Sunday, March 22, 2009

After Reading Chapters 3 and 4


3.) Dr. Nolen describes treating wealthy patients differently than poor, indigent, alcoholic ones. This is a problem with our health care system. What do you think could remedy this situation so that all patients are treating fairly and equally?

4.) What is meant by the term “differential diagnosis?” What is the benefit/drawback of this term?

27 comments:

  1. First, as a side note, Bellevue Hospital was mentioned on 60 minutes tonight.

    3. To be honest, I'm not sure there is a remedy. Unless we live in a socialistic society, those with money and power will always receive better care than those with no money. As said in the chapter, those with power will not only be able to pay for better care, but complain to those in power when they don't receive the level of care they think they deserve.

    4. I think differential diagnosis based on utility is a great way of diagnosing patients when not enough is known about their ailments. Differential diagnosis is basically a process of elimination diagnosis when not enough info is available to make a decision in its own standing. Benefits for this are that often doctors are able to start treatment for a patient right away even if they don't know exactly whats wrong. Often patients come to hospitals needing treatment right away, and sometimes something is better than nothing. A drawback though is that a patient may receive care based on differential diagnosis for the wrong illness, causing the original one to worsen. Ultimately, I support the use of differential diagnosis

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  2. 3. Well, this is a rather large and difficult question that I feel really includes many more aspects of society than just how hospitals operate. It seems that this sort of behavior arises often from the doctors' idea of whether or no a patient has a legitimate reason for being hospitalized. Nolen talks a lot about how poor patients wanted to spend time in the hospital because it was one of the only places they could have a comfortable bed and consistent meals. While it doesn't seem fair that these unemployed patients, who are "non-contributors" to society, would mooch off other people's tax dollars when they aren't really sick or hurt, if these patients are in need of medical attention then they deserve it just as much, and just as quickly, as any patient in these public hospitals. I think that to address this question hospitals have to think about the admissions process. Nolen also talks about the A.O. (Admissions Office) and the process of deciding on patients, which is often unexact and marred by insufficient time. It seems that reform to this process would help eliminate time and money that goes towards patients in ways that some would find objectionable. Some ways to do this might include hiring staff specifically to deal with these incoming and potential patients, or supplying these preliminary stages with the potential to run necessary tests to determine and patient's legitimacy. Aside from this, however, it seems to me that the heart of the problem lies in the conditions surrounding the hospital. The fact that so many people return from winter to winter suggests, to me, not something flawed in the hospital system, which does the best it can on meager resources, but instead a flaw in the welfare and resources available to the poor and homeless of the city. If people are hurting themselves and getting sick all the time so that they can enjoy hospital comforts then the problem must be solved by addressing the fact that only by damaging their health can they hope to live comfortably. Instead of worrying about unfair conditions within the hospital, maybe first we should think about unfair living conditions on the city streets.

    4. A differential diagnosis is one in which a doctor will suggest a number of possible causes for the symptoms a patient exhibits. Nolen explains that this is a response to the fact that doctors, like everyone, can sometimes be wrong about things. Often cases that seem to be something simply like appendicitis can end up being something more serious, so in order to take these eventualities into account diagnosticians must include all possibilities. This allows doctors to focus broadly at first and then narrow in with more certainty as they obtain new test results or observations. In this way they will be less likely to leave out a possible cause for symptoms that could become problematic later. I suppose a drawback of this strategy would be that a patient will feel slightly less confident in their doctor's competance if they are aware that the doctor is not confident of a single diagnosis. Also, operating with hesitancy, a doctor may not be able to act quickly or decisively enough to save a patient in certain scenarios.

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  3. 1) For Dr. Nolen, there appears to be two uses for the term “treatment” by doctors: physically working to resolve a patient’s illness, and judgment and behavior towards a patient. In terms of the literal quality of medical treatment, it is more obvious that a wealthier patient who seeks care at a wealthier, better-equipped, better-staffed, and otherwise better-resourced hospital will receive higher quality care. However, things get more difficult and blurry when doctors’ judgments of patients affect their behavior towards them, which in the bigger picture unjustly influences the physical quality of care that indigent patients receive.
    Therefore I think that a major underlying problem undermining health care equality is the social stigma that exists for people who live in poverty. For substance abuse patients, that stigma is even more complicated. Because of public ignorance and prejudice, these types of people are perceived to be a burden on society and worse yet… “inferior.” They may be less educated, have menial jobs or no jobs at all, depend on government assistance, and/or are homeless, so they must be less intelligent, less hardworking, less motivated, and less willing to improve their lives. Why should they be entitled to the same type of services that everyone else receives? That is a lot judgment being passed that should have nothing to do with the quality of medical treatment that a sick patient should receive. Ultimately, medicine should come down to ensuring that patients, regardless of their socioeconomic background, will receive the most appropriate medical care that will give them the best chance of being healthy.
    One aspect crucial to remedying the situation is focusing on making the public hospital strictly a treatment facility. Many homeless patients had to pretend to be ill in order to obtain shelter. This draws time and resources away from focusing on truly ill patients, contributing to overall decreased quality in medical care at Bellevue. Hence this is not solely a problem in the health care system, but with the lack of resources and opportunities that is made available to marginalized communities.

