Manual Over Autofocus.

I am astounded that in a month I will be one half of the way through my third year of medical school. As I've gone through a handful of rotations and have spent more time than I cared to at the hospitals, I've noticed something that has been irritating me. As a student, for as much as we are active and participating in patient care, we spend a lot of time observing. We watch residents, attendings, and nurses, seeing how they interact with patients and approach the art of medicine. The mantra that is often taught, or supposed to be taught, or ideally taught but secretly thought by some of those teaching as foolish, is that in medicine you should not treat the disease; you should treat the patient.

The sentiment of that statement rings true with how I feel. The execution? Not so much. Many physicians stop short of treating the disease, let alone the patient. Instead, they treat the symptom or a specific manifestation of the disease. An ID doctor treats the infection; the surgeon opens and drains the abscess; the endocrinologist manages the diabetes. This makes sense from a practical point of view. If I have learned anything over the past two and a half years it is that I cannot learn everything. An expert should handle the complexities and nuanced management of certain conditions. But what happened to treating the patient? (This is not to say specialists cannot treat the patient instead of a symptom or aspect of disease; it simply means I haven't seen it yet. I am wanting to, believe me.)

Recently on rounds, the attending reminded us that "In medicine, we treat the patient, not the numbers." This statement was made regarding abnormal lab values. It was meant to remind the students and residents that we cannot simply try to correct abnormalities on paper; we must look at the patient clinically to confirm, adapt, and change plans. Sadly, it was meant on nothing more than a level of clinical correlation. As opposed to a grander statement about the lofty responsibility of treating the patient, it was about confirming laboratory findings clinically. What this statement actually did for me was point out the failures of the medical team to go beyond a talking point and treat more than the patient; I instead wondered: what about the person?

Too often it seems medicine becomes bogged down in labs or physical findings. Sodium is corrected; cholesterol is monitored. While these things are astoundingly important, I do not want to be a physician who works through tunneled vision. I do not want to be a physician who treats the patient instead of the disease.

I want to be the doctor who cares for the person.

Most of the people I have worked with thus far- who no doubt care about patients immensely and typically practice good medicine- do not focus on the patient as a person. Maybe this is naive and foolish. Maybe I cannot actually appreciate the weight of what it means to be a physician and all its struggles because I haven't reached that point yet. Honestly, I do not know and don't get me wrong: there have been a handful of docs who continually impress me both with their control of medical knowledge and their approach to patient care. Such physicians do exist. I just suppose my hope is to join their ranks in one and half years (technically) and four and half years (board-certified-ly).



Until next time.

All Work and No Play

Time is a sneaky mistress. For most of school thus far, any kind of ending has been far off in the future. The slippery and fluid nature of time has changed that. As things currently stand, two weeks of regular lecture, a final exam, a pharmacology shelf exam, and about 250 drugs are all that stand between me and the halfway point of my medical education. Such a time crunch might, as one would expect, explain the severe lack of blogging accomplished by yours truly.

For this I apologize, but sadly, school and all of its craziness take priority. In the mean time I hope everyone else enjoys the spring for me. I'll see you for a week and a half in the summer. (For fun, check out the new countdown at the bottom of the blog.)



Until next time.

Alive and Kicking

Contrary to what I can only assume to be popular belief, I am alive and well.

Much to my surprise, or at least cautiously optimistic belief, I successfully defeated the modular of Brain and Behavior. A nine week behemoth, it was advertised to be the most challenging module of the first two years of school- a reputation it seemed both pleased to have and eager to maintain. The most enjoyable result of being done? No more anatomy. A year ago we started in the cadaver lab and have sense made our way from the heart and lungs, through the GI tract, all around the GU system, up and down the extremities, and lastly into the brain, head, and neck. While dissection lab was usually pretty nice and a change-up from regular lecture, it's really nice to be freed from the afternoon time commitment and additional exams.

We're now into the module of Blood and Lymph which is going fairly well; it's very pathology focused which might mean a test that has its devil in the details. I still want nothing more (going on 2 weeks later) than to revel in the joy of being done with B&B, but have decided to get back to the grindstone. If I'm going to dance on the grave of this semester, I want to be damned sure it's dead. I don't know if it's cold in the ground just yet.

So that's what's going on. Fiction writing is still happening, slowly, but I am currently planning on waiting to post more until I have a better story formed.   If I had more time, I'd like to be able to finish NaNoWriMo on time. I suppose with my late start, it'll just be a two/three/four month excursion for me. I mean, I'm a little busy with not shaving this month...

It is November, after all...

Until next time.

Nothing But The Rain

Throughout my life, my hobbies and interests have widely varied. I can remember devouring everything I could about ancient Egypt and dinosaurs in elementary school. This transitioned to drawing and sketching to playing percussion which lead to freestyle biking to golf to learning the guitar. My unending desire for knowledge and the revolving door of activities that engaged me have both given me countless experiences. The changing focus resulted from my starting something new, tearing through it as fast as I could until I felt I had a good handle on it, then being stolen away by something else. Fortunately, the spoils of my sporadic nature have never completely abandoned me when I seemingly ditched them. I love riding my bike when I get the chance, obviously still draw and sketch, occasionally hit the links with my friends, and maintain a prehistoric presence in my life (Winston, duh).

Certain passions, however, have endured throughout my life. One of my greatest can best be described as a love of the story. Since Kindergarten, I have loved to read and have been drawn in by books and stories. From Dr. Seuss to The Boxcar Children and Goosebumps to Scottish detectives, a perpetually walking man, and a sprawling epic, this has grown throughout my years and manifested most obviously in my studying English in college. Yet, my interest in stories has never been confined to just the written word, bound and printed. Movies, TV shows, plays, musicals, bands? They can all show the complex weave of human interactions and emotion. And I love it, being more than willing to commit and dedicate bits of my elusive free time (namely whenever I can't hang out with my wife/friends and my brain can no longer handle studying).

