intro to hc chapter 3

History of Western Health Care Overview

The history of health care in the Western world showed gradual change until the 20th century. Rapid advances in medical technology, diagnostics, and treatments occurred in the last few decades, surpassing changes from the previous 100 years. Infectious diseases were the major killers at the start of the 1900s, with influenza and pneumonia leading. The discovery of penicillin, antibiotics, and immunizations greatly reduced infectious diseases.

Ancient Times Health Care

Fossilized bones and Egyptian mummies show conditions like arthritis, bone infections, appendicitis, arteriosclerosis, urinary and intestinal diseases existed in ancient times.

Ancient Times Disease Beliefs

Disease was believed to be caused by spirits, ghosts, or gods. Treatments included rituals, loud noises, beating the sick, or bloodletting.

Ancient Times Preventive Medicine

Preventive methods included wearing amulets and painting or mutilating the body to ward off evil spirits.

Ancient Times Life Expectancy

Average life span was 20–35 years; chronic illnesses were rare.

Hippocrates of Cos

Greek physician (460–379 BC) called the “Father of Medicine.” Emphasized observation and conservative treatment, using dietetics before drugs or surgery.

Medieval Times Plagues

Plagues in 543 and 568 AD killed most of Europe, leading to societal breakdown.

Medieval Times Knowledge Preservation

Monks preserved medical texts; monasteries served as learning centers.

Medieval Times Disease Beliefs

Disease seen as punishment for sins, devil possession, or witchcraft. Treatments were prayer, penitence, and saints’ help; cures were considered miracles.

Black Plague 1348

Killed 30–50% of European population; quarantine recognized as preventive measure.

Medieval Times Hospitals

Networks of hospitals provided refuge for the sick, old, disabled, or homeless; marked more humane care.

Renaissance Overview

(1350–1650) Revival of science and learning, exploration of body structure, numerous autopsies; first connection between autopsy results and clinical observations.

Renaissance Disease Conditions

Cities had filth, disease spread, and superstitions persisted despite scientific advances.

Printing Press

Allowed widespread distribution of medical and scientific knowledge.

Gunpowder & Surgery

Gunshot wounds from wars increased, elevating barber-surgeons to higher status due to need for surgical treatment.

17th Century Blood Circulation

William Harvey discovered blood circulates through a continuous network; initially opposed. Enabled injection of medications and blood transfusions in the future.

17th Century Microscope

Antonie van Leeuwenhoek invented the microscope in 1666, allowing study of microscopic anatomy and organisms. Connection between germs and disease discovered centuries later.

Quinine for Malaria

Imported from Peru, separated malaria from other fevers, confirmed disease-specific cures.

Brain & Psychology Study

Nervous system and muscle stimulation studied; disproved old beliefs that mucus from colds came from the brain.

18th Century Body Function Theories

Three main theories: 1) body as hydraulic pump; 2) diseases due to overstimulation, treated with depressants/stimulants; 3) clinical observation to categorize diseases (2,400 described).

Surgery in 18th Century France

Surgery respected after King Louis XIV’s anal fistula repair; elevated surgery from craft to experimental science.

Vital Signs Measurement

Techniques to measure blood pressure and temperature developed to monitor patient status.

Chemistry in Medicine

Digestion understood as chemical process; metabolism and dietetics studied scientifically.

Enlightenment Philosophy

Rational approach to problems, dissemination of knowledge, rapid progress in studies and experiments.

Mental Health Recognition

Focus shifted from possession/sin to disease; mentally ill treated humanely, chains removed.

Preventive Health

Sanitary reform in hospitals, prisons, military; personal hygiene improved; child health emphasized to reduce infant/child mortality.

Edward Jenner & Vaccination

Vaccination with cowpox provided smallpox immunity, saving countless lives and opening doors for other vaccines.

19th Century Physiology

Advances shifted from organs to specific tissues; heart inflammation categorized as endocarditis, pericarditis, or myocarditis.

