Friday, February 29, 2008

The Appropriation of Gentility & Power

As a future Osteopathic Physician I have the great privilege of interacting with, and treating patients in a more personal, less invasive way. A simple reality of physics and humanity is that more force or more power = more pain. What this means to me is a change in perspective about my osteopathic manipulative medicine (OMM) training...

We as students come into it wanting to learn 'the money' treatments, the 'snap, crackle, & pop' treatments that gets everybody so excited. But, like I said, more power/force = more pain. These treatments do have their appropriate time and place, but a body responds physically, emotionally, and spiritually to gentility. Likewise a body responds in not such positive ways to sudden, forceful, powerful manipulation. I have seen and felt the discomfort from treatments my body or others' bodies were not prepared for. I'm not the only one either. There are many OMM doctors who only do the soft tissue, fascial release, and tender point techniques, with phenomenal results. Many of those who do incorporate the high velocity, low amplitude (HVLA) treatments have learned that better results come from pre-treating with gentler techniques. I am of the opinion that time taken to relax the muscles will only help the patient to relax and trust the physician.

This is the core of the Osteopathic identity. Not only can we offer our patients these skills, in addition to prescribing power and knowledge of pathology, but our goal is healing. Not just healing after months of regular visits, but healing after one to three visits in so many cases. We can treat the whole body, and to me that includes the whole mind and spirit. That's why I decided to become an Osteopathic Physician! I believe in the power of gentility!

Monday, February 25, 2008

The Hole in Health Care Reform

I had a breakthrough thought late last week as I listened to a speech by Iowa State Senator Hartsuch (also an E.R. doctor) about politics and health care legislation. What I realized really shocked me, both for its simplicity that I somehow missed, and for the enormity of the consequences that I see. What it all boils down to is supply and demand! Read on...

Yes, this simple law of economics I believe is going to forcefully break any Health Care reform, beit Republican free market systems OR my dear, sweet Democratic universal health care.

When you call your doctor to setup an appointment, how long do you sometimes have to wait? Days or Weeks? If you show up as a walk-in to a primary care office, or emergency room, what is the wait time? When you do see your doctor, how long do you actually get to spend with them?

In general, there is already a crunch on availability of physicians, physician assistants, and nurse practitioners. There are even documented and projected shortages of these healthcare providers, and of nurses nationwide, especially in rural, native american, deep urban, and prison settings.

So what happens when an already limited supply sees a dramatic, and fairly sudden increase in demand... like getting 47 million more Americans health insurance? Well, you have 2 options: raise prices or ration services. Granted, not all 47 million will start using the system dramatically, but there will be a definite bump, especially if the health care reform plans actually achieve a system focused on prevention (more, regular checkups or interactions with healthcare professionals) as opposed to reactive treatment? The issue is that healthcare access may actually be harmed by the health care reform initiatives being proposed! Improving efficiency through paperwork reduction, 3rd party best practice forums/quality initiatives, and electronic medical records will only help so much.

This is a tough issue. Even if you try to influence medical students to go into primary care, it is still a 7-10 year delay (med school & residency years) before seeing the increase in the number of practicing primary care doctors. P.A.'s have a bit shorter training but still require physician supervision. N.P.'s, like Physicians suffer from a lack of available spots in schools. Regardless of profession, all classes of health care professionals lack available clinical and residency (physician) training sites. My school, DMU is currently is a desperate search for clinical rotation sites for 3rd & 4th year med students, just like every other medical school.

So, how do we fix health care with the issue of health care staffing figured in? Well, the big problem with health care is a lack of access to affordable, prevention focused medical care & guidance. To fix access I believe, as stated previously, that we need government to provide a low cost insurance alternative to existing insurance companies to induce some competition and give everybody health insurance. The rest of the access issue can be addressed by increasing the number of Title VII residency slots, clinical training slots, medical & nursing school slots, medical & nursing school faculty, and dramatically increase the funding of loan repayment programs and the National Health Service Corps. Those changes need to be made first such that the supply will be preparing to meet the demand.

And guess what? After I had this realization last week, I found out that the U.S. Senate Health, Education, Labor & Pensions committee held a hearing on Feb. 12th to discuss this exact issue. The testimonies shared by experts in this area can be found at:

'Addressing Healthcare Workforce Issues for the Future' Feb 12, 2008

We'll see what comes of it.

Tuesday, February 19, 2008

A Kitten in a Boot

I would like for all of you to take a moment and view this video:
My question to you is, 'What is the significance of a Kitten in a boot?' My answer is...

It has absolutely no significance, and all the significance in the world, both, at the same time. In my world, my med school friends and I spend hours a day thinking, discussing, and learning things like the effects of obstructive pulmonary disorders on forced expiratory volume. We debate over health care policy, what presidential candidate will lead this country to a healthier future and what system will be best for patients and healthcare providers. We memorize the leading causes of bacterial meningitis in neonates vs. infants vs. children vs. adults. And where does it leave us...

Needing to take a moment and look at a kitten in a boot, or hear a story from our spouse or family about their day, or blogging about the need to blog...

See? Relatively insignificant things become unbelievably significant to a medical student. It's like we have no middle ground... passion or play, grind or gawk, a dichotomous life!

I like it when the kitten roars. It makes me laugh.