An interesting addition began during college. Rather than merely taking in the stories, I began to produce my own, writing fiction, first for a writing class and then for fun. Much to my chagrin, the time-sinks of life and medical school stopped any continual creative progress. This fact has been sitting my mind, gnawing at my post-central somatosensory gyrus (not really- I'm just in the Brain/Behavior module right now). Throughout the day, I'll imagine bits of scenes, shadows of characters, and inevitably think I should write a story with this. Considering the frequency of my blog updates, you can imagine my success rate (hint: dismal).

Because of this, and in an effort to change it, I'm going to try and write- short stories, scenes, chunks of dialog- and probably post them here. Will these be complete stories? Good stories? Worth reading? I honestly don't know. As any writer or would-be-writer will tell you: writing is hard. It's work; it's tough; but, I think it might be worth it.

In closing: what are some of your favorite stories? Personal stories, books, movies, TV shows, anything. Feel free to post away, if you're out there.



Until next time.

Pretty Shameful

My heart sinks and dies a little bit every time I read something like this.

Do people forget that any greatness the country has comes from its freedoms? You know, including Freedom of Religion? Does anyone really think things would be better if we were all the same? Do people not realize that there is a huge difference between Islamic Extremists and a person who is simply a Muslim? Just like there is a huge difference between a crazy member of Westboro Baptist Church (aka Fred Phelps) and a person who is a Christian?


Until next time.

A Little More Personal

In honor of a previous post of mine, I've decided to again talk about things I like and/or like to do. This stems not out of disdain for my current academic situation as before; we've only just begun second year and I think I'm going to like it. Instead, this blossoms from my simple desire to think about things I like and have something to do while my better half isn't around. So, without further ado:

Things I Like More Than...Other Things?


-Extra computer storage space. External hard drives, USB sticks, blank CDs/DVDs, I am an equal opportunity advocate. I don't actually know why I have such a fascination with extra space (I may or may not have three external hard drives, two USB sticks, three spindles of discs, and an iPod), but I think it goes back to a feeling of freedom and potential. Do I have space to buy that [electronic media]? You bet your ass I do. I have space three hundred times over.

-Naming inanimate objects. This partially ties to the previous comment as I also name all of my computer drives (don't tell me "T-REX" isn't cooler than "C-Drive"), but it goes beyond that. My computer? Persephone. My T-Rex? Winston. Turtle Ottoman? Herbert. iPod? Nightwing. Phone? Alfred. Doing so just gives everything a bit of punch and personality. Try it. Need to kick you off? Spartacus.

-Discovering my water bottle to be full without remembering having filled it.

-Forgetting about E-learning assignments for class (online assignments) only to find that we never had any.

-Stepping outside on the first real day of Autumn. The air has just enough chill that you know Summer is finally over.

-Fruit snacks.

-Having a good author draw you in and then finding out he/she writes a series or has additional books.

-An indie girl, an odd but wonderful group of people, and two crazy Frenchmen.

-The Library.

-The Wire. I'm through season 3 and would argue it's the greatest story told on television, and I'm a frakkin' Lostie. ((+10 nerd points if you know what else I'm referencing here)).

-The unusual feeling/pain that you feel in your face after laughing so hard you start to cry and can barely breath. This exclusively happens with friends, usually when ridiculous stories are being told.

-Anything that satiates my ridiculous need for trivia.

-The ultimate gateway fruit.

-Hanging out with old friends, and feeling so at home it's almost like you never left.



Thoughts? I'd love to hear them in the comments below.
Until next time.

Unforseen Difficulties

The preparation for medical school is ridiculous. If one were to try to compile all the possibilities together, I have no doubt the process would be damned near infinite. Some people start prepping in high school. They take tough science classes, shadow docs, and begin the process of building up a history of interest in medicine. This way, when college rolls around, they can reference all that they've done so far. Then college consists of pre-med courses, volunteer work at hospitals or labs, the entire MCAT preparation and process, and -topping it all off- the application process. Buckets of forms, letters, grades, personal statements, and interviews.

There's a lot to do.

Assuming all of this works out, you're all of the sudden in medical school! You get to become a doctor! Your hard work has paid off! What does school do? Well, they continue with preparation, but this time it's to really become a physician (for now we'll ignore the residency process needed before you can become a practicing physician). In other words, the journey continues.

Some of you might be saying, "Wow, that sounds pretty tough." You, Hypothetical Constant Reader might be right. I won't argue that the process is lengthy and can be challenging. It's true. But I believe the real troubles arise from the unforeseen difficulties. The problems that pop up and create situations you've never even begun to consider in your- literally- years of preparation. All of that preparation has been so that when problems arise, you have the skill set and ability to assess and act. A child presents with shortness of breath. Assess and Act. A young man becomes violent and aggressive as he pesters you for drugs. Assess and Act. An old woman codes on the hospital floor. Assess and Act.

But what happens when unforeseen issues arise within the process of your preparatory education? How do you handle the different thoughts, opinions, ideas, and behaviors of your fellow students and teachers? The situations that arise away from the classroom? How do you assess and act? Do you stick to your own Self and values, possibly straying from the carefully constructed path of the Medical School Journey? Or do you keep quiet, noting your feelings, and hope for the best?

I suppose the real question is: can a person really complete this journey through medicine and end up the same core person at the finish line?

Now you might be asking, "What on Earth is he on about?"

