Healthcare access and insurance in John Q.

John Q. Reaction

The movie John Q. was released in theaters more than a decade ago. Even so, the topic at hand in that movie is still very relevant and current in terms of its applicability to society and the medical world. It is also something that has a ton to do with the way in which patients and providers interact and facilitate healthcare that is provided in a modern context. While John Q. was clearly a work of fiction, the parallels and applicability to today's medical climate is unmistakable.

Of course, John Q. is about a situation where a man's child needs a heart transplant. The man (portrayed by Denzel Washington) is told that the transplant will not be covered by his insurance. The rest of the movie revolves around Washington's character taking the hospital hostage until the transplant is promised and delivered. The ways in which money and insurance pervade the themes in this movie can easily be compared to what is experienced by a lot of people in real life and in 2015, rather than just looking at situations that were ten to twenty years ago. In one way or another, money and insurance does seem to have an effect on the healthcare that people receive and this has a direct and pronounced reaction on how providers and patients interact with each other (IMDB, 2015)

Indeed, going to a regular medical office will lead to someone interacting with administration, billing and other personnel. Those people will talk a lot about copays, paying the amount due, when things are due, what is covered, what is not covered and so forth. At the same time, there is a concurrent cacophony of words and interactions that pertain to the recent debate and eventual passage of the Patient Protection and Affordable Care Act in 2010. That law was not popular back then and it is still not popular. The nature of the discontent regarding that law is much the same thing that was muttered or even yelled during the Hillary-Care debate in the 1990's. The gist is that many people are very apprehensive or even hostile about the government being involved in one's healthcare decisions or outcomes. For example, many would argue that John Q's child should have had the transplant as a matter of procedure even if it was not covered by insurance. Others might suggest that a heart should go to someone who more likely will become (or already is) a contributing member of society (Drench et al., 2007).

In terms of what can and should be learned from the classwork and the movie are numerous. This author will cover some of the main ones. First of all, while medical care is seen as a right to a lot of people, there are medical offices that get a little on edge if a patient is unwilling or unable to provide a copay at the time of medical service. For sure, a major reason for this is the fact that much of the healthcare sector is for-profit in nature. Even so, if someone is suffering from something major like bronchitis, pneumonia or something else like that, whether or not care should be provided should not really be in question. However, anyone who is honest with themselves and with who they are speaking to knows that money is indeed one of the main factors (Drench et al., 2007).

Even so, there has to be a balance of the books when it comes to healthcare, who receives it, why they receive it and so forth. While this was certainly not true of the John Q. plot, some people need organ transplants because of bad lifestyle choices and behaviors. For example, a doctor or nurse will have to explain in fairly blunt detail why someone with a shot liver due to alcoholism is not going to be put on the liver transplant list. Indeed, a liver that is available for transplant should not go to someone that is almost certainly (at least from an odds standpoint) going to ruin that one as well. Even when such a reason exists, providers have to explain that at some point that they will not be put on the list. However, there are other times that this decision might be made and it might not have anything to do with bad lifestyle choices. Indeed, there was the case of the little child that needed a transplant due to her glands going crazy (Drench et al., 2007; IMDB, 2015).

The main point of the above and indeed the main reason the author of this report chose John Q. As the movie or other selection to draw from is that there does indeed seem to be a disconnect. The author of this report has observed that the providers are more and more focused on cost and the patient making sure they pay their bill while the patient is more focused on becoming or keeping healthy. This perhaps explains that the author of this report sees more than one report about there being a disconnect between providers and patients and/or patients choosing to forgo medical care due to cost concerns. The author of this report has also seen more than once instance where medical standards and outcomes are much worse for the poor and disadvantaged because they either do not know how to live in a healthy manner and/or they are not getting preventative screenings. For example, someone that can barely afford to live is not going to be focused on getting a colonoscopy or a mammogram even if their genetic or medical history dictates that they should definitely get one (Gourlay et al., 2014; Drench et al., 2007).

