[Juby Thomas]

Question #1: Why can’t the US just import or export Healthcare Systems? Explain two limitations of direct comparisons.
Healthcare system cannot be imported or exported because health of a population in itself depends on multiple factors, that can be tied to a country’s development and economic status along with other factors like methods used for diagnosis, screening, or treatment. prevalence of different conditions among populations, costs of treatment, cultural beliefs also influence the policy making and healthcare delivery. I also agree with Dr Suzy, that countries maintain the records differently, in India most hospitals don’t use EMR or EHR which can affect the survey and the high rate of out-of-pocket payment in India also causes people not to seek medical care, as Dr Barry said it does affect the outcome of a comparison done.

[Juby Thomas]

Question #1: Describe the three most important characteristics to you in selecting your own care provider and if ‘Prescription for the Future’ has impacted these and why.
I like the way how Dr Emmanuel in the book prescription for the future included stories and examples, recommendations for improvements and transformations to reduce cost and to increase the quality of care. He also points out the areas where the healthcare system is underperforming. Even though the book was focused on the US healthcare system, many principles and certain transformational methods mentioned in the book (Standarization of care, behavioral health, shared decision making, community and lifestyle interventions) can be adopted into LMIC like India. many countries might not have a governing organization and set standards to measure the performance. selecting the health care provider also depends on what the patient’s values. personally, for me I would like my doctor to have competency, who listens to me without jumping into conclusions, who offers practical and thoughtful recommendations, offers alternative nonpharmacological options when possible.
I agree with Dr. Barry that there should be transparency and fairness in pricing, which is a huge problem in Indian healthcare system. I also appreciate that you try to help your patients by trying to advocate and shop for them so that they can get the best deal possible.

[Juby Thomas]

Question #1: Describe any specific healthcare process and the potential for virtual medicine to improve quality and reduce cost. Provide supporting evidence and address potential problems with this approach.
Patients with certain physical disabilities for whom getting to hospitals for appointments can be challenging, can benefit from virtual medicine. It can lower transportation cost, can reduce the need for paid personal assistance services, can lead to lower cost of care, provides better access to care and provides convenience for the patient and can increase patient’s satisfaction. Sometimes physical examinations are necessary to make a full diagnosis and there is also a chance for misdiagnosis if a patient fails to report an important symptom that otherwise could have been detected during an in-person care. I agree with Dr Barry on human contact and face to face interaction are a must at times, and virtual/tele medicine cannot be considered as a complete replacement for in person appointments rather can be used to supplement the in-person visit.

Question #2: Is “all healthcare local”? Agree or disagree and provide one supporting argument for both positions.
Some aspect of healthcare can be considered as local but not all. Locally designed and tailored health care system can give care specific to that particular region or community, while taking into account cost, needs and convenience which can benefit the population and the providers, to achieve measurable results and to make significant change collaboration from multiple stakeholders are necessary.

[Juby Thomas]

Question #1: Describe one response from a low or middle-income country (LMIC) which might be applied with effect in the USA and one response from the US Healthcare System which might be applied with effect in LMIC
Insurance, most people in India are not covered by insurance, one study done by BMC health service research in 2020 suggested Out-of-pocket expenses accounts for about 62.6% of total health expenditure in India. Secondly to implement value based care, which will help to align incentives with patient’s outcomes than on number of tests/treatments/procedures performed. In India this method can also help to shift the focus from healthcare to health, reducing burden from the available healthcare resources. Thirdly India should work towards digitization, making electronic medical records more available which can help to keep the patients records, to avoid duplication, increased cost, and other inconveniences like treatment delays. One of the ways how India was able to bring down health care cost, and was able to provide accessible, affordable medical care to the rural areas was by implementing the hub and spoke model, which reduced the cost of operations/services thereby reducing the costs for patients.

[Juby Thomas]

Question #2: Describe one treatment approach that may benefit from greater patient-informed, shared decision making and propose two strategies to attain it.
I believe shared decision-making process is more beneficial and relevant in situations where there is more than one reasonable option for treatment/screening/management, where there is no one single right decision, or for conditions in which there is a close tradeoff between risks/harm and benefits. I agree with Dr. Barry that hypertension management, also pain management or as in hypercholesterolemia where reduction of cholesterol levels can be achieved by patients by implementing lifestyle changes like exercise and diet low in saturated and trans fatty acids, here shared decision-making approach can benefit the patients. In most of the private hospitals in India, pregnant moms who wanted to have vaginal birth ends up having emergency C section, without any medical reasons. The prominent culture of “doctors knows it all” makes it difficult for the patients to ask questions. Informing and discussing with the expectant mothers about birth plans, risks, possible complications, recovery, benefits of normal and c section is important. Correct/sufficient information should also be offered at a timely or useful point where it can aid in decision making.

[Juby Thomas]

Question #1: Define the “Fundamental Attribution Error” and provide one illustrative example from your experience
Fundamental Attribution error is when people Judge or assume that an individual’s actions depend on their personality and what kind/type of person they are while under emphasizing social or environmental factors and forces that could have influenced the individual’s certain behaviors. one of my dorm mate is overweight due to hypothyroidism and other metabolic, hormonal problems and she has knee pain which has gotten worse in the last two months after she arrived here in China as her room is on the 6th floor, finally requested the office to change her room from the 6th floor to the first floor as she is finding it difficult to climb the stairs and we do not have elevators. Many people assumed that she’s obese because she’s lazy and overeats, some also commented she would lose weight if she climbed the stairs every day.

