The Mind of a Medical Student

Video Blog - Physical, Spiritual, and Mental Healing

2010-09-09T01:42:00.003-05:00

Reigniting the Flame

2010-07-25T15:48:00.002-05:00

There have been several periods of my life where I have lived with a very distant, unimpassioned relationship with God. The last year or so has been one of those times as life struggles with finances, health, previous church, and the occasional/rare difficult clinical rotation have stacked on top of each other. But today I felt a spark of that spiritual flame in my heart. Who knows what will come of it but flames can only start with a spark and that is the great encouragement. I am very thankful that we found a church that has helped me (and Katrina too) to reconnect with God. Check it out at http://www.thegatewaychurch.com/.

God Bless!

Opening Up Again

2010-06-27T20:25:00.002-05:00

So it is time to start over with this whole blog thing. I stopped blogging over a year ago because I was so worn out by the rigors of medical school and the short-sighted idea that blogging is about having people read what you have to say. Really, the purpose is cathartic, to share your thoughts so that they are not stuck in your head, weighing you down, keeping you from freeing your mind and being present in the moment. The person who realized first that I needed to open up again was my dear wife Katrina. I am very thankful that God brought this woman into my life that now knows me better than I know myself and encourages me to be what I need to be.

With all the seriousness out there, I wanted to do something less serious for the rest of this post.

What color are your socks right now? No socks, bare feet just like God intended.

What are you listening to right now? My wife and son on a Skype video call with Grammy in Florida, with the movie 'The Waterboy' paused on TV.

What was the last thing you ate? A 100 calorie bag of Pop Secret with Parmesan Garlic 'Colonel Seasons' popcorn seasoning.

Can you drive a stick? Of course and I wish I still had a stick shift. Driving is so much more fun with a stick!

Last person you spoke to on the phone? My mom called a bit ago to discuss hotel arrangements in Omaha next weekend where we are meeting them for a fun weekend out of Des Moines before they follow us to Des Moines for a week in Iowa.

How old are you today? 30. It's a good age.

What is your favorite sport to watch on TV? I would have to say football is my favorite but I like to watch Baseball, Golf, occasionally Basketball, and I'm even getting more into NASCAR.

What is your favorite drink? This is a tough one. I really like a good cold soda or iced tea, but every once in awhile an ice cold beer from the tap in a frosted glass is wonderful!

Have you ever dyed your hair? Yes I have... and I'm sorry but I don't think I have pictures. For Halloween in 2005 my roommate Nate and I decided to dress up as Gilligan and the Skipper. So to get into the role of the Skipper I tried to dye my hair blonde. Unfortunately it turned out a weird orangish yellow.

Favorite food? When I read this the thing that came to mind first is cold, leftover fried chicken. Mmmmmmmmmmmm!

What is the last movie you watched? Apparently we are watching an Adam Sandler movie marathon on FX today. We watched the Wedding Singer earlier. Yesterday we watched The Red Baron (not great), She's Out of My League on Friday (great except for the excessive language), and recently Invictus and When in Rome which are both really good.

Favorite day of the year? Another tough one. Probably any day that I get to be back in the mountains of Colorado, especially with my wife and little boy. I sure do miss home.

How do you vent anger? Passive-Aggressive. Not good at all. When I do better I usually am writing or doing something athletic.

What was your favorite toy as a child? That's tough, I know I had quite a few favorites at different points. Since I played sports I did a lot of shooting hoops, chipping golf balls in the backyard, and pickup games of football on the street. Video games and baseball cards were also a pass time for me.

Favorite Season? Definitely Fall when the leaves are changing, the temperatures are in the 60's, football season is on, and daily attire consists of sandals, shorts, and a hooded sweatshirt.

Cherries or Blueberries? Neither really. Cherry pie is good. Cherry flavored stuff is good. But plain cherries are not great. Never tried a lot of blueberries.

Living situation? Living in a condo on the very south edge of Des Moines, IA with my wife Katrina, son Ezekiel (22 months), baby girl due in October, and cat Edmund. I am in my 4th year of medical school at Des Moines University. I am completing a 1 year fellowship in Osteopathic Manual Medicine and thus will have a 5th year of medical school.

