Thoughts on Health Care

Tax Sugary Foods?

Dan — Sat, 17 Oct 2009 19:30:29 +0000

While this is far from a new idea, Brownell et. al. write in this week’s Journal about the public health and economic benefits of taxing artificially sweetened beverages. They make a very strong case for the health implications, noting that there are “well-documented adverse physiological and metabolic consequences of a high intake of refined carbohydrates such as sugar includ[ing] the elevation of triglyceride levels and of blood pressure and the lowering of HDL…”. This doesn’t begin to scratch the surface of their argument and their proposed solution is tenable and useul for funding public health options.

http://content.nejm.org/cgi/content/full/361/16/1599

Coming soon…

Dan — Mon, 07 Sep 2009 20:37:18 +0000

It has been awhile since I’ve posted anything to this blog, but it is not without reason! I’ve been mulling over in my head a series of posts/articles/discussions on aspects of health care, and the debate surrounding it, that I consider critical. I have finally felt the urgency to write. The articles will be forthcoming over the next couple of weeks. I would greatly appreciate insight, feedback, commentary and criticism as that is the only way that the arguments will improve to a point of validity. Hopefully I should have the first portion done within the next week or so, but the demands of life as a medical student can make that difficult, so please be patient and understanding of my inherent handicap.

American Values on Health care

Dan — Tue, 04 Aug 2009 23:47:36 +0000

The New England Journal of Medicine had an excellent article by Dr. Allan Brett detailing some of the misinformation being thrown around during the health care debate. He specifically discusses this concept of “American Values” and the talking point that a single payer health insurance system would be antithetical to those “values.” I personally think he brings up an important point which needs to be addressed by the health care debate, specifically the question: how can we let individuals hijack the discussion by claiming a single-payer system is against the rather homogenously presented concept of “American Values”? Read more here and I’m looking forward to hearing what everyone has to say.

Health Care Lobbying

Dan — Mon, 06 Jul 2009 13:41:17 +0000

The Washington Post has an incredibly detailed article on the issue of health care and the behind the scenes action that is taking place, mostly at the behest of big pharmaceuticals and, gasp, doctors. It’s such an outrage that over $1.4 million is being spent per day by big health care PACs such as PhRMA, Pfizer, AMA, etc. Take a read and hold your congressmen/women accountable – we should not be bullied into granting unnecessary subsidies or tax breaks to the few already profitable individuals at the expense of excellent health care for the entire population.

[Read Here] via. The Washington Post

The Myth of Prevention

Dan — Mon, 22 Jun 2009 13:54:06 +0000

Dr. Abraham Verghese, a Professor of Medicine at Stanford University, published an interesting opinion piece in the WSJ this past Saturday entitled The Myth of Prevention, a discussion on President Obama’s health care reform policies. It’s an interesting piece which states the rather obvious answer to all of our health care spending problems – that we need to cut costs. It appears no one else is willing to say this and I am personally glad that someone with Dr. Verghese’s stature is making a stand. Take a read and hopefully it will help us all understand the problem a little better and come to a solution that we all are for – that doctors are there to heal, that we should care for our patients and that we should do so with the smallest economic footprint possible.

Day 1 and an APRN’s Wise Words

Dan — Mon, 22 Jun 2009 02:11:23 +0000

Tomorrow marks my first day as a medical student where I actually am responsible for taking care of patients. It is nerve wracking to think that in 24 hours I will have helped take care of at least one other human being and help them “get better” in some way. At a speech I heard this past Friday, a wise and seasoned APRN named Linda Pellico presented us with her 10 commandments for how to provide the best care possible to our patients. These “rules” really struck me as insightful so I asked her if she would mind sending them to me. She obliged and gave me permission to reprint them below, along with her reasoning behind the establishment of each. Take a read and hold each of your physicians to these standards because everyone deserves to be treated as such.

Linda Pellico’s 10 Commandments

Commandment Number one – Be authentic to who you are. You will meet many seasoned professionals, many that wear a mask that they put on an off with seeming ease. I think that mask is a barrier that limits their ability to connect to patients. Patients can sense if you are real and in the moment with them. A word of warning, you may even be persuaded by textbooks, professors and practitioners that in order to be an excellent provider, you need to detach from the personal and enter the professional. I submit to you that they are wrong. You can be real; you can be authentic and still be a respected professional. Don’t buy what they are selling; I think if you do, it will prevent you from experiencing the joy of truly connecting with another human being. Lots of people are wearing masks, hiding under the trapping of starched white lab coats- Don’t be one of them.

