Part Four: Psychosocial Health

This is the random left over blog post. Honestly, this post could be much longer because there are a million awesome articles out there, but I'm trying to be concise (yeah, I realize I'm terrible at it, but at least give me some credit for trying!).

• 20 Things Poor People Do Every Day: There's lots of misinformation out there about poor people and that they are lazy and doing nothing all day. These are the things that are actually done: find food, find shelter, find warmth, try to stay safe, live in chronic pain (and poorer health outcomes), and do everything in their power to stay alive. 
• Appendectomies are Expensive in the US: This person posted his bill for his overnight stay in the hospital after getting his appendix removed on Reddit. Apparently it's about $55,000. His insurance covered the bulk of it, but still. That's a lot of monies! Our healthcare reform isn't perfect by any means, but hopefully it's a step so that people don't have to pay these enormous bills! 
• Med Students Save Lives!: Remember those OSCEs I talked about taking? Well this student at Virginia found out something that was really wrong with his fake patient during one of his OSCEs and he saved his life! Sometimes medical students are idiots (myself included), but sometimes we are awesome too! 
• Inactivity Changes Your Brain: I sort of alluded to this already yesterday. But here's some science to back it up more! Being a lazy bums changes your neurons. And not for the better. Inactivity leads to greater sympathetic nervous activation which may causes higher blood pressure (due to vasoconstriction) and ultimately leads to heart disease. So work your little body...Make Your Day Harder!
• Vaccinations...good or bad?: This is a post from someone who grew up being unvaccinated. And why she decided to vaccinate her children. And why she suggests that you do too! Her parents lived the organic, healthy lifestyle (let's be real...this is not me condemning that lifestyle. I love organic foods!) and yet she contracted measles, mumps, rubella, viral meningitis, scarlatina, whooping cough, yearly tonsillitis, chickenpox, HPV, and penicillin-resistant quinsy by not being vaccinated. She says, "If you think your child's immune system is strong enough to fight off vaccine-preventable diseases, then it's strong enough to fight off the tiny amounts of dead or weakened pathogens present in any of the vaccines." I someday will be having children and plan to vaccinate them! But here's a side of the argument that you don't often hear! 

All of these things affect health in some way. Take a look! I have lots more posts planned, so keep your eyes peeled!

Residency Symposium.

Last weekend (and this week!) was a busy one and that's why I'm just now getting around to writing a blog about it.

We had the memorial service for the families of the people who donated their bodies for us to use during anatomy. It was done well. It was nice to see all of the families and friends that were affected by our very first patients, our very best teachers.

On Saturday was the Residency Symposium that the AMA puts on at UNMC every other year. It was pretty overwhelming. For anyone that knows me even a little bit, you'll know that I tend to get myself over-involved. The morning lectures were all about building your résumé by getting involved in different extracurriculars. Unfortunately it made me feel like I wasn't involved enough (but let's be honest, that couldn't be further from the truth) and that I'd never get into a residency program. I can only imagine how my classmates were feeling as the end of the school year was looming over their heads with finals and a paper left to write. As bummed as I am to not be in school right now, I have to say that it's really nice not to be stressed to the max currently.

Throughout the afternoon at the symposium, we had small groups with different specialities to learn all about their residency training. I went to the med-peds (you get board certified in both internal medicine and pediatrics), neurology and infectious disease talks. They were pretty great, although I have to admit that they pushed me back towards wanting to go into neurology more than anything. We shall see...who knows what the future holds.

No one can predict where healthcare will be in the next 10-15 years, so it was sort of hard to give us cold, hard facts about what to expect. I personally find this unknown exciting, but I'm sure that many others find it frustrating and annoying. The one thing that we do know, is that how we practice medicine and how we train our doctors is changing.

There is all sorts of research and talk about changing the way in which we train future medical professionals. There are several residency programs that are moving more towards a skill-based assessment of residents instead of a temporally based one. Eventually this shift will work its way down to medical schools too. Eventually the way students learn in the pre-clinical years will be different too. Medicine is reforming. And it's about time. We have taught our doctors in the same manner for 100 years now. And medicine is vastly different now than it was in the early 1900s.

