I am now 1/6 done with second year. Five more tests and I'm done with pre-clinical medicine. Well, that's not completely accurate, since after those five tests I have to pass that ONE HUGE TEST to actually be able to get into third year... but we'll worry about boards later.
Test went well, although I couldn't fall asleep last night and so consequently went through 8 hours of testing feeling woozy and tipsy. I guess that's what residency is going to be like, so maybe I should get used to it now? On the bright side, I proved I can pass a test being the equivalent of half-drunk, but how does that translate to patient care? Will I only successfully treat 70% of my patients when I'm half-drunk? How about when I'm full-drunk? A recent issue of JAMA was devoted to the theme of medical education, and it was chock-full of really interesting articles. One of them, a study of interns' compliance with the 80-hour work week regulations, cited a study that found that being awake for 24 hours causes performance decreases comparable to a blood alcohol of .10 (JAMA. 296(9):1063-1070). Scary stuff. (By the way, the study found that 84% of interns in the study period reported ACGME violations.) If any of you are JAMA-ers, I highly recommend the Sept. 6 issue.
Another article in that issue discussed the value of pre-medical requirements. Dr. Emanuel of NIH proposes dropping physics, calculus, and orgo from the pre-med curriculum and instead adding biochem, genetics, molecular biology, ethics, and statistics. Then, we should drop some of the unnecessary biochem, genetics, and molecular bio from the medical curriculum (eg, Krebs cycle) and make more room for biostatistics and medical ethics. Overall, I think his proposal is great. I, for one, certainly could have done without two semesters of orgo (OK, OK, it was three...), and I think some more biostats would do most of my classmates some good. Emanuel calls physics/calculus/orgo what they really are: weed-out classes. Granted, if the powers that be think weed-out courses are necessary, then biochem can certainly fill that role. But wouldn't it be nice if we fostered humanism in medicine at the pre-med level (that would be the ethics part), rather than creating gunners gunning to get into med school, then arriving in med school planning to gun their way through the next four years?
Anyway, that's enough heavy thinking for one night. Especially a night that has me feeling half-drunk.
In other news, it's been raining all day today -- thunderstorms, too. We're under a tornado watch until 2 am. Tons of lightning and thunder, but it's not bad on a night I get to stay inside, snuggled up on the couch or in bed. I'm just afraid that my car is going to be flooded tomorrow -- the convertible top has finally kicked the bucket, and one of the seams is wide open. I keep duct taping it together, but it keeps opening back up... It's going to cost me $700 to get a new top, but I don't think I have much of a choice right now. Mechanically, it works great, especially since I just sank $700 into it a couple months ago to fix something under the hood.
Finally, my last comment, and then it's time to have a glass of wine and watch Will and Grace:
The Grey's Anatomy premiere was last night. Medically, it's pretty much crap. They use nursing stethoscopes. The surgical residents are constantly in the ER or NICU or some other odd place -- I do NOT understand that. Does that hospital only have those 5 residents? Oh yeah, there is Callie, the one random ER resident. Plus, bubonic plague is NOT spread by person-to-person contact. Maybe if McDreamy had cut himself while doing head surgery on that woman and their blood had gotten all mixed up, then there would have been a risk for contamination. But otherwise, the plague is spread by the fleas that live on the rats, and you only get sick if you hang around the fleas or the rats. So the quarantine storyline was a bit implausible. However, there was one golden moment in the whole episode. Callie is talking to Finn, and she is explaining why Meredith is a dating idiot. "We're socially retarded. Four years of high school, four years of college, four years of medical school, focusing on science. Then we graduate and we're 28 years old and we have no idea what to do. We're all 17 years old. This is high school with scalpels." Great line. Great concept. How true.
Friday, September 22, 2006
Tuesday, September 19, 2006
dorks, not nerds
I've had a discussion with numerous people over the years, namely, whether smart people like to be called dorks, nerds, or geeks. I found the above quiz linked in adspar's blog, and decided to take it. Granted, it only measures nerdiness, not nerdiness compared with dorkiness or geekiness, but nevertheless, I am nerdier than 51% of people who take that quiz. I find fault with the quiz, because it seemed as though there were a lot of computer-related questions (I didn't actually count them; that was just my impression), which I wouldn't necessarily know. One of the questions asks what Internet browser you are using to take the quiz. I use Firefox, but that's only because I have computer nerd friends who told me to, not because I'm a computer nerd -- does that count?
