Days 9 and 10

We had our first days of classes, and we were on the topic of emotional intelligence and Insurance systems in the U.S. and Mexico. In class, what I found most interesting were all the constraints that doctors must work with to deliver care in the U.S., due to an inefficient system of health care. Private health care, which is limited to the rich or corporately employed has limited access to the general population, and public systems such as Medicaid are contingent on the federal and state definitions of poverty and eligibility status. The problem is most serious for the Mexican-origin population of the U.S., due to the fact that they are concentrated in lower socioeconomic levels and occupational locations. They work in industries where the employer does not offer insurance, yet they make enough money to lose eligibility for Medicaid, making them a class of uninsured known as the "working poor". The problems with improper health care due to low economic status translates to patients waiting for problems to get big enough that they need emergency services, not filling prescriptions due to cost, and lack of regular health care services, which turns out to be ultimately more expensive for the patient.
I never realized that there was so much beauracracy within our system of health. What's scary is that the current national debate over the future of our healthcare system will affect the way I practice as a doctor. I never realized it's so important to know the issues. Due to the fact that insurance is so privatized, doctors have no bargaining power in procedural costs, therefore insurance companies set all the prices, which will put more constraints on the types of tests doctors will run on their patients. In my opinion, there needs to be a movement for a national health care system that offers a beneficiary package of basic health care services, and optional supplementary insurance (public or private) for patients who want more coverage. Our health care system, today, is not a vertical system, due to the fact that the private sector deals with ALL the direct medical care of the patient, and public programs like Medicaid only provide funding (no actual health services) for procedures done in the private sector (which cost way more than medicaid can fund, which why many doctors are unwilling to take medicaid alone). The government should provide fully vertical programs that integrate funding and resources all the way down to direct medical care, through the existence of vertical public systems, for at least basic health care needs and services.
Another important concept emerging in quality care and effectiveness of treatment comes in the form of a doctor's ability to be culturally competent. A doctor must understand his patient's perceptions and emotions in order to deliver care. Factors for treating an illness don't only lie in the pathology of the illness but also the cultural and belief factors that the patient has regarding the advice the doctor may give. For instance, a patient may not take medication the doctor prescribes because their culture or belief system dictates otherwise, and a doctor must be able influence patient perceptions to alter behavior or figure our a way to treat the illness in another way. Emotional Intelligence is something the doctor must have in order to fully understand his/her patient's behaviors and provide an environment where he/she can effectively give care to the patient.