What a difference 4 years makes

Election night 2008 is a vivid night in my memory.  I arrived back at my house around 6 or 7pm from 2 long days of medical school interviews to find a house full of friends watching the TV and an envelope from a school I had recently interviewed at.  I opened my first acceptance letter surrounded by the love of my community and with the optimism of change in the air.  The night was spent intensely watching returns, having both light hearted & deep conversations, coloring in maps, and day dreaming about what the future would hold.  I went to sleep with the certainty of Obama’s victory and my long awaited admissions ticket to medical school in the fall. 

[However, learning about the prop 8 results when I woke the next morning was heartbreaking and felt like a personal attack.  And now, 4 years later, we’re still trying to untangle the mess it created.  Hopefully, tonight’s vote on marriage have an opposite outcome as prop 8 did.]

4 years later, I am wrapping up medical school.  I would be on the interview trail again right now had I not elected to take this year for research.  I am anxiously awaiting the news tonight will bring in a new city with a new community.  I am uncertain about my future – about what our healthcare system will look like tomorrow and how it will affect my career.  While the economy is likely to continue to improve (assuming we don’t start another war), healthcare, women’s reproductive rights, and queer communities in the United States are resting on a precarious ledge. I pray that I go to bed tonight with the same optimism and certainty that I did 4 years ago. 

Health care blues

We had a discussion yesterday on the Affordable Care Act and how it affects women's health care, especially contraception.  I left the talk totally depressed.  This was further amplified by watching the 3rd presidential debate last night. 

I recognize that the ACA is not perfect, but it is a HUGE step towards affordable and comprehensive health care in this country. I believe that health care is a right, not a privilege.  I also know that we can not continue to afford the rising cost of health care as we can't even currently afford it.  I'm sickened by the fact that politicians play political chess with people's health.  I can not understand that level of disregard for another humans welfare; but I guess that is why they are politicians and I'm a (future) health care provider.

In the discussion yesterday, we were shown a slide from the New England Journal of Medicine article "A watershed election for health care (2012)".  The chart dives up the likely results to the ACA depending on the election outcomes.  It is no shock that Romney winning would be a very large step back for health care in the US (a long with LGBT rights, abortion rights, and so many other things), but what did give me pause was what happens if Obama is reelected with a republican house and senate.  "Maintenance of near pre-ACA levels of uninsured Americans; no substantial growth in levels.  Less aggressive implementation of ACA health system provisions".  Shit.  So basically more political chess with people's lives at stake.  Nothing will be accomplished, will still be stuck in the middle of nowhere.  Lovely.

Needless to say, I'm very worried about this election.

I am also so grateful to be an insured American with unlimited access to quality care. This year off from medical school has been full of many more doctors' visits than I would have imagined. After the horrible car accident with trip to the emergency room this summer, I'm now dealing with a whiplash, a pinched nerve (upper trunk of my brachial plexus), and radiculopathy. Weekly chiropractor appointments in attempts to fix that. I'm also finally address my chronic anemia, fatigue, and constant general yuckyness by figuring out the trigger. A round of visits to a GI and a abdominal CT have ruled out my celiac as the culprit. [Even if I did read my CT as having a "speckled colon and a titled uterus" - thankfully a radiologist who actually knew what he was reading righted my incorrect paranoid diagnosis.] Good to know that I'm not being accidentally glutened. The GI's answer to this was that I'm probably allergic to something (or many somethings) and so I should take a low level steroid to blunt my immune system. Um, no thanks. I'd rather just figure out what the cause is so that I can avoid it. So, today I am finally getting much need allergy testing. Thank G!d that my comprehensive trusty health care insurance is along for the ride.

Voting for Big Bird

Last night's presidential debate was awful.  Romney was totally charismatic in an absolutely condescending way.  I couldn't decide if I wanted to hug him, or slap him.  I also kept imagining a thought bubble of loose associations over Obama's head.  I am not sure where he was but he clearly was not present at the podium. 

There were nonsensical sentences.  There were long run on thoughts that led in a circular manner towards nowhere. There were lies and empty promises followed by more lies.  The discussion was harder to follow than those of my floridly manic patients when I was on my psych clerkship!