    2) When a doctor makes a differential diagnosis, s/he comes up with a diverse list of possible diseases or conditions that the patient can have based on their symptoms. The benefits of this system are plentiful: the doctor can compare and contrast likely symptoms from the various possible diagnoses and derive the most probable diagnosis is more easily. However, a possible drawback to this method is the doctor leaving off the correct diagnosis off of his/her list for whatever reason, making it impossible for the patient to be diagnosed with it.

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  4. 3) Although it is definitely unfair for the wealthy patients to be treated better because they have the money and the poor, indigent, alcoholic patients don't, I don't think that it is possible to treat them all fairly and equally. If the doctors deny the rich patients they can get in trouble. At the same time, the poor patients are wasting resources by staying at the hospital. More often then not, it seems like the patients at Bellevue stay for motives other than to get healed. The rich patients want to find excuses to sue and get more money while the poor patients just want a nice place to stay for a few weeks. The doctors can't reject the poor patients because they actually have conditions that need to be helped. Although it may not be possible because of money concerns, splitting the hospital into a side more focused on mending and one more focused on facilitating could help. The facilitating side would need less nurses and resources to look after the patients while the mending side is focused on those that actually need the help and the attention would be focused on them.

    4) A differential diagnosis is a method used to diagnose the condition that the patient has. It is done by considering all of the different possibilities of diseases that could be the cause depending on the properties found. The benefit of using differential diagnosis is that it saves time. Instead of doing x-rays or checking with others, the doctor can just skip to the treatment stage for what is most likely the cause. However, a drawback of differential diagnosis is that it is also more prone to errors than diagnosing a condition through other ways. The percentage of error decreases through experience but it will always exist.

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  5. 3.There is definitely a gap between the richer and the poorer in terms of treatment available and quality of treatment. Wealthier patients are treated better because of their importance and position, while attitudes toward the poor patients is much colder and less caring. Dr. Nolen describes a situation when a patient was admitted during a night shift, and he treated the patient coldly and meanly. However, the patient made Nolen realize that he had been treating the patient as "a human being with a problem" versus "a patient who needed compassion and care." Furthermore, many poor and homeless patients take advantage of the comfortable conditions of the hospital and try to be admitted so they can live off of the hospital's resources and care for them. The fact that they are having to hurt themselves on purpose to have good living conditions hints that we need to provide these people with more care and a place to live. A hospital is a place for treating patients and is not a home. If these homeless receive more help, they will not take advantage of the hospitals. The doctors will be more compassionate toward the poor if they know these poor people are not trying to get into the hospital just to take advantage of the comfortable care. Then, they will be more likely to treat them better and provide the same level of care as they provide for the wealthier people.

    4. A differential diagnosis is a process in which doctors brainstorm and think if many possible diseases that could be causing the symptoms in a patient. Doctors use this method to make sure they do not overlook a possible disease, even if it is unlikely that the patient has the disease. This allows the doctors to come up with the most likely diagnosis by comparing and contrasting symptoms. Also, this procedure slows down the diagnosis process, and this could lead to less error during diagnosis. The doctors might consider a disease that they otherwise would not have thought of at first, and it may be the right diagnosis for the patient. Taking a longer time to diagnose a patient is a drawback because the patient could be in very serious conditions and could need treatment immediately.

