some patients may require complete autonomy and independence when making decisions about their health. Despite the fact that these patients may make decisions that go against medical advice, it remains evident to me that many individuals hold their personal values above their own life. To some people, what they believe in IS their life. If a health-related decision impedes on their values, they should be allowed to exercise their right to decline that decision. To some people, going against their values, beliefs, or culture is worse than death. From a purely psychological perspective, however, I think that this should not apply to children as their cognitions are still undergoing development and they therefore lack the proper faculties to adequately provide health-related decisions.

Characterized by their opposition to the regular profession, their reformism and their opposition to "heroic" medicine.

Eclectics

Which of the following changes to healthcare organizations did the Affordable Care Act make? (Check all that apply)

Encourage the formation of Accountable Care Organizations Prohibit new specialty hospitals Encourage the use of "bundled payments"

According to Atul Gawande in "Naked," which of the following is TRUE about physical examinations?

Expectations for physical examinations vary widely by culture.

Why does Kochi's doctor believe he is refusing chemotherapy?

He thought Kochi's religion told him chemotherapy was wrong.

Fennel & Adams report that most studies find that government deregulation (and therefore increased market competition) have increased physician autonomy.

False

T/F: All US states place a cap of $250 000 the amount awarded in malpractice suits.

False

TRUE OR FALSE: Van Ryn finds that there is no evidence that provider beliefs about patients contributes to racial disparities in health.

False

TRUE/FALSE: Once penicillin was discovered to be an effective treatment for syphilis, the men in the Tuskegee Syphilis Experiment were treated and the project ended.

False

TRUE/FALSE: The health care systems described by Udenski improved care by banning Hmong shamans from their facilities.

False

The introduction of DRGs (Diagnosis-Related Groups) as a way to set reimbursement rates for Medicare led to longer average hospital stays.

False

True/False: In "Hospital Land, USA", once it became clear that Chet was not going to recover from his cancer, it was Dr. Last who suggested Chet stop chemotherapy.

False

True/False: Kathleen Bartholomew found that there was a big status difference between nurses and doctors, but not very much between nurses and other nurses.

False

What stood out to you most about the chart "How Americans Get Their Healthcare"? Be sure to use a few sentences and discuss the SIGNIFICANCE of your observation(s).

For one, my initial response to this chart was a bit unsavory so I will refrain from indulging. Quite honestly, I do believe that was the point of looking at this chart. Health insurance and facilities are the main focus of this chart. The spaghetti bowl of arrows pointed every which way seemed like a desperate attempt to make sense of the American health care system. This attempt, albeit a good one, fell short of the "making sense" aspect of the system.

Drawing on both the readings for this week AND your own opinion, what makes a good doctor? What kind of training would be necessary to create good doctors?

From my reading, and my own personal opinion, I think a good doctor is one willing to grow and maintain empathy. It is easy for medical professionals to view patient care as a numbers game. Furthermore, it is easy to become more interested in the personal gain that surrounds a doctor's position. Just like we saw in "The Score", obstetrics has grown and improved exponentially in its field. This is due to the willingness to test new ideas, and constantly ponder if strategies the field possesses now can be improved upon further. I feel as though this narrative should be applied to the breadth of all health care positions.

What kind of things limit a nurse's autonomy? How can nurses assert their autonomy? In particular, how do working conditions, the economic health of a hospital and organizational rules affect nurses' abilities to do their job well?

From this week's readings, I have found that, what limits a nurse's autonomy the most are a lack of consistency and communication. In particular, most nurses found their lack of autonomy in the constantly changing policies and regulations. They serve to oftentimes disrupt whatever semblance of flow nurses have found within their position. Moreover, a lack of communication regarding these policies can create further disruption. This includes issues surrounding hours each nurse may be allotted each week. These are usually ever-changing with little to no consistency. It seemed like nurses were always required to play "catch-up" with new policies and regulation on top of their usual daily tasks, which are far reaching and ever expanding. In order to break away from this, I believe there needs to be a balance struck regarding what a nurse is required to do, how many hours they work, and ensuring their own conditions are met. All in all, a humanitarian approach should be heavily considered for management.

Is competition between hospitals good or bad for care? Why? Use specific examples from the readings for the week.

GroupCare remains an example as to why competition between hospitals can be good. This organizational structure saw a need to tame the market for care through the dimensional integration of medical practice as the wider marketplace remained uncoordinated. This specific hospital structure did so by investing in technology in order to reduce medical practice uncertainty. This structure also utilized social technologies along with their technological infrastructure in order to aid in organization conformity. Objectively, expansion in medical technology and advancement will aid in more positive patient outcomes.

What makes Donald Berwick an "extremist" when it comes to patient-centered care?

He believes in a near total shift of power to patients and their families.