When was the last time you cried? Last Monday when I talked with my preceptor Doctor about struggles I've been having in the clinic. I'm an emotional person, she's an emotional person and one of my top role models in medicine so it was hard for me to ask for changes in my learning environment. She was so supportive and understanding!

What is on the floor of your closet right now? Shoes, some clothes, a storage bin, and probably a variety of items deposited there by my son 'Z'.

What are you most afraid of? Finances. We have been struggling with money for over a year now and it has taken its toll on my mind, body, and spirit. We struggle to get money and then to use it wisely.

Plain, cheese, or spicy hamburgers? Spicy with cheese, mushrooms, and ketchup!

Favorite day of the week? Friday, a great mixture of work and play.

How many states have you lived in? Three; Colorado, Ohio, Iowa. One Canadian Province for a few months - Ontario.

Diamonds or pearls? Pearls. Diamonds are too fancy. Pearls say 'real beauty'

Did you get an H1N1 vaccine? Yes, being a healthcare professional we have to take precautions for our own health, and to not be carriers of illness.

Convinced or Conviction

2009-04-26T20:53:00.002-05:00

Evidence?
What is evidence?
Is there not a difference
between what convinces
each of us
regarding truth?

Why should a dimensionless God
constrain himself
to dimensions which I can observe
which I can comprehend?
Would I really be convinced?
Would I really be forever changed?
Would my faith grow
or would I require more
Evidence?

Acts 2

2009-04-26T20:49:00.001-05:00

The flaming Holy Spirit
is but a glowing ember
in my soul today...
but not extinguished.
It awaits a breeze
a blowing wind
my own internal Pentecost
my own collision
with ignition
my own collision
of dark soul carbon
pure God-breathed oxygen
and spiritually passionate heat.
From somewhere far within
I hear a faint sound
that maybe, just maybe
is God taking in
a long, deep breath.

Question

2009-04-03T19:16:00.003-05:00

Why is it that so many of my fellow Christians want the government to stay out of the religious realm of charity and caring for the poor (because big government is anti-God...), YET want the government to be dominant in denying equal rights based on our religious views?

Seems like hypocrisy to me. Thoughts?

Great Pharma Humanism

2009-03-27T19:50:00.002-05:00

So today while reading the news online I saw an advertisement for a new drug from a big pharmaceutical company named Allergan. Before I reveal the name and purpose of the new drug, let me share with you some statements from Allergan's website about their honorable mission...

From the main page: "We combine this strategic focus with a diversified approach that enables us to follow our research and development into new specialty areas where unmet needs are significant."

"We know we are successful... when our efforts make a meaningful difference in the lives of the patients and communities we serve."

From the about us page: "With a heritage of nearly 60 years of discovery and research, our products have made a meaningful difference in how medical conditions are treated and in the quality of patients' lives worldwide.

From the Research & Development page: "We vigorously invest in research and development to discover and develop new treatments that meet the needs of specialty doctors and their patients.
Allergan's world-class research and development (R&D) program embodies our efforts to bring the best of medicine to life."

"research and development expense was $1,055.5 million ($1 billion), $388.3 million, $342.9 million, $762.6 million and $232.7 million in 2006, 2005, 2004, 2003 and 2002 respectively."

So with that great humanitarian vision and massive investment in research and development Allergan recently announced FDA approval of their newest 'meaningful' medicine Latisse for the treatment of the previously unmet needs of patients suffering from hypotrichosis...

Hypotrichosis... definition: inadequate or insufficient eyelashes.

Yes, we now have an FDA approved pharmaceutical to help people get fuller, longer, darker lashes...

What a freaking crock! While people are suffering and dying from all forms of disease, and ordinary citizens are giving money out of their relative poverty to support research, Allergan is investing millions and millions of dollars to create prescription strength mascara!!!

Allergan is not all bad. They are making some donations to the Make-a-wish foundation, and some of their other drugs and pipeline potential drugs have some real value. But seriously... mascara! MASCARA!

At least doctors won't have to wait for 7 years for the patent to expire in order to prescribe a generic. Maybe I can line up some free samples of Covergirl or Maybeline to give to my poorer patients.