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  6. 3. I'm hesitant to bring up a TV show, but Scrubs presented a case really similar to this. The head doctor, Dr. Kelso is notorious for being cutthroat and gives preferential treatment to richer patients. Two men were admitted to the hospital with literally the same symptoms,but one was rich, and the other wasn't. There was a drug trial going on that would be the last hope for curing either man. There was one spot. Guess who got it? The rich guy. The doctors criticized Dr. Kelso's decision to not give treatment to the other man, but at the end of the episode, we find out that the money that the rich man donated to the hospital brought back the free service the hospital offered to teenagers who were pregnant and didn't have any medical insurance. Of course, there is no indication of what is done with the money given to the hospital by the rich people, but there is a reason that this happens. However, I would never justify preferential treatment on the basis of money. I think it would be really difficult to weed this kind of behavior out of the system. I think part of the problem lies in the fact that the doctors at Bellevue were almost trained to be cynical about the reasons that the patients came through the doors. Quite a few of them simply walked in to get three square meals and a soft bed. Dr. Nolen described many patients who actually grinned at him when he admitted to these people that "Yeah, that looks pretty bad, let me admit you." That's maybe why the system treated those who had money better; because those people would never walk in just so that they could not have to worry about sleeping on the streets. Hospitals like Bellevue, I think, should deal with this problem, not with the fact that richer patients get better attention, because , not to be cynical, nothing really will change. You can't just tell the doctors "Don't be preferential" because they will most likely keep doing what they're doing. Maybe they should have some sort of community center attached or some sort of relief program that not only gives these people a place to come to, but a place to help them help themselves. That would cost money, so I don't know how happy the administration would be to do such a thing, but that would probably deal with the fact that the doctors would assume that any poor-looking person came to the hospital to get a place to sleep. But obviously, because this is not a perfect world, it won't solve all problems. In all probability, actually, it might cause even more problems. But I think that creating some sort of place for these people to go to (instead of the hospital) would definitely solve the problem of people trying to bum their ways into the hospital.
    But all said and done, hospitals are there to treat people. But I suppose sometimes people forget that.
    4. Differential diagnoses reflect the inexact nature of medicine. After the doctor thoroughly examines the patient, he/she may have more than one diagnosis! They write it down and juggle it around with different tests and eventually, with some consultation and collaboration from other doctors, come to a most likely diagnosis. I think it's a good process because it doesn't rule anything out immediately and that it recognizes that medicine is not a cookie cutter science; it literally evolves. But I also think it might be a risky way to diagnose; what if the doctor/surgeon is wrong? I suppose that would be a problem with all types of diagnoses, but arriving at a conclusion where you can only say "well, it's most likely it's this disease" is a little unsettling.

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  7. 3. I think an important thing that could be done to help the situation is to provide alternative places where people who do not have a place to sleep or food to eat--but who do not actually need medical care--can go. In the book, patients are described as trying stay in the hospital as long as possible because they do not have anywhere else to go, and although it's conditions aren't great, it is "luxury" for them. As a result, some of the doctors and wealthier patients seemed to look at them as a "burden" on the system, even though they had no place else left to go. So many of the doctors like Dr. Nolen didn't trust patients when they actually needed help, like the man with the broken hip, where they would have trusted a wealthier patient. If there was a system in place that would help people who wanted or needed to be hospitalized to stay out of the cold by giving them an alternative and safe place to go, then the doctors could consistently trust the patients who actually did come in to Bellevue, which would equalize how these patients were perceived and treated by others. As for changes strictly within the hospital system, just remembering that not everyone who can't afford to pay for their healthcare is a "bum" (the term that was often used) and deserves the same treatment would go a long way towards fairer and more equal treatment.

    4."Differential diagnosis" is when doctors are not completely sure of what the diagnosis is, so they list possible options. (An example of this is that someone who seems like they have appendicitis may actually have pneumonia or other sicknesses.) A benifit of this is that if a doctor operates before all the tests are done (to not take the risk of waiting to long) based on one common diagnosis and the operation does not go well, it would be easy for the doctor to go back to the original list of different possibilities and try to figure out which one could cause the unexpected effects of the surgery, instead of having to make the diagnosis based on symptoms that may have been replaced by new symptoms that resulted from the surgery. A drawback is that if the doctor makes the list and acts quickly, it still could be the wrong diagnosis and this could lead to problems later if the surgery caused more harm that could have been avoided by doing more thorough testing and diagnosis.

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  8. 3) I think one way to stop this discrimination in patient treatment is to make hospitals only accept donations from businesses and charitable organizations, not private benefactor. This way, doctors would not treat their wealthier patients lavishly in the hopes of having them want to donate to the hospital that treated them so well. There are obviously problems with this, such as hospitals having insufficient funds due to a lack of donations.
    4) A differential diagnosis is a list of possible diagnoses for a patient that a doctor makes if he or she is not sure of the cause of the patient's illness. It takes into account not only the patient's symptoms but also the patients lifestyle, age and medical background to get a clear picture of what he/she might have. That it establishes multiple possible diagnoses is helpful in case one is incorrect. But the drawback is that the doctor could still be wrong even after eliminating all the possibilities down to a "Yes" diagnosis, and thus surgery could harm the patient

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  9. 3) Nolens situation with the wealthy and poor or alcoholic patients is a difficult issue to deal with in healthcare. The wealthier patients tend to contribute more to society, and under a strictly capitalistic healthcare system would receive a far better quality of treatment. The poorer, alcoholic patients on the other hand would receive a lower quality treatment for their maladies because they are considered as giving less to society. America is a purely capitalist country, where everyone receives according to what they earn. The problem with this is that the distribution in quality of healthcare varies greatly from demographic to demographic, giving an unequal chance to various groups. We need a system that both rewards hard work and wealth, yet also ensures that those who reside on the bottom rung of society receive plenty of healthcare. If everyone were to receive good treatment, yet the wealthy could pay for better treatment, the healthcare system would be much better off.

