Thursday, June 30, 2005
Sunday, June 26, 2005
Dog Days of Summer
It was established by Dr. Arnold Gold at Columbia University Medical School in 1993. It was designed to impress upon students, physicians and the public the important symbolic role of the white coat in patient-doctor interactions. Gold argued that students were reciting the Hippocratic Oath four years too late-upon their graduation from medical school. He felt the oath and the conferring of white coats would be better done at the start of medical school, when students receive their first exposure to clinical medicine. The White Coat Ceremony provides a mechanism by which values that are key to our profession can be openly articulated and carefully considered in the company of peers, parents, partners and faculty.
With mine less than a month away, I've reflected on the humanistic values that such a ceremony attempts to, not instill, but remind students of as they start the journey towards a career of caring. No one leaves a medical school interview without saying, "I want to help people." However, I would like to elaborate on my view of the situation.
I want to help people, but there are limitless ways of doing that. At the time I decided I wanted to be a physician I was set in the most careless, spoiled city in the country -- Los Angeles. As well I was set to enter the pettiest, self-centered profession in that city -- Hollywood. I went out looking for ways I might contribute to the betterment of life and considered a number of paths however, when I saw that first surgery, I was sure that this was the most amazing, jaw dropping way of aiding your fellow man that any person could undertake. This little girl, with the VSD and narrow aorta, would die without this surgeon. If she lived, every moment from then on, all the good she did with her life -- raising a family, building a better light bulb -- all the people she touched, those moments in time and accomplishments could be traced back to this surgeon and these nurses and everyone who helped her achieve such by giving her the gift of life.
It was a contribution that would grow exponentially as this little girl would age. It is something I wanted to be a part of.
Saturday, June 25, 2005
U.S. Job-based Healthcare Flawed, Economists Say
I'm not saying the job-based health insurance system is efficient but the article is more about the necessity for "equality" in health coverage than other problems inherent in the U.S. system. As well, several inaccurate 'scare statistics' exist in the article -- including the 45 million uninsured million Americans figure -- which is patently false.
In Case You Missed It
Blogger has a new photo upload feature. I think some users were getting to beta test it earlier. In anycase, so long Photobucket.
Friday, June 24, 2005
George Will on Kelo
L. Ron Hubbard's views on psychiatry arose before the founding of the Church of Scientology. However, they are an intricate part of the "religion's" practice. Slate magazine has a nice article on just what those views are. As can be seen they have no basis in science, and you basically must forget the most basic ideas of cause-and-effect and the scientific method, which every high schooler is taught, in order to buy into these ideas on how to treat mental illness.
Thursday, June 23, 2005
The Supreme Court has dealt yet another blow to the idea that property rights are somehow inherent. I guess you can tax me all you want once I'm wealthy. What a load...
Wednesday, June 22, 2005
Virus Kills Cancer Cells
Tuesday, June 21, 2005
How Far Away is an AIDS Vaccine?
The first AIDs vaccine will appear in the next decade. It's effectiveness may be in question, however.
Saturday, June 18, 2005
AAMC President Calls for AA
Despite that belief, I hold up the right for private institutions, including medical schools, to discriminate all they want. If they believe that affirmative action serves their school then they should be able to insert that as a policy.
However, public, government run and funded state schools have no place with reverse discrimination and affirmative action.
It is actually cooler than I thought it could be. I'm working with the ophthalmologic photographer who takes pictures of patient's eyes (inside and outside). I can pick out obvious cholesterol deposits, melanomas, ulcers, some glaucoma complications after only a week. That part of the work is actually pretty fun.
An ophthalmology residency is pretty difficult to get into, yet is only four years (including a transitional year). The pay per hour is superb. It is a clinical based practice, with office hours, and yet as a specialty the average annual income is excellent. Unlike other clinical based specialties which have good hourly pay (like derm) you perform far more procedures and surgeries as an ophthalmologists. As well, I would argue, since almost none of your work is cosmetic (you have optometrists to do that), compared to say dermatology where the majority of income is derived from cosmetic work, ophthalmologists are actually doing more...well, good.
Consider going on a mission trip to Africa. A Medicine doc sees a young malnourished child and diagnosis him with a parasite. He gives some drugs to expel the parasite and leaves Africa, knowing that because of the patient's lifestyle he'll probably have worms again in a month. An ophthalmologist sees a blind patient, whose been that way for years. He performs surgery, fixes the detached retinas, and leaves knowing the patient has his sight back for the rest of his life.