Don't fret, Constant Reader. I'd say all is and will yet be well.  I simply sit here thinking, on the cusp of a new year, I see all of the new M1s going through orientation. They anxiously and awkwardly begin their journey. Cramming onto a charter bus to breeze through the other campus. Nervously accepting the white coat in front of your peers. Awkwardly talking and drinking at the parties.  I can't help but wonder, how different am I from them? Have I changed over the past year?

Looking back, I'm surprised by how much medical school, and all its tangential connections, have factored into my life in so many different ways. One year ago I wrote my thoughts and hopes on beginning school. Rereading those words now, I feel as though I managed pretty well. Was it easy and did I ever do it alone? Of course not; no way. Many thanks to all who've helped me (especially a certain redhead).

Two points of advice, however, given then by someone who is still wiser than me now, stick out more relevant today:

-Don't be dazzled by bullshit.

-Make sure all things pass the smell test for veracity, virtue, and truth. 

I think those are good things to think about and constantly return to. All things considered, I'm looking forward to my second year.


Until next time.

Ongoing Changes

If you can't tell, I'm in the middle of shaking somethings up around here.

You may or may not have noticed if you came here from a bookmark or previous address, that there was a feeder page and my blog has a new URL. If you're currently going, "What are you talking about?" you can pretty much ignore what I am, in fact, talking about. I originally wanted my blog to be orderly and systematic in its makeup. That flew out the window when my desired address, to match my desired title, "Paging the Doc," was not available. This led to the use of the alternate address -pagingdocgib- that you know and love (or maybe just bookmarked). Imagine my delight when I discovered my ideal name, that which so perfectly captures the essence of my writing (or maybe just the title of my blog), was available. I snatched it up!

So what does this mean for you? Nothing if you don't want it to. You can go to pagingdocgib.blogspot and be redirected here (although you will no longer see new posts in feeds/notifications), or you can do what the cool kids are doing and delete that old mismatched bookmark and save yourself a new new. The choice is yours. Choose wisely.

"But MG," I hear you -faithful reader- calling, "What about a real update?"
Well. If you insist.

From where we left off, I have now successfully finished my first year of school and am currently doing some summer work in Pediatrics. Let me repeat that.

I HAVE FINISHED A YEAR OF SCHOOL.

This is also known as, Good-lord-how-did-time-go-by-so-quickly or I-don't-feel-like-a-quarter-of-an-official-doctor. Other milestones? I have also now been married for over one year and, as expected, lived in a new city/apartment for the same amount of time. I cannot believe it.

The summer work in Pediatrics is going swimmingly. I have really enjoyed getting to see how the hospital system works, met some really interesting and fun patients, and its nice to see if I might want to do Peds for real. You know, when I'm done in 3 years (=insane.) The most amazing part thus far? Just how resilient and upbeat children can be. Some of these patients have acute problems that will be done in a week, others have lifetime chronic illnesses that will put them in and out of the hospital every year or six months, but all of them are so joyful and happy. They really add perspective, in the best possible way. Sometimes it's been heartbreaking, yes. But overall? I wouldn't change a thing.

Well. One thing. That my own sinuses would obey me and stop acting out so that I could be at the hospital now, rather than at home, seemingly blowing my brains out through my nose. I haven't had anatomy of the head yet, but I'm sure there's some kind of pathway/condition that could make that possible.

Until next time.

What Really Happened

So everyone is clear: this post is my response to the LOST finale and frustrated place to vent about how some people just don't seem to get what happened.

So: if you're a LOST fan- SPOILERS.
If you're not a LOST fan- sorry, this blog will suck.

Begin rant:

Did other people just not get it? People seem to think that the characters were dead all along, or there was no plane crash, or they all died when the nuke went off, or that the island was purgatory. No, no, no, and no!

The island is/was decidedly NOT limbo or purgatory. As Christian (Jack's father) said, everything that happened in life and on the island was real. The plane crashed, the oceanic 6 went home and went back, everyone time traveled. All real. Jack fixed the Well of Life, that last bunch of people got off the island, and Hurley/Ben took over guarding it. Jack died on the island. All real. Thinking anything else is simply not understanding what happened on the show.

The ONLY THING that was them being dead/in purgatory was the sideways world that we STARTED TO SEE after the bomb went off at the beginning of the season. In "real life" the bomb exploded, brought the characters into present time, but the island/life never "reset." The writers simply started showing us the sideways purgatory world at the same time.

"What was the point of the sideways world?" you ask.

It allowed the show to essentially give us, the viewers, half of a season of character resolution. Having the sideways world be the characters post-death was perfect. It allowed us as viewers to see what each character truly thought of themselves at their core and then reconciled those feelings with the happenings and conflicts of the tumultuous lives they had with each other on the island. We got to see Sawyer be the good man he knew he could be and always wanted to be as a cop in LA. Jack became the father and family man he never had. Kate was no longer a murderous fugitive, but an innocent fugitive. Locke lived a life where he loved others and, most importantly, loved himself without feeling shorted for being in a wheelchair.

The characters being "touched" (by Desmond or otherwise) and remembering each other was them remembering their REAL LIVES and being able to then grow and move on (which is what happens in purgatory). How could it get any better?! Ben stayed outside the church because he was not contented with himself and the life he led, hence him not moving forward. People you didn't see in the church? All people who had either moved on individually (as I suspect Richard had- he knew what he wanted- his wife) or weren't ready yet, such as Daniel Farraday and Charlotte (this is what Desmond and Eloise were discussing at the concert. Desmond was not "taking" Daniel because he wasn't ready).

((Fun Did-You-Remember Moment: Sideways (aka dead) Jack looks in the mirror and asks his mother where he got that scar on his abdomen because he doesn't remember. She says he had his appendix out. We know better than that now. StabbedbyFakeLockeduringtheEpicLastBattletoSavetheIsland.))

