Conserva-Care

Interesting reading from the LA Times - on four prominent conservatives opinion's of how to reform health care.

I find myself pretty much agreeing with Bill Frist - the only reasonable one in the article and the only MD... his proposition to focus on wellness - on preventing health not through screening for diseases (which is still needed and saves lives) but by actually addressing such as working with employers to get employees to eat better and exercise (umm, not just sit and eat Dunkins all day) and looking at how we build our communities to be better for health (increasing utilization exercise, reducing sprawl) his service on the board of the Robert Woods Johnson Foundation's Commission to Build a Healthier America is doing. That was a good start.

After that it went downhill. The most vexing was David Frum. Healthcare will NEVER work as a regular market such as how consumer products such as what does work with computers or say, shoes. I just don't see how you can incentivize health by making it monetarily penalizing people who utilize health care services more.... can someone please explain to me concretely how this would work?

I see health care costs as multi-factorial... the major factors driving up costs, I believe, our really outside the control of insurance/healthcare complex as it is currently in the debate going on right now. These are:

Habits/Behaviors - think smoking, exercise and food
Built and Work Environment (sedentary lifestyle + commuting)
Pollution (indoor + outdoor)

A lot of that has to do with how we've built our suburban dream... the long commutes, quick meals and need to drive EVERYWHERE leading to our current obesity and diabetes epidemics...

In terms of actual health-care system issues... a few come to mind:

The Fee for service of system of healthcare (hospitals/docs get more money for more tests, not for better care)
Malpractice Reform (one of the top issues eroding the salary of many physicians and leading to defensive medicine)
Uninsured Gap - it's unjust not to close this even it if costs a little bit of money.
Big Pharma (20% profit margin) and the device makers (16% profit margin) need to be reigned in
But, ultimately, Technology COSTS MONEY AND SAVES LIVES

In terms of the current bills going through Congress, it appears that the first point on "systemic" issues got watered down, that malpractice reform won't be touched and that we'll only get some - but not all - of the uninsured gap closed. And nobody has said much of anything about reigning in Big Pharma...those device makers also have excessive profit margins that insurance companies would kill for...

But the last point is really a take home from medical school. You know all those things that have extended lives (um, chemo) and made grandma be able to walk (hip replacement) and keep you alive while youre in a drug induced coma so you can survive that car accident caused by some idiot drunk drive (see the "non-systemic" section for that) - those things actually cost money. And they've gotten much better over the past few decades but also more expensive. I don't think it's the main factor, I think the "systemic" factors are all minor factors second to the "non-systemic" behavior/built environment. But it's good to have it in context of what you're paying for... which is your life. Not an iPod.

Relativity

When you are courting a nice girl an hour seems like a second. When you sit on a red-hot cinder a second seems like an hour. That's relativity.
-Albert Einstein

When you somehow manage to study glycolysis, PDH Complex, TCA Cycle, Beta-Oxidation, and Glycogenolysis all in one week - for just one class - then the amount of work feels like a month of undergrad. But throw an ever increasing histology study budget gap (well, I'm working on paying that down) and then the never-ending anatomy on top of it, and well, I can appreciate what relativity means a little better. The time has gone fast but I feel like I've been here for a long time even though I have felt there is never enough time. It's an odd feeling of going forward on a jet at hypersonic speed and the gravity pushes you back at 5g... you're making up a lot of ground but you feel slammed at the same time...

That's just a long way of saying working/studying 100 hours/week starts to wear on you. The key thing becomes time management of balancing pacing your studying, breaks, sleep and proper eating. Exercise has been helpful - I think the time sacrificed to it makes you feel better and at the same time improve concentration when you are studying.

At this level you become really conscious of your efficiency. Sitting down for 5 hours to study you want to make sure you set out reasonable goals and get them accomplished. It starts to get real obvious what reasonable study goals are for an evening or weekend are after a few times of over-reaching. Then once you find this average, the times when you don't get that much done you have to analyze why and see what is dragging you down.

For instance, I went full out last weekend and didn't take the usual Friday evening of only doing 2-3 hours of studying instead of the usual 5-6. I was able to plug through the weekend but once Monday night rolled around I really couldn't get much done. Nevermind Monday morning I couldn't wake up and so lost maybe 6 hours of work total because I didn't give myself a 3 hour break when I needed it. I think some of my classmates need to learn this... though others apply the breaks too well...

This is probably not very interesting.

I learned that hemorrhoids can be a sign of liver cirrhosis, and so possibly a sign of alcohol abuse... is that neat? I also was taught about the transverse colon - with a real one - and the hindgut, midgut boundaries - 2/3 through the transverse colon - while the professor picked up the colon to show me the spot. He got poo poo on his hands when he did that! The smell wasn't as bad as the look of it... am I getting warmer?

Future posts on healthcare coming soon.... found some interesting reading to share...

Pounds of Cure

I realized last night that I can probably already name a few dozen diseases and their causes (if not idiopathic) and some treatments for those diseases. We've learned about mutations, and improper structural formations, degenerative diseases and cancer. The information has been fascinating and is absolutely essential, but for all the diseases and treatments I've begun to notice two biases emerging - and this may have to do with the classes we're taking this semester.