Do you believe the US has the best health care system in the world? Using the readings/materials from this week, justify your answer.

I do not believe the US has the best health care system in the world. As mentioned in the documentary "Escape Fire", our health care is one of the best for rescue, emergency, and complex surgeries. However, overall care is grossly overlooked within the US. This is because complex surgeries or rescue missions are costly and therefore the most profitable. The glaring issue found within US health care is the lack of preventative care as these forms of care are not profitable. Corporations strive for profit. Taking time for individual, personal care does not align with this need. Therefore, care for health is not a priority within US health care.

Do you think the culturally competent care techniques we discussed in the previous module help to improve care for people of color? Would they solve the problems?

I personally do not think culturally competent care is the solution to improving care for people of color. This level of care is one that all medical professionals should strive to achieve. I believe it can help improve care for racial minorities, but it is not the answer. The primary means by which racial minorities will experience improved care is through representation. One medical professional will not be able to realistically apply culturally competent techniques to the best of their ability for all patients. Even if this option were viable, a patient who is a racial minority may still not feel comfortable with their provider. As a result, they may withhold information from their provider. Moreover, there may be a cultural/language barriers inhibiting their quality of care. Overall, I think the main solution to these problems would be for an increase in representation within the medical community.

Which of the four "new" primary care models described in the "Primary Care Overview" document do you think is most likely to improve use of primary care. Why?

I personally found the direct primary care (DPC) model to be the most revolutionary and therefore the best option to improve the use of primary care. I hold the notion that the health care system we maintain in America today is failing immensely. A lot of this has to do with money being an issue, specifically insurance. This model is unique in that it eliminates the third-party payer and calls for direct, monthly payments to a PCP in exchange for a defined set of care benefits. The costs can only range so much and you know exactly what you are paying for with consistent monthly care readily available. Moreover, long-term patient care can finally become a point of focus within the health care system which serves to benefit patients' overall health. This model can only work, however, on the basis of more PCPs within the system. As it stands today, this model is not entirely applicable. If this model were to be applied, however, consistent and long-term care can become emphasized.

What three things make up the "triple aim" of a health care system?

If we focus on what policy makers strive for within health care arrangements, that would include access, quality, and cost containment. This means improving care for patients, improving overall population health, and cost reduction.

In what kind of discussions did the Nurse Practitioners in Trotter's chapter defer to doctors?

In medical decisions

Are patient-centered care and culturally-competent care the same thing? Why or why not?

No. Both patient-centered care and culturally competent care are similar but lack the same focus. Patient-centered care places an emphasis on improving individual quality care for patients. Culturally competent care emphasizes the equitable distribution of quality care to culturally diverse and disadvantaged groups.

Using at least one specific example from Hospital Land, USA, what are the barriers/difficulties in carrying out patient-centered care? What changes could have been made to the organizational structures of the hospital to support more patient-centeredness?

In this article, there were many instances where patient-centered care was not carried out completely or at all. The more glaringly obvious and consistent barrier I saw throughout this article was the fact that so many professionals who saw to Chet appeared to lack the time or care regarding his emotional state. I would call this barrier one that is well-integrated within all health care professions. It is a barrier of the belief system that has been utilized for so long in order to make advances in medicine and treat patients on a macro scale. One specific example of this is when Chet was arguing against taking his Benadryl as he hated how it made him tired. In response, the nurse left him, only to return with a pharmacist who threw a bunch of numbers at Chet in order to get him to comply. The issue here is not making Chet take the medicine. In fact, medically speaking, it is in his own best interest to take the Benadryl. No, the issue with this interaction is how the nurse left Chet without empathizing with him and validating his concerns. Furthermore, when the nurse returned with the pharmacist, Chet was met with statistics used to scare him into submission. This issue should be met with an integration of emotional intelligence training. Moreover, implementation of emotional caregivers within the hospital should be utilized. Their role would be to provide emotional support for the patient as well as serve as a bridge of communication and understanding between the patient and the professional.

According to the Washington Post article, which of the following is true?

Infant mortality is decreased for black infants when cared for by a black doctor.

In Escpape Fire, Dr. Erin Martin leaves her job at La Clinica, a low-cost clinic because:

Insurance systems do not allow her the time with her patients she needs to do preventative medicine.

How was the organization of the Mayo brother's clinic different from the organization of most physician's practices at the time (according to Starr, Chapter 6 "Escape from the Corporation")?

It was organized as a group practice.

According to the introductory video, in order for something to be a "profession" it must have an exclusive claim to a certain set of skills or body of knowledge which is called a....

Jurisdiction

An area of work that a profession can lay claim to.

Jurisdiction

Starting in 1908, what selective incentive could the AMA (via local societies) offer potential members?

Malpractice insurance

According to the podcast for the week, which patients in the United States have difficulty finding a stable Primary Care Physician or practice?