The only people who will be truly upset are the ones who don't understand what happened (but now hopefully they do with my explanation) or those who do not accept that the show is about the characters more than the mysteries (which it always has been). People will ask about Michael/Walt and other characters, or other mysteries on the island (the numbers- etc), but I respond: we KNOW answers for most of them and for the others- who cares? Will it make any difference knowing those details? We know Michael has become a "whisper" on the island- which is what happens to people who die on the island but are not finished. We can assume Walt has gone on to lead a normal life. The numbers relate back to Jacob's master plan of bringing the candidates to the island to save and protect it. They stem from the lighthouse, as each candidate had a number (1-108). 4,8,15,16,23,42 were the numbers of Locke, Jack, Sawyer, Hurley, Kwans, etc.

It comes down to this: Did you enjoy watching a thought-provoking, well-made program, that is and will be different than anything on television?

For me that answer is a resounding YES. Well done. Fantastic finale.

Thoughts? Comments?

End Rant. End of LOST. Sad face :(

Until next time.

A Return to Form?

With the point of this blog being to keep me writing, it would probably be more effective if I actually wrote something once in a while instead of posting comics.

I'm rather taken aback by the fact that it's almost the end of April. I cannot believe that the school year is nearly finished. No small amount of disbelief hits me when I ponder the fact that I'm almost a quarter of the way through my medical education. Well, let me clarify: I'm a quarter of the way to being a doctor; I'm nowhere near close to even remotely thinking about the end of my medical education. I'll probably finish my schooling when Winston, my faithful and inquisitive T-Rex, finally stops questioning every aspect of the world.

Read: Never. His curiosity is insatiable!

Side-Note Medical Reminder: Ladies- do a self breast exam once a month. Fellas- same goes for you with your testes. Seriously. I'm not kidding.

At this point I would like to remind all of my faithful readers that medicine can be gross and you should consider yourself warned. The following isn't a detailed description of a random medical procedure or graphic photo, just my musings on the poor word choice by those in medicine. Examples are, however, given.

The terms that people in medicine use to describe different aspects of things that can go wrong with your body disturb me sometimes. In addition to using food-words such as caseating (from the latin caseus meaning cheese) to paint the delicious image of dead and decaying body tissue onto the blank canvas of your imagination, the particular description that currently gives me the creepies is- wait for it - "like a bag of worms." This line of text would be where I normally delve into all of the medical details none of you find particularly interesting. Instead, I think a more fitting option is to simply let that phrase- like a bag of worms- float around, wafting in the air while you silently shudder and try to imagine what it could be used to describe.

(If you really must know, it describes the widening and dilation of veins that run from a man's testis- aka Varicocele. Not awful or really even that disturbing. It was just more fun to portray it that way.)

Until next time.

The Beginning of the End of the Beginning

This just might be the current feeling. Or at least the one that seems to crop up right at the end of any breaks.

(Click for better view)

Thoughts?


Until next time.

Health Reform? Huh?

If you find yourself asking the above question, look no further.

Well, look further if you'd like, as I'm only posting my summary, but the info is pulled from both my school and the Kaiser Family Foundation (a great resource for impartial info- I recommend it over any news-media sources).

I'm going to outline what's up and then give my brief opinion of the situation for those who are interested. More extensive information will follow after my opinion. It should be a pretty good outline as to what's going on as of today. (Certain things might change if the reconciliation package passes the Senate- namely the removal of special preferences for specific states and a restriction on the proposed minor tax on really wild insurance policies.) Let's go!

What's going to happen change right now? These things will happen in the first year.

• People who are currently deemed "uninsurable" due to preexisting conditions will be able to enroll in a new federal insurance program that should be established in 90 days. This will serve to kind of get the ball rolling until such conditions are banned outright for adults in 2014.
• Children under 19 cannot be denied covered due to preexisting conditions. Parents will be able to continue covering their children on their plans up until the age of 26 (unless they are offered insurance through their employer). This helps give kids access.
• The Medicare Part D Coverage Gap (the giant "doughnut hole" in coverage for drugs for the elderly) will be halved, with 50% being covered (up from zero). This helps fix a huge cost issue in providing pharmaceuticals to the elderly. Fun fact: Want to know the quality of the legislation that made Part D coverage, passed in 2006, so awesome? The main proponent of the legislation and head of the committee on pharmaceuticals, Former Congressman Billy Tauzin (R-LA), quit Congress two days after it passed and then immediately started working for the PhRMA lobbying group. Insane.
• Small businesses (less than 25 employees/wages of less than $50,000) qualify for a tax credit of up to 35% of the costs of health insurance premiums for employees.
• No more lifetime caps on insurance coverage and restrictions will be placed on annual limits.
• Insurance companies not cancel coverage retroactively except in cases of fraud.
• Increased government oversight of insurance costs and overhead. Companies must report how much they spend on medical care against administrative costs.

Fast Facts

- Everyone will be mandated to have health insurance. To help with this, insurance subsidies will be available to individuals making $14,404 to $43,320 or families making $29,326 to $88,200. People below these ranges already qualify for coverage through Medicaid, or if old enough, Medicare. The subsidies would be given on a sliding scale. If you already possess insurance through an employer or group, nothing changes. You keep your insurance and continue as usual.

-If you do not purchase insurance, you will be fined. It is $95 dollars for an individual, starting in 2014, and increases to $325 in 2015, and $695 (or up to 2.5% of income) in 2016. For families, the maximum would be $2,085 in 2016, however, people can be exempt from this fine because of financial hardship or if they are Native American (and thus already provided with a degree of federal health insurance).

-Preventative health care visits, regular check ups, and many cancer screenings can no longer have a co-pay and will be free in some cases.

-The Medicare payroll tax of would be raised to 2.35% (from 1.45%) on individuals making more than $200,000 a year and couples making over $250,000.