Monday, June 13, 2005
New York Times Supports Universal Healthcare
What Krugman fails to mention, but I have, is that more recent surveys find that support for national health insurance drops well below the majority mark if 1) Patients are limited in what physicians they can see and 2) Waiting times for elective procedures increase.
Both of these are inevitable in a single payer system.
That is the most concrete problem with such a system. Other problems include, but aren't limited to, a significant decrease in physician compensation; over time and if such a decrease is significant enough fewer med school applicants which means a drop in the quality of physicians.
And finally, it's simply, matter of fact, unethical. To support universal healthcare is to support the wealthy paying for the healthcare of the poor -- it is as simple as that. What you are saying is that there is an inherent right to some subjective level of healthcare but not to property.
A single payer universal healthcare plan cannot guarantee the highest quality care for everyone. There will always be expensive elective procedures that would, not save lives, but improve care, which simply cannot be covered in a pragmatic sense. So the level of care provided is subjective. Someone in some bureaucratic office says that if we cover such and such a procedure but not another, then we've fulfilled one of the basic human rights -- that of healthcare. Ridiculous.
If you're going to be subjective about what quality of care people are entitled to (and let me make it clear I don't believe they're entitled to any), then I say the quality of care the uninsured receive NOW is completely satisfactory. And that argument is just as legitimate and defensible as any other claim of what constitutes acceptable care.
This is why healthcare is not an inherent right. It's an amorphous and ever changing thing, unlike say the right to speech or property or life.
Family v. Doctors
A child with Hodgkin's who had been through chemo was told she would have to go through radiation therapy by her oncologist. When the family decided to postpone the therapy and try to get a second opinion with another oncologist, the physician's practice reported them to CPS, and the state took the girl away and her brothers.
Child negligence when it comes to healthcare is a tough situation. How far do, say, religious freedoms extend when it comes to trying to force your children to practice them. It's perfectly all right for a Seventh Day Adventist to refuse a blood transfusion but should he be able to refuse one for his child?
1 Million HIV Cases
Sunday, June 12, 2005
I'm Supposed to be a Doctor
I mean, it's not everyday someone with a background in screenwriting decides he's suppose to be a doctor. I'm sure it is. However, all of my life I've loved politics and there is no doubt as a physician I want to be tightly involved in healthcare policy and politics. Here's a neat looking Health Policy Fellowship Program through the AMSA.
I applied to Texas' only MD/JD joint degree program and didn't get in. A close family friend who is a practicing academic physician has decided to go back, more than 10 years into his practice of medicine, and get his JD so that he can become more involved in the policy aspects of the academic health center. I think it's noble and it's a role I aspire to and it's got me back to thinking. Despite the fact it's four years away I wonder about two things -- 1) If a graduate degree, a JD, or an MPH, or an MPP; would actually help me get my foot in the door and my voice heard on healthcare policy and 2) When such a degree should be pursued.
Take this physician who I look up to, he is older and his place in this academic practice established and will be waiting for him when his JD is complete. Yet, on the downside the man will, for all intents and purposes, almost not practice medicine and receive no income from such for three years.
I think the worst time to pursue such a degree would be, say after your residency. In such a case you would have no established career, and your clinical skills and knowledge would likely degrade to some extent over the your years away as you studied.
If I'm going to be a full time student pursuing a graduate degree beyond my M.D., then it seems like the best time is either immediately following graduation, so that you postpone your residency training and lose none of those skills; or after you've settled into a career.
I have four years to ponder this. It's more than likely I'll come out of medical school understanding I don't need a degree to be involved in healthcare politics. But maybe...
Friday, June 10, 2005
The Uninsured & Universal Healthcare: Ideologies (Part 3)
I am not a pragmatist. I do however define myself as an idealist. That title however has come, with time, to denote a bleeding heart. I'm much more cerebral about my ideals but they are certainly there. I would rather do what I believe to be right despite charges that sometimes such action lacks real world functionality.
To all who level such charges I paraphrase George Bernard Shaw:
The reasonable man adapts himself to the world...The unreasonable man expects the world to adapt to himself...Therefore, all progress depends on the unreasonable man.Individual liberty versus equality. From slavery to the welfare state to the Cold War, it has simply been the underlying struggle of America's more than 200 year history. There are notable historians and political philosophers who will say it is not simply that black and white. There are well versed and highly educated and intelligent individuals who claim that these two things -- individual liberty and equality -- are not mutually exclusive and to view all political debates in terms of one or the other limits your thinking and blocks out solutions to the problems facing the world.
