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"I wouldn't do it twice, but I would not 'not' do it once."

- ZDoggMD

Entries in Healthcare reform (6)

Wednesday
Dec122012

The Future Of Medicine Is A Problem and An Opportunity For Young Doctors

Creating Opportunity In Your Future Medical Career.

The world of medicine that the next generation of physicians will be inheriting from their predecessors is the most advanced, complex and dysfunctional in the history of humankind. As future physician begin to take the wheel of a health care system that is at times revolutionary and at times in complete disarray, we must realize a few important facts.

  • We will become the leaders of a heath care system that will have new pressures and demands placed on doctors at an unprecedented rate.

  • We will enter a world with a global aging patient population. This is happening at a rate unseen by any previous generation of physicians and this rate will only continue to increase.\

  • We are entering a more centralized medical care system. This centralization will take place at both the patient-physician and physician-hospital level.

  • The economics of modern medicine demand increased specialization among doctors and this will continue to progress as biomedical advances progress. 

These simple facts about our modern health care system present a laundry list of problems and opportunities for young doctors. It also places us in a position to suffer or thrive more than any group of doctors in medical history.

This means one thing, the traditional approach will not work....

The level of specialization, rapidly changing knowledge, outside pressures in today's medical practice has evolved beyond the current medical education models which are still largely build on the 100 year old Flexner Report. Thus, the length of study, focus, and framework are build around principles of medical education have not kept up with the pace of modern medical practice. In fact, there are some leaders in medical education that are and have been calling for a complete overhaul of the US medical education system.

In an interview for the University of Virginia Magazine Dr.Randolph Canterbury, the medical school’s senior associate dean for education said this,

It’s become pretty clear in the last couple of decades that this is probably not the best way to learn something as complex as medicine. The idea that physicians ought to learn the facts of all these various disciplines—anatomy, physiology, biochemistry and so forth—to the depth that we once thought they should doesn’t make much sense. About half of all medical knowledge becomes obsolete every five years. Every 15 years, the world’s body of scientific literature doubles. The pace of change has only accelerated. The half-life of what I learned in medical school was much longer than what it is today.

There will need to be huge changes to every level of the medical system and medical school is not exception. I feel that student doctors who realize medical school cannot, and will not teach them everything they need to make in the future are best in the position for success.

Working hard to learn the skills taught in medical school is imporant but when you consider that most of what you learn will be outdated in 5-10 years, it makes you look at your grades differently.

Yes, getting good board scores and having a nice class rank are important, but the will not be important past residency.

Doctors will no longer expect to graduate and have a killer practice handed to them on a platter. Skills like networking, leadership, managment, and creativity are all vital if you want to separate yourself from the crowd once you become a doctor and they are all completely impossible to teach in a lecture hall.

 

 

Sunday
Jun102012

US Healthcare Spending vs. The World

This chart presented without editorial comment, there's really not much more to say.....

source

Tuesday
May292012

Fixing Patients In A Broken Healthcare System

"Status Quo, you know that is Latin for "the mess we're in."" -Ronald Reagan

As I glanced at the chart of my next patient I felt my heart sink. It was littered with warning phrases; words like progressing, recurrence, and worst of all, suspicious. Most of the time these charts are filled with unintelligible scribble recorded in a half-hearted SOAP format. A few lab results, a differential diagnosis or two, followed by the solution to the patient's ailment. However, as a medical student, you learn to develop an eye for the warning phrases. Once they begin to pop up you know that a doctor is trying to communicate that this patient’s findings are giving them a bad feeling. It seems that once you have been in the game for some time you develop a visceral reaction when you see certain patients. It transcends the lab tests, the imaging studies, even the all hallowed physical exam. There is some thy of "gut factor" experienced physicians develop, and evidently my patient had triggered a few on her way to see me.

“Do you people even care if I live or die!?” My patient blurted out as I entered the room, she looked tired, exasperated, and scared. Her question left me reeling, but only for a split second. I knew that this was one of those questions that required a swift and definite answer. You have a similar time frame when your wife or girlfriend inquires about her outfit and if it makes her look fat. Of course in that case the only response is an immediate and decisive “are you kidding, no....” Thought the implications of this encounter where much more serious. I did my best to deliver an answer dripping with as much empathy and reassurance as I could heap on, but I knew in my heart that I could not deliver the full truth to my patient.

Of course it’s ludicrous to think that any doctor would ever have total indifference toward the lives of their patients, however, we are the face of a system that, by some measure, truly does not care. This patient had recently lost her job and the “perks” of health insurance that came with it. I knew that eventually she would be able to get the care she needed but I could not have confidence in the timeliness of this remedy. This is understandably disconcerting for someone with a mass relentlessly growing (and possibley spreading) inside your body, with no regard for the timing of an overloaded clinic schedule.