-The reform is estimated to cost $940 billion dollars over the course of a decade. However, with all of the changes being made, the reform will actually decrease the federal budget deficit by $138 billion over the same decade. In addition, it is estimated to reduce the deficit by ~$1 trillion over the second decade.

My Thoughts?

Very briefly, I think that the bill will do much more good than harm. It extends coverage to people who need it while adding regulation and changes to the industry that will help make it more viable for the future and help the national economy (Health care is currently ~16% of the GDP and rising, that needs to change. In comparable countries it's less then 10%). I get frustrated with people who want something that is XYZ-more liberal or ABC-more conservative. To me, and I view this as being more practical, the question must be if this is the best step in the right direct that we can take at this moment? Does it lay the groundwork for things being better both now and in the future?

In my opinion, belief, and thoughts, it does. The reform does not murder Liberty or kill Freedom. The Constitution is still intact and well. We are not becoming a crazed totalitarian nation and this doesn't set us on that path, or close to it; such notions are nothing more than the rantings of those trying to make money or short-term political capital, preying on fear and appealing to the extremes.

Nothing will ever be perfect. Remember, the object is to form a more perfect Union. I think this qualifies as more perfect than what we have now.

Your thoughts?

P.S.- Want more info? About how this affects things in the industry? Here's some summary:

HOSPITALS: "The hospitals are ultimately the winners — one doesn’t increase spending on health care by nearly $1 trillion without some significant part of it flowing to hospitals," said Sheryl Skolnick, a hospital analyst with CRT Capital Group in Stamford, Conn.

· Pros:

o Worried they might get hit hard by the health legislation, hospitals were the first industry to make a deal with President Barack Obama and the Senate Finance Committee last year. Hospital groups agreed to give up $155 billion in Medicare funding over the next decade. But they are expecting that to make more than that – at least $170 billion - by having to treat fewer uninsured patients.

o An individual insurance mandate and subsidies for low-income Americans to buy coverage means hospitals will have more paying customers.

o Hospitals got guarantees that cuts in federal Disproportionate Share payments that they receive for treating the uninsured wouldn't occur until the insurance expansion is in place. And even then, some of the funding will remain to help hospitals treat illegal immigrants and recipients of Medicaid, the state-federal program for the poor.

· Cons:

o Hospitals are slated to lose $155 billion in federal funding over a decade.

o A new independent commission would have broad authority over Medicare spending, though most of its powers don't kick in until 2018.

· Mixed

o The bill sharply expands Medicaid, which will reduce the number of uninsured patients. But Medicaid typically pays less than private insurers or Medicare.

INSURERS : In the short term, insurers will gain enrollment but the bill may cost them in the long run if health costs don't come under control," said Peter Kongstvedt, a McLean, Va.-based insurance industry consultant.

· Pros

o The individual health insurance mandate, along with subsidies for low-income Americans, will bring insurers tens of millions of new customers.

o The expansion of Medicaid will also provide new customers; many recipients will be covered by private managed care plans.

· Cons

o The bill calls for $132 billion in cuts to Medicare Advantage plans, the private health plans that cover one in five seniors (only one in ten seniors in Kansas).

o New taxes on the industry total $70 billion over 10 years, beginning in 2014.

o Insurers are facing a new requirement to spend 85 percent of their premium dollars on health care, potentially leaving less money for administration, marketing and profits.

o The so-called "Cadillac" tax on high-cost health plans is aimed at insurers, though it won't take effect until 2018.

o Lawmakers called for relatively low penalties -- just $95 in 2014 – for not buying insurance, which could encourage many healthy people to skip coverage.

PHARMACEUTICAL COMPANIES: "Pharma is one of the big winners," said Nancy Chockley, president of the National Institute for Health Care Management, a nonpartisan health policy research organization funded by Blue Cross and Blue Shield plans and government grants.

· Pros

o The drug industry will put up $84.8 billion to help fund the legislation. Part of that goes to making brand-name drugs more affordable for seniors who hit the Medicare coverage gap - the "doughnut hole." But pharmaceutical firms stand to make much more in return. With more Americans insured, more can buy brand-name drugs.

o Expensive biologic drugs would get 12 years of exclusivity protection from generics. Obama, AARP and the generic drug industry were calling for a 5- or 7-year limit. While biologic drugs are only a small portion of industry sales, they represent the fastest-growing segment of the market.

o The legislation, despite the pleas of some lawmakers, doesn't make it easier for Americans to buy less expensive drugs from abroad. Nor does it allow the government to negotiate lower drug prices for Medicare.

· Cons

o The industry will pay out $84.8 billion in new fees, rebates and discounts over the next decade.

DOCTORS : "Primary care doctors got a bump up in funding and overall doctors got a pass," said Gail Wilensky, a senior fellow at Project Hope and former head of the Medicare program.

· Pros

o Primary-care doctors and surgeons practicing in areas with a shortage of physicians get a 10 percent bonus payment from Medicare from 2011 to 2015. Medicaid will pay primary care doctors Medicare rates in 2013 and 2014, to coincide with the Medicaid expansion. Medicare typically pays at least 20 percent higher rates than Medicaid.

· Cons

o No significant medical liability changes are in any of the overhaul bills, though there is money for states to run pilot programs.

· Mixed

o The Medicaid expansion, to everyone under 133 percent of the federal poverty level ($29,326 for a family of four) means more patients have insurance, though at the lower Medicaid rates.

o The current Medicare physician payment formula that each year threatens to slash doctor payments was left untouched. But Congress traditionally steps in to nullify the cuts.

NURSING HOMES: Because most nursing home patients are covered by Medicare or Medicaid, reducing the number of uninsured doesn't really help the facilities. As a result, the industry doesn't see much gain in the overhaul.

