The often overlooked consequence of a single-payer system

Maggie Mahar–one of my favorite health care policy bloggers–has an excellent op-ed in the Washington Post pointing out that coverage of medical conditions under a single-payer system could be subjected to the political whims of whomever is in power in Washington.  Under a single-payer system, conservatives could deny coverage of any number of medical conditions they deem “morally objectionable” and there would be little recourse.  The debacle over the Stupak Amendment is an excellent example of what could be.

Pronouncing someone “dead”

Every once in a while, med school knocks you in the head and sees if you’re actually paying attention to what exactly you are studying 10 hours a day for.

I had such an experience today.  All 1st year med students have to take a Basic Life Support (read: CPR) class (for obvious reasons).  Thus, I went to our skills lab and listened to a current fireman explain all of the latest CPR techniques.  He was a great instructor and it is actually very fascinating material (at least more than interleukins and cytokines).

At one point, one of the student’s basically asked when you wouldn’t initiate CPR or at what point you would stop.  He said for himself and the paramedics he works with, they have specific protocols and regulations they follow.  Then, he pointed out the fact that we (as future doctors) would ultimately have the responsibility of stopping life saving measures and pronouncing someone dead.  That is a specific legal responsibility granted to physicians.

It’s a sobering thought.  One of those things you don’t really think about when you’re applying to med school.

Explanation for why health insurance is so expensive

See First Blog has an interesting piece explaining why health insurance is so expensive (and by extension why so many Americans don’t have health insurance).  Will fixing some of these problems do more in the long run for health care in the United States than the plans being discussed in Congress?  Nobody knows.  The best way to find out would be federally-sponsored pilot programs in different states using different approaches.  Careful policy analysis of these programs could then tell us what works and what doesn’t.  But, as I’ve said before, such a solution would not provide a political “win”, which is really what the current health care reform is all about.

Finally, an article on the real problem in health care

The NY Times nails two of the biggest obstacles in forming effective health care reform plans that almost never discussed and poorly understood by the American public.

1. Cost containment is essential to any successful reform–The bulk of the health care reform discussion has focused on providing insurance for the nearly 50 million uninsured Americans.  Unfortunately, simply insuring these people doesn’t address the underlying problem–health care cost inflation.  The biggest reason these people don’t have health care insurance is because they or their employer can’t afford health insurance.  Now, instead of creating artificial systems (like a public option or government subsidized private insurance) to provide insurance, we should be working on ways to make insurance affordable for everyone.  A good first step would be figuring out how to bring the 8% year-over-year health care cost inflation under control.
2. Reforms eventually passed in Congress won’t be the “best” reforms, but those most palatable to powerful interest groups–Unfortunately, policy (regardless of the arena) is not set by those who know the most about the subject.  The debates going on in Congressional offices right now are not between health policy experts/doctors/patients and their elected representatives but between lobbyists of powerful interest groups with deep pockets and Congressmen.  The resulting legislation will reflect this fact.

 

Interviewing for Medical School

While on campus today practicing some “doctoring” in our clinical skills lab (aka interviewing actors playing patients), I came across some nervous souls doing their interviews for medical school.  My interview day seems like it was 5 years ago, but actually I interviewed around this time last year.  Here is the quick and dirty guide to interviewing for medical school:

1. First of all, if you’ve been granted an interview, congratulations! There are many, many people that never make it this far.  Take a moment and reflect on how far you have come.
2. After patting yourself on the back, the next thing to do is relax. Medical school interview aren’t as terrible as they seem.  Most interviewers really do just want to sit and talk with you for a little bit to get a sense of who you are, why you want to be a doctor, and what you are going to contribute to their school.
3. Know the interview format. Each medical school has their own format for interviewing students.  Some will have several one-on-one interviews and others will have you interview in front of 3 or 4 people at once and most will have some combination of the two.  The admissions people should let you know the layout for the whole day.  Be familiar with this info just so that nothing is a surprise and you can relax because you know what’s coming.
4. Read up on the school you’re interviewing at. The Student Doctor Network is a great resource for inside information on the interview process at nearly every medical school in the US.  Also read the schools website, know something about their stated mission and anything that may make the school unique (ie–if it’s a Jesuit school, maybe know something about the Jesuits).
5. Do some practice interviews. To be perfectly honest, I never did this.  I am naturally a pretty good interviewer.  Plus, I had some intense interviewing experiences during the few years I was in the “real world.”  However, almost everybody recommends doing some practice interviews with a pre-med counselor or other advisor, so I’m going to recommend it as well.  If possible, find somebody (a family friend perhaps) that has been on a medical school admissions board.  They will be the best at giving you good questions and critiquing your performance.   Don’t waste your time practicing with somebody who is not familiar with the medical school admissions process (like your friends).
6. Develop an answer for the question, “So, why do you want to be a doctor?” Honestly, I think this is the dumbest question to ask in an interview and there is no right or wrong answer to it, so why ask it?  But, somebody will inevitably ask it, might as well be prepared.
7. Give yourself plenty of time to get to the interview. If you’re traveling or otherwise unfamiliar with the school, there is no shame in going the day before and driving around to make sure you know exactly where you’re going.  Being late or lost just makes you unnecessarily more nervous for the interview.
8. Take something to read. This one may sound a little bit ridiculous, but I not kidding.  You are more than likely going to be waiting at some point during the process so you might as well have something to read.  I’m not suggesting lugging in your hardback copy of War and Peace, but maybe a printout of the latest NY Times article on health care reform.  Which brings me to my next point…
9. Know something about health care other than doctors write prescriptions and do surgeries. Health care reform is a hot topic right now and it is likely that your interviewers might ask your opinion of the current reform efforts.  Don’t flatter yourself, they don’t care what you actually think.  But they do care that you are engaged in the “health care world” and know what you’re getting yourself into.  I interviewed during the elections and was asked how much I knew about each of the candidates health care reform proposals.  If you’re looking for some resources on what is going on in the health care world, look at the health sections of the major newspapers (NY Times, LA Times both have good coverage of most major health care issues) or read some of the archives of this blog.  I don’t cover everything going on in health care, but I try to do my best.
10. Have a question or two in your back pocket to ask your interviewers. Interviewers always ask at the end of the interview if you have any questions for them.  Personally, I like to develop questions while I’m interviewing so they are related to what we had been talking about or are specifically applicable to my interviewers.  However, this is a little difficult to do–especially if you’re nervous about interviewing.  So, beforehand come up with one or two questions.  This does not mean that you HAVE TO ask any questions at all, but it does show you were engaged in the interview.

Only one final thought–remember, you are interviewing them as much as they are interviewing you.  You may be receiving multiple acceptance letters in the coming months and have to decide which school to go to.  Make sure you have a firm grasp of what the school is like and in particular any strengths or weakness you feel may impact the direction of your career.  Finally, enjoy the process!  Granted, the actual interviews are a little nerve-racking, but you will also meet fellow applicants who may be future classmates and possibly some future professors and mentors…so be nice!

Cost Control and Health Insurance Mandates

Tyler Cowen–famed economist from George Mason and one of my favorite bloggers–has an excellent NY Times column laying out why current reform efforts won’t work. As he points out towards the end of this piece, mandating health insurance won’t alleviate the root of our health care problem–out of control costs. Over the past decade, health care costs have risen on average more than 8% each year. Such growth is unsustainable and unfortunately providing insurance for all Americans (no matter how it is accomplished) will not address this problem. The current administration and Congress are racing forward with the intent to do something on health care reform, but they are targeting the wrong problem.  Even more worrisome is the fact that the “solution” they likely will put in place will saddle future generations with an unsustainable entitlement program that will be ten times more difficult to deal with.

