In his book How We Do Harm: A Doctor Breaks Ranks about Being Sick in America, Otis Brawley illustrates the battle between doctors honest practice based on ethics and evidence-based science and corrupt medical practice that seeks greed, clinical experiments that cause harm and inadequate standards. Ethical importance includes: doing all that is reasonable to prevent harm to patients, preventing medication errors, providing individual care to each patient, dealing honestly and openly with patients and peers, and taking responsibility for nurses' judgment and actions /suppliers. The aspect of the book that had the greatest impact on me is the demonstration of honesty and skepticism about how traders operate. Before I was a nurse, I was a patient. As a patient I believed that my providers were up to date on best evidence and practices and that my provider would have my best interests at stake. When I became a nurse, I realized that this isn't always true. There are honest, knowledgeable providers and there are those who get by with just enough basic knowledge to provide care and make a paycheck. Organizations tend to fit the same mold. It's time for honest providers to speak up just like Otis Brawley and demand that standards of care rise to the occasion to point to the evidence and not make the rules up as they go. “The characteristic of the health professions is that our actions are guided by a code of ethics.” Inappropriate and inadequate policies and standards deny nurses and healthcare professionals the opportunity to provide adequate patient care, thereby compromising their ethical responsibility. Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an original essay Health care's current "social mandate" is largely influenced by the individual mandate of the Affordable Care Act (ACA) and how the health budget is influenced through federal, state, and private insurance by directly linking the quality of payment and patient satisfaction. Under the ACA, individuals are required to purchase insurance or receive a penalty if they are not covered by some type of insurance entity. In 2019 this mandate will end and individuals will no longer receive any sanctions. The coming year will bring many worries as America eliminates the penalty for not having insurance, changes Medicaid and Medicare, secures funding for the opioid crisis, and attempts to reduce pharmaceutical spending by lowering prices. Changes start with those in leadership positions. Advanced Practice Registered Nurses (APRNs) can serve as excellent facilitators to shape public policies and standards. APRNs are trained in advanced communication skills/processes to lead quality improvement and initiatives in health systems. APRNs must seek support that values ​​the nursing profession and empowers them by including them in the process as respected stakeholders. In doing so, APRNs are empowered to improve the health of their patients. We, as healthcare professionals, have a duty to serve our patients and provide them with quality care. Brawley explains in chapters 20 and 21 how he witnessed the harm associated with unnecessary health care and screening based on the thought that screenings reduce mortality when detected early (Brawley, 2012). Describes a man named Ralph whose wife sees an ad for free prostate screening and is insistent that her husband undergoto screening. This screening leads to a biopsy, an internist for hypertension, a radical prostatectomy using the Da Vinci robot causing impotence and incontinence, a remaining piece of the prostate producing 0.9 prostate specific antigen (PSA), and radiation causing rectal proctitis which in turn forms a rectal fistula in the bladder requiring colostomy and ureterostomy. He explains that there are debates about the usefulness of prostate screening and how the studies are conducted without any cancers found. The type of cancer Ralph had based on knowledge from that era left questions about whether or not to treat it. Ralph had lost a high quality of health due to screening, when in reality he could have been fine without treatment. Brawley emphasizes the need to define evidence-based disease criteria and practices based on hard science with respect to relative risks and theoretical treatments. In the same chapter he also explains how studies have found that the use of radiographic exposure revealed a greater mortality risk than life-saving measures. One study suggests that screening will likely reduce cancer-specific mortality, but that overall mortality does not decrease. In Chapter 5, Brawley describes Mr. Schmidt as an “insured” white male with colon cancer who seeks treatment from a well-known doctor whose specialty is non-colon cancer. Brawley expresses his disgust with the system for insured people who rack up large expenses due to suboptimal care, medications, lost time at work, and ultimately, loss of insurance while the doctor makes money. Mr. Schmidt was forced to go to Grady Hospital due to lack of funds, but in return he was treated with the right care and recovered from the disease. A study of nontrauma emergency departments (EDs) versus transfers to trauma centers emphasizes that patient needs should come before the patient's ability to pay; this article revealed that policyholders receive lower-quality care while paying in a non-trauma emergency room when their critical illness requires transfer to a trauma center. One ethical issue I found frightening in Brawley's book was how the patient so easily influenced a doctor to administer unnecessary treatments based on the patient's persistence, even if this was against standards and evidence-based practice. Brawley argues throughout his book that more is not better. Debbie Kurtz fears the cancer will return and contacts several doctors to get more treatment for Dukes' A colon cancer. Debbie received all the appropriate care based on the latest medical evidence for Dukes A colon cancer. Debbie ignores this information, a doctor chooses to give her treatment based on the thought that if she didn't do it someone else would, and insurance pays for this unnecessary treatment because of limited information. Even though Debbie has had surgery to remove the cancer and a clean post-surgical pathology report, she chooses to harm herself. Providers should practice with the patient's best interest in mind, even if that means telling the patient NO, to ensure they are not doing harm. Brawley addresses the cultural issues of the African American population's fear of medicine and doctors during his time. These fears stemmed from exclusion from the system, from unregulated pathways that caused many deaths of African Americans, and from a fear conceived because they felt that doctors only practiced on them and really had no idea how to treat them. These perspectives have.