    4) Differential diagnosis is a method of diagnosing a patient with a disease. Physicians use it when they do not haver adequate information to single out one disease, and choose to look at the entire range of possibilities. Without using differential Diagnosis, a patient may come to the doctors office with bad vision and be sent to the optometrist, when he may actually have botulism which would be far more dangerous. The drawbacks of it are that the doctor may have to rapidly treat the patient for one of the possible maladies, yet may actually be incorrect, therefore causing further harm to the patient.

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  10. 3.) This is a difficult problem to solve, not only because it is so common, but because “solutions” are likely to never be widely accepted. I personally don’t have any idea of a good solution, one that would work well… at least. Doctors, and all people in general, need to be able to look past a person’s class, status, race, or any other factor besides the fact that that person needs help. When someone is in desperate need of help, it would be inhumane to do nothing because of, for example, where they’re from. A doctor is a trained professional who is supposed to treat patients. Obviously there are different types of doctors, but they should all have the same goal… to treat people. My only suggestion to this dilemma would be to have better/more strict watch over the treatment doctors give to patients.

    4.) A differential diagnosis is a systematic method used to identify unknowns, in this case, diagnoses of specific disease in a patient. In Making of a Surgeon, Dr. Nolen said they would list the different diagnoses when they were unsure of the problem. When making this list they make sure not only to take into account visible symptoms, but also dietary life styles, age, weight, the patient’s medical background, as well as many other factors. The benefit of this is that the doctor may have a chance of operating before the patient has to wait too long and is at risk of getting even more sick. Even if the surgery does not give the wanted results, it will still give more evidence to work with to figure out what the patient’s actual problem is. The drawback of this is the what I just said, but in negative terms. The doctor may have rushed into things, causing the surgery to go terribly or even have a fatal outcome.

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  11. 1. The problem of unfair treatment is not easily resolved. First of all, the mindsets of the Bellevue patients foster these difficulties because the poor patients take advantage of the hospital by faking medical problems, while the rich take advantage of the hospital by using their power to be treated specially. As Nolen explains, one patient, Ted Rosseter, purposefully separated his stiches so that he did not have to leave the hospital. He favored the neverending service, the food, and the bed over his less luxurious life. Patients like Ted built up a reputation of faking illness in order to stay at the hospital, so much that this reputation began affecting the doctors. For example, Nolen assumed that one poor patient was faking his illness and so he chose not to treat it until he realized that the patient was genuine in his concerns. This could have been a huge problem. The other, more wealthy, patients have their own reputations. One patient, Mr. Carlton, believed he deserved special treatment because of his wealth and power. The doctors were forced to decided whether to be fair or unfair and face the consequences of both options. Nevertheless, I think doctors should treat the patients all fairly and thus prove to the wealthy that they cannot have special benefits. The doctors should also continue to find ways to detect whether a patient is faking their illness.

    2. A "differential diagnosis" is mixture of possible potential conclusions that a doctor can draw from a case. Because, as Nolen explains, no one case is alike, it is important to make note of all possibilities in order to not rule out the true diagnosis. However, this system could also have a disadvantage in that a doctor's choice of treatment could be more difficult because they would have a less specific case to treat.

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  12. 3.) Dr. Nolen describes treating wealthy patients differently than poor, indigent, alcoholic ones. This is a problem with our health care system. What do you think could remedy this situation so that all patients are treating fairly and equally?

    This is a complicated question without a clear-cut solution. On one hand, it is obvious that the current state of our health care system is immoral; why should patients of higher socioeconomic status receive ‘better’ care than those of lower class? Perhaps it is merely a side effect of our capitalist inclinations; we believe that anything worth having can be bought, and we all know there is no such thing as a free lunch (unless in this case you’re willing to settle for an inferior sandwich). In a society that places such a strong emphasis on competition and business, it’s logical that the healthcare system would too become competitive, money driven industry. Yet medicine is, at its core, about helping people physically; and certainly we would be loathe to admit that a poor person is ‘less’ of a person. Yet, here our system remains, which effectively relegates our lower classes to a lesser degree of existence by offering higher quality care to those with more to spend.
    The inclination would of course be to call for some form of a universal healthcare system. It seems so simple, and so logical. Yet, with a universal healthcare system, it’s possible (more than possible) that many, if not all hospitals could be turned into a Bellevue style, underfunded facility. If suffering from acute appendicitis, the last thing you are thinking about is your egalitarian ideal of equality in hospital treatment. If the money is there, you want the best doctor you can buy, who won’t screw up your operation. Is it right to deny a portion of the population superior medical treatment simply so everybody is on equal ground and feels better about themselves? No; if the superior treatment exists, it should be offered, despite any political incorrectness it may incur. Until the arbiters of our medical fate in Washington decide that they are willing to admit themselves into Bellevue hospital in order to comprehend the struggle of the common man, superior tiers of treatment will always exist. The best we, as a society, can do is to make our Bellevue hospitals are as accommodating and well funded as possible. If we do enact a universal healthcare system, we must be sure we don’t let our existing hospitals degrade just to be in line with a place like Bellevue, the lowest common denominator.


