Right around the Olympics this summer, there was an internet photo running rampant of the "first picture of Michael Phelps." It featured a single spermatozoa swimming faster than others on its journey towards fertilizing the ovum. While this was clever and entertaining, it actually wasn't the first picture of Michael Phelps.
Well actually, hopefully that was obvious to everyone. Because it was a cartoon and not an image of the innards of Mama Phelps, but what I mean is that we (scientists) can actually take a picture of people long before they are even spermatozoa...that's way before people even have enough genetic information to be considered a person!
Okay, mind blowing. This might need some unpacking.
This past week we learned about primordial germ cells in embryology. For the purposes of more clearly explaining these cells, we are going to hypothetically assume that I am pregnant (in real life I am NOT pregnant nor do I plan to be for many, many years). Back to primordial germ cells. These cells develop in the gonads of the fetus/child/baby/person that I am carrying. So basically these cells are my GRANDCHILDREN. And we can take pictures of them as early as 4 weeks after my child is conceived. That's a good 20-30 years before there are any baby pictures of them! Perhaps I will print out a copy of the picture (below) and frame it alongside copies of ultrasounds of my unborn child. Then everyone could see a picture of my child with his/her unborn children by their side.
Primordial Germ Cells. 4th week gestation Thanks to Dr. James Turpen, PhD for this photo.
Whoa. Science is cool. And doesn't that picture just look awesome anyway? The colors are pretty and the pattern is sweet too. And then you realize what the picture is actually of, your jaw drops, and you silently thank the scientific community for the work that they do.
As I wrap up this post, let me just reiterate that I am NOT actually pregnant, but that I just pretended to be for this blog post so that you could better understand primordial germ cells.
Test on Saturday. I can't believe I only have a few more days left of the first core of my medical school experience. After Friday, I will never again have a formal anatomy class as a medical student. The past 9.5 weeks have flown by! Just 6.5 weeks until Christmas vacation :)
It may disappoint some of you to know that this blog post has nothing to do with the most recent health care reform which was declared constitutional this summer and will be put into effect in the coming years. While I do (mostly) support so called "Obamacare" in theory, I am still suspicious about how it will actually be put into practice. Beyond that, I don't think that the most recent "reform" really even scratches the surface of the reform needed in this country in order to actually become healthy. But none of that really pertains to this post, so back to the real reason I'm writing.
Tonight I went to a documentary showing put on by an interdisciplinary group on campus. The documentary was "Escape Fire: The Fight to Rescue American Healthcare" and you can see the trailer below:
It was hard not to get inspired once I saw the trailer. I was hooked and needed to see the whole film. I've kind of been on the whole healthcare reform train for a few years, so really this isn't anything new, but it's always good to continue learning about topics which you are passionate about. Sadly, there wasn't a great turnout for the showing of the film because it truly was great.
The issues presented in the documentary are as follows: (descriptions are taken from the "Escape Fire" website which can be found here: http://www.escapefiremovie.com/issues)
An Entrenched System: Pharmaceutical companies, medical device manufacturers, hospitals, and insurance companies are all profiting on our declining health. And all those companies spend their money lavishly – millions of dollars go to Washington lobbyists – to ensure that nothing ever changes.
Over-medication: We spend roughly $300 billion annually on pharmaceutical drugs – nearly as much as the rest of the world combined.
Over-treatment: One of the hardest things to understand as a patient is that “more” doesn’t necessarily mean “better.” But it’s imperative that we do. Recent studies have shown that “more” can often mean “worse” when it comes to our health.
Paying More, Getting Less: We pay more, yet our health outcomes are worse. We give well-intentioned doctors, nurses, and hospitals the wrong tools and the wrong incentives, and it results in higher costs and poorer health.
Preventing Disease: 75% of healthcare costs go to treating diseases that are largely preventable. That’s a lot of unnecessary money, and worse, a lot of unnecessary disease.
Reimbursement: The healthcare system often uses a “a fee-for-service” model of payment – government or private insurers pay a hospital or a physician every time a procedure is performed.
Treating the Whole Person: Your body isn’t a car, but that’s how it’s handled when you take it into the doctor’s office. Instead of being treated as a person, your broken parts get fixed separately, one by one.
After viewing the documentary, several points are still resonating within me. The point was made time and time again that our current system is a flawed, fee-for-service system. The trailer even called attention to the fact that spending 5 minutes with a patient before performing a surgery could earn a doctor $1,500, but spending 45 minutes with a patient determining feasible treatment routes would only earn a doctor $15. That seems utterly backwards. Moving beyond the money, our current system does not reward patients or doctors for healthy behaviors, but instead keeps us coming back for more. One quotation from the documentary, "We don't have a healthcare system in this country, we have a disease management system" (Dr. Andrew Weil, Founder of the University of Arizona Center for Integrative Medicine) was especially poignant if combined with a point made by medical journalist, Shannon Brownlee. She talked about the fact that our current system doesn't actually want us to become healthy (to be fair, it doesn't want us to die either) because then the system doesn't make money. We are simply managing diseases in many cases (several of which are fully preventable), instead of encouraging health because it keeps us coming back for more in order to keep the industry alive.