Most patients

What restraints are there on doctors autonomy? You may consider how concerns and incentives about money/payment and organizations influence the care doctors can provide and/or how things like checklists and rules constrain autonomy.

My main takeaway from "What Doctor's Owe" and "Piecework" is that many doctors are essentially pushed into a corner between the fear of malpractice suites, overall financial wellbeing, and insurance companies. Because of this, many specialized providers opt to not accept insurance as seen in "Piecework". The "bracing clarity" that was gleaned from discussing these limitations surrounding providing medical care has shown me that it is not the doctors who are stingy or careless. Most often, it is due to financial stressors such as these that doctors may overcharge or not take insurance or issue more testing than necessary.

Pick one "arrow" in van Ryn's model (A, B, C, D, E or F) and use it to give a possible explanation for the main finding from the Washington Post article on infant mortality and physician/patient "match".

One possible reason why higher mortality rate can be found in black infants could be due to many white doctors lacking the means to correctly interpret symptoms. This arrow, arrow B, is reflective of the hypothesis that a physician's beliefs regarding the patient influences their interpretation of the patient's symptoms. The issue of health care professionals treating every patient the same is common for racial minorities. For example, a white doctor may observe a skin condition on a black patient under the assumption that their condition presents itself in the same way that it would in white patients. This is often not the case. The findings within this article showed that mortality rates for black infants decreases when they are under the care of a black health care provider. A black doctor may be more observant when caring for a black infant because they may be more inclined to know what to look for better than a white doctor.

To what extent should health care providers support patients in making autonomous decisions about their own care, even when the health care provider believes that patient is making a choice that is harmful or otherwise unwise?

Personally, I believe that a good health care provider should be able to encourage a patient's autonomy while also maintaining the ability to dissuade them from making decisions that may prove harmful or unwise. I think there should be regulations, if there are not already, that cover this exact issue. However, instead of these regulations made based off of impersonal science or law, they would focus on and facilitate a patient's personal needs. These regulations, likely written by those who are trained in dealing with emotion, empathy, and communication, would be set in place in the case of a situation where the patient is insistent on a harmful or unwise decision regarding their health or the health of a loved one. These regulations would outline the proper techniques and precautions used to diffuse emotionally-charged interactions with patients and provide an emotionally safe environment where the patient is able to feel personally cared for.

Which of the following most accurately describes the class position of physicians in the late 1800's?

Physicians class position mirrored that of their patients.

Which of the following is NOT one of the four main features of good primary care services, according to the World Health Organization (as discussed in Starfield et al.)

Primary care should be provided by a single physician throughout a person's lifetime.

In your own words, explain what QALY measures?

QUALY, or "quality-adjusted-life-year", is a standardized tool used to measure how effective various kinds of medical treatments are in improving and extending the patient's life.

What does "QALY" stand for?

Quality-adjusted-life-year

Anxieties/strains/challenges that arise from conflicting roles an individual may hold.

Role conflict

A benefit available only to members of an organization that convinces people to join that organization is called a...

Selective incentive

What kind of hospitals ended up being built as a result of the Hill-Burton Act?

Small hospitals in middle-class neighborhoods

Name and explain one role Craig & Muskat ascribe to social workers.

Social workers aid in the facilitation of collaborative relationships that are necessary in order to meet family and patient goals. This can be seen through brokering services and support for families and patients through discharge planning and crisis intervention. This is particularly crucial for more vulnerable patients.

Which of the following is true of how New Zealand handles compensation for medical errors?

The system does not distinguish between negligence and bad luck.

Are there any advantages for social workers in having so many different roles in a hospital? Disadvantages? What does the sheer number of roles social workers take on in hospitals suggest about the nature of their work?

Social workers, despite the range of titles and varying hospital settings, continue to fulfill critical roles found within urgent basic needs. This is because HSWs are required to master the ability to negotiate and engage within families and other teams acting like the "glue". They have seemingly mastered the ability to "switch hats" depending on the specific location and situation they are placed in. Despite this advantage, HSW is incredibly difficult due to the ambiguity surrounding the position and jurisdiction. The role ambiguity of HSW is their greatest strength and a potential catalyst for burnout and emotional exhaustion. The excessive number of roles these social workers are expected to fulfill suggests that the nature of their work is to provide a secondary level of service toward other disciplines like supplying support and skills such as negotiation and advocacy.

What does Atul Gawande (in his Ted Talk) mean when he says doctors should be "pit crews" not "cowboys"?

That doctors should work in teams, not alone.

In the early 1900s, why were physicians able to maintain small independent practices, while other independent craftsmen in other industries were not?

The AMA controlled licensing which could prevent large-scale health organizations from consolidating power.

