Medical Plan Of Care Chapter 1-14 Summary

The Case Management program is offered by Kaiser Permanente to support members with complex medical, psychosocial, and care management essentials. This specialized service is provided by case managers. The case managers are either Registered Nurses who are certified in case management or qualified Social Workers. Case managers provide necessary information and education to promote understanding, reduce the chance of possible complications, and facilitate effective and proper delivery of care and services.

Nao Kao and Foua had been conflicted with abiding with the Hmong ways to not seek physician help. Certain parts of Hmong culture, such as taboos against procedures, beliefs of disease origins, and power structures within the family and Hmong clan often conflict with western culture of medicine. But when the Lee’s had not taken one of their children to the hospital, his soul was lost, and he died. Considering this incident and their lack of knowledge of Lia’s condition, the Lee’s had to involuntarily comply to western culture and take Lia to the doctors, as their last line of defense. It is important to note here that as a provider, I must be aware of my own assumptions of care. The doctors’ goal of treatment was to use medication and procedures to find out what caused her seizures and treat it with various medications. Lia’s parents considered her disease a blessing as a chance to become a shaman and a curse that caused great stress over the family. This often resulted in misunderstandings between the physicians and the Lee family as the Lee’s perceptions of Lia’s illness were not in line with the doctors.

I cannot accept the Lee 's refuse to hive lia her medicine. But as Lia 's parents a traditional Hmong family, they belief in what they had known and learnt from the past and their culture. They believe medication should not be taken forever or doctors cannot be trused. No, I do not sympathize with it, because Lia should be taken by Dr. Ernst and let Dr. Ernst to help Lia.

The doctors assuming the Lee were giving their daughter her medications, were surprised to not see levels of the medications in her blood. Dan Murphy who was one of Lia’s doctor questioned the parents and he learned that due to their cultural beliefs, Lia’s parents have not been administering her with the proper medicine. Where Lia’s mother believes she is doing the right thing for her daughter, Murphy has sympathy for the mother and told Fadiman “I remember having a little bit of awe of how differently we looked at the world”. A key feature of the Hmong is that they have no interest in being rule, do not like to be told what to do, and are rarely persuaded by the customs of other culture. The mistrust and open hostility between the medical staff and the Lee family seemed to overshadow Lia’s disease. Both side obviously loves Lia and wants her healthy but neither was willing to compromised and meet half way.

On account of the conflicts between the family and doctors, the psychosocial complications of Lia's care overwhelmed dramatically not just for Lia but also for everyone who was surrounded her. First of all, the severity level of epilepsy in Lia's case had increased dramatically over the years. The treatment was such a hindrance to Lia. The Lees family and healthcare staff both were prejudiced, and that made it worst. From the family view, distrusting the American medical system contributed to did not cure well. on the other hand, American doctors, thought they had advanced education and training system, they are the best and they only know what is the better for

The Affordable Care Act was signed into law March 23, 2010 by President Barack Obama; however, the constitutionality of the law remained in question. In a controversial 5-to-4 ruling, The U.S. Supreme Court upheld the law on June 28, 2012. The ACA is thought by some as the United States health care rescue, and as its downfall by others.

Most Hmong fear western medicine because of a lack of understanding, and a refusal to try to understand. The Lees had the importance of the medicine that was given to them explained to them many times, but they still believed that their thoughts about medicine and disease were far superior. In contrast, the Americans also refused to even attempt to understand the Hmong culture; even though slightly adapting to their medicine would have likely made the Lees much more compliant. This general misunderstanding of the other culture is best summarized by Fadiman, saying,

The US has recently adopted a healthcare policy aimed to get more Americans insured. This policy is named the Affordable Care Act in 2010. “In 2013 there were 42 million uninsured individuals in the United States. “(The Common, pg. 153) There has since been increase in individuals who are covered either by private insurance or by Medicaid/Medicare which had a coverage increase with the new policy. It is believed that millions of people will now have health insurance compared to previous years.