    4.) What is meant by the term “differential diagnosis?” What is the benefit/drawback of this term?
    A differential diagnosis is the list a doctor composes of the likely diagnoses for a patient. The ailments are listed in order of likelihood. Then, the doctor picks the most likely ailment and proceeds to attempt to fix it. The benefit of this is that this early, decisive course of action will more often than not solve the problem; and by acting quickly they will have a better chance of stopping it. However, because they cannot know with absolute certainty the nature of the ailment befalling the patient, it’s always a possibility that the illness they treated for was not the illness of which the patient was suffering. They will have to reevaluate the patient if illness continues and attempt to treat for the correct illness this time but they have wasted valuable time; even worse is the possibility that the original treatment has harmed the patient, and compromised their chances of fighting the disease they actually have.

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  13. 3.) Dr. Nolen describes treating wealthy patients differently than poor, indigent, alcoholic ones. This is a problem with our health care system. What do you think could remedy this situation so that all patients are treating fairly and equally?

    I think that this is a very difficult problem to solve which is probably why the health care industry hasn’t solved it yet. I think the only solution that would totally solve the problem would be to have doctors who treated everyone the same as a manifestation of a personal belief that all patients should be treated the same. Doctors would have to believe that all patients should be treated equally in order for the problem to go away. If doctors feel that rich and poor patients should be treated differently than no amount of health care industry reforms will keep them from treating them differently when they can. I guess I don’t really have an answer to this question because I’m not sure that it can ever be completely remedied. I think the best thing to do is to have teachers in medical schools put a particular emphasis on the importance of treating patients equally and hope that medical students will take that message to heart. I really don’t think there is a more concrete way to combat the problem because it stems from stereotypes that are successfully controlled by hardly any industry. Unless medical schools can produce students without prejudices then the problem will persist.

    4.) What is meant by the term “differential diagnosis?” What is the benefit/drawback of this term?
    Differential diagnosis is a term used for the list of possible diagnoses that a doctor comes up with when they see a patient. The doctor takes into account as many variables as they can such as age and past problems to create a list of possible problems the patient might have. The benefits of this process are that the doctor has a starting place to make decisions about tests or possible treatments for the patient. The doctor is less likely to misdiagnose a condition if he or she has a wide range of diagnoses because he or she can use tests to rule out conditions without ignoring all the possibilities. However, this process can also be confusing and inconclusive. Sometimes symptoms for two diseases are very similar and the doctor is left unsure which of the two diseases to try to treat. This confusion can lead to extraneous treatments that may even be detrimental to the patient. I think that the benefits out way the drawbacks because it is better to have lots of options than to stick to just one. Using the example about two diseases, if the doctor decided to treat the patient for one disease and gets no improvement or even deterioration in health of the patient’s health, they already have an idea of something else they could treat. Differential diagnosis enables a doctor to quickly change treatments if a patient isn’t responding to one type of treatment without having to think about what else could be wrong because the doctor already has an idea of several ways to treat the patient.

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  14. 3)When Dr. Nolen describes treating wealthy patients, he mentions how much power the patients themselves have over their treatment. The poorer patients, on the other hand, are entirely in the hands of the medical staff. The way he treated the patient with frostbite on his toes shows how patients without money are at a disadvantage for two reasons: because they cannot afford better quality treatment and because of the impact of stereotypes. I don’t think there is anything that can be done to fix the first issue; there will always be patients who can afford better treatment and those who can’t. What could be remedied is the latter, the way in which prejudices impact the staff’s will to help those in need. Dr. Nolen resents having to care for patients he labels as “poor, indignant, and alcoholic”, but these labels are based on stereotypes. He believes that they are responsible for their condition, and this leads him to treat them with disrespect.

    4)Differential diagnosis is a method for rapidly diagnosing a patient. Doctors will conduct an exam and come up with several possible explanations for the symptoms exhibited by the patient. The primary benefit of this method is that operations can be conducted before conditions become advanced. A drawback to early surgery is that patients may receive the wrong operation, but surgeons would rather accept this risk than the risk of allowing a condition to become more severe.