Out of money? Print more...

2009-03-12T21:08:00.003-05:00

So a good friend of mine shared this video with me and I felt the need to verbalize my thoughts on the issue:

This is a topic where I definitely follow a more conservative, even libertarian ideology. You absolutely cannot just print more money without the gold or other item of universal value to back it up. It is idiotic public policy. Here’s the problem in our two party system:

Party 1 = we want public services like schools, jails, etc, but we don’t want to pay much in taxes and we want the government to stay out of things.

Party 2 = we want the government to step in and do more, tax the wealthier people to pay for it, or come up with some other way to pay for it.

For somebody to get elected they have to please just enough of both sides that we’ve ended up with: Government step in and do more while not concurrently raising taxes. People want the government to help them, or help the companies they work for, but they don’t want to pay to do it. So where does that leave our government? Borrow from other nations (who aren’t lending now that the global economy is tanking) or print more money. So what is worse, letting General Motors, AIG, and other multi-million employee organizations shut down or keep those millions of people receiving paychecks that are worth less? Where do we cut funds from? Schools, Universities, Research, Jails, Medicare, Medicaid, Military, Food Stamps, Non-profit grants, Roads, Police, Fire Protection… what deserves less than the others?

Maybe now would be the time for the greatest unification of church and state in American history. What I mean by that is maybe now would be a phenomenal time for the Christian Church to step up and say to the state, ‘we will take care of the poor, the needy, the sick, the hungry. We will volunteer our time to work on infrastructure projects or to police our streets. We will volunteer to help clean schools or make lunches for kids. We will spend our Sunday mornings knitting hats for babies or repairing cars for single moms, instead of just sitting and hearing a sermon we’ve heard 32 times before. Christian kids can bake cookies and make sandwiches during Sunday School for the poor or other workers. Christian executives and wealthy individuals with savings will take temporary pay cuts or cessation of salary for a period of time. Christian doctors will offer an evening a week seeing patients at free clinics. Churches will offer free job re-training, counseling, housing, etc.

Maybe that would be a more Godly, Christ-like response from us than to just be upset about the government printing more money to solve problems we aren’t willing to solve ourselves.

A Great Example!

2009-03-06T21:58:00.000-06:00

Hello Friends and Family,

I heard this great story on NPR this week about a young pastor in Bend, Oregon working to refocus his church on serving the poor and forgotten, loving unconditionally, and generally living the Christian faith. This story documents the challenges, successes, and new directions faced in this process. I would strongly encourage you take the 15 minutes or so to listen to it at:

http://thestory.org/archive/the_story_721_New_Church.mp3/view

Scroll down and click on the ‘Listen Now’ or Download link. This story is the first 15 minutes or so of the recording. Please let me know your thoughts!

Poetry Free-Write

2009-02-19T22:27:00.002-06:00

The art of palpation
touching the body and soul
of a patient, a person
a soul that longs for healing

a soul that breathes inside
of malleable bone
and muscle tension

a soul that longs for...

And what does the physician feel?
Do they try to feel?
Do they believe in feeling...
with their hands...
with their hearts???

Can they feel a bone out of place?
Can they feel a muscle strained?
Can they feel a reflex tender point
of an organ in disarray?
Can they feel a patient?
Can they palpate and heal with their hands?

I desire to be a physician who feels
a physician who sees heart, soul, bone,
fascia, fury, fear, muscle, and meekness
all with my hands
and to cure with my hands
and a kind, compassionate word
and a... medicine? surgery?
Only if need be.
For I believe
that the patient's body will progess towards healing
if given the permission to heal itself
if put in the position to heal itself

Oh to palpate a history
Oh to palpate a physical
Oh to palpate a diagnosis
Oh to promote healing
Of heart, mind and soul
in the patient and myself!

