How Medicine Is Really Practiced In America In “How We Do Harm” By Dr. Otis Brawley

Otis Brawley shows in How We Do Harm: The Story of a Doctor Who Breaks All Rules About America’s Sickness. He demonstrates the conflict between ethical medical practice and science-based medicine. Brawley also illustrates how corrupt medical practice seeks to exploit patients and create harm through clinical experiments. Ethical importance means to do everything possible to prevent injury to patients, avoid medication errors, provide individuality in care to all patients, communicate honestly with patients and their contemporaries, and to take responsibility for nursing/provider decisions and actions. The book’s honesty and openness about providers’ practices is what I found most important. Before I was an nurse, my experience as a patient was invaluable. As a patient, it was assumed that my providers would be up-to-date on best practice and evidence. I also believed that my provider would represent my best interests. It wasn’t always true, however, when I became an nurse. There are both good, honest providers and those who just have enough knowledge to give care and get a paycheck. The same pattern is often followed by organizations. Honest providers must speak up as Otis Brawley. “A code of ethics is the hallmark for health care professionals. Inadequate or inappropriate policies and standards prevent providers and nurses from giving proper care to patients. This compromises their moral responsibility.

The Affordable Healthcare Act (ACA) is a direct link between quality and payment. This is how the “social mandate” to healthcare currently exists. Individuals must purchase insurance to avoid being penalized for not having it. Individuals will no more be penalized if they do not meet the ACA’s requirements in 2019. Many concerns will be raised in the coming year as America removes the penalty for not being insured, modifies Medicaid, Medicare, funds the opioid crisis, and attempts to reduce drug spending by lowering prices. Leaders are the first to make changes. Advanced Practice Registered Nurses can act as mediators and help to create standards and policy. APRNs are skilled in communication and can lead initiatives to improve quality in healthcare systems. APRNs have to seek out support for the nursing profession. They must also be empowered by including them in the company as well-respected shareholders. APRNs can improve the health of patients by doing this. As healthcare professionals, our duty is to ensure that patients receive quality care. Brawley discusses Chapter 20 and Chapter 21 the harm that unnecessary healthcare can cause. He believes screenings reduce mortality when they’re done early (Brawley 2012). A man named Ralph sees an advertisement for prostate screening. His wife insists that her husband be screened. This screening is followed by a biopsy. A doctor for hypertension will then perform a radical prostatectomy. He says that prostate screening is controversial and studies that he conducted did not identify as many cases as they should have. Based on that knowledge, Ralph chose the type of cancer he believed was most likely to be treated. Ralph was now in poor health, despite the fact that he could have survived without treatment. Brawley emphasizes the importance of having disease criteria defined and evidence-based treatments that are based on hard sciences verses theoretical and relative risks. He also discusses the findings of trials that radiography exposed revealed a higher risk of death than life-saving measures. Screenings may reduce the mortality rate for cancer-specific mortality in some cases, but not overall.

Chapter 5 features Mr. Schmidt, an “insured” white man suffering from colon cancer. He seeks treatment from a highly respected physician who isn’t a specialist in this area. Brawley laments the system’s inability to provide the best care possible, as well as medications and lost time. The physician makes money while the insured suffer. Because of his financial constraints, Mr. Schmidt had to visit Grady Hospital. However, he received the correct treatment and was cured. An analysis of trauma center emergency departments (EDs), non-trauma centers, and transfers to trauma centres showed that patients should receive better care than those who can pay. The article also revealed that insurance companies are paying more for trauma center services when they need it.

Brawley’s book had one problem that I found shocking: how a patient could easily influence a doctor to provide unnecessary treatment despite the fact that it was against evidence-based standards. Brawley’s book demonstrates that less is more. Debbie Kurtz has concerns about the return of cancer. Debbie was given the best treatment available based on current medical evidence regarding Dukes’ Acolo cancer. Debbie ignores this information. Debbie is treated by one doctor who believes that if he doesn’t, then someone else will. This insurance pays for unnecessary treatment. Debbie was able to have surgery to remove her cancer. She also received a clear post-op pathology report. However, she chose to cause harm to herself. Even if this means that a patient is told NO by a provider, they should still practice in the best patient’s interest.

Brawley discusses the cultural issues surrounding the fear that African Americans had of doctors and medicine during his lifetime. These fears resulted from fear of the past and unregulated trails which led to many deaths among African Americans. They also felt that doctors were only treating them, but had no idea how they could treat them. These perspectives led to distrust and suspicion of the system.

Brawley’s book on health policy highlights the gap in health care. He discusses the difficulties in achieving good health due to differences in economic status, race, gender, and gender. He offers many examples of Grady Hospital taking in uninsured and desperate patients. Edna Riggs confesses that she waited to seek medical attention for fear of dying, and because she didn’t have insurance. APRNs can serve as great mediators for policymakers to help reduce health disparities.

Brawley says that it is impossible to change the system by just one person. The collaboration of healthcare professionals across all levels requires methods that are deliberate. Team members must be clear about their roles and to support one another, as well as being able to spot any weaknesses or shortcomings in current practices. All healthcare professionals in the scope of health must collaborate to develop policies and standards. The best approach is for all healthcare professionals and their colleagues to come together and recognize the flaws in policies and standards. This will help reduce the cost of treatment, increase the disparities and decrease the quality of care.