Medical Profession Unification

Physicians and surgeons united; surgical specialties developed: tracheostomy, thyroid and uterus removal; pediatrics, psychiatry, dermatology, public health, preventive medicine established.

Microscopy Advances

More powerful microscopes allowed cellular-level observation of human tissue.

Chemistry & Diagnostics

Laboratory tests for diagnosis became common; metabolism, dietetics studied scientifically; pharmacology emerged as a new science.

Dentists and Anesthesia

Dentists introduced anesthesia, which expanded to major surgical procedures, allowing large-scale surgery and decreasing death rates by reducing shock and the need for speed.

Elizabeth Blackwell

First female MD in the U.S. (1821–1910); opened the first U.S. nursing school in 1860; opened medical education and established nursing as a profession.

Louis Pasteur

Chemist (1822–1895) who proved bacteria cause specific diseases; led to germ theory development and understanding that infectious microorganisms are transmitted via humans, animals, mosquitoes, or food.

Joseph Lister and Germ Theory

Applied germ theory to surgery in 1864; microorganisms in wounds identified; anesthesia, asepsis, and new surgical instruments revolutionized medicine.

20th Century Preventive Medicine

Pasteurization, vaccination, asepsis, and sanitation increased life expectancy from 47 years in 1900 to 70 years in 1950.

Karl Landsteiner

Discovered blood groups in 1921; made blood transfusions safe.

Insulin Discovery

Extracted and tested for diabetes treatment; transformed diabetes from fatal to manageable disease.

Vaccination Programs

Large-scale vaccinations eradicated many infectious diseases; 1918 influenza epidemic reminded of ongoing risks.

Biomedical Engineering Advances

New diagnostic and therapeutic tools: X-rays, ECG, EEG, ultrasound, pacemakers, dialysis, tomography; computers advanced biomedical engineering.

Vitamin Discovery

U.S. led research linking vitamin deficiencies to diseases like scurvy and beriberi; disproved belief all diseases were microbe-based.

New Synthetic Drugs

Developed for allergies, cancer (chemotherapy), and bacterial infections (antibiotics).

Mental Health Treatment

Shock therapy and psychosurgery replaced with drugs and psychotherapy; tranquilizers improved patient management.

Organ Transplantation and Surgery

Advances in surgical techniques and anesthesia enabled organ transplants, prosthetics, and redefinition of death as brain death.

End-of-Life Decisions

Mechanical life support raised ethical questions; living wills emphasized; first hospice opened in England in 1967; Dr. Jack Kevorkian advocated physician-assisted suicide.

Trauma Medicine

Growth of transportation and machines caused accidents; trauma medicine became a specialty.

Genetic Research

Genes associated with specific diseases identified; gene therapy research ongoing.

First Test Tube Baby

Born in 1978 in England; enabled reproductive options for previously infertile couples.

AIDS Identification

1981: disease identified; led to life-prolonging medications but no cure.

First Cloning of Sheep

1997: opened possibility for human cloning and organ growth for transplantation.

21st Century Health Hopes

Develop vaccines for HIV, cure AIDS, obesity; clone organs; genotype-specific medications; cures for heart disease, hypertension, cancer; effective mental illness treatments; preventive and alternative medicine integration; healthy lifespan 100+ years; less-invasive treatments.

Trends in Modern Health Care

Rapid growth in treatments: organ transplants, robotic surgery, gene therapy, targeted drug therapy; pharmaceuticals lead prevention and treatment; continual learning needed.

Aging Population

Life expectancy increased from 47 (1900) to 73.2 for males and 79.1 for females; baby boomers aging increases health care demand.

Health Care Services for Older Adults

Includes long-term care facilities, chronic disease management, home care, Alzheimer’s care.

Handwashing Discovery

Ignaz Semmelweis observed handwashing reduced maternal death; ideas initially rejected; illustrates resistance to new practices.