A Seminal Moment

2009-01-20T16:50:00.005-06:00

Today I am prouder of my country than I have ever been before. I have always loved the United States of America, but today I understand why. We have peacefully transferred power to a freely and democratically elected leader. We have elected the son of an African immigrant and Kansas farm girl. We have elected a leader who has already demonstrated an unprecedented openness and ability to communicate with the electorate by bridging old-fashioned oratory and modern-age technology. We have placed a man into an oval office that only a scant few decades ago he would only have been allowed to clean. Glass ceilings, racial and social barriers, and class inequalities still exist in our perfectable union. Today though we have been made more perfect, and most certainly the States of America are more united! There will be triumphs and tragedies during this administration, victories and defeats. But when a 45th American becomes president in the years to come, I believe there will be a collectively renewed American soul. May God bless Barack Obama. May God bless his family and administration. May God Bless America!

Little Z!

2008-12-12T23:27:00.001-06:00

What a fun little man!

The Cure for the Common Cold

2008-12-07T21:20:00.008-06:00

For centuries scientists and doctors have been searching for a cure to the common cold, of which I'm currently suffering. However, I have solved the mystery and here it is...

See... don't we all feel better now!!! Merry Christmas!

New Formats

2008-11-18T08:24:00.005-06:00

This morning I'm filling time waiting for my 2nd Respiratory exam in a few minutes and it suddenly hit me, as it often does, that it is time to refresh and reformat. You see my classmates and I have come to the end of a stretch of 8 exams in 15 days, and 15 exams in the last month. Despite the general zombie-like mental state most of us are in, there is a palpable excitement, a mass sigh of relief. We have made it through what has likely been the most challenging and emotionally insecure academic period any of this conglomeration of professional students has ever been through. Not only surviving, but succeeding... and that is encouraging, energizing, refreshing! We are proud of each other, proud of our families, friends, and support systems, and proud of ourselves!

For me, I praise God for two things. First, He has blessed me with recall and analytical abilities during exams that has proved invaluable. Second, He has blessed me with a sacrificial and supportive wife who has suffered through this stretch with me. Through her words, notes, and simple presence in my arms she kept me going as strong as possible. Thank you God and thank you Katrina! I love you!

What Gay Marriage Bans are Really About

2008-11-07T11:15:00.003-06:00

While most of us were focused on the history-making election of Barack Obama as President on Tuesday, another interesting vote took place that day. Californians narrowly approved Proposition 8 to eliminate the right of same-sex couples to marry, overturning a California court decision from earlier this year. This, of course, is headed for a long legal battle but I want to share some thoughts I have behind the motivation for gay marriage bans... Read on...

Gay Marriage bans are consistently put forward by Christian-affiliated religious and political groups. The reasoning usually goes something like, "protecting the institution of marriage" or "protecting the family unit" and it is based on a few passages of biblical scripture that condemn homosexual behavior and describe the unity of man and woman. Different people can argue all day on that issue alone but I want to go somewhere different with it.

Why is it that these same groups have not made an effort to ban common law marriage? It seems to me that a man and woman living together, having sexual relations without the public marriage commitment before God and man could be condemned for the same reasons by these groups. It seems to me that if the 'Anti-Gay Marriage' movement was really about protecting the institutions of marriage and family, that we would see just as much effort to ban common law marriage.

So maybe this is not about protecting marriage and family as much as it is about discrimination against homosexuals. If we really believe homosexuality is a sin and that these souls will eventually have to face God with that sin, is it really a good idea to do all that we can to isolate them, condemn them, and make them hate Christianity here in this life. That seems to correlate well with Jesus' statement to the Adulteress in the book of John... (sarcasm intended).

"But Jesus went to the Mount of Olives. At dawn he appeared again in the temple courts, where all the people gathered around him, and he sat down to teach them. The teachers of the law and the Pharisees brought in a woman caught in adultery. They made her stand before the group and said to Jesus, "Teacher, this woman was caught in the act of adultery. In the Law Moses commanded us to stone such women. Now what do you say?" They were using this question as a trap, in order to have a basis for accusing him.

But Jesus bent down and started to write on the ground with his finger. When they kept on questioning him, he straightened up and said to them, "If any one of you is without sin, let him be the first to throw a stone at her." Again he stooped down and wrote on the ground.

At this, those who heard began to go away one at a time, the older ones first, until only Jesus was left, with the woman still standing there. Jesus straightened up and asked her, "Woman, where are they? Has no one condemned you?"