Drawing on the Starfield, Shi & Macinko reading, pages 471-473, describe a feature of primary care in one of the non-US countries described there.

The Costa Rican reforms of primary care features reallocating and distributing the responsibility for providing care, specifically for the most socially deprived areas. This includes reorganizing primary care into "integrated primary care teams". This allowed for a redistribution of a team of health professionals who were assigned to specific regions that covered roughly 1,000 households. This organized form of care served to lower infant mortality rates and increased average life expectancy.

What would medicine in the US look like had the Flexner report not happened? Consider the other social conditions of medicine at the time.

The Flexner report emphasized a call to reform medical education. This included adherence to the scientific method in research with an emphasis on hands-on training and a strong foundation in biomedical sciences. Without this report, it is entirely possible that medical advancements in education and practice would have taken much longer to establish without these standards.

Which of the following is TRUE of hospital types.

The US system includes non-profit, for-profit and public hospitals.

Which of the following is true of racial disparities in health?

The causes of racial disparities include both general social factors and health care factors.

What does the title of Gawande's chapter, "The Bell Curve" refer to?

The distribution of quality outcomes among hospitals.

Which of the following is NOT true of the Banes' experience with white doctors, according to the chapter?

Their care has been consistently better with white doctors.

Which of the following most accurately described the outcome of Madrigal v. Quilligan, the Supreme Court case at the heart of the No mas bebes documentary (and discussed in the optional NYTimes article)?

The hospital won the case, but practices around informed consent changed.

Drawing on the readings for the week, how might distrust of health care organizations and professions have affected the COVID-19 vaccine roll-out? What can be done to ensure that people get vaccinated without damaging relationships between health care organizations and people of color?

The issue of the COVID-19 vaccine roll-out has largely been due to the fact that many minorities have become suspicious of the intent our health care system maintains regarding our population. Not only have racial minorities fallen victim to nonconsensual medical experimentation through the use of manipulation, coercion, and forced cooperation- they also now bear witness to the potential the health care system has on providing care. The AIDs epidemic in the 80s is largely viewed as an organized genocide within the black community. This is due to the time it took for a treatment to be formulated and distributed. It took 7 years after HIV was discovered before a drug was introduced to help with treatment. The COVID-19 vaccine, however, was manufactured and introduced to the public in under a year. The main differentiating factor between these two treatments is the demographic it affects. In order to ensure people get vaccinated without damaging their relationship between health care organizations and racial minorities would be to introduce comprehensive means of obtaining information regarding this vaccine. In other words, a means of providing information regarding COVID-19 that is able to be read and understood by proletariats within our society will help ease the anxiety and panic they feel. Unfortunately, I think the only way for racial minorities to truly begin to regain trust in the health care system is through time. It will take many years of culturally competent care and representation for all patients in order to see this change occur.

What happened between 1909 and 1932, what happened to the number of hospital beds?

The number of beds increased 6 times faster than the population.

Name (in one sentence) one way that concerns about the hospital's profitability affected nurses' practice in the Morris reading ("A Day in the Life of an Obstetrical Nurse").

The policy change regarding hours and vacation time made nurses' jobs more difficult as the hospital changed all shifts to 12 hours and attempted to give everyone the same amount of call time each month but this made being a part-time nurse with the same amount of on-call hours potentially taxing.

Choose one of the answers above and explain it. Your answer should explain the PROCESS in which complexity is increased, as well as the EFFECT on patient care according to Fennel & Adams.

Today, we stand witness to the immense technological advances that have carried the study of medicine into the future. However, this technological boom brought about assumptions that technology would act as a guide and provide structure for the right corresponding medical configurations. Essentially, the idea that technological advances would influence medical practice and spark reform. Unfortunately, we have found a rather large and growing gap between genomic development and applications in medicine and the ability for medical treatment organizations to adopt and advance these new innovations. In other words, while technology of treatment is growing, the corresponding medical treatments and sciences remain in the past, attempting to play "catch up". This serves to negatively impact patient care as a gross misalignment between aspects of health care can result in increased levels of medical error.

What were the four trends in community hospitals McConnell identifies in Chapter 3?

Trend 1: Downsizing, Mergers, and ClosuresTrend 2: Tighter Profit MarginsTrend 3: Increased Establishment of Specialty HospitalsTrend 4: Increasing Shortage of Nursing Personnel

According to the Starfield, Shi & Macinko readings, a strong primary care system increases equity in a country.

True

In the chapter "The Score," how does Gawande characterize modern obstetrics' approach to improving care?

Trying new things and keeping those that work.

Why are "Minute Clinics" and other non-urgent walk-in care clinics not a good substitution for primary care organizations?

Walk-in clinics do not provide continuity of care.

According to "Primary Care Overview", which of the following populations has seen particularly sharp declines in visits to primary care?

Younger patients