The simple reality is that we work in a world of limited resources and at some point there must be people who will bear the brunt of this limitation. As it stands now the nature of selection favors those who have the means to pay for options. In some ways, this may always be the case but I do feel that we can do alot to make the system better. The political rhetoric surrounding health care at the moment is in many ways missing the boat because no matter how many people you give access to health care we still come back to this issue of limited resources. Sure you can give everyone health insurance but it won’t mean anything if it takes 5 years for an appointment to get your colonoscopy done so the doctors can rule out colon cancer. All you have done is substituted one form of selection for another.

I do not know what will become of my patient. I want to truly believe she will get all the appointments in all the free clinics that she needs in a timely manner so that she can go on and live a meaningful life. Though by the end of our visit, after calling various clinics, and coordinating lab tests that must be complete before surgery,  I have begun to develop an imperceptible feeling in the pit of my stomach. I cannot seem to shake it off as I go back into the exam room. I try my best to hide it and leave my patient with a bit of hope as we part ways.

As I go forward in my medical training I not only see the challenges of developing my own clinical skills as a doctor but I also see that future physicians will be taking over a health care system that is, at best, overburdened and, at worst, dysfunctional to the point of breaking. It is for this reason that our health care system is in need of a different type of doctor or at least a greater variety of them. Attributes like creativity, vision, outside-the-box thinking, and risk taking are likely not the ones that got you a spot in medical school or residency. However those character traits are the ones that must be cultivated in the next generation of physicians as we move forward in finding better ways to care for our patients.

Thursday
May242012

Man Robs A Bank For $1 To Get Medical Care

A felony is all you need if you want affordable health insurance.

As reported by SFGate.com

James Verone calmly walked into an RBC bank in North Carolina and committed his first crime in his 59 years on this planet. Verone handed the teller a note that read "This is a bank robbery. Please only give me one dollar," took the dollar from the terrified clerk, and sat down on a couch in the bank's lobby.

"'I'll be sitting right over there in the chair waiting for the police," Verone told the bank teller. And wait he did. Police arrived moments later and apprehended him, hauling him off to the jail cell he so desperately wanted to enter.

No, James Verone isn't crazy. He isn't a career criminal. He didn't rob the bank to get drugs or booze. He didn't do it to get attention or on a lark. James Verone walked into that bank and committed a felony because going to jail was the only way he could receive the health care he needed to survive.

 

Thursday
May242012

Why Your Stitches Cost $1500

The Unites States is one of the richest countries in the world. I guess that means we have to pay more for healthcare.

 

Why Your Stitches Cost $1,500 - Part One

Created by Medical Billing And Coding

Tuesday
Dec202011

The Healthcare Future We Have To Look Forward Too. Unless...

BE INFORMED: Health care reform does not have to be as scary as it sounds. Ron Paul, laying down the truf!

It is my humble and correct opinion that every person interested in any way in being involved in a medical profession should have at least a general understanding of the politics behind the healthcare system. I know there are alot of persons out there that "don't like to get involved in politics," or are of the opinion that they "are going to be a doctor not a politician" or are just apathetic about such issues as the broken healthcare system and what is being done about it. The truth is that all these excuses are sheer and utter crap, because the fact remains that if you are earning a living in medicine, or ever plan to, this will be THE central issue influencing your future career for the worse... or hopefully the better.

It will influence how much you work, what you get paid, what sort of torture you will need to put yourself through to get certified and how much that will cost, what sorts of treatments you will be reembursed for, and LITERALLY every aspect of your career the super healthcare person you plan to be. Heck, I think that any person planning on getting sick EVER should know where this country is headed in terms of who runs what in medicine and why. So at the very least if you don't watch this video: either because you hate Ron Paul's guts (can't imagine why any rational or informed person would), or you are too busy watching people slip and fall on youtube, do me a favor and inform yourself someway... somehow.

There is alot of political arm waving about how this big behemouth called corporate healthcare got derailed and advice about what needs to be done to forklift it back on said tracks. Most of this arm waving is being done by career politicians who know very little about actually providing healthcare to people. An odd and sad paradox indeed. This puts presidential candidate Ron Paul in a unique position. In case you didn't know, Ron Paul had a private practice in the 60s and 70s as an OB/Gyn that walked his talk. He didn't accept medicare of medicade and instead would provide medical care at little or no cost to those who needed it but couldn't pay. After which he has served as a member of Congress and written several books. He has a unique perspective on the history and future of healthcare in this nation and is probably one of the few politicians truley qualified to speak with authority on the issue.

Regardless of your political persuation... bes listen up... this guy KNOWS the profession of which he speaks. Viva La revolucion!

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