My perspective on the H1N1 vaccine

The Daily Show succinctly sums up my feelings on the media’s coverage of the H1N1 flu and the most recent “controversies” over the vaccine (click on “Doubt Break ‘09″ because I can’t seem to get the video to embed properly):

The Daily Show With Jon Stewart	Mon – Thurs 11p / 10c
Doubt Break ‘09
www.thedailyshow.com
Daily Show Full Episodes Political Humor Health Care Crisis

For the record, I will be getting the H1N1 vaccine and if I were a practicing physician I would be recommending it to my patients, especially those in vulnerable populations.

Were latex gloves invented for money or sex?

[from The Long Road to Medical School]

But then [the neurosurgeon] asked me: Who invented latex gloves? Was it for money or sex?

Allow me to satisfy your burning curiosity. The answer is William Stewart Halsted. For sex.

So apparently, Halsted had a thing for one of his OR nurses. But her hands were becoming red and chafed from all the hand washing she had to do in order to assist him. Eventually things got so bad that she told Dr. Halsted that she was returning home to Ohio or some such because she just couldn’t take the hand discomfort any longer. So, in order to keep her around, Dr. Halsted commissioned someone at Goodyear Tire Company to invent a pair of gloves so thin that they would not interfere with sensitivity while operating.

Thus, the nurse was able to continue working in Halsted’s OR, and in fact later became his wife.

Read Halsted’s wikipedia page.  It is the most fascinating biographical wikipedia page I’ve ever read. It will also make you feel like you haven’t done enough with your life, no matter how accomplished you may be.

Ouch

[via Jay Parkinson]

Determining your own prognosis in the hospital

Non-Clinical Clinical Prognostic Indicators

Good Prognosis:

Your doctor hasn’t seen you yet, and you’ve been waiting for (insert average wait time) hours.

You’re in a bed in the hallway.

Your complaint consists of “months” or “years” of pain/nausea/headache/X Y Z.

You’ve come to the emergency department for a second opinion, despite multiple subspecialist evaluations.

You answer yes to every symptom the doctor asks you about.

You get a blood draw, but no IV.

The only medication you’re given is tylenol.

Your doctor says the words “probably” and “virus” in the same sentence.

You are talking on your cellphone, playing a game, or chit-chatting.

You are talking on your cellphone, playing a game, or chit-chatting and the doctor has to ask you to stop.

You “just wanted to get it checked out.”

Your primary care doctor sighs on the phone when the emergency physician calls him or her.

Bad Prognosis:

You get not one, but two IVs.

You remark, as my GI bleeder did last night, “Boy, I’ve never been to a hospital so attentive and efficient!”

You get your own personal doctor to take you to the CT scanner.

Multiple doctors, nurses, and staff greet you in your room.

The triage nurse walks you to your room and points at you while speaking to the doctor.

You get a room all to yourself.

You get a monitor.

Your monitor keeps beeping, even though you’re not doing anything.

Your doctor keeps checking on you.

Your doctor sticks a finger in your bottom.

You don’t argue with the doctor about getting this treatment or that one.

You are kind, good-natured, and have been a good person in this life.

“Non-Clinical Clinical Prognostic Indicators”

[from The Central Line; visit for the full lists]

Good Prognosis:

• Your doctor hasn’t seen you yet, and you’ve been waiting for (insert average wait time) hours.
• You’re in a bed in the hallway.
• Your complaint consists of “months” or “years” of pain/nausea/headache/X Y Z.
• You’ve come to the emergency department for a second opinion, despite multiple subspecialist evaluations.
• You answer yes to every symptom the doctor asks you about.
• You get a blood draw, but no IV.
• The only medication you’re given is tylenol.

Bad Prognosis:

• You get not one, but two IVs.
• You remark, as my GI bleeder did last night, “Boy, I’ve never been to a hospital so attentive and efficient!”
• You get your own personal doctor to take you to the CT scanner.
• Multiple doctors, nurses, and staff greet you in your room.
• The triage nurse walks you to your room and points at you while speaking to the doctor.
• You get a room all to yourself.
• You get a monitor.
• Your monitor keeps beeping, even though you’re not doing anything.