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  15. 3.) Since money is essential to running a hospital, it is almost impossible to not favor those who have the money to keep the hospital running. Because of this it is not possible to strictly reserve the hospital for only those who need it most, because funding might not be sufficient in this case. A very fine balance would need to be met to completely remedy the situation. This balance would need to take in account the amount of care each patient needs, and how long they need it for. A complex process would need to take place in which patients were examined to make sure the right patients were in the hospital. This process would also need to take in account how much money the hospital was taking in because if all the patients were very poor they would not receive proper care from the money-lacking hospital. Essentially, the hospital would need to very carefully figure out which patients needed the care the most, and how much care they could offer all of them based on the circumstances. This still does not completely eliminate inequality issues, but it makes sure that the hospital still functions for the patients who need the care the most.

    4.) Differential Diagnosis is a method to try to help a patient when the diagnosis is uncertain. The doctor creates a list of possible conclusions about the case, and uses these hypotheses to try to help the patient. This method is often harmful to the patient because it is so premature. Prescribing drugs or other things to help the mystery condition might not work at all. If this is the case and it doesn't work, the condition might become untreatable in that time. Worse, the medications might harm the patient even more than his/her previous state. Although there are many downsides to Differential Diagnosis, it can also be very beneficial. If the doctor can positively predict the condition and prescribe correct medications then the condition can improve even if the doctor is not exactly sure what it is. Overall, if the method is used carefully and correctly, it can be very beneficial.

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  16. 3. Treating the rich and privileged with the same quality as the poorer patients is something that is not likely to be seen. The wealthier patients need to be treated with more care and attention, as they are the people with the highest positions and most money in society. Treating them well will increase the likelihoods of their donating to the hospital. One way to fix this might be to only accept money from organizations or businesses and not invididuals, so that potential donors wouldn't get special treatment over the other patients. However, with this system, the hospitals may not get the amounts of donations that they would have liked. Some of the poorer patients also try to enter hospitals simply because they offer a place to sleep as well as consistent meals, something that Dr. Nolen talks about. Although it's unfortunate that this is the only way some people can get consistent meals, these patients should not be allowed into hospitals as resources are being wasted on them, resources that could be used for patients that are actually suffering from one sickness or another. This could be fixed, but the changes would have to be made on a city-wide level, as opposed to changes to the hospitals. These people would need places to live so that they would not have to seek homes in the hospitals.

    4. A differential diagnosis is the list of possible problems with a patient based on their symptoms. With this, the doctors include all possibilities, even if they might be stretches in terms of the symptoms of the conditions. But with all the possibilities, the doctors can start broadly and narrow the list down as they observe new things or conduct tests. However, this method might take too long to decide on the condition of the patient, which could either lead to a loss of confidence in the doctor by the patient or maybe even increasing severity in the condition if the doctor takes too long to come to a conclusion on the condition.

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  17. 3. I do not think this is as much a problem with the healthcare system as it is a problem of the economy and the government. As the book stated, people who are more financially stable generally detest staying in a hospital. They prefer to wave some money under a doctor's nose and get in&out as quickly as possible. This is because they probably already have the luxury of living in a home and eating comfortably. However, people who live on the streets or in crummy apartments may see the hospital as a "godsend." For someone who does not know where their next meal will come from, a warm bed and three hot meals a day is a huge improvement. As the book outlined, people may often injure themselves in order to stay in a hospital. How can a hospital work efficiently when it is over-crowded and understaffed? The hospital spreads itself too thin and the patients who really need care aren't given the attention they deserve. This is Bellevue Hospital. This is a hospital in a poorer neighborhood. A wealthy person would most likely not attend this hospital. They would attend a hospital that would give them more attention. In other words, a hospital that would charge more. A doctor cannot be held responsible for the problems that the government has created. This disbalance in socio-economic class is what defines the difference in care that a hospital can give.

    4. Diffential Diagnosis is when a doctor diagnoses a patient. There are way too many variables that come into play when diagnosing someone: Age, gender, syntoms, the list goes on... Differential Diagnosis is on one hand, evidence of a well rounded analysis. This stops a doctor from rapidly jumping to conclusions and mistakingly treating the patient for the wrong ailment. On the other hand, it can make a doctor doubt his/herself and also waste precious time. There are circumstances where a quick descision must be made to save a life. It is easy to see how differential diagnosis can complicate this.

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  18. 3) Although I believe that this kind of practice of treating wealthy patients differently than poor patients is totally unethical and unfair, I don’t think it that it will change anytime in the near future. In an ideal world everyone would be treated equally, but we are far from this ideal. Doctors will continue to favor wealthy patients who could potentially donate to the hospital. This is especially important in hospitals like Bellevue, where it needs all the help it can get. Bellevue is in desperate need of money and support, and if they have to favor those who have an abundance of money to receive financial support then so be it. There is no clear way to remedy this problem, especially in a world like today’s where so many hospitals are understaffed and underfinanced to function efficiently.