There was one sentence in particular that sat very poorly with me though: "I would like to take the Medicaid dollars that go to states and say to a state, you're going to get what you got last year, plus inflation, plus 1 percent, and then you're going to manage your care for your poor in the way you think best."  Let us just quickly look at two case examples.  Alabama wants to take care of their poor by using medicaid as the sacrificial lamb for their budget issues.  Louisiana took care of their poor by cutting $329 million from their state healthcare, and by closing one of the state's 3 psych hospitals, likely adding more strain to the hospital and jail structure.   Two shinning examples of how one should take care of valued citizens.  I totally feel confident that allowing states to have sole decision making power on the nations healthcare will solve all our finical issues and improve the health of ever individual American... Not.

I'm voting for Big Bird.  I'm voting for ObamaCare.  While not perfect, it is a start.  I have to believe in something.

Brenner's army

Based off of The New Yorker article that came off this year, PBS put out this documentary on "doctor hotspots".   I propose we start Brenner's army: doing the research to find hotspots in our own cities and towns and implementing programs to change it.  It is about time we drastically change the way health care is accessed and better utilize our finite and precious resources!

Think there is any way that I can arrange a research year under Dr. Brenner next year?

Interesting idea

The NYT opinion page posted a proposal to make med school free, and then charge for specialty training, as a way of increasing interest in primary care. The idea being fiscally neutral since the government already pays for all US residency; it would just mean shifting orders and priorities. Seeing as increased access to primary care lowers overall costs, this idea could actually end up saving considerable amounts in healthcare spending. It is a fascinating idea. The more I think about it, the more I like it. While a possible genius idea, the realist in me realizes that the fine United States government would never approve such a socialist plan, even if it would help to increase access to quality primary care and neutralize the ever-increasing-although-already-exorbitant healthcare spending.

Maybe I should just move to the UK? Or the Netherlands?

Hell in a handbag

I'm feeling both overwhelmed and depressed about the current state of women's rights in politics. Rachel Maddow explains it much better than I can. I've been doing as much local protesting and organizing as I can, but honestly, I'm currently feeling defeated. That no matter how hard I hold on, my rights as a woman and as a future medical provider are slipping from my hand. But I can't stop fighting. It is a lot easier to continue to hold on than it is to try to get rights back once they have been taken from us. Plus, I can't turn my back on my grandmothers and future daughters/granddaughters. The generation before us fought so hard in the first place to make ab. The generation below us, growing up without comprehensive sex ed, will inherit the mess we leave them with. It is our responsibility to guard the present, to ensure American women the right to safe and legal abortions.

It is also our responsibility to make sure that future providers (myself included) continue to get the training necessary to ensure access. The US house of representatives is currently trying to put make training even more difficult than it already is. They passed a bill on Wednesday, the Foxx amendment, to ban teaching of abortion in federally funded residency programs. Since all residency programs are federally funded, this basically means even less training will exist. Keep in mind that the list of programs that teach abortion training is already very short. My point is that you should call your senator. Or write them. Or both. Tell your friends too. Please, I beg you, do your part to make sure that the Fox amendment dies in the house. I don't want to be a doctor that has to sit ideally by watching my patients die from botched abortions simply because the US government put too many hurdles in the way of my training.

The revolution will not be televised

I'm beyond frustrated with politics in our country. While we are a very diverse country with very diverse views/morals/ethics, violence is NEVER the answer. Hopefully we can all agree on this. Hopefully we can use the tragedy that happened yesterday as a spring-board for anti-violence campaigns. Rather than simply saying "it's a pity" and then returning to our normally scheduled lives, let us not stand idly by in the face of the unacceptable. Let us teach our children about the power of hate and evil speak, and then through our own actions we can teach them that they too have the power to stand up against this type of behavior.

What I'm currently fixated on though is the House's desire to repeal the health care reform bill. How is this productive? Effective? Are we seriously going to waste time tying up the legislator with silly political games instead of getting shit done? Oh, and waste tax payer's money in the process too. It is not like the repeal will get by the Senate, or even if it does, that Obama will approve it. Fine, I admit, I'm a STRONG believer in health care reform. I DO believe that health care is a right (not a privilege) and that our pre-reform system of health care was on a crash course towards crashing. Not only was it doomed to eventually fail, it was accelerating on it's trajectory in the process. Way too much of our GDP was going towards health care and the money being spent did not reflect the quality of care being offered. Why do we spend far more than any other developed country and yet have some of the worse health care available? So yes, I will not deny that I am biased and I am pro-health care reform.

In short, I'm angry. I want to know what I, as a medical student and as a concerned citizen of The United States of America, can do to take a stand? How can I do my part to make people realize how important health care reform really is? What kind of national movement can I, along with other concerned citizens, start to ensure that our voices are collectively heard? That we want politicians to stop playing childish games and start actually fixing the problem!