I was a speaker earlier this spring who told us that the only thing you have to do to become a doctor is to stay out of trouble and pass 6 large multiple choice exams (MCAT, USMLE Step 1, USMLE Step 2 CK, USMLE Step 2 CS, USMLE Step 3, and your respective boards), but that we have doctors who are terrible clinicians because they haven't learned all of the skills they need to by the time they finish their residency or they struggle interacting with humans. There was an interesting article in the Times about this earlier this spring.

So all in all, the residency symposium was good, albeit overwhelming. I know now what things I need to work on still to make my application all the more strong. Lucky for me, I have a whole extra year to make and implement those changes!

politicality.

So you've had to been hiding under a very well secluded rock to not know that Barack Obama was re-elected. Moving beyond my personal political beliefs about whether this was a great move or a terrible move for the country, I want to talk about the election from the standpoint of someone going into the medical profession.

Truthfully, we don't know exactly how this is going to affect the future of medicine. But one thing is for sure, it's going to change it. While I know that many practitioners are upset about this (electronic medical records are evil, billing is a nightmare, etc), I don't think that change is necessarily a bad thing, but it definitely is something new and different. Further, I am in the really lucky few years where things won't be a change for me...I actually am going to be trained under the new system! The transition towards ObamaCare actually started way back in 2010, so that means that the kinks are already starting to be worked out in various parts of the system. In addition, other parts of the law will be introduced in the coming years, so it's not going to be a monumental change all at once like some people are imagining it to be.

Here's a quick run down of just a few things that have changed or will be changing as a result of the Affordable Care Act (a.k.a. "ObamaCare"):

• insurance companies can no longer discriminate against adults and children with pre-existing conditions
• more (but not all) Americans will be insured under the individual mandate/Medicaid/Medicare/private health insurance (people can pay a fee to opt-out of insurance if they'd like) 
• insurance rates should become more competitive in the public sector
• Medicaid and Medicare reform...it's not perfect, but it's a start!
• more of each dollar spent on medical care will actually be going to medical care--80-85% must go to care instead of administration, etc, or else the provider must reimburse the patients
• more emphasis on preventative health care (if you know me, you know that I think this is GREAT! If you don't know me, you can read about my feelings here.)
• children can be covered under their parent's insurance until the age of 26 
• better prescription drug coverage for seniors who are in the Medicare donut hole
• funding and loan repayment for students interested in healthcare fields

Lastly, but I think pretty darn importantly:

• moving from a fee-for-service system of care to a system of quality-based care

It's nowhere near perfect, but it's still reform. If we look at the Protestant Reformation (y'all know that studying Religion from an academic perspective is another one of my passions too, right?), we see that reforming things takes time. Although Martin Luther is often credited with starting the reformation with the 95 theses in 1517 CE, we know that it started before his time (don't get me wrong, I think Luther is SUPER awesome and if you want to know why please ask!). The beginnings of reformation can be traced back to the Council of Constance (1414-1417 CE) and even to the Great Schism (1378-1416 CE), far before Luther's time.  And it didn't end until after much blood was shed in the Thirty Years' War (1618-1648 CE) and the Treaty of Westphalia (1648 CE) was signed.

So if it takes the Church almost 300 years to reform its system (let's be real, no church really is ever done reforming...or at least it shouldn't be because that's when it dies), why would we think our medical system would be any different?

It's going to take time. But this is just one step. Hopefully a step in the right direction for the good of our PATIENTS.

Because patients are what it's all about anyway.






My information for this post was derived from http://obamacarefacts.com/affordablecareact-summary.php and http://www.healthcare.gov/law/features/index.html. Please feel free to check my fact-checking abilities and let me know if I've screwed something up!

Healthcare Reform

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)

1. 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.
2. Over-medication: We spend roughly $300 billion annually on pharmaceutical drugs – nearly as much as the rest of the world combined.
3. 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.
4. 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.
5. 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.
6. 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.
7. 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