    4) A differential diagnosis is a list of possible conclusions a doctor makes when examining a patient. Often times, not enough information is available and there are a variety of conclusions that could be drawn. Differential diagnoses have their ups and downs. One benefit of having such a list is that doctors are able to act quickly to treat an ailment. Waiting any longer to confirm the conclusion could possibly lead to worsening of the condition. With a differential diagnosis doctors can act quickly to cure a patient, and move on to the next treatment if the first one doesn’t work. A drawback to this system is the possibility of further harming the patient with the wrong treatments. Because of the uncertainty, doctors could possibly prescribe the wrong treatment which could lead to worsening conditions and possibly even death.

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  19. 3. Unfortunately our society is based around money, and as long as this is the case, wealthier members of society will have preferential treatment in all areas of their lives. Sadly it can all be chalked up to just "the way things work." There is no reason that things would be different in such a high-priced field as medical care. So much has to change in our society before health care will. For financially-limited patients, until they are treated completely equal in all aspects of their lives they are going to be given no better respect in a hospital. While I do understand that Dr. Nolen is stressed and does not have extra time for anyone, I think he treats the poorer patients with less respect because he would do the same outside the hospital. I don’t have a quick and easy solution for the social problems in medical care, but I can say that if any solution is to be achieved it will not arise with the creation of laws but instead with an overall societal change in the public’s views on social class.

    4. A differential diagnosis is when a doctor makes a catalog of all the possible ailments a patient could be suffering from based on multiple components. First are the symptoms and second are such aspects of the patient as gender and age. Using these the doctor can hypothesis what possible problems the patient could be suffering from. The upside to this practice, is that then the doctor can treat the possible cause of the problem, and either fix it completely or stall for more time to create a firm diagnosis. On the contrary the downside to this tactic is the patient could either go to long without the correct treatment or they could have a negative reaction to the administered drugs or treatment.

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  20. 3. The societal issues of distinct social classes has been a problem that has plagued (if you call it that) mankind throughout history. People will always find ways to collect more power and money than others. Consequently, there is no simple fix or remedy. There are many ways to redistribute wealth; however, that is not science related. On the smaller issue of patients being treated equally at hospitals regardless of their wealth or social status, there are some adjustments that could be made. To keep patient treatment equal, you could withhold the social status information about the patient (though I feel this would hinder the process of certain diagnoses. i.e. a poor patient would have been less likely to travel to Africa recently and contract some rare disease.) By withholding this information you could ensure that patients were at least treated more fairly though it would obviously not completely equalize the system.

    4. Differential Diagnoses are essentially diagnosing through the process of elimination. In a differential diagnosis, one establishes a list of symptoms and subsequently a list of possible ailments. The goal is to systematically test the patient and remove diseases until there is only one left. Theoretically then this is your disease. Obviously this was an ideal situation as things do not always come out simple. If all of the diseases are eliminated it likely indicates that the physician made a mistake or the disease is not known to modern medicine.

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  21. 3. The problem is not with the system of doctors giving preferential treatment to those who are more affluent and wealthy. The problem is with the very fact that there are terms such as "affluent" and "wealthy" in our society. Trying to remedy the surface problem will only suffice to a certain degree, after which it is usually worse. Giving someone solely painkillers for a pain that is caused by cancer is not going to help with the cancer at all. In order to actually get everyone treated by doctors in a completely fair and equal manner, they have to be viewed as completely equal, and until this is the case there is no solution to the problem.

    4. A differential diagnosis is a way in which doctors come to a conclusion upon how a certain patient should be treated. They first list every possible ailment based on the symptoms. Then, by looking at a number of factors of the patient, including age, sex and living conditions, they order the possible problems from most to least likely. The doctor can then treat the most likely cause. This allows for a doctor to treat a patient much more quickly than if he waited for a full slew of tests that would give a much more sure diagnosis. The drawback of this is that there is always a chance that the doctor will come to an incorrect conclusion and mistreat a patient leading to further problems for the patient.

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  22. 3.) I really don't think in our society can we really change the health care system. We need to change the society that we live in. In many hospitals, people who donate money get better treatment. This is becuase they want the money to kepe flowing. I hate to pull my examples from TV, but this can be pulled from Scrubs. Dr. Cox prefers to treat everyone as if they could be there grandmother. HOwever, Dr. Kelso prefers to treat the richest patients because if he didn't, then he could not keep the hospital open. Each believe they are doing the right thing.
    A nationalized health care system could solve the system some what. The only problem is that surgeries that are not life threatening would take for ever to do and that often leads to a cap.