Earlier this year Dan Savage had an idea to take a stand. Out of his inspiration the "It Gets Better Project" was born. Why can't we do the same? Why can't we create a national movement to support health care reform? Any ideas on how we can start our own grassroots movement would be greatly appreciated. If someone else out there is bouncing around some idea in your head about how to do this, stop thinking and start doing! If you do, I promise to be standing proudly beside you!

Living in the south is bad for women's health...

The National Women's Law Center in conjunction with Oregon Health and Science University published the "2010 health report card for women" today. This report card looks at all factors important to women's healthcare: access, family planning, abortion, wellness & prevention, policy, etc.

The first thing I did was to look up the state I currently live in: F. Then I looked up the states that surround me: F, F, F, F... The south (TN, KY, LA, AB, MS) = fail. While not at all surprising, it is beyond frustrating. We theoretically live in a rich country with access to some of the best healthcare in the world; except clearly not. Women should not be receiving inferior care based on their gender. Southern's should be at a disadvantage based on their geographic location. Aren't we all US citizens?

My very liberal view is that we need some serious healthcare care reform NOW. Bring on the universal care with a single payer plan! Bring on preventative medicine. Bring on health education. Better incorporate other professionals into a person's care plan: social workers, nutritionists, and the such. Integrate more reproductive health care into primary care. OR, I should just move to Canada, or England...

What is my role in all of this? How can I help to improve healthcare as a medical student? Should I be getting more involved in health policy? How can I better prepare myself to provider comprehensive healthcare in such a broken system?

"Letting Go"

Here is another amazing article by Atul Gawande. He speaks of issues that make us Americans very uncomfortable: end of life care. It is not surprising to anyone that a disproportionate amount of our health care spending goes towards those facing death; is it worth it? When do we say that enough is enough? While drawing concrete lines that such and such a procedure under x circumstance is wasteful doesn't seem so hard; it all changes when talking about a specific person. How do we create a fair, finically responsible and sustainable medical system? How do we do it while valuing each individual life as priceless? Thoughts?

My inner-anthropologist thinks that we need to come to terms with death being a natural, and sometimes even desirable, end to life. As doctor's we need to stop seeing death as failure on our parts, and need to start seeing palliative care as an alternative option. We also need to really listen to our patients, identifying what their true desires about end of life care and encourage them to share this information with their loved ones.

Broken, part 1

"Medicine used to be simple, ineffective and relatively safe; now it is complex, effective and potentially dangerous." -Cyril Chantler

This is the first part of what I am sure will be a many part saga; an epic about how broken the US health care system currently is. I say all of this with the caveat that a) I'm really not sure what would be better; b) if I did, I'm not sure I would know how to transform our current system to this new shiny, effective, and cost efficient system; and c) as imperfect as I know single payer systems to be, I support systems that acknowledge my belief that health care is a right. However, I am never really sure what to say when asked "how much health care is a right?"

Two things happened last week that made me think about how broken our system is. The first was a public health class on health care management. We spent 5 days sitting around a room, shooting for the moon with our ideas about what health care should offer. We then discussed authentic leaders, and how to use leadership to make these things happen. In 20 years it will not surprise me to see these classmates transforming the way health care is delivered; and with the ideas that were shared, I pray that these minds are able to make an impact much sooner than 2030.

Second, I received two e-mails. The first from a friend worrying that her birth control pills were fallible. This friend should have been educated about all the possible signs and symptoms that may present when put on the pill. The lack of premptive education caused needles worry, undue anxiety, and possible misstrust in the system. The fact that she came to me (a know-nothing medical student) instead of her clinician speaks to the inaccessibility of educational services. Second, another friend, with a history of asthma ended up with multiple time-consuming and stress-inducing specialists appointments because of follow-charts. She saw her clinician presenting with shortness of breath and heart palpitations which automatically sent up the red-flag for cardiac trouble. While this red-flag supports the effectivness of the system (along with the fear of malpractice litigation), no one took a time out to actually think about the situation. The fact that she's young, healthy, had a normal EKG in the office, and that her signs and symptoms were consistent with her asthma regiment. If this thought process had been followed, she would have been saved excess time, money, use of precious resources, risk of added interventions, and excess time before the necessary change in asthma medicine.

I may be a naive medical student. Maybe you don't agree that these examples illuminate some of the many issues with our medical system. But, even still, can you really say that our system isn't problematic? And should we settle for something so broken?