However, more than the trailblazers of political correctness and moral ambiguity would have us believe, the world is often black and white. The world has come to accept all viewpoints and potentially legitimate; it is the greatest folly of the political correctness 'movement,' although giving such a title implies an organization not present. It dilutes individual responsibility, excusing any situation and with the erosion of responsibility comes the loss of liberty and morality as well. Perhaps what we have witnessed in the past forty years is merely the inevitable liberalization of the western world which history has clearly shown. Such inevitability does not however make the ideology correct, of course.
I've rambled off track and I've failed to mention universal healthcare once so far, but bear with me.
Individual liberty and equality are mutually exclusive except in the sense that there is an equality to every individual being free in his or her own right. It is the difference between a free market and socialism. The ultimate expression of equality - the complete redistribution of wealth; communism.
A defense of universal healthcare, whether the proponent recognizes it or not, is of course, like the defense of any welfare program, a defense of equality. Since, equality is exclusive of individual liberty, a defense of universal healthcare necessarily requires the erosion of someone's liberty. In the case of programs which redistribute wealth involuntarily, such as universal healthcare, equality and someone else's 'rights' are more important than your right to property and privacy.
It is another matter whether you believe that property is an inherent right. Proofs of that are long and arduous and beyond my scope. However, let's just make it clear that I believe it is. So there are two final points to be made. One, even if you believe healthcare is an inherent right as well, there are still problems with universal healthcare. Two, healthcare isn't an inherent right.
If healthcare and property are both inherent rights, then by definition one isn't more important than the other. Being inherent gives them the ultimate weight. You cannot say something is more inherent than another. It may seem obvious in one's everyday understanding of the world, to say if someone is dying, and you have a needle that could save him or her, then that needle can be taken from you, as this person's life is more important than your ownership of that needle. But, if property is an inherent right, then that is not the case. I understand this is hardest thing for some to accept in this argument but from a logic and rhetoric point of view it is correct.
Fortunatley, I think there's ample proof that healthcare is not an inherent right. Try to define the right to speech or life or property. Fairly simple, you can phrase them in your own words. Try to define a right to healthcare. Does it include a CT to make sure a sprain isn't broken? Does it include birth control? Does it include the most expensive surgical procedures in the world just to relieve non-threatening foot pain?
It's a subjective definition whatever you come up with. The only universal definition possible is that all people are entitled to the best and most advanced healthcare possible in the world. Even that however, I assure you, is subjective. I couldn't pull 10 random doctors off the street and have an agreement, on the periphery of disease and healthcare, just what the best treatment is . As well, but of less importance, implementing the "best" healthcare is obviously pragmatically impossible. A universal healthcare system in the real world could never provide such a system of ultimate care. There is nothing inherent about healthcare.
If healthcare isn't an inherent right but property is (I haven't really shown that but I believe it), then how can you deny someone their inherent right, by taking their money to pay for someone else's healthcare involuntarily? I don't think you can.
I know this post has been far more cerebral than most are willing to accept.
Thursday, June 09, 2005
Private Insurance In Quebec
This quote shows the type of thinking that proponents of socialized anything have going for them:
Opponents of changes to [Canada's] Medicare claimed it could force Canada into a two-tiered health care system in which those who have deeper pockets get faster, better service from doctors who opt out of the public health-care program.And I ask, So?
They deserve to be able to do that at the least. It's one thing to say that everyone deserves some subjective level of care and that the rich should be made to pay to guarantee such care for the poor. It's a step beyond, in the absurd department, to say that the rich shouldn't be able to pay for their own medical care.
"Well the wealthy can certainly chunk up some money to pay for care for the poor but the idea that they can pay for their own choice of care...hmph..."
Wednesday, June 08, 2005
Questionable Study on Uninsured Costs
The mere fact they cite a ludicrous figure for the number of uninsured in this country (48 million; see previous posts and do a google search: here and here) raises questions about the credibility of all other figures in the study and potential bias from this partisan group. I'm not sure this is even newsworthy except for liberal media outlets.
I'm a little vindictive right now.
Kevin, M.D. has posted on the topic.