· Pros

o The bill would establish the Community Living Assistance Services and Supports (CLASS) Act, a national voluntary insurance program that would allow people to finance their long-term care in advance through payroll deductions. It would provide a cash benefit of about $50 a day for long-term care, including nursing homes, in the home and adult day care.

· Cons

Nursing homes would see their Medicare reimbursements cut by about $15 billion over the next decade. While Medicare comprises only about 13 percent of nursing home revenue, the industry relies on the money to offset low Medicaid reimbursement.

A Complex Situation - Part 1: Politics

UPDATE: I really am going to post parts 2/3. I promise. School has just swamped me and I'm not sure when I can sit down and devote the time I want to present everything clearly. Until then: why not leave or check out the comments?

NOTE: This discussion will need to be split into multiple blog posts. There's just too much information for a single one. The discussion will most likely be divided into the categories of Politics, Insurance Companies, and Philosophy. Don't worry; I'll cover everything that everyone commented about.

I think that my title pretty much defines the current state of health care. If you're just joining in on this little session, I highly recommend that you read the very different opinions and views expressed in the comments of this post as I'll be summarizing and referencing peoples thoughts here.

Looking at each person's response, the reason for debate/fighting/disagreement pretty much slapped me in the face. Out of the six of my friends that commented, each brought up different issues, concerns, and possible solutions. Now think about how we have 300+ million people in our country . Yikes. No wonder people are heated about things.

The common fact that everyone acknowledged: something needs to change. No one thinks that our status quo should be maintained. Health care needs to change.

So, I've decided to make the discussion more manageable by breaking it down into the subcategories of (I think) Politics, Health Insurance, and Philosophy. I'll try to pull points from each person into the category where it most fits for my discussion/presentation. Don't worry if you think I've missed something right now as I'll likely bring it up in one of the following posts. Where possible I'll link/cite facts that I've learned. Let's go!

First up: Politics.

-Caleb said the predominate issue is the "time in which to revamp" health care and that he thinks Democrats are trying to rush things through to bolster political power. Instead, the process should slow down because it is "affecting everyone...not just the deaf Democrats in power." He thinks "that Obama's tactic of "we must pass everything now, no questions asked" is dishonest and insulting."

-Tyler talked about how the US is behind Europe in health care standards and that if "legislation allows some Americans a higher quality of life, but is an imperfect plan, it is worth it." The final goal and objective should be to "improve quality of life." [Side note: the US ranks 37th in the WHO rankings from 2000 (most current) and yet we by far spend the most money]

-Kevin said the government shouldn't have access to medical records or "the right to determine, based on set criteria and yes/no symptom check sheets, whether or not an individual receives medical care." He also thinks the government should "slow down when developing a new system of health care" because it's often a flawed design and concept of an idea that leads to problems and failure. The role of government, and politicians, is to analyze the situation and revamp healthcare "for the fulfillment and benefit of the majority," because "legislation passed without adequate consideration for the people fails."

-Megh talked about how she thinks health care should be free and paid for through taxes because anyone can get sick at any time, but acknowledged that the US will likely never have this reform due to the financial stakes of large companies. She also linked an article that spoke of the need for Democrats to maintain their push for legislative reform despite the short-term implications it may toward re-election.

My Thoughts?

First, I take issue with the idea that the problems of healthcare reform are somehow the individual fault of either the Democrats, Republicans, or the Obama administration. In my opinion, if blame were to be assigned it would fall at the feet of Congress, both Left and Right alike.

As previously stated, most everyone agrees that the country seriously needs reform. Sadly, the big problem of passing/not passing any legislation is not because of the differing views of the political parties but instead the issue of politicking. Both parties have become so obsessed with winning and being correct that the legislative process has ceased to function. Democrats in Congress, feeling jilted from decades without full political power (holding both Congress and the Presidency), seem to occasionally feel the need to flex their power over the GOP and not compromise. This could be really bad if someone wanted to compromise. Republicans, upset about this and their lack of a cohesive party theme/identity, have essentially stuck their fingers in their ears, tucked their head, and hoped that Democratic failure=Republican success. You have one side attempting to enact some kind of payback and the opposing side trying to not do their job and hope that it leads to being re-elected.

This is no way to run a country.

Kevin said it best in his comment, explaining that we

"elected them [Congresspersons] to make decisions not necessarily based on their goals or ambitions but based on our [the citizens'] situation and needs. It is their job to view the current national and global situation from every possible angle. It is their job to make sense of things and then approach the problem with the goal of improving the lives of those they serve."

I think most everyone in the country would agree with that. We need less politicking, fighting, bickering, partisanship, and worrying about the next election and more cooperation and accomplishment. How does this play out in health care and with the reform that is being debated now?

Like most everything about health care: it's debatable. The current bill is HR 3590- Patient Protection and Affordable Care Act (that's the FULL TEXT- you won't read it). There are also quick summaries from the Democratic and Republican parties. As an overview, the bill would reform/regulate circumstances for physician malpractice, prevent insurance companies from denying coverage to anyone with a preexisting condition, expand health insurance coverage to the ~40-60 million uninsured Americans (I quote a range because we learned how about each year millions of people lose/gain coverage; it's a cycle), offer a federal pool for those without insurance to buy into, and require everyone to have health insurance (much like mandatory auto insurance). This would be paid for through taxes on individuals making more than $500,000 a year (actually repealing an old tax cut), people with really ornate health plans now (I refuse to use the name of a certain car brand), and through cutting/reworking existing programs and funds. It is estimated to cost ~$850 billion total over the next 10 years, but actually result in a ~$150 billion deficit reduction over that time.