What's more interesting is that people tend to identify strongly with either dork or nerd, and have strong opinions as to why they've chosen that one. In my experience, people my own age do not like the term "geek." The nerd quiz author actually has a little explanation of his own here, including Merrian-Webster definitions of nerd and geek, which I've copied:
Nerd:
Etymology: perhaps from nerd, a creature in the children's book If I Ran the Zoo (1950) by Dr. Seuss (Theodor Geisel) : an unstylish, unattractive, or socially inept person; especially : one slavishly devoted to intellectual or academic pursuits
Geek:
Etymology: probably from English dialect geek, geck fool, from Low German geck, from Middle Low German. 1 : a carnival performer often billed as a wild man whose act usually includes biting the head off a live chicken or snake 2 : a person often of an intellectual bent who is disapproved of
Here, also, is dork:
slang : NERD; also : JERK 4a
First of all, doesn't "geek" sound better than "nerd"? I don't think of myself as unstylish, unattractive, or socially inept (observations to the contrary welcomed). The definition of "dork" doesn't really help any argument, unfortunately.
Perhaps they ARE all the same, and I am fully aware that it doesn't really matter. However, I tend to identify with "dork" -- my definition would be someone who not only has a lot of knowledge, but who also finds it cool. Case in point: In an ethics discussion we had a couple weeks ago, we were discussing reproductive scenarios, such as a couple who divorces, then finds out the woman is pregnant. The father doesn't want to keep the baby, but the mother doesn't want an abortion, so the father fights to not pay child support. Our facilitator said, in the context of the discussion, "Unfortunately or fortunately, these things occur because men cannot have babies." Which made me turn to my friend and say, "Unless you're a seahorse!" at which point she gave me a look like I was crazy. Crazy? No. Cool? Absolutely! Dork.
Or maybe it's best to just combine them, as the nerd quiz guy says. Gerd, neek, gork, whatever -- although that last one is something else entirely, and it's something I aspire never to be. That's why I'm a DNAR, people! (More on that last thought at some other time.)
By the way, I just re-took the quiz, changing a couple answers that could have gone either way the first time, and here are the new results:
I think it says something about my nerdiness that I wanted to go back and change those answers to see what would happen to my score...
Saturday, September 16, 2006
Tests, round 1
I can't believe that I've already been in school for five weeks. It seems like it's been forever, but it also seems like it just started -- that's the wonderful dichotomy of medical school, I guess. I have the next week off to study for my first round of exams -- we call it block testing. We have a week off to study, then we test for about 7 hours straight on Friday. Each block lasts about an hour and has about 45 questions, all mixed up from each of the three subjects we're being tested on (Path, Micro/Immuno, and Intro to Clinical Medicine) -- it's supposed to emulate board testing, and it's supposed to be good for us. I like it, actually. It's nice having the week off to catch up, as opposed to having to cram test studying into the week while classes are still going on. Unfortunately, I have a lot of studying to do this week. I was caught up for the first 2-3 weeks, then the last two have been just crazy, and I'm a little behind right now. In addition, I've already forgotten the stuff I knew two weeks ago :( This isn't going to be a very fun week.
On the other hand, I really like this year better than last year. Over and over, I had heard that second year was much harder, but everyone likes it because it's more clinically relevant. Boy, is that true. It's MUCH harder -- the workload, mostly, not that it's conceptually that much harder -- but it's MUCH more enjoyable, as well. I like learning about diseases in Path -- putting together clinical scenarios with underlying disease processes. I wasn't a huge fan of the memorization aspects of immunology, but I like it conceptually. And I love microbiology, so the rest of the semester will be fun (we just started it). Even ICM, which I've always stuck up for, has gotten better. We just finished a whole section on medical ethics (fascinating stuff!) and healthcare financing (obviously, an issue I feel strongly about).
Speaking of healthcare financing, I got a chance yesterday to meet two really cool people: Dr. Steffie Woolhandler, and John Yarmuth. Dr. Woolhandler is a Harvard primary care physician who is one of the co-founders of Physicians for a National Health Program. She came to Louisville to give a public lecture on single-payer health care and to give a lecture on single-payer systems at the Kentucky Medical Association annual convention. In fact, the focus of this year's KMA meeting was covering the uninsured and underinsured, which I found really surprising, because I've always thought of the KMA as a much more conservative group -- it shows how much the problems with the current healthcare system have resonated across all groups, patients and physicians alike.