Cost of Health Care

Health care costs rose faster than most sectors; access and affordability became major social/political issues; debates over health care as right or privilege.

New Approaches to Health Care

Driven by disease understanding, cultural practices, less-invasive alternatives, natural products, mind-body connection, preventive focus, patient self-care, humanization, and advertising.

Wellness Concept

Promotion of health through prevention, good habits, education, routine care, immunizations, nutrition, exercise; patients responsible for own health.

Margaret Newman’s Expanding Consciousness

Theory: help patients live meaningful lives with incurable diseases by focusing on possibilities, not limitations.

Holistic Medicine

Considers physical, mental, emotional, spiritual, environmental factors; emphasizes prevention, patient education, participation; mind affects body; psychosomatic illnesses recognized.

Principles of Holistic Medicine

Prevention preferred over treatment; patient responsibility; stress reduction; proper nutrition and exercise; attitude affects health.

Public Health History

Vital statistics collected in early U.S. colonies; Paul Revere led Boston board of health in late 1700s.

Complementary Medicine

Used alongside Western medicine; example: meditation with medication.

Alternative Medicine

Used instead of Western medicine; example: acupuncture instead of surgery.

Integrative Medicine

Combines Western medicine with complementary/alternative approaches; example: chemotherapy plus meditation and nutrition supplements.

Whole Medical Systems

Homeopathy, naturopathy, traditional Chinese medicine, Ayurveda; complete systems of healing and theory.

Mind–Body Medicine

Patient support groups, meditation, prayer, guided imagery, art/music, yoga; enhances mind’s influence on body.

Natural Products

Aromatherapy, herbs, dietary supplements, shark cartilage; substances from nature.

Manipulative & Body-Based Practices

Chiropractic, osteopathic manipulation, massage, reflexology, relaxation exercises; restore function via physical manipulation.

Energy Therapies

Biofield therapies, Qi gong, Reiki, therapeutic touch, bioelectromagnetic therapies; manipulate energy fields to heal body/spirit.

Complementary and Alternative Medicine (CAM) Benefits

Treats body, mind, spirit, emotions; emphasizes lifestyle changes, patient education, mind-body influence; increasingly adopted by Western providers.

Prevalence of CAM

~40% of Americans use some form; common methods include natural products, deep breathing, yoga, chiropractic, meditation, massage, special diets, homeopathy, progressive relaxation, guided imagery.

Health Fraud in CAM

FDA warns of products claiming quick cures, “scientific breakthroughs,” secret ingredients, undocumented results, limited availability; cancer, AIDS, arthritis, obesity, sexual dysfunction, diabetes often targeted.

Osteopathy

Belief body can protect itself if musculoskeletal system, nutrition, and environment are optimal; osteopathic physicians (DOs) trained like MDs, can prescribe drugs and perform surgery.

Chiropractic

Belief nerve pressure from spinal misalignment causes pain/dysfunction; treatment is spinal manipulation; chiropractors cannot prescribe drugs, may recommend nutrition/herbs; state licensure required.

Massage Therapy

Massage therapy, when administered by a trained practitioner, involves using pressure or friction on the body to relax muscles, improve blood circulation, speed healing, relieve pain, supplement other therapies, and reduce stress; most states require therapists to be licensed.

Naturopathy

Naturopathic medicine is based on the body’s natural healing ability; naturopathic doctors (NDs) use diet, exercise, lifestyle changes, and natural therapies alongside traditional medicine to treat the whole person; licensed in 23 states, D.C., Puerto Rico, and U.S. Virgin Islands.

Homeopathy

Treatment method using very small amounts of substances that cause symptoms in healthy people to stimulate healing; examples include diluted onion extracts for colds and belladonna for pain; licensed in Arizona, Connecticut, and Nevada.

Energy Theories

Belief that body energy flows are necessary for good health; therapies like acupuncture insert needles into specific points to relieve energy blocks and maintain health; originated in China over 5,000 years ago.