Now most people see those things, having heard about them in the news, and go "Whoa, those are all the things the Democrats want. None of the Republicans want that." To that I reply: not exactly. Surprisingly, that reform is actually more of a centrist option. Many people who are far left or far right would prefer something different (a single-payer and completely private system, respectively but they'll be more of that later, under the Philosophy post). HR 3590 actually isn't that different than the current Massachusetts health care system, signed into law in 2006 by Republican then-governor Mitt Romney.

Now, I know that's a lot of information but sadly it's really just a quick overview of the current situation. Don't worry, I'll present a discussion/reasoning of the various different types of health care systems during the Philosophy post while going through more comments. The gist of all this? Congress, meaning both political parties, need to cut the crap, do their jobs (meaning make the necessary changes to fix the country), and stop worrying about their own job security.

Lastly, and this is more of a detail, I don't think Obama can be blamed for allegedly pushing reform through too quickly or- and I'm paraphrasing- for playing the urgency card too much, simply because he does not set the pace. (All of this assumes one thinks things are going too quickly.) The president's role is to set the agenda. A pillar of Obama's campaign message was health care reform; it makes sense to me that he would be calling for Congress to tackle such legislation (not to mention it makes up ~14-17% of our economy). The reform itself and its timing is an issue of Congress and their responsibility to write and pass.

Personally, I don't think that there is ever going to be a "right time" to work on health care reform or any big issue for that matter. Don't get me wrong, I want things to be well thought out and done right, but health care reform is not a new issue. FDR, Truman, Johnson, Nixon and Clinton have all attempted comprehensive health care reform. Only Johnson succeeded (partially) with the creation of Medicare and Medicaid. (Fun fact: FDR was going to propose socialized medicine until a certain country had to go crazy with that whole whacked-out-final-solution-socialism-world war thing. It's in this book which I've recommended before.) With the current political environment of every action being analyzed through the prism of the next election and everyone too worried to simply do the job they were hired for, I'd rather Obama make it a national issue (thereby doing his job) and try to get Congress to finish it.

Still with me? If so: more to come later.

Until next time.

*While I don't think it's a fair way to describe any of my readers, Glenn Beck is probably certifiably insane and terrible for our political process. Regardless of political views.

A Delicate Balance and an Open Forum

The beginning of the semester thus far has been pretty interesting. I've found it a bit of a challenge to hit my stride both in the general sense of how my day plays out and with my motivation. Part of it is becoming acclimated to a new schedule (with the addition of our anatomy dissection labs), but another side of it is getting back in the routine of focusing on things that don't necessarily seem relevant right now, namely the physics of air in the lungs.

So how do I solve my dilemma of motivation and focus? By hanging out with my wife and writing on my blog, of course. But let me confess: I may or may not have spent the majority of my not-at-school-time today running the gauntlet of online assignments so all is not lost.

To add to one of my many methods of getting myself refocused and recognizing that there is more to medicine than alveolar gas exchange I offer you, my faithful reader, a question and open forum to speak your opinion. What is your opinion of medicine and healthcare? What's wrong? What's right? What should be done?

I've found myself slightly frustrated and perplexed at others' views of the current state of healthcare in our country and what is or is not being done to remedy any problems. I can't help but wonder, as I think everyone should, if I've become too closed off and set in my ways (or, let me be real, if I need to do a better job of articulating my point and its obvious truth to others).

So let me have it. I'll read them all, mull it over, and post my thoughts/summary/response after a couple of days.

Until next time.

A New Decade

2010, eh? I'm down with that (but really only if we call the 00s the aughts like we're supposed to).

While everyone seems to be excited about the new year (and sure, I'll go along with that), I'm more excited about the prospect of a new official decade. When I look back at the past decade, my mind explodes when I see just how much of my life has changed (and oddly stayed the same)

What changed? During the aughts I:

-cycled through middle school, high school, college, and am now studying medicine.

-have lived in three different towns and progressed from living at home to living "on my own" with people who are essentially brothers (if I didn't already have 3 good ones- that I gained in this past decade) to being wonderfully married.

-went from being an awkward and strange single teen to an awkward and strange (but very lucky) husband.

-became an uncle to not one, not two, but three hilarious boys.

What didn't change? I still:

-read incessantly (but like to think that I read better now thanks to that whole college degree thing)

-play and/or unabashedly enjoy video games/comic books/computers/tv shows/etc. (although I like to think my that tastes have refined)

-maintain a ridiculous competitive streak that school has been kind enough to keep alive.


The point of all this? I don't really know. Perhaps just to stop for a moment and think back at what's happened and changed over the past 10 years. You should, too. This is, after all, your life. Don't forget the immortal words of advice.

Until next time.

Edit: Upon reading this post, my new year resolution will be to slash my use of parenthesis. My bad.

The Heart of It All

I can assure you all that a giant sigh of relief and a weekend of nothing medical followed my completion of I2. Now that Inflammation and Immunity is slowly rotting, dead in the cold cold ground, we're moving on to a more meat-and-potatoes-esque med school module.

CardioPulm.

That's right, after 8 weeks of straight science, 4 weeks of genetics and cancer, and 4 weeks of I2, or as I like to call it: 16-weeks-of-occasionally-interesting-but-typically-dreadful-information-on-tiny-molecular/cellular-changes-in-your body (it rolls off the tongue), we're finally digging into an 8 weeks module that will be tiny molecular/cellular changes sprinkled with gross anatomy!

The holiday season splits this module right down the middle, with cardiology falling sooner and pulmonary falling later. The truly exciting part? (Note: I say exciting now and reserve the right to change it to ridiculous once we begin) We start cadaver lab when we get back in January! Woo!

So, in honor of our new module, I shall post one of the many slides we were told to memorize today. Get pumped!