    4.) A differential diagnosis is when doctors figure out a disease through the process of elimination (or POE as the SAT prep book calls it). This is very good for some patients as they will always get some treatment. Doctors will ususally try to eliminate the medicines that will hurt people if they don't have it. A doctor also has to pay close attention to the patient if they want to keep the patient alive. The drawback would be if the patient was given the wrong drug that could make them worse. It also can lead to the wrong conclusion or letting people think that the patient is getting better even if they aren't

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  23. 3) It is truly unfortunate that the experience one might have with our health system is based on any level upon how much money they have. But the problem does not lie with the health care system as it does with our society. In most areas of our society, how much wealth one has determines their experience. Health care is the worst field for this to be present because getting treatment can be the difference between life and death. As long as people have money to pay for better treatment and have influence in the public sphere, they will get preferential treatment when they are sick. The only true way to solve this is to socialize medicine, but even then.

    4) A differential diagnosis is when a doctor analyzes a patients symptoms and then gives several possible diagnoses. The advantage to this is that the doctor has a wider range of possible conditions to test for. The disadvantage is that if a patient has serious or life threatening symptoms, the doctor cannot act as quickly.

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  24. I can't speak about the healthcare system as a whole, because it is so vast and I have really no knowledge about it. However, with the situation of the Bellevue Hospital, I think there are several things the hospital could have done to make their treatment of different patients more egalitarian. Although the doctors treat the poor patients who are looking for a free place to stay for a few weeks with condescension and cynicism, it is important for those doctors to remember that many of the poor in Bellevue had no other options but to scam their way into a hospital. The doctors have a duty to try to cure the ill, and poverty and homelessness can be conditions as debilitating as any illness. The doctors should understand that they have the same obligation to attend to the needs of a poor person and to a rich person. In general, it is only by employing doctors who truly believe in helping people recover from whatever ails them that a healthcare system will succeed.

    A differential diagnosis is a methodical system that basically uses the process of elimination to diagnose the ailment of a patient. The process of differential diagnosis boils down to making a list of possible diagnoses, and eliminating them until only one remains. The benefit of this method is that a doctor will not diagnose carelessly or blindly, he will consider many options before focusing on one in particular. Unfortunately, this process is often long, and if the patient is in grave condition, it is possible that his sickness could worsen or end his life.

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  25. 3.) Treating all patients fairly and equally is, I am afraid, impossible. It is impossible, at least, to take into account the poor, indigent, alcoholic ones are more difficult to work with - malnourished, and with a wider range of possible problems. Dr. Nolen mentions Tuberculosis as one example of a disease rarely seen in better off patients. Ideally, with infinite resources and surgeons, perhaps. But realistically, no. The best we can do is follow the "first come, first serve," basis to be as fair as possible. (Even there, exceptions must be made. Very, very influential people with power can demand to be treated first. This is a situation that cannot be avoided.)

    4.) Differential diagnosis is when a surgeon evaluates the problems of a patient, and suggests not one, but multiple possible problems. Even when a doctor finds one possibility incredibly likely, he/she cannot be sure. (Dr. Nolen compares this to the 10:1 horse race; there is always that slim chance that the odd horse will win.) The benefit of this is, of course, seeing beyond what seems "obvious," possibly finding the actual problem. The flip side, of course, is not selecting the right possibility, and not performing the best operation. Even so, differential diagnosis seems to safe more patients than not.

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  26. 1. The ideal, in regards to the different treatment of wealthy or poor patients, is that there should be no difference in treatment. I think very few doctors would say that they advocate basing their care and treatment of a patient on said patient's financial means, rather than actual sickness. However, the thing about rich people is, they have money, and can use that pay to get more and better care, more advanced treatments, and more doctors. They can afford to travel to the very advanced specialist in a different city, and I don't think they should be expunged for being able to do that. Doctors should strive to treat all patients the same, but that says nothing as to the patients being able to afford better care with more expensive medicines, I think.

    2. A differencial diagnosis is a method of diagnosis by examining the symptoms a patient presents with, and seeking the likely causes. Causes are eliminated or made more likely by examining many different factors. While differencial diagnosis is slightly more prone to error, it is much faster and sometimes a more apt method of discerning treatment.

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  27. 3. If there were such a thing as an anonymous lottery system in which patients' files were fed past an assessor to determine who was in greatest need of treatment, that would be great. Unfortunately, I doubt such an equitable arrangement would ever be widespreadly adopted. Besides which, people have made the good point that poor people sometimes feign illness in order to have a comfortable place to sleep, as described by Dr Nolen, and that is not good. And even an impartial assessor cannot take in all the variables in an anonymous patient's case. It is a difficult question.

    4. A medical differential diagnosis involves systematically eliminating possible causes of a patient's condition based on the patient's symptoms, until a probable diagnosis or a set of them is arrived at.

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