First Thoughts

If you've been following along, I have no need to explain what today was. Overall, I'd say that the first day played out as expected, but that it's an interesting feeling to think about what it signifies. While I am truly no different than I was this morning or yesterday or two weeks ago (or really than I will be in another two weeks), there is a marked change in the potential to which I can- or am expected- to reach.

*Warning: the following will be a lot of my thoughts on the current state of health care. Read at your own risk*

The deans and higher-ups payed much attention to the status of the profession of medicine and how "we" operate/fit in society (I use 'we' to encompass the working members of the health care field- and don't worry, it still freaks me out to include myself in that definition). Not in the sense of a higher status than others, but in the sense of obligation and trust. Physicians- and all professionals (traditionally medicine, law and clergy)- operate out of the basic trust that society gives them. People surrender their sovereignty and judgment to doctors under the expectation that they work toward the greater good and only on the best interest of the patient. A doctor's power stems from this trust and if such a valuable thing isn't acknowledged and upheld it can (theoretically) be revoked.

The presentation made me think about the current issues of health care reform/insurance/cost/problems. Can we in the profession, by allowing it to get to the state it is in now, be held responsible for the current problems? Has the social contract been broken through the acceptance of a third party (being insurance/pharmaceuticals) in the patient-physician relationship? And if this is the case (which I believe it is), have we progressed so far that the power of the patient to revoke the social agreement has been made obsolete?

It's a big debate and a huge question. My thoughts will follow and don't worry, I know I'm mostly dreaming I believe we must (with all others- patient/administrator/insurance/pharmaceutical/government) be held accountable to the current problems and need to be instrumental in reform. Insurance companies need to stop focusing on charges and focus on costs. There's a huge difference between the two. Pharmaceutical companies need to quit worrying about patents and shift from a business-focus to a public-good-focus through providing affordable drugs. Patients need to accept the fact that the system isn't perfect, cannot be ruled by the market alone and that they cannot always get everything they want. The system exists with a finite number of resources and (I know this is shocking to hear) some rationing and restrictions must be made. From a med school/student view, I honestly think there needs to be restrictions on specialties and residency programs. There's an astounding shortage of primary care doctors, and too many people need a dedicated and gate-keeping primary care doctor to focus on preventative and consistent care to keep churning out the wonky ratio of primary care/specialist docs that we are now (32%/68%- and that's being generous. Read here). It's a nasty thing to hear (particularly from a med student perspective) and I don't know if it'll ever happen. Just like patients being regulated to specific doctors, med students don't like to have their choices restricted. It goes against the ingrained nature of the American ideal: freedom of the individual.

*End of thoughts of current state of health care*

Wow. If you read all that, bravo. I commend you. If anyone has any questions or wants a discussion, I'm all for it. If you want to really get a good look at this, read The Social Transformation of American Medicine by Paul Starr. It'll rock your world. As for the actual happenings of the day, we got a sweet computer (which I'm currently posting from) and found out some (kind-of) interesting information about student services (health center/rec/study options/etc).

In closing, so that everyone knows exactly where I stand on the health care ladder, I can be referred to (and should call myself) a student-doctor. I feel like some kind of awkward teenage of medicine. Also, there's no way that I'm the only one who thinks the phrase "patient-contact" (used to note situations where we'll encounter patients) conjures images of discovering a new alien species.

Dean: Everyone dress business casual tomorrow, as we'll be having patient-contact on the trip to Wichita.
Student: Should we expect hostiles or friendlies, sir? Do they look human in nature?