First, almost all treatments we've learned about jump right into surgical treatments with barely any treatment of conservative options. This may be due to anatomy and the fact we're learning about structural defects... but still I feel as though its a bit biased regardless.
Second, though I can name many things that can make people sick and maybe a few drugs that can relieve or treat these diseases and their symptoms - sometimes removing the cause of the disease and other times just managing it, I've yet to learn much about anything that can actually improve health in patients. We KNOW about eating right and exercising, but there has been little discussion about the interaction of these factors - among others such as certain types of fruits or vegetables, or particular exercise regiments - with diseases either biochemically or anatomically.

I think this is from two main factors, among others - first that we need to know what can really kill people so that we can rule these nasty factors out when treating diseases (zebras) and two, already the allopathic model of treating disease rather than focusing on prevention, is showing its true form. It will be interesting to see how this plays out over the coming months and semesters of medical school.

On a somewhat related note - there was a Complimentary and Alternative Medicine course given as a selective this semester. I wanted to but couldn't find the time to go - but I see it (at this point) as a separate compartment and not really integrated into our overall education. In the end, this is less the fault of SGU and more the structure - I would assume - of the USMLE.

Of course, the whole prevention/cure thingy can be perverted a bit...

Dream Anatomy

This week, I finally learned how to learn in Anatomy. The class that was feeling overwhelming just became one that I can chart a course towards an A. I felt a wave of desperation on Tuesday, but remembered how I memorized things in the past - by just looking at it - and I sat down with my Netter's and was able to memorize all of the muscles of the forearm in one night. The following night I took care of all the features of the ulnar, radius, humerus, scapula, and clavicle as well as the nerves and arteries of the arm. When I went to lab this morning I knew what I was talking about and could understand even when I didn't get things right what was going on and why. Suddenly, the class transformed into one of going over notes and trying to apply hazy terms to traveling in an unfamiliar country with a handheld GPS loaded wtih ArcGIS desktop. I may not have known everything but I can figure it out.

This copperplate engraving, held by the National Library of Medicine and part of the online interactive Dream Anatomy gallery, show the posterior compartment muscles of the forearm which are innervated by the radial nerve and act on mainly extending the wrist, fingers and thumb. It marks the true beginning of my journey into Gross Anatomy.

A Clockwork Cervix

Last week was my first Anatomy lab, though I did go to lab the previous week to get study tips from honors students and check out the bodies.

It was an interesting experience and gave me that "I'm really in med school" feeling that apparently traveling 2,000 miles and attending lectures for the past two weeks coudn't quite do...

The anatomy lab is divided into 4 portions: Dry Lab, Wet Lab, Small Group Discussion and Physical Examination.

For me, first was dry lab. Ok, so it's 8AM and we're looking at X-Rays and going through some discussion questions in pairs. The guy with me knew what he was doing so that was good. I was still waiting for my coffee to kick in.

After going through a few pages of X-Rays the Prof's call attention to the front and begin to show slides on the TV screens hanging throughout the lab. Then they point to structures and begin to randomly call on people. OK, I think, I can handle a question... then, before I realize it I am one of the 5 people (out of like 50) that are called on. OK, it's a softball.... nice and easy "what is this structure here?" and she's pointing to the Cervicle Vertebrae.

I know this!

So I blab out "that's the cervix vertebrae"

Silence.

Professor: "Nooo... guess again"

I am stumped - didn't I just say what it was?

I can't remember if I say anything but before I know it she call's on someone else and they say "Cervicle Vertebrae" - Correct!

Dr. Brahim offers consolation since cervix does mean neck, just not in that part of the body... afterward he says my mind was in the right place. Cervix, of course, is in the uterus.

AAAH!

Things get better from there as wet lab went well. We go around in clockwork to different bodies which are arranged in stations showing different body parts. The spinal cord that was just on its own was neat. Random farm animals announce when it is time to switch stations, which is only after about 2 minutes.

Some people are a bit immature around the cadavers and show a lack of due respect by playing around and joking. Probably just their way of coping with the situation. At the other end of the spectrum are those who don't want to touch the body at all. I'm interested in figuring out what it is I need to know so I just jump right in and poke around. Most of my guesses are wrong but I learn so it's OK.

Then was off to small group discussion where we were admonished for not knowing the arteries of the vertebrae well enough but I ended up making up for my cervix obsession by giving a nice summary of the spinal stenosis clinical paper we had to read - and now don't have to give another summary all semester ;)

The physical exam was fun as we got to palpitate various parts of the back and find various vertebrae based on landmarks. I also showed people my scoliosis which they all remarked upon with interest... but for a bunch of future docs, only 1 actually showed sympathy and asked what the future complications are for me with this disease. To which I referred him to the spinal stenosis paper.

Overall, an interesting time and I look forward to more physical exam and wet lab... and hopefully the papers will stay interesting too.

Better than Ambien

Watch out big-pharma! A new sleep aid has been discovered here at SGU! Listen to this:

""I always thought I was a funny person, but when my sleeping problem got in the way, I wasn't myself anymore. I thought over-the-counter sleep aids would do the trick, but they only made me feel groggy the next day and didn't always keep me asleep. Then my doctor recommended BIOCHEM lectures at SGU. Now I stay asleep*, and can concentrate on the day ahead. I am back to my old self again. Heck, even Frank's jokes are funny now.""

-Brian: Year 1 SOM student at SGU

I know that if I ever have troulbe sleeping, a double shot of Dr. D and Dr. T will put me right to sleep.

Why do people have to read right off of slides in a monotone voice??!?!?