The author of this report did some further research and found that this problem is far deeper and wider than the author originally thought it would or should be. This even holds true for truly dire situations where the disease or disorder in question is potentially or definitely lethal. For example, one article that brought this to life was the story about AIDS-infected mothers in Tanzania and whether they transmit the disease to their children. Indeed, the pull quote from the article was "it is like that, we didn't understand each other." The evidence was found when talking to about twenty-one women that were mostly HIV positive. Those twenty-one women dealt with a total of nine different healthcare providers. There were three themes that came out, those being decision-making processes, level of trust and features of care. Those three themes could be applied directly to John Q. First, there was the decision-making process that led John Q's son to not be put on the transplant list. Second, there was no trust because the choice was made in direct contradiction with what John Q. thought should be done as opposed to what was done instead. Features of care are obviously different in the John Q. case because some people get on the transplant list and some do not (Gourlay et al., 2014; Drench et al., 2007).

The article continues by talking about the dimensions of patient-centered care and it also talks about influencing factors. Examples of the former include the bio-psychosocial perspective, the patient as a person, the doctor as a person, therapeutic alliance involved in care and the sharing of power and responsibility. The latter, that being influencing factors, includes doctor factors, patient factors, shapers, professional context influences and consultation-level influences. The examples that are noted for each would make sense to the author of this report and it would be tragic if the best-case scenarios listed in the report are not actually happening in real life. The class text has made it clear that they need to happen for optimal care to be provided. However, it is clear that this is not happening in real-life situations at least some of the time. For example, a the author of this report, based on the textbook and the source just consulted, would expect the doctor or nurse to cover social and psychological issues and not just the medical aspects of care. Also, the author of this report agrees that there are going to be differences at the individual level when it comes to how they experience, perceive and deal with an illness. The author understands from the book and from the other source used that there are factors with the doctor or other provider. Sometimes doctors have a bad day, sometimes they get burned out and sometimes the clinic or office knows they are not going to get a dime from a service and the service may not be all that cheap. The article reviewed for this report would drive that point home even further because many to most of the people in Tanzania have no means to pay much of anything for their medical care. However, there are people that are providing it nonetheless. Of course, AIDS and HIV require multiple visits over time so the Tanzania people were often reinvited. Some people would come back while others would not. It is not clear why the people that refused to participate didn't come back. However, given what they were facing in terms of mortality and such, it is obviously not a good idea for them to not show up. This makes their refusal to cooperate all the more vexing (Gourlay et al., 2014; Drench et al., 2007).

The vexation mentioned regarding Tanzania keeps up for the author of this report when it comes to looking at the textbook as compared to more local situations. For example, there are many gay or bisexual men in the United States that can and should be visiting doctors and/or other providers that can teach them about proper sexual habits so that there is less or no spread of diseases such as HIV / AIDS, syphilis or gonorrhea. When looking at the statistics, barely more than half of the people on the list have visited a provider within the last year. Considering the statistics about gay men transmitting disease, this is clearly alarming. To be sure, it is no mystery (and has not been for twenty to thirty years) that gay men are one of the more riskier groups when it comes to spreading HIV / AIDS and other sexually transmitted infections (STI's). Gay men are by far not the only high-risk group out there but they are certainly one of the more stigmatized. There are obviously many heterosexual men and women that are not using proper protection and other measures when having sex. However, gay men are mentioned differently. This may explain why interactions are fleeting and not nearly common enough. One study on the subject mentioned that visits were based on having health insurance (and how good it is), comfort with the provider and the results or process of proper HIV / AIDS or STI training (Meanley, 2015).

In looking at these sources, the book, the movie John Q. And so forth, it is clear that there is not a happy center where everyone feels they can go into a doctor's office or hospital and get the care that they should get. To be sure, that is the way it should be but that is now where we are at for the time being. The gay stigma has obviously been presence since AIDS came about in the 1980's. It has faded but has not completely gone away. Instead it seems to be tapering off over time. However, this problem is literally causing problems with quality of life, length of life and it has reverberations across all of society (IMDB, 2015; Meanley, 2015; Drench et al., 2007).

What Author Has Learned

The author of this report would suggest the following things based on what has been learned in this report and from the class or class text:

Doctors and other medical areas should be "judgment free zones" and they should not give any sense of judgment or negative thoughts from the feedback that is being given IMDB, 2015; Meanley, 2015; Drench et al., 2007; Gourlay, 2014).