[Juby Thomas]

Question #2: What health and wellness problems might a behavioral health provider address and how could co-locating with physicians improve care quality? Provide a specific example of success.
Behavioral health is often overlooked but is important to address. Many acute chronic medical conditions may involve psychosocial behavioral issues which has the ability to exacerbate symptoms. Co locating physicians and integration of behavioral health service with primary care provides a pragmatic strategy to enhance patients experience, like it saves patients time traveling from one healthcare provider office to another, patients are less likely to miss appointments, also eases the stigma of seeking treatment for mental health wellbeing which can be a barrier for some people( which is one of the major causes in India for individuals not seeking medical help) and Separate primary care and behavioral health systems can lead to fragmented care delivery, higher healthcare costs, poor health outcomes, and duplication of services. I agree with Dr Abanda, Behavioral health services cover a wide range of healthcare services (mental health treatment, addiction and withdrawal treatment developmental disabilities). Thank you, Dr. Suzanne, for bringing out this point that parents whose infants are in long term care in the hospital, needs mental health support and care too, before i didn’t thought from this aspect.

[Juby Thomas]

Question #1: Provide an example (from current events, home, school or work) of the promotion or ‘contagiousness’ of desirable behavior (Positive Peer Perception/Pressure).

Obesity runs in my family. Family members from both of my parent’s side are mostly obese. At the age of 12 and 10 my sister and I weighed 90 KG and 83 KG. our pediatrician explained to our mother, how important it is for both of us to lose weight, so for over two months my mother (my grandmother also joined in) tried everything they both knew to get us to reduce weight and to eat healthy, one day mom joined yoga classes, started going for small walks and started to eat healthy. Within a short period of time me, my sister, other family members noticed that our mother has lost weight and she started to look more beautiful, she had more energy, she stopped complaining about pain. suddenly it felt like losing weight is a doable task, giving up chocolate cakes and ice creams was not that difficult, if mom can do it then we too can and we reduced over 8 to10 kg that year.

[Juby Thomas]

Question #1: Outgoing President Trump promised price transparency in healthcare. What are the barriers and intended outcomes? Is this supported by available evidence?
The one of the barriers according to the article was the low utilization of the price transparency tool which may be due to the fact that healthcare is different from other consumer services. Determining the cost of medical care in advance is difficult, as it’s hard to predict what combination of services a patient might need. The information available regarding the cost of a particular procedure might not capture a patients actual cost of the care.
Also, when individuals are just presented with price and comparative quality information is not available patients might believe that higher cost translates to higher quality care. Some people might make less emphasis on health care prices compared to other factors like where to get care or which doctor to see. Here I also agree with Dr. Barry and Dr. Suzanne that many patients are loyal to their health care providers, patients may be unwilling to go against their doctor’s advice in the interest of saving a few dollars.

[Juby Thomas]

Hi Dr Suzzy, i agree with your view on employee satisfaction, i think when an individual works for 8 to 10 hours per day in an organization, job satisfaction becomes more important to that individual, many people consider their jobs central to who they are.

[Juby Thomas]

Question #1: Describe two examples of deliberate strategies pursued by your school or employer to encourage a dispositional affect that contributes to the mission.
Every year our university includes the new students in the Chinese New Year celebration and lantern festival, teachers teach how to make traditional dishes likes jiaozi, organizes shows which includes traditional opera, music, and dances. It makes the adjustment to new environment less stressful, and students become more active and productive.
Every year university organizes a weeklong trip to Beijing to see great wall of China (for new students), other places for other students, such activities from a student’s perspective can boost positive emotions.

[Juby Thomas]

Hi Dr Suzzy, thank you for pointing out performance evaluation, even though self-evaluation has its own importance I think it’s important to receive evaluation from supervisors/teachers who can point out areas which needs improvement, which otherwise can go unnoticed in self-evaluation.

[Juby Thomas]

Question #2: Select one transformational office-based practice and describe a change you would implement in your own context.
standardization, I believe that proper Standarization can minimize risk of errors, decrease variation, improve efficiency, prevent operational mistakes and accidents and increases patients’ safety. for example, at the hospital where I was working previously in Kinshasa, some nurses would prefer to draw blood for testing microscopically while others would perform rapid test. standardization decreases cost, supports value-based medicine, provides a check list of what needs to be done and all staff are aware of the protocol, medical supplies which are needed can be kept at a designated place for all the medical staff to access, standardization leads to better management, coordination between different departments and can enhance personalized care.

[Juby Thomas]

Question #1: How does your school or workplace intentionally encourage a sense of identity and individual development?
I think sense of belonging and feeling of inclusion is important for foreign students to perform at their best, since everything around them at first is different and feels alien. one of the ways how our university has intentionally encouraged a sense of identity is by creating a group for new students, where the teachers in charge check in with us on a weekly basis, updating us with any new rules or regulations, covid measures and so on. secondly by giving the students the opportunity to share our opinions either online or during the weekly class meetings. Thirdly by recognizing the efforts and accomplishments of the students by giving the students awards, red packets (Hong bao) which is the most common way to appreciate and encourage students here in our university.

[Juby Thomas]

when the change happens suddenly or some systems which was running for a long time needs to be changed, people tend to resist that change more often, as Dr Abanda mentioned “elephant ran in automatic mode”. we had a similar experience when the financial department wanted to go digital with the billing, this change was resisted the most and took more time than anticipated to install and run. The existing inequalities became more prominent and obvious during covid. many blue-collar jobs cannot be done or can only be done in a limited way from home, to work from home for extended period of time was basically not possible for them. I think most people went from getting paid less to not getting paid at all. many saw and used covid as an opportunity for making financial gains. This widened the inequality and economic gap.

[Author]

Posts