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Over time, some doctors have been quick to default to psychological explanations for medically unexplained illnesses. For Coda, David Tuller tells the story of Maeve Boothby O’Neill, a bright young woman in England who was diagnosed in 2012 with myalgic encephalomyelitis or ME — also known as chronic fatigue syndrome — after several years of constant exhaustion and poor health. Doctors said her symptoms were “normal for her age” and “all in her mind,” and continually shrugged off her illness as psychological, rather than biological. After a gradual decline in health, Maeve died at 27, essentially from malnutrition, because the hospital refused to tube-feed her. Through interviews with Maeve’s mother, access to Maeve’s diary, and other reporting, Tuller recounts Maeve’s journey and mistreatment from the NHS over the years, shining a harsh light on the medical establishment’s long history of ignoring patients whose illnesses they don’t understand. But, as Tuller writes, perhaps the similarities between ME and long COVID patients may finally bring about change.
Medicine has a long and sorry history of bias and discrimination on the basis of sex. Given that ME and other functional and medically unexplained disorders are known to be much more prevalent among women, it is not surprising that patients with these conditions routinely report receiving poor treatment and even abuse at the hands of the healthcare system.
We think of being in the hospital as enduring isolation in a clinical setting, cut off from normal life. But what if being hospitalized meant something different? What if you could be receive hospital-quality care in your own home? Helen Ouyang profiles a movement of health care providers who, propelled by a range of factors, not least among them the COVID-19 pandemic, are working to redefine what hospitalization in America might look like:
Other countries, including Australia, Canada and several in Europe, had already been experimenting with this practice, some of them extensively. In Australia, which has been running home-hospitals for decades, these services provided in Victoria alone are the equivalent of what a 500-bed facility could offer in one year. Overall, the patients treated in this way do just as well, if not better, in their homes.
The obstacles impeding Leff and other hospital-at-home advocates in the United States were bound up with America’s labyrinthine health care system and particular medical culture. The Centers for Medicare and Medicaid Services (C.M.S.), which is the largest payer of hospitalizations, has required that nurses must be on site 24 hours a day, seven days a week, effectively keeping patients within the hospital walls. This matches how American society has come to regard hospitalization, too — nurses at the bedside, doctors making their rounds, in elaborate facilities pulsating with machines.
But Americans didn’t always convalesce in hospitals. Before the 20th century, treatment at home was the norm. “Only the most crowded and filthy dwellings were inferior to the hospital’s impersonal ward,” the historian Charles E. Rosenberg writes in his 1987 book “The Care of Strangers: The Rise of America’s Hospital System.” “Ordinarily, home atmosphere and the nursing of family members provided the ideal conditions for restoring health.” As Rosenberg puts it, “Much of household medicine was, in fact, identical with hospital treatment.” As health care became more specialized and high-tech, however, diagnosis and treatment gradually moved into hospitals, and they evolved into institutions of science and technology.
FreshRSS