John Yarmuth is the democratic congressional candidate for our district here in Louisville. I like the guy a lot, mostly because he has extremely strong views on healthcare -- as a first-time candidate and unknown, he's really been pushing the single-payer cause hardcore, which is very impressive. He told me that his opinion, from speaking with people, is that the people are very much ahead of the politicians on this issue. The politicians are the ones preventing this from going forward at this time, but hopefully that will change. (The other cool politician who was in town this week was Barack Obama -- he spoke at Slugger Field on Thursday, and I heard he was awesome, but I wasn't able to go.) Here are the interesting things I learned at the KMA conference and Woolhandler lunch yesterday (plus some additional things that I already knew but maybe you didn't):
-In the 1960s, the pre-Medicare average physician salary was 2x that of the national average salary. After Medicare was enacted, it was such a good payer that the average physician salary became 5x that of the national average salary. (My new argument for people who keep countering me with the fact that Medicare is a bad payer; yes, there are currently Medicare cuts in the works, but we still need to fight those, even if we go to a single-payer system.) When Medicare was enacted, it created a whole new pool of patients/customers: the elderly, who had previously not been seeking medical care.
-If we create a single-payer system, there will be 46 million new customers who now have insurance. If we create a single-payer system, there will be an estimated additional 40 million new customers who now have good insurance. (There are currently 46 million Americans without insurance, and probably another 40 million who are underinsured.)
-Underinsurance is a big problem: In 2005, 22% of insured Kentuckians reported not going to a doctor even though they thought they needed to, because of cost. Twenty-one percent did not take a medical test, medical treatment, or complete follow-up visits recommended by their physician because of cost. An astounding 26% did not fill a prescription they needed because of cost (or filled it incorrectly -- "stretching" a month's supply to last two months, which can be a serious problem). And 15% did not see a specialist when they or their doctor thought they needed to. These are people WITH health insurance who cannot afford health care!
-Anecdotally, one of the largest groups opposing universal health care is medical students (surprise, surprise!). Apparently, we apply to medical school claiming we want to help people, but then we get greedy and think a single-payer system will create paycheck cuts for physicians. Or, to give us the benefit of the doubt, we get scared at how much debt we're in and are worried we'll never be able to pay it back (I myself am going to graduate with about $250,000 in medical school debt. Add on undergrad and my master's degree, and it will probably be about $300,000). Then, we graduate from med school and residency program, go into practice, and see the reality of how little we get paid under the current system and how wasteful it is, and sign onto the cause. (I heard that from someone who heard it from someone -- I have the attribution, but I can't verify it, so don't hold me to it. However, it does agree with the reactions I've gotten from medical students as opposed to physicians when discussing universal health care.) And yes, a few physician salaries are likely to decrease if we go to a single-payer system. But if you're currently making $600,000 and you get cut to $500,000, I think you'll survive. The current average salary for a primary care internist is $160,000-180,000. That's not a small chunk of change, by any means, and that's pretty much the bottom of the barrel. The highest-paying jobs in this country are physicians, and they still will be, even under a single-payer system.
-Nearly 1/3 of medical expenditure in this country goes to administrative costs. If I have a primary care practice, I might be paid $40 for a typical patient visit. Say $10 comes from the patient as a co-pay, and I need to track down the other $30 from the patient's insurance company. I pay an office person (who needs to be qualified and educated in this field to know what they're doing -- it's not a minimum wage job) to fight the insurance company for my extra $30, and God forbid it becomes a real fight and the insurance company doesn't want to pay. It's very likely that what I'm paying my office person to get that $30 comes very close to $30 itself. At some point, it becomes not worth it, and that's why more and more physicians are moving to fee-for-service systems. Sad. (That particular story came from a lawyer who gave us a lecture yesterday; it was about his wife, a psychiatrist, and what she actually went through.)
-Only about 50% of employers offer health insurance to their employees. Many small businesses can't afford it. Ford is offering $140,000 cash to employees if they'll sign away their rights to lifetime health coverage, which they were initially offered when they started working there 30 years ago -- that's a sign that even the top employers can't afford health coverage. Apparently, the president of GM and Hillary Clinton were talking recently (this is supposedly in the Congressional Record but I haven't checked) and GM said that health care was killing them. Clinton asked why they didn't push for universal health care and then she'd sign on. GM asked why SHE didn't push for universal health care and then THEY would sign on -- I guess at this point, the manufacturing industry doesn't want to break with Bush, but the time is going to come. Right now, everyone is waiting for someone else to say that the emporer isn't wearing any clothes -- let's see who finally says it. It's dumb for health insurance to be tied to employment. It's done that way for historical reasons (I'll tell you the story if you like), but it doesn't make sense anymore.