Lia Lee born and raised in America, but brought up as a Hmong, faced health issues specifically epilepsy. Her parents who practice the Hmong culture had a different view on how to handle Lia critical condition. Hmong did not believe in traditional medicine but believed in Txiv neeb, person with a healing spirit. Not only do they believe in a person with healing spirit to help cure their illness but also consider epilepsy as power; “Their seizures are thought to be evidence that they have the power to perceive things other people cannot see, as well as facilitating their entry into trances, a prerequisite for their journeys into the realm of the unseen” (Fadiman, 1998, p.21). Right at this moment is where you can tell conflict is going to occur.

Even though Foua and Nao Kao never completely understood the reasons for why they had to administer Lia with so many prescription drugs, they eventually participated in proper medication trainings with the social worker in order to comply and appease the doctor’s demands. Over time, Foua and Nao Kao were able to develop a good relationship with Lia’s doctors, with the assistance of the family’s social worker, Jeanine Hilt, in order to regain custody and comply with the medication regimen. This was a difficult concept for them to grasp, as the methods of the doctors were completely foreign to them, and they felt they had no control in what was happening to Lia who they, according to their cultural values, wanted to take complete responsibility

Many years ago, an epileptic Hmong girl named Lia Lee entered a permanent vegetative state due to cross-cultural misunderstanding between her parents and her doctors. An author named Anne Fadiman documented this case and tried to untangle what exactly went wrong with the situation. Two key players in her narrative were Neil Ernst and Peggy Philp, the main doctors on Lia’s case. As Fadiman describes, “Neil and Peggy liked the Hmong, too, but they did not love them… [W]henever a patient crossed the compliance line, thus sabotaging their ability to be optimally effective doctors, cultural diversity ceased being a delicious spice and became a disagreeable obstacle.” (Fadiman 265) At first glance, this statement seems to implicate Neil and Peggy as morally blameworthy for a failure to be culturally sensitive enough. However, upon further inspection of the rest of the book, it becomes clear that Neil and Peggy’s failure to be more culturally sensitive to their Hmong patients was caused by structural issues in the American biomedical system. To prove this point, this paper will first present a background to Lia’s case, then discuss possibilities for assigning blame to Neil and Peggy, then show evidence for the structural issues in American biomedicine, before finally concluding.

What would it be like to come to a country and not understand anything about its health care system? To many this would be a very daunting task. Unfortunately, this is the scenario that the Lee family has to deal with in the book The Spirit Catches You and You Fall Down by Anne Fadiman. The Lee family, and the other thousands of Hmong immigrants, try to understand and navigate the complex and sometimes confusing health care system of the United States. As the book points out, the values and ideals of the Hmong culture and the United States health care system are not always the same and sometimes come into great conflict with each other. Lia Lee was unfortunately the person stuck in the middle of this great conflict.

In recent years, health care has been a huge topic in public debates, legislations, and even in deciding who will become the next president. There have been many acts, legislations, and debates on what the country has to do in regards to health care. According to University of Phoenix Read Me First HCS/235 (n.d.), “How health care is financed influences access to health care, how health care is delivered, the quality of health care provided, and its cost”.

This chapter focuses on some of the conflict between the Hmong healing traditions and the doctor’s practice in medicine. The Hmongs took the doctors prescriptions as advice not as orders, and they did whatever they wanted regardless of what the doctor prescribed, but at the same time if they left the doctor’s office without being prescribed something, they felt cheated. The doctors and the Hmong have many problems communicating because of the language barrier and cultural barrier. This makes it hard for the doctors to try and treat someone, and some of the Hmong’s healing techniques aren’t acceptable and considered abuse in America.

Health care administration is a very important and crucial role in today’s healthcare system. With an ever-changing national health care system, the role of a Health care Administrator or Healthcare Executive more than ever is needed. Healthcare facilities, organizations, and or offices rely on health care administrators to plan, direct and coordinate all medical health services (United States Department of Labor , 2014). Some areas where one might find administrators are managing entire medical facilities, specialized clinical departments, or a medical practice for a group of physicians (United States Department of Labor , 2014). The need for high-quality health care administers is more now than ever with the fast-changing health care laws.