"No one, sir," she said.
"Then neither do I condemn you," Jesus declared. "Go now and leave your life of sin."

I would like any of my fellow Christians to please explain how a legal ban on gay marriage is a Christ-like, loving, non-condemning way of challenging people to examine, recognize, and leave their sin. Again, I am not going to state definitively whether homosexuality is or is not a sin because that is not the point of this blog.

Maybe before we go around banning gay marriage, throwing stones, we should focus on taking care of the sin and struggles in our own hearts and lives. That seems to be what Jesus is saying to me.

Thanks for reading and commenting!

Heart and History

2008-11-03T21:43:00.004-06:00

What can I say on the eve of one of the most important and improbable moments in U.S. history that I have been privileged to experience? Tomorrow this country that I love will turn the page in so many ways. Regardless of the outcome tomorrow I do believe change will happen in this country to some degree, because I know that patriotism is still a guiding principle for both McCain and Obama despite campaign pandering. Both men will not allow this great country to fall, but I believe with all my heart that Barack Obama is the leader to help the U.S. rise once again.

It is my heart though that is so restless tonight. I am nervous that power will not concede to change, that somehow this hope for transformative leadership will be quashed by the status quo. I am fearful that the passion of my generation to engage in policy and patriotism now for the first time, will be snuffed out by longstanding political tactics and election day 'ground games'.

That having been said, the Presidential Election of 2008 has left an indelible mark on me!

You see, this catchphrase, this now tongue-in-cheek word 'change' has actually resonated with me. I spent the first months of these two campaign years knowing about policy, discussing policy, having opinions, all from the sidelines. Then came caucus night in Iowa and I became engaged! Better yet, I became transformed in my own way. It became apparent to me that I did not want to sit back for the rest of my life and let things be dictated to me. I found inside of myself a renewed desire to be an activist and leader on issues important to me and my future profession. As I look back over the past year as my passion for an Obama presidency grew, so too grew my passion to positively impact policies at my school and in my profession. I am now working towards a Masters of Healthcare Administration degree while also serving in leadership for several organizations and groups on campus.

The purpose of all of this? Well I think that this whole experience for me has been God's way of directing my path, facing me in the direction He wants to take me, and reminding me of the capabilities He has given me. I have no idea what that means or where it will lead but it will be exciting to see where this road winds its way to! On top of that, I get to share the journey with an amazing, beautiful wife and a strong little boy! God is good!

A Response

2008-09-09T18:27:00.002-05:00

In response to the great comments that I've gotten to my previous blog, which have stirred so much thought and contemplation in me I thought I would share this e-mail I wrote to one of my commenters...

Thanks for your comments on my blog and your passion. I am excited to know that there are others who are passionate about faith and politics here on campus. You hit the nail on the head with what I’m struggling with in our political system in that neither party fully represents Christian values. I don’t agree with abortion but I also don’t agree with forcing a woman to go through 9 months of pregnancy and labor, and the stigma of giving a baby up for adoption if say she were raped. I also know that prior to Roe v. Wade abortions still happened in large numbers in poor “back alley” conditions. So will that be any different if we overturn Roe v. Wade? Can we overturn Roe v. Wade and somehow keep allowances for certain situations (like medical necessity for mom’s safety, rape, incest, etc)? How do we change the culture as a whole to stop unwanted pregnancies from happening? What I’ve heard is that abstinence-only training programs do not work. What are your thoughts?

I am legitimately wrestling with this conflict between supporting a party that is pro-life but won’t push for immediate, significant energy/environment change, won’t treat all people with simple respect and human dignity, will take action to remove a dictator whose biggest crimes were decades ago, but won’t step in to end genocide happening now. I have a hard time supporting a party that says we need to put criminals in jail longer, but will cut the taxes that pay for jails, a party that says life should always be protected but we will kill criminals because apparently their life is not the same life. I have a hard time supporting a party that says we need to improve our schools but will cut the taxes that pay for schools and teachers. Taxes are not pleasant but they are necessary. I have a hard time supporting a party that preaches individual liberty but will hold people in Guantanamo for years without even bringing official charges against them, much less a fair trial. This only promotes extremist hatred of the United States. I have a hard time supporting a party that says the Constitution (checks and balances) is the rule of law but wants the President to be able to veto anything that comes from Congress and to appoint judges who will legislate that party’s platform from the bench.