Wednesday, February 13, 2008

A Parable to Ponder

A parent sits in a hallway of their child's school, outside the classroom of the teacher entrusted with the responsibility of educating that child. Vitally important, indeed. The parent waits for their appointment, the annual parent-teacher conference to discuss the state of the child's educational progress. Next to the parent sits a handsome, younger man in a suit. Too young to be a parent, maybe an older sibling. The curious parent asks the young man, "Do you have a child in the class?". His response leaves the parent stunned; "I'm a curriculum sales rep, here to meet with the teacher." (Read on!)

Upon recovering from the momentary shock, the parent notices a box and bag next to the young man. "So, it looks like you brought a lot of stuff for the teacher?". The young man replies, "Well, it's just a few curriculum samples, some pens and notepads, and the bag is a dinner from Joe's Deli since I know the teacher won't be able to get dinner in her schedule tonight."

The Parent, trying to grasp all the aspects of these revelations asks, "So you're hoping the teacher will get students to use your curriculum?"

Sales Rep: "I just want to educate the teacher about our product and why it can improve their students' performance."

Parent: "Can't the teacher get that information independently?"

Sales Rep: "Well, yes, but they are busy so we try to help them save time."

Parent: "But you only inform them about your product?"

Sales Rep: "We make sure the teachers know the benefits of our product."

Parent: "Why the need for the free samples, pens, notepads, and food?"

Sales Rep: "Well, honestly, we need them to remember our curriculum product when a student has a need for it. Poorer students can benefit from the free sample curriculum."

At that moment the classroom door opened and the teacher invited the young curriculum sales rep into the room and closed the door. After a few minutes he emerged and quickly left the school. The teacher then invited the parent into the room. The parent's now heightened sense of awareness glanced around the room, making several observations. There was an 'Educat-O' brand clock on the wall. The calendar made by 'Superior Curriculum Co.'. The teacher's desk held a plastic apple paperweight 'The World's Best Teacher uses EDUCATOR XR by Schoolmax'. A cup filled with pens all bearing curriculum logos sat on the corner of the desk. On the other corner sat a half-eaten club sandwich from Joe's Deli and several Schoolmax pens. A shelf behind the desk held hundreds of curriculum booklets labeled 'free sample'. The parent recognized some 'MathExcel by Schoolmax' free samples from the young salesman's box.

Teacher: "So let's talk about your son's math scores. They have been slipping and I think putting him on a new curriculum would help."

Parent: "What do you recommend?"

Teacher: "Well, I have these free samples of this MathExcel program that I think will help him."

Parent: "Why do you feel this is the best option for him?"

Teacher: "I just heard some very good research on the effectiveness of this program."

Parent: "Don't you think that you may be making this recommendation based on gifts that salesman brought?"

Teacher: "Well, other teachers may be affected by sales rep marketing, but I know that I only recommend what's best for the child. Plus I need the free samples to give to the children."

Should this parent trust this teacher? This teacher cares for the children and believes they aren't affected by this marketing. Are you comfortable with this situation regardless of whether or not the teacher is effected? The teacher has the best of intentions and education, but aren't they human? Would the sales rep be there if the marketing did not work?

The pharmaceutical industry spends billions of dollars annually marketing directly to physicians. Often times it is under the pretense of 'Medical Education'. While their product is good and these companies are limited in how they can get the product to consumers, are you comfortable with the ethical conflict this places on physicians? Doctors believe they are above the influence of the marketing. Scientific studies have shown otherwise. Pharmaceutical companies wouldn't invest the money if the marketing didn't work. I encourage you to learn more at and to ask your physician if they are pharm-free.

This message is my own thought and work, not sponsored by any organization or entity other than my own conviction. Please pass this message along!

Tuesday, February 5, 2008

Super Tuesday Observations

Just some observations as of 9:40pm:
-Hillary Clinton is winning her home state New York by 17 points while Barack Obama is winning his state Illinois by 32 points
-Obama is winning the South, the northern plains to northwest and a couple smaller New England states. Clinton is winning New England and the states around Arkansas where Bill was Governor.
-Clinton is winning among older voters and women. Barack is winning amongst under 65 year old voters.
-Clinton is winning high delegate states. Barack is winning more states.
-Colorado is going for Obama! Just another reason to love Colorado!

Sunday, February 3, 2008

Yes We Can!

Superbowl & Superbugs

So Superbowl Sunday has arrived and it looks so much different than normal. As opposed to years past, the 'Big Game' will not be the focal point of my day. In fact, it is almost more of a nuisance. Here's why...

Don't get me wrong! My man card is still intact, as indicated by the outfit I intend to have our baby wear to next year's Superbowl, and I still desperately want to see the game, the commercials, the L'il Smokies sausages, etc. But here's the deal. I have a Microbiology exam Monday morning at 8am... yes, an exam on Monday at 8am...

So my Superbowl Sunday started at 6:30am... with studying. 2 hours of gastro-intestinal diseases like Hepatitis, Botulism, and all sorts of diarrhea. Now a quick blog before going home and picking up Katrina for church. Ahhh, church! My respite of joy for the day! And after church? Back to studying for several hours. Then the game at our friend's house, or at least part of it (probably all of it, because my man card will be revoked if I miss NFL history). And then a bit more studying before bed. And then up at 6am on Monday for some last minute review before the exam.

Just a glimpse into how life changes in Med School. I could have spent more time studying this stuff throughout last week, but that doesn't work for me. The good news is that I spent quite a bit of time with Katrina and working on other personal stuff. I also got to watch the Democratic Debate Thursday night. Ultimately there is still plenty of balance in my life and I'm thankful to God for giving me that! He's also given me some additional opportunities to challenge myself. More to come on that!