I know that this reform will not be easy. It will require overhaul of several, very politicized lobbies of people. These include insurance companies, hospitals, pharmaceutical companies, the farm lobby (in spite of my Cornhusker heritage, I can recognize that the subsidies for corn are not beneficial to national health...you will be hard pressed to find foods that do not contain corn or corn byproducts on the shelves of our grocery stores which are truly not all that healthy for us...this also will require elimination of food desserts...oh now we're into a whole other bird's nest of issues), schools (health classes that actually teach healthy behaviors, school lunches that provide adequate nutrition to students, etc), fast food corporations, all food production corporations, and many, many more.
This is no feat to be taken lightly nor will it be easy.
If reformed, Americans would have to begin living in a manner which is completely foreign to many of us. No longer would we be managing disease, we would be maintaining health. Our lives as we know it would be over. Over in an absolutely terrifying, but absolutely rewarding way. Benefits to better healthcare would include, but not be limited to:
Better health. Simple as that! (this is not to say that we will be in perfect health as a nation. There are still germs present within our lives, but many major chronic conditions which affect millions of people nationwide could be drastically reduced)
Increased life expectancy (clearly this leads to the problem of over-population, but that's for another blog post...)
Reduction of preventable chronic conditions such as diabetes, hypertension, high cholesterol, heart disease, certain cancers, etc.
Decreased insurance premiums.
Increased productivity at work...better health=more energy=ability to accomplish more.
Reduced national deficit.
Lowered incidents of mental health fatalities and associated stigmas.
Fewer unplanned pregnancies, abortions, and reduced STD/STI transmission.
Increased education. When people, especially children, are healthy, they are capable of learning. And eventually they can do something productive with that knowledge. Perhaps even change the world.
Moving beyond my concerns as someone who loves the practice of medicine for its scientific components, as a person of faith, I personally feel that I am even more obligate to help my patients work towards being healthy in mind, body, and spirit. My philosophy on this front is highly influenced by Dr. Scott Morris of the Church Health Center. I've written about CHC on other occasions, so I won't bore you by rehashing the details, but Dr. Morris believes that we, as a Church, are called to preach, teach, and to heal. Generally, we do a pretty good job of preaching and teaching and not so great of a job with healing. At some point in history, we adopted a dualistic philosophy (thanks a lot Descartes...not!) and our bodies, minds, spirits became considered separate entities causing physicians to stop treating the whole person in our medical clinics. I cannot, in good faith, treat a person without considering their mind, body, and spirit as a budding physician (or in science-y terms, without considering a patient's biopsychosocial situation), Christian, or a human. The current system of practicing medicine does not allow for me to fully treat patients with this approach.
Don't get me wrong, obviously I still like Western medicine. After all, I am writing this critique on a blog about becoming a medical doctor. I have even taken full advantage of the student health program here at school this fall. It's not that the system is worthless...it helps millions of people each year. BUT (a big, emphatic "but" at that) it doesn't provide infinite amounts of health care. It also doesn't provide care in cost effective manner. Not only that, we currently allow for millions to fall through the cracks of the system, never seeing, preventing, or treating their health concerns.
We are in dire need of an overhaul. My generation is sitting on the horizon of change, I hope we are able to enact it, so that our patients/the nation can work towards becoming healthy in mind, body, and spirit. I know that I'm still in school and ideology overshadows what will likely be actual experience, but without acknowledging that there IS a problem, we can never work towards solutions to said problem(s). At the very least, I now open the floor for conversations to begin about healthcare for those of you who read this. I look forward to our discussion!
We are overly-medicated, overly-treated, overly-charged, disease-ridden people. It's about time that changed for the better, if you ask me.
"Let your food be your medicine and your medicine be your food." -Hippocrates
Today I went to a local assisted living nursing home to screen some of their residents for hypertension. I only performed blood pressure checks on 3 people before this and even then I struggled to hear the Korotkoff sounds, so I was nervous. But as a general rule, elderly people are pretty patient, so I wasn't stressed to the max about it.
Turns out, it was loads of fun! I pretty much love anything I get to do where I actually have patient interaction these days. As expected, I learned quite a few more details about each of the residents than I needed to know for the screening, but I still love talking to people, so I wasn't upset about it. It reminds me a little of the days of volunteering at Good Samaritan Village in Hastings (I was volunteer of the year one year...not to brag or anything ;) ).
I am no longer nervous about checking blood pressures. Something about taking 10+ pressures in a half hour makes it less scary to do! Each of us are assigned a certain day and a certain assisted living facility throughout the year to do these checks. I think it's a great idea! It gives us practice and its goal is to help keep the residents healthy...I'm all about preventative medicine!
Today was also the start of a new unit. We are beginning the pelvis/lower limb unit--our last unit of anatomy! I cannot believe I'm already 8 weeks into my first year of medical school. During orientation week my M2 buddy said that the days would drag on for seemingly ever, but that weeks would fly by. Boy was she correct! It's crazy how quickly the year seems to be going.