As far as I’m concerned, “the least of these” represents more than just unborn babies. It represents all of those lacking in salvation, so let’s talk about capital punishment, throwing people in jail for years but not funding those jails or rehabilitation programs, stopping genocide, treating homosexuals and muslims with the love of Christ while being firm in our faith. If you want to respect life, you must also respect those that are living outside the womb.

Let me go into more detail on some of the concerns I have with the Republican platform from a Christian standpoint. The model of Christ as a leader to me was somebody who interacted directly with those who opposed him or those living in sin and challenged them both firmly and compassionately to change their ways. That is in direct opposition to this statement in the GOP Platform, “We oppose entering into a presidential-level, unconditional dialogue with the regime in Iran until it takes steps to improve its behavior.” What my experience in life has been is that when somebody is threatened and not given some level of respect, they lash out. This is no different at the individual or governmental level. If you act arrogantly towards people and governments you cannot be surprised if they respond negatively. Jesus was impactful because he spent time with those who were used to being shunned. This obviously is very tricky to translate to diplomatic policy but I think it is important.

I also feel like an energy platform that does not put a timeline goal in place, like 10 years is absolutely in violation of our call as Christians to be good stewards for the earth. We’ve already seen the impact of 40 years (28 years of Republican Presidencies) of talking about changing our energy focus and not doing anything about it, expecting the market to take care of it and develop new technologies. We need specific plans with specific goals and specific timeframes. I’ve read the entire GOP platform on energy and climate change and while it looks good, it lacks commitment.

As a future healthcare provider I disagree with components of this statement, “No health care professional —
doctor, nurse, or pharmacist — or organization should ever be required to perform, provide for, or refer for a health care service against their conscience for any reason.” Every medical ethicist with any credibility agrees that we at least have a responsibility to refer patients if we personally will not provide a service. I also think it is horribly reckless to say we could deny care “for any reason”.

I’m sure I’ve probably stirred more frustration in you and for that I apologize. Discussion is good and you have challenged me to think more deeply about priorities!

My Christian Democrat Dilemma

2008-08-26T19:36:00.003-05:00

Recently a Christian friend of mine from church gave me a copy of an essay, presumably in response to my openness around him and his grandson about my democratic political views. Generally when I present myself as a Christian Democrat I get a lot of funny looks and become the butt of somewhat harmless jokes. Thus I wanted to set my own record straight and I hope it opens some eyes. For reference, here is the essay I was presented: http://www.whatiam.net/

Now, allow me to respond. I was quite impressed by Mr. Essef’s full page ad and the passion and values he obviously holds. Obviously I do not approve of, nor agree with Howard Dean’s statement about Republicans. I think Mr. Essef was quite justified in feeling deeply offended by those remarks. I am disappointed that in offering his response to negative generalizations of Republicans, he chose to use many negative generalizations of Democrats (such as the statement that Democrats only see negativity in America).

I think it is unfortunate that Christianity has been pidgeon-holed into Republicanism. There does not seem to be a place for a Christian like me who is pro-life, but who also believes that we must fix our horribly flawed health care system, immediately change course on our destruction of the environment, end our dependence on oil period (not just foreign oil), and treat other nations with respect through diplomacy and not the ‘superpower’ arrogance that the White House has shown in the past few years.

Both parties both use shameless attack ads and then whine about the other candidates’ attacks. Both parties are led by politicians whose integrity can be legitimately questioned. Neither party truly represents all of the values and desires of the majority of Americans. Where that leaves each one of us is with the solemn duty to examine the political landscape for ourselves and not blindly follow one party’s propaganda. We all must figure out for ourselves what party and candidate most closely aligns with the majority of our values and ideals. We must encourage our children and youth to engage in policy debates and not try to force them down one political path. On several instances my friend's grandson has bluntly said to me, “Obama is a Muslim”. This has been shown to be a lie over and over again, yet it persists because people refuse to believe that the Republican party and leaders might be using propaganda for political gain. I find it unfortunate that the Christian and conservative right has chosen to attack the faith of a man who has devoted 20 years of his life and treasure to a Christian church in Chicago. When this young boy has asked me about why I support Barack Obama I tell him the honest truth that I want to see environmental and health care reform. When he calls Obama a muslim I have told him that he should not spread lies and needs to find out the truth for himself. That may be hard for him to grasp at his young age, but I feel it essential that he knows that he has the God-given freedom to think for himself and pursue truth for himself (with some guidance of course at his age).