-And the bottom line is, there are plenty of things that work in a market system. Electronics, groceries, clothing stores -- these should all function in a supply-and-demand system. But health care is a basic human right, and everyone should be on a level playing field. There's no reason that health care should be fought out in a market system. Market systems have winners and losers, and that's all well and good. People should not have to fight to be winners or losers to ensure a healthy life.
So that's my re-affirmation of the single-payer cause. If you want more information, you can check out Physicians for a National Health Program; www.kyhealthcare.org, which is a joint project of PNHP-KY and Kentuckians for Single Payer Healthcare, a layperson group; the source for those percentages I quoted up above; AMSA's section on universal health care; and, to be fair, the AMA site on the uninsured, although the AMA is only supporting Bush's system of tax credits and health savings plans (if you don't know anything about these, you can find plenty of sources yourself. I think they're one of the dumbest ideas in the world.).
Now, here's to a productive week of studying! There's no point in championing a cause if I don't graduate!
On the other hand, I really like this year better than last year. Over and over, I had heard that second year was much harder, but everyone likes it because it's more clinically relevant. Boy, is that true. It's MUCH harder -- the workload, mostly, not that it's conceptually that much harder -- but it's MUCH more enjoyable, as well. I like learning about diseases in Path -- putting together clinical scenarios with underlying disease processes. I wasn't a huge fan of the memorization aspects of immunology, but I like it conceptually. And I love microbiology, so the rest of the semester will be fun (we just started it). Even ICM, which I've always stuck up for, has gotten better. We just finished a whole section on medical ethics (fascinating stuff!) and healthcare financing (obviously, an issue I feel strongly about).
Speaking of healthcare financing, I got a chance yesterday to meet two really cool people: Dr. Steffie Woolhandler, and John Yarmuth. Dr. Woolhandler is a Harvard primary care physician who is one of the co-founders of Physicians for a National Health Program. She came to Louisville to give a public lecture on single-payer health care and to give a lecture on single-payer systems at the Kentucky Medical Association annual convention. In fact, the focus of this year's KMA meeting was covering the uninsured and underinsured, which I found really surprising, because I've always thought of the KMA as a much more conservative group -- it shows how much the problems with the current healthcare system have resonated across all groups, patients and physicians alike.
John Yarmuth is the democratic congressional candidate for our district here in Louisville. I like the guy a lot, mostly because he has extremely strong views on healthcare -- as a first-time candidate and unknown, he's really been pushing the single-payer cause hardcore, which is very impressive. He told me that his opinion, from speaking with people, is that the people are very much ahead of the politicians on this issue. The politicians are the ones preventing this from going forward at this time, but hopefully that will change. (The other cool politician who was in town this week was Barack Obama -- he spoke at Slugger Field on Thursday, and I heard he was awesome, but I wasn't able to go.) Here are the interesting things I learned at the KMA conference and Woolhandler lunch yesterday (plus some additional things that I already knew but maybe you didn't):
-In the 1960s, the pre-Medicare average physician salary was 2x that of the national average salary. After Medicare was enacted, it was such a good payer that the average physician salary became 5x that of the national average salary. (My new argument for people who keep countering me with the fact that Medicare is a bad payer; yes, there are currently Medicare cuts in the works, but we still need to fight those, even if we go to a single-payer system.) When Medicare was enacted, it created a whole new pool of patients/customers: the elderly, who had previously not been seeking medical care.
-If we create a single-payer system, there will be 46 million new customers who now have insurance. If we create a single-payer system, there will be an estimated additional 40 million new customers who now have good insurance. (There are currently 46 million Americans without insurance, and probably another 40 million who are underinsured.)
-Underinsurance is a big problem: In 2005, 22% of insured Kentuckians reported not going to a doctor even though they thought they needed to, because of cost. Twenty-one percent did not take a medical test, medical treatment, or complete follow-up visits recommended by their physician because of cost. An astounding 26% did not fill a prescription they needed because of cost (or filled it incorrectly -- "stretching" a month's supply to last two months, which can be a serious problem). And 15% did not see a specialist when they or their doctor thought they needed to. These are people WITH health insurance who cannot afford health care!