80 Hour Resident Work Weeks
Refill: A Short Short Story
At the end of the day there are a dozen messages to be sorted through. As if the days in clinic don’t try your stamina enough.
You flip through them looking for the one’s you can ignore until tomorrow or the next day or a week from now when they’ll call back angry. You thank God they can’t see you roll your eyes (and you understand why video phones never took off).
Five messages in is the one you really want to ignore. You stop at it though. Mr. Jones has dropped his pain killers down the sink. You would go grab his chart or call the pharmacy but you know he’s weeks from his next scheduled refill.
Two weeks ago Angela told him to bring in a police report if he wanted a refill, after he claimed his pills were stolen out of his car. Kind of amusing. Kind of sad.
There’s no use grabbing the doc. Mr. Jones doesn’t want the surgery, and the decision has dropped him well down the priority list. You, however, can’t personally fault anyone for not wanting to go under the knife.
You could call him back now. He knows he can’t have the drugs early but he still gets angry. You could call him though, with the best intentions. You could run through a list of rehab treatment programs and pain management specialists.
“Goddamnit, can’t you just give me the peels?” You can hear him draw out the i, like he was educated in the backwoods. That wouldn’t surprise you so much, and you chastise yourself for thinking that. “I can’t make it another week and a half!”
You’ve never seen him in here with any family and his emergency contact’s relationship is “co-worker,” scribbled in almost childish letters on his chart. Even if there’s someone close to him, you can’t tell them your suspicions. You pray there is someone anyhow and that they’re starting to notice.
Life would be easier, for you at least, if you would just call in the prescription. Then when you came into work tomorrow there wouldn’t be a new message from Mr. Jones waiting for you.
Angela pops her head in to tell you she’s leaving for the night. You ponder chasing her down the hall and asking her to tell Mr. Jones he can’t refill his meds yet.
You strum your fingers and stare at the phone instead. You’re not fearful of the call. Not really. You’re ashamed you decide. You’re ashamed you can’t help him. Isn’t that the reason you got into this profession in the first place?
You pull some rehab clinic brochures from a drawer. You try to imagine Mr. Jones smiling like the people on these things. And surprisingly, you can. The man has perfect teeth you remember.
You pick up the phone and return the call. You’re calling with the best of intentions.
Tuesday, June 07, 2005
Mental Illness Overdiagnosed
Today however, I have been through the ups and downs of poker. I love the game and there is something to be learned from it. You're not as good as you think you are when you're winning, and you're not as bad as you think you are when you're losing.
Monday, June 06, 2005
How Many Med Mal Bills?
This bill caps awards at just under a million dollars. That ain't right.
Saturday, June 04, 2005
Wednesday, June 01, 2005
I've got to have proof that I've had a lot of vaccines before they'll let me register for medical school (July 25th!). MMR, Hep B, Chicken Pox, Tetanus, and a test for TB. I'll have to get an antibody test for chicken pox (suffered through them, like almost everyone my age) and TB and maybe a tetanus booster.
I called my physician's office though and I actually have all three of my Hep B shots. My mom probably made me do it, but boy am I happy she did now.
Since I've been back I've gotten my financial aid information, my ID card made, and my parking permit. I park so far from the lecture halls as a first year medical student, that I'd need a golf cart to get to class without getting winded.
For years, the debate was over whether this was an actual cost of physician fear of litigation. If it is, then clearly such costs must be tacked onto the already large bill the AMA and other physician groups claim that medical malpractice lawyers and their lawsuits have already rung up.
A new study published in JAMA has drawn a lot of attention over the past few days for its contribution to the debate: an overwhelming percentage of Pennsylvania doctors practice defensive medicine for fear of being sued.
AMA on Malpractice Premiums
This is a talking points on malpractice reform myths put out by the American Medical Association.
I'm unsure if this figure cited in the AMA pamphlet can be contested. Perhaps, there are different ways to figure such ratios but I don't know how, if this figure is true, that anyone can claim the medical malpractice insurance industry is not in crisis if they paid out $1.53 in med mal claims for every $1.00 collected in premiums. There is no way, in my mind, that insurance companies have sources outside of premiums (i.e. investments) that account for over 1/3 of their income. That would need to be a case for them to pay out $1.53 for every dollar collected and still make a profit.
I suppose there still may be debate on what has caused this underlying financial strain -- bad investments, past undervaluation of premiums, or, as I believe, an increase in frivolous malpractice cases.