Commandment number two – Don’t believe you are any more special than anyone else. Don’t role model what you see. You will witness rude behavior that not only impacts patients but also other hospital workers. You were not raised to speak to anyone in an abrupt, condescending manner, yet that is what you will see. You need to take responsibility for changing the culture of our standard behavior; you can be a great provider without emulating the intolerable behavior you will observe … And when it comes to tolerating situations where power is abused, remember you and only you have to choose the situations you cannot walk away from and no other opinion matters…At the end of the day we wish you peace and contentment with the decisions you have made…

You will also experience what you perceive as rude communication with colleagues and superiors; either it has happened to you already or will happen to you soon. I know it’s easier said than done but in a teaching/learning environment, it is important that you try not to take criticism personally. You see, when you take things personally, you feel offended. When you are offended, it’s a natural response to want to defend your position and then what happens? You lose the opportunity to learn. Some educators are not gifted with the ability to provide feedback in terms that are pleasing to the ear, it will be raw, it will be direct but it is not meant to hurt you, it is not a power play, it is so that you become the best provider possible. Don’t make it a power issue; we have enough power disparities to go around without falsely creating new ones. If the criticism is coming from one who is authentic, you can and will forgive any blunder.

Commandment three – Speak in plain language. If we all spoke plainly, and asked simple questions, we would do everyone a favor. I am convinced that our language, the medical jargon itself, sets the stage for the disparity in power between patient and provider. He has a stage one erythematous area on his coccyx related to shearing forces. In English, your backside is red from pushing yourself up in the bed! No wonder patients and families look so scared….

Now, I love words, lyrical, eloquent, elegant words that paint visual pictures but, I know words can be used to separate rather than unite. I have sat through countless lectures of nursing and medical educators who use the power of position or words to limit students’ connection to them and if students don’t connect well… then they don’t have any questions, do they? In healthcare, the same scenario plays out with different actors so now it becomes a quick visit, an easy patient … If on the other hand I make it so easy that anyone, including your patient understands, well now we have a partnership and it takes more time and is much harder work to create a partnership than to issue orders. So commandment #3- speak plainly, check your ego, don’t be foolish enough to think that medical terminology buys you prestige, wisdom or respect; if that is what you desire think simplicity, commonalties, and analogies. They will get you much further.

Commandment four – Acknowledge our own mortality. You will soon believe you have power over life and death. My God, why wouldn’t you when you will hold a beating heart in your hand, relieve intracranial pressure and midwife new life. But you will also see the 10 year old asthmatic die or a 40 year old father of four deteriorate without any reason; everything was normal yet… why, what did I miss? Well, maybe you didn’t miss anything. There will be patients that defy all the odds and live and others who despite the best treatment plans, research and care…die. They should both teach you lessons. One should teach you that with all our knowledge of cellular function, scientific method and prognostic indicators, patients survive, thrive and live. On the other extreme despite monumental scientific progress, we are still mortal! Lives will and do change in moments. So acknowledge your mortality and understand you do not have power over this area, you can only do the best you can-other forces are at work- welcome their help.

Commandment five – ask yourself, “who’s need am I meeting?” I was thinking about this when I read William Carlos William’s words “ the damned little brat must be protected against her own idiocy”,…”It’s a social necessity” and I thought of times when diagnoses are sought for the sake of a label when the end result would have no bearing on the outcome. On the other hand, I stand here without my 39-year-old cousin who had surgery at a major medical center and died on post op day four. Why, because he was a young prominent politician who did not get the same standard of care because after all he was young, he was virile and it would be a risk to put a central line in him, what if the he blew a pneumo on insertion? Who wanted to see that on the front page of the paper? When Chiefs of surgery tell you to put them in sweatshirts with baseball caps and wheel them into a strange hospital where no one knows them, it’s not because they are shy of publicity, it’s because they are afraid you will alter the plan of care because of “who they are”. You see, you are not always in the powerful position, sometimes your patients will have the lead and you must stay the course, the standard of care is the standard of care- SO ask yourself, who’s need am I meeting here? If the need is to repeat the labs, then do it. It sounds too simplistic to be really important but I submit to you it is vital.

Commandment number six- check your lens, center before you encounter the patient. You are being watched- every subtle nuance is being observed and will be replayed over and over again, all day by the patient… Don’t go into the room, thinking about the insurance company you are fighting with, your loan repayments or the treatment plan you will order for your pre-conceived diagnosis. Go in open and ready to listen; the chief complaint may be a guise for other problems that will only be discovered if you allow the exposure. Listen and really hear what the patient is saying. Patients are interrupted approximately 10 seconds into their narrative, whereas if one let the patient tell their story it would take no more than 60 seconds. People need to talk…Give patients the time to tell their stories. Remember the gift of the spoken word is magic; we are the only animals that have the gift of speech. Use the power of this gift.

Commandment number seven – enjoy the ride, choose right, if this is not floating your boat then get out… You have to enjoy your life, the love you liberate in your work is returned to you. Don’t feel stuck, if you are not happy, belly up and reinvent yourself…Sure, it may be tough but you did not get into these hallowed doors because you were timid or weak.