Hah! Get it? Pumped...
Until next time.

Health Care Reform: My Thoughts on "The Speech"

This evening (as most people know), President Obama addressed a joint session of Congress on Health Care, specifically:

• the current state of it in the U.S.
  
• his thoughts on why reform is needed
• what reform should accomplish
• what is/is not true about the rumors that have circulated about the proposed reform "bill."
  
  (I put "bill" in quotations because no official bill has yet been agreed upon. Four submitted, one more on the way)
  

A number of things stand out with this address, both in regard to his speech, and the nature of the event. While the President often addresses the nation, be it on prime time TV or otherwise, presidential speeches to joint sessions of Congress come few and far between. The last one given, to my knowledge (and excluding State of the Union/Inaugural Addresses), was given by President Bush after 9/11. I personally think this scarcity is because of how much time is spent applauding (if you're the party in power) and attempting to look as-defiant-as-one-can-while-sitting-during-a-joint-session-of-Congress (the minority party). The fact that Obama chose to hold such an address on health care stands as a testament its importance.

So, enough about the actual event, what about the speech? Overall, I found myself pleased with the speech. The President seemed to approach the entire debate head-on and systematically work through some problem issues. Could there have been more discussed? Of course. More details given? Without a doubt. From a practical stance, however, he seemed to cover the most important things as best as he could for the time being (it was only a 45 min speech, after all). I was specifically glad to hear Obama address the few following things (among many others, because my opinion obviously weighs heavily on both him and Congress):

• The current outrageous costs of health care when compared to nations similar to the U.S. Health care accounts for ~18% of our GDP , while the next closest country slides in at ~9% (That link is also just a good website to checkout for general health care facts).
  
  When compared, health rankings between the US and similar nations have no real statistical difference (measures include infant mortality, life span, cancer survival rates, etc). If there's no real different in that, and in patients' satisfaction with their physician, why does our cost so much more? For more information, this article summarizes things pretty well and pulls statistics from the CIA World Fact Book.
  
  
• The idea that an extreme change, to either the right (complete individual privatization) or the left (national single payer), can not be viewed as a feasible option right now. The health care system ties too tightly into the entirety of our economy and way-of-life that any major overhaul would simply be too detrimental .
  
  One of the most frustrating things to hear others talk about is how the US will have "socialized medicine." It's just not going to happen, and really, socialized medicine wouldn't actually be the end of the world (surprised, no?), we as a country just make terrible connections when we hear the world "Socialism" (You can thank the National Socialist German Workers Party for that, along with the Cold War. Oddly enough neither are true examples of socialism).
  
  I'm also glad he addressed other silly things like the idea of death panels and the fact that many in the GOP (and some on the left) are actively choosing to not work because it's a better political move. I'm sorry, I like to think that you were elected to work. I wish all in Congress would work so hard that there was no one the people could NOT reelect them rather than sitting-bored because you'd rather not make waves.
  
  
• His inclusion of Ted Kennedy's well-touted view that the health care debate should not be a political or partisan debate, but a moral debate. It's not often that I would prefer our Congress to debate moral issues, however the issue of health care strikes a different chord with me.
  
  I've always thought a person's ability to easily access adequate medical care when needed as something that just makes sense. I cannot understand why people are more than okay with protecting citizens and their safety by having military/police/firefighters/clean water/etc but then run scared when prompted to protect a persons general well being.
  
  It just does not compute for me. I think when people get sick they should be able to focus on getting well rather than even entertaining the idea that they might not go see the doctor because of access/cost.
  

I could go on for pages explaining all of my thoughts and comments about the speech and debate, but I'm not sure how many people have made it this far. If you really want to read more of my rambling ideas: click here.

If you missed the speech, NPR has a pretty good summary , or you can read the entire text here (it's a few clicks down, past an initial summary).

For a good website that just has interesting health care facts, check out the NCHC (National Coalition on Health Care- they were linked above too). I find the "Facts" tab at the top to be most interesting.

Sidenote: I wish my time stamp was accurate. Anyone know how to change that?

Lastly, what did you all think of the speech? Or how do you feel about the debate/reform? I'm happy to discuss or just see what other people think. Until next time.

D-Day Minus Seven

Today marks the beginning of the end for me.

Actually, that's not true. That's just melodrama. In one week, I will begin orientation for medical school. I am nervous, yes, but I am also really excited and worried and giddy and any other number of emotions. The spectrum of feelings comes from the unknown nature of what's to come. In a literal sense, I understand the entity of med school. I know that I'll have classes/tests/labs/etc and that I'll likely do just fine. I know people who are doing it now and who have finished. It is possible. Will it be a challenge (and by challenge I mean the hardest thing I've ever done)? Of course. But, I don't know (and I don't think you can know until you experience it) how I will handle life as a med student and the changes to myself and my life that come along with it.

Will my view of health care and what it should be in society change? My opinions and outlook concerning ethics and the obligations of others? There are big questions involved in starting something like this, or at least I imagine there to be. And lest we forget the other questions that inevitably arise: What will gross me out the most? Will I ever get used to the idea of people turning to me, the guy who builds fictional wooden cubes for fun and still routinely reads Calvin and Hobbes, for answers in huge life decisions?

I suppose more than anything, even with these questions and concerns, I'm still just really excited to start. I can only liken it to the first day of school, be it kindergarten or college. Right now the unknown still triumphs (although I suspect it always will) and I love the potential that exists. The thought of the amount of information I will learn (which will be but a fraction of what they teach) excites me and I think I'm as ready now as I'll ever be to begin.

But don't let me get ahead of myself. It's really the beginning of the beginning. I still have 7 days of freedom. I'm going to go read, play Xbox and make some chicken stir fry for dinner when my better half gets home. After I fold the laundry.