-Anecdotally, one of the largest groups opposing universal health care is medical students (surprise, surprise!). Apparently, we apply to medical school claiming we want to help people, but then we get greedy and think a single-payer system will create paycheck cuts for physicians. Or, to give us the benefit of the doubt, we get scared at how much debt we're in and are worried we'll never be able to pay it back (I myself am going to graduate with about $250,000 in medical school debt. Add on undergrad and my master's degree, and it will probably be about $300,000). Then, we graduate from med school and residency program, go into practice, and see the reality of how little we get paid under the current system and how wasteful it is, and sign onto the cause. (I heard that from someone who heard it from someone -- I have the attribution, but I can't verify it, so don't hold me to it. However, it does agree with the reactions I've gotten from medical students as opposed to physicians when discussing universal health care.) And yes, a few physician salaries are likely to decrease if we go to a single-payer system. But if you're currently making $600,000 and you get cut to $500,000, I think you'll survive. The current average salary for a primary care internist is $160,000-180,000. That's not a small chunk of change, by any means, and that's pretty much the bottom of the barrel. The highest-paying jobs in this country are physicians, and they still will be, even under a single-payer system.
-Nearly 1/3 of medical expenditure in this country goes to administrative costs. If I have a primary care practice, I might be paid $40 for a typical patient visit. Say $10 comes from the patient as a co-pay, and I need to track down the other $30 from the patient's insurance company. I pay an office person (who needs to be qualified and educated in this field to know what they're doing -- it's not a minimum wage job) to fight the insurance company for my extra $30, and God forbid it becomes a real fight and the insurance company doesn't want to pay. It's very likely that what I'm paying my office person to get that $30 comes very close to $30 itself. At some point, it becomes not worth it, and that's why more and more physicians are moving to fee-for-service systems. Sad. (That particular story came from a lawyer who gave us a lecture yesterday; it was about his wife, a psychiatrist, and what she actually went through.)
-Only about 50% of employers offer health insurance to their employees. Many small businesses can't afford it. Ford is offering $140,000 cash to employees if they'll sign away their rights to lifetime health coverage, which they were initially offered when they started working there 30 years ago -- that's a sign that even the top employers can't afford health coverage. Apparently, the president of GM and Hillary Clinton were talking recently (this is supposedly in the Congressional Record but I haven't checked) and GM said that health care was killing them. Clinton asked why they didn't push for universal health care and then she'd sign on. GM asked why SHE didn't push for universal health care and then THEY would sign on -- I guess at this point, the manufacturing industry doesn't want to break with Bush, but the time is going to come. Right now, everyone is waiting for someone else to say that the emporer isn't wearing any clothes -- let's see who finally says it. It's dumb for health insurance to be tied to employment. It's done that way for historical reasons (I'll tell you the story if you like), but it doesn't make sense anymore.
-And the bottom line is, there are plenty of things that work in a market system. Electronics, groceries, clothing stores -- these should all function in a supply-and-demand system. But health care is a basic human right, and everyone should be on a level playing field. There's no reason that health care should be fought out in a market system. Market systems have winners and losers, and that's all well and good. People should not have to fight to be winners or losers to ensure a healthy life.
So that's my re-affirmation of the single-payer cause. If you want more information, you can check out Physicians for a National Health Program; www.kyhealthcare.org, which is a joint project of PNHP-KY and Kentuckians for Single Payer Healthcare, a layperson group; the source for those percentages I quoted up above; AMSA's section on universal health care; and, to be fair, the AMA site on the uninsured, although the AMA is only supporting Bush's system of tax credits and health savings plans (if you don't know anything about these, you can find plenty of sources yourself. I think they're one of the dumbest ideas in the world.).
Now, here's to a productive week of studying! There's no point in championing a cause if I don't graduate!
Wednesday, September 06, 2006
untitled
Had a great weekend with Eric's sister and her husband. I didn't get a whole lot of studying done, but then, when do I ever get a whole lot of studying done? Ate at Toast, the new breakfast/lunch place downtown, and at Melillo's for dinner. Saw a Bats game -- a winning one at that -- and rode around on a surrey at Waterfront Park. My favorite part was singing the surrey song from Oklahoma and "A Bicycle Built for Two." The only downside to having guests is that, as usual, I gained a few pounds this weekend. We'll see if I can will them away...
Today we bought season tickets for the Broadway series. I'm really excited for it -- it includes All Shook Up, Dirty Rotten Scoundrels, Twelve Angry Men, The 25th Annual Putnam County Spelling Bee, Spamalot, and The Lion King. The first show is in October, and it wraps up with The Lion King in June -- I'm in for a year of culture!
For now, it's time for bed. Here's to dreaming about pathology!
Today we bought season tickets for the Broadway series. I'm really excited for it -- it includes All Shook Up, Dirty Rotten Scoundrels, Twelve Angry Men, The 25th Annual Putnam County Spelling Bee, Spamalot, and The Lion King. The first show is in October, and it wraps up with The Lion King in June -- I'm in for a year of culture!
For now, it's time for bed. Here's to dreaming about pathology!
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