Commandment number eight - Do not limit your learning to the narrow focus on the scientific method. You have to construct your knowledge. You are now overwhelmed with anatomy, medicine, surgery, pediatrics, assessment, epidemiology, and pharmacology but this is just the scientific knowledge. You will soon learn, if you have not already, that despite the fervor, with which we have been stuffing your head full of facts, and procedures and numbers and values, it is not enough. The scientific method will never collect all the data; we are all far richer that. Humans are not just genetic, chemical, physiological data for you to analyze. If algorithms alone could assess, diagnose and treat, computers could be providers of care.…. It is time to begin to construct that knowledge. You need to add richness to your learning and your life. Open yourself up; keep a journal, paint, garden, read children’s books. The velveteen rabbit will remind you about the value of being real, There’s a nightmare in my closet will tell you to face your fears head on, The little engine that could will bolster your confidence as you meet new challenges, Miss Rimphius will remind you of your obligation to make our respective professions “more beautiful” than you find it. Find something other than Harrison’s book of internal medicine to enrich your soul. Becoming is not without pain, struggles and challenges….You must find an outlet for the anguish, injustice and inadequacies you will witness.

Commandment number nine - Know you are not alone. Do not believe that any one person other than the patient has or should have the power. All providers have roles to play, information to share. Listen to everyone; add voices to your conversations. Innovation comes when a new set of eyes looks at a problem, not sameness. Add texture and context to your knowledge. Use the resources around you. If you don’t you will have the weight of the world on your shoulders. After a while, feeling like Sisyphus loses its cache and all you will be is exhausted and overwhelmed.

Finally, Commandment number ten- Patients are not deaf or dumb or blind and you are not invisible. Stop talking about the patient in front of the patient without involving him. Ask do they have any questions? Explain to your patients what you are saying in plain, unadorned language. There is beauty in words, but there is art and sophistication in simplicity.

Those are my ten commandments: Be authentic to who you are; Don’t believe you are any more special than anyone else. Speak in plain language. Acknowledge our own mortality. Ask yourself, “who’s need am I meeting?” Check your lens, center before you encounter the patient. If this is not floating your boat then get out. Do not limit your learning to the narrow focus on the scientific method. Know you are not alone. And remember you are not invisible!

What if Doctors had More Time?

Dan — Tue, 09 Jun 2009 17:24:28 +0000

The NYTimes has a very interesting article today detailing a push by a small subset of doctors toward more personalized medical care. Instead of seeing 40-50 patients a day (meaning they probably have a database of well over 20,000 patients total) these doctors only care for about 1,500 patients total, allowing them to give personalized medical care and spend a larger (almost an hour) amount of time with each patient.

The attention to each patient really seems to be paying off (and saving costs) for both the doctor and the patients. Personally, I feel like this method of caring for patients is the ideal situation. My personal modification would be to place these caring doctors in larger practices that can pool resources and further reduce administrative costs. Furthermore, these centers for excellent care could cover larger populations and become a mechanism for reforming health care from the bottom up.

Check out the article here: NYTimes Article. I’m interested in hearing what everyone else thinks!

The Five Big Health-Care Dilemmas

Dan — Mon, 08 Jun 2009 18:02:31 +0000

Karen Tumulty wrote an interesting article detailing 5 areas where the U.S. faces major obstacles to the overhaul of the health care system. For those who want to skip reading the article and just take a look at the 5 major issues she outlines, they are here:

Will there be a big, new government system?
How can a nation already deeply in debt afford health-care reform too?
Can we really cover everyone?
What will be covered? (this is probably the single most important issue, but the least discussed)
How will we bring down costs?

It is a good introduction to the major issues we face for health-care reform and a great jumping off point for those who haven’t been following the debate. Check out the article here.

A Refocusing and a Plea for Help!

Dan — Mon, 08 Jun 2009 14:49:37 +0000

Over the past month or so, this blog has struggled to find its “voice.” I started with posting unlinked issues and ideas that just plain interested me. However, after talking with a bunch of people, we’ve all agreed that for this blog to really have any benefit to me or anyone else, it should focus on a specific topic and explore and delve into that topic full bore. I’ve decided that since I’m a medical student and will be spending the next few years (i.e. rest of my LIFE) in the medical community it would be ideal for this blog to focus on health care, medical advances and potentially scientific research that I find interesting.

On that topic, this blog needs a new and good name! I’ve temporarily renamed it to “Thoughts on Health Care” because it was an easy rewording of my original name, however I feel like it needs something that POPs or at least catches people’s attention, while also being informative! So, if you have good names, please send them to me at admin@danokin.com or post them below! Facebook posts, twitter replies or any other method of contact works GREAT as well!

Thanks and looking forward to seeing you around the new site as it comes up and running!

Anderson and Roe Piano Duo

Dan — Thu, 21 May 2009 14:05:02 +0000

Check out this video by my friend Greg and his piano duo partner Elizabeth Roe! They reinterpreted “Stayin’ Alive” on the piano and made a music video that is pretty awesome.

They are two exceptionally talented musicians that graduated from Yale School of Music last year and are now striking out on their own. They have performed around the country and even released their CD Reimagine which is a composition of works by Stravinsky, Bach, Saint-Saens and some original compositions. Enjoy their video and, if you like it, visit their websites to hear more.

via. Greg Anderson and Elizabeth Joy Roe