Personalized Medicine

Also called precision medicine; health care prevention, diagnosis, and treatment are based on individual biochemical makeup using genomic research and DNA sequencing; aims to select the most effective treatments for each patient.

Precision Medicine Initiative

Launched in 2015 by President Obama to enable individualized care through research, technology, and policies that empower patients, researchers, and providers.

Providing Affordable Health Care

The Patient Protection and Affordable Care Act (2010) expanded access to insurance but may be expensive with high deductibles; challenges include unemployed, part-time workers, and middle-class Americans; government subsidies help but are limited.

Long-Term Care

Care for aging individuals or those with chronic conditions needing assistance beyond hospitalization; includes nursing homes, assisted living, adult foster homes, and continuing care communities; high costs often require private insurance or Medicaid.

Social Conditions Affecting Health

Factors like education, neighborhood, poverty, and social support affect health and health care delivery; poor conditions contribute to higher rates of obesity, diabetes, infectious diseases, and limited access to care.

Racism in Health Care

Racial and ethnic minority groups experience more health problems and shorter life expectancy due to discrimination and systemic biases; addressing implicit racism is the first step toward health equity.

Maintaining Quality of Care

Rising health care costs and profit-driven organizations can compromise care quality; measures include preauthorization, insurance oversight, Joint Commission accreditation, and monitoring nursing home standards.

Alzheimer’s Disease

Most common form of dementia (60–80% of cases); progressive memory and cognitive decline leading to death; care is costly and often supported by Medicare/Medicaid; 2020: 5.8 million affected in the U.S., expected to rise to 14 million by 2060.

Public Health Concerns

Ongoing monitoring and research are needed to address infectious diseases, pandemics, and other health threats, as shown by the COVID-19 pandemic.

Medication Adherence

Taking medications correctly in dosage, timing, and frequency; critical for managing chronic illnesses; pharmacy-based interventions recommended to improve adherence.

Opioid Crisis

Overuse and addiction to opioid painkillers, initially promoted as non-addictive; 2021: 91,799 deaths from overdoses; strategies include treatment access, overdose-reversing drugs, data collection, research, and safe prescribing guidelines.

Antibiotic Resistance

Occurs when bacteria mutate to survive antibiotic treatment, making infections harder to treat; causes 2 million illnesses and 23,000 deaths annually in the U.S.

Suicide Prevention

U.S. suicide rates have risen; health care providers play a key role; warning signs include hopelessness, threats, substance abuse, and withdrawal; programs like Zero Suicide aim to improve identification and treatment.

TV Prescription Drug Ads

Increased exposure to drug ads may mislead patients, promote unnecessary medication, and contribute to high health care costs; U.S. and New Zealand are the only countries allowing such ads on TV.

Health Care Facilities

Include hospitals, clinics, long-term care facilities, and nationwide health systems; offer services from preventive care to emergency treatment; employment opportunities are diverse.

Hospitals

Traditional care facilities; offer trauma centers, emergency departments, ICUs, CCUs, step-down units, general units, surgical/medical floors, TCUs, and rehabilitation units; specialize in high-tech, continuous patient care.

Ambulatory Services

Outpatient care not requiring hospitalization; includes provider offices, diagnostic centers, surgery centers, and specialized clinics; many procedures formerly done in hospitals are now outpatient.

Long-Term Care Facilities

Provide care for individuals unable to live independently; include skilled nursing facilities (SNFs), intermediate nursing care facilities (INCFs), adult foster homes, assisted living residences, and continuing care communities; high costs and quality are key concerns.

Home Health Care Providers

Home health care is rapidly expanding due to shorter hospital stays, growing older population, advances in home medical equipment, and desire of patients to age in place.

Registered and practical/licensed vocational nurses

Administer medications, IV therapy, monitor progress, change dressings, remove sutures, educate on self-care.

Physical therapists & assistants

Teach exercises, improve mobility, monitor recovery after injury/surgery.