Right now we are amidst a crazy few weeks of tests. It all started with our thorax/abdomen exam on this past Saturday. This week we have an ICE midterm (the class where we learn clinical things: professionalism, standard precautions, performing exams, etc). Next week we will have our lower limb anatomy exam on Saturday morning and then finally we will have our OSCE (I don't actually remember what this stands for) late the following week. During the OSCE we are given 10 minutes to perform a certain task with a patient. Possible tasks could be taking vitals, getting an accurate history, performing cranial nerve testing, and many, many others! This OSCE has 4 patient tasks and will take 40 minutes to complete. We will get a week off from testing after the OSCE before we have our first biochem exam. Yikes, what a daunting schedule! I'll just have to take it one test at a time...
I got to see my parents this weekend, which was a wonderful refresher. I've been missing them quite a bit lately. It was also a plus that I got to have my mom's home cooking! They sent me back with bags full of groceries and clean laundry (which I did by myself...I'm not completely worthless domestically) to face another week. I'm looking forward to having them in Omaha later this month too!
And thus begins another week in the med school grind.
Say "ahh."
Just a hint, this is not how human throats look. Or at least they shouldn't.
Quite obviously I'm learning lots of very valuable information at medical school...
you have a dream about the pathway that food takes from ingestion until it leaves your body. Not only that, you are diagramming said pathway and the nerves and arteries that supply those areas.
As embarrassing as it is, the above situation is not a hypothetical situation. That was one of my dreams last night. Anatomy has truly become all-consuming in my life! I frequently will wake up in the middle of the night and find myself tracing the course of arteries through a specific area or naming the muscles which a specific nerve innervates.
I suppose it's good that I'm fully dedicated to studying...? Exam on Saturday!
Today was our video-taped interview with a standardized patient. The patient was purposefully an easy patient, so that we didn't have to worry about the medicine part of the interview and could concentrate on our interviewing skills. Before entering the room, we were provided with some vitals (blood pressure, pulse, respiration rate and temperature) and then we were sent into our respective rooms (there were 16 of us interviewing various patients at a time). We had no idea who would be sitting behind those exam room doors nor did we know what sort of medical issue we would encounter.
I suppose that's one of the exciting things about medicine...depending on your specialty, you may not have any idea about what you'll experience on a daily basis and medicine stays fresh and exciting because of that. You are always on your toes and always learning. The further along I get in my education, I realize how much I truly just love learning. I feel very blessed to be able to learn for the rest of my life!
But back to my patient. The interview actually only lasted about 5 minutes. Immediately afterward our patients critiqued our interview skills. The gentlemen that played my patient was a kind, retired gentlemen with a sweet sense of humor. He has been a standardized patient for 9 years at UNMC! I hope that someday I will be able to be a standardized patient...except I doubt the students will describe me as a kind old lady...I will be quite the trouble maker, I'm sure! :)
He said that I built a good rapport with the patient very easily and that if the patient had something more serious than a cold, he would feel more than comfortable with bringing it up with me. It was really great to hear that! Obviously knowing a patient's anatomy is important, but it's just as important to be able to talk with them. If nothing else, this interview was a nice confidence booster that yes I am, in fact, in the right profession. After a short patient interaction break, I'm off to hit the books to review the cardiac plexus and the peritoneum.
I didn't even have a rough day, but tonight I had plenty of laughter! Megan and I went to see the movie "Pitch Perfect" and I laughed incessantly! It was hilarious (mildly inappropriate) and adorable. It's about a women's a capella group and is also a sappy romantic comedy complete with singing and dancing...so basically I was bound to love it!
Today I interviewed my first standardized patient! Truthfully, I think it was more intimidating to talk to the patient because I had a roomful of my classmates observing and not because I was actually nervous about talking to a patient.
Just so everyone is clear, standardized patients are local people who are trained by UNMC to adopt personas that allow students to practice patient interview techniques in a safe environment. We actually don't even meet with these patients in an exam room setting (except for test days), we meet with them in small classrooms. These patients are trained to critique students on specific interview skills that we're supposed to be practicing. We have the ability to "time-out" at any point during our interview to ask for guidance from our classmates or our preceptors (my group has a general practitioner and a microbiologist leading us) or to simply just to reorganize our thoughts. It's really helpful, although seriously intimidating, to have 10 other students surrounding you and supporting you while you're talking with a patient. Because we haven't had much practice, if any, with these skills we often are unorganized in our interviewing and we can also tend to forget important questions to ask, so our colleagues (holy goodness...not only are these people my classmates, they're actually my colleagues! That's pretty cool!) can redirect us or make helpful suggestions about good questions to ask.
One set of skills that we were supposed to be working on can be summarized with the acronym "PEARLS." Basically, the purpose of PEARLS is to validate the concerns of and empathize with the patient ("Yes, I can see why that would worrisome to you..."). The letter 'R' in PEARLS stands for 'respect'. One of my classmates asked "How do we do respect?" today and I replied, "Ask Aretha Franklin." Only one of my classmates chuckled--I'm assuming it was because she's the only one that heard me and not that people didn't get the joke and/or I'm not actually funny. But anyway, enjoy a little Respect from Aretha!
Friday is our video-taped interview with a standardized patient. I'm sure glad that I got my first small-group standardized patient interview under my belt before then!