Because I believe in the sanctity of life I believe that health care is a right and should be provided to all citizens. Because I believe in the sanctity of life I believe that for our childrens’ sake we must immediately enact massive energy policy change to provide a healthy environment and a future free from ‘oil wars’ as other nations’ economies modernize and increase demand. Because I believe in the love and grace of God and Jesus Christ, I believe we must cease the Christian hatred & fear of homosexuals, pro-choice advocates, and muslims. Jesus was only harsh to the Jews, those of his own faith, who spread legalism and rules. He was always gentle to the lost sheep. We as Christians need to follow Christ’s lead on this. Those are the reasons why I identify more with the Democratic party. I only wish both parties would behave more ethically toward each other, especially during campaigning. I hope that helps all of you understand where I’m coming from.

The Rapp Family

2008-08-22T14:36:00.004-05:00

Some Pics of the family and momma with baby Z.

Little Baby Rapp!

2008-08-21T16:42:00.003-05:00

Ezekiel Thomas Cadman Rapp was born just before 8:00pm on Wednesday 8/20/08. The new little giant weighed in at 8 lb. 1 oz. and measured 21.25 inches. Mom is doing well and the baby is phenomenal :-)!!! Here are some pics:

Politics, Sweet Politics

2008-07-16T14:59:00.001-05:00

Send a JibJab Sendables® eCard Today!

The Crazy Dream

2008-07-16T12:36:00.003-05:00

A few nights ago I had this dream. Normally I don't remember my dreams but this one stuck and after telling a few people about it I was encouraged to share it here. So here it is.

In my dream a very pregnant Katrina and I woke up one morning and her first words to me were, "My water just broke!" She immediately started contracting so I remembered that I had some left over unused, non-latex rubber gloves from Anatomy lab last year which I found and put on. I checked her cervix and found her to be fully dilated and the baby descending. Knowing at that point that we were going to have to deliver the baby right there in our bed I went on a scavenger hunt for supplies in our apartment. Somehow my limited 1st year medical training and my experience delivering a couple robot babies in the sim lab came out. Here is a list of what I picked up.

1. The hand pump from our exercise ball. It has a reverse pump to do suction (which I would use to suction the baby's nose and mouth.
2. Potato Chip Bag Clips. I would use these to clamp the umbilical cord before cutting.
3. Scissors from our knife block. To cut the umbilical cord
4. A shirt of mine to wipe down the baby

With all that gathered I began the process of delivering the baby. Doing cervical and vaginal swipes with fingers to help the baby's head clear the "ring of fire". I assessed the presentation of the baby to prepare my hand placement. When the head crowned I held it in extension (heads flopping down cause tears in mom). Then I delivered the head, anterior shoulder, posterior shoulder, grasp the neck and pull baby all the way out, suction nose then mouth. I handed the baby to Katrina, never looked at the gender (and she didn't say either) and then proceeded to clamp and cut the umbilical cord. Then I went through the process of uterine fundus massage to deliver the placenta and checked the placenta to make sure of its cotyledons were intact.

And then... I woke up. Crazy huh?

And I never saw the gender... but the baby was pink, healthy, and crying.

The Patient Viewpoint

2008-07-10T15:22:00.003-05:00

As you know, this blog is often a forum for health policy and other similar issues. On occasion though I do desire to get personal and share with you something from the heart. Today is one of those days as I have spent much of the day reflecting on a current health battle. To be honest, I must say that I am a little scared but also a bit relieved...

For those who know me personally you are likely aware that my gastrointestinal tract leaves much to be desired. Throughout my teenage years and adult life I've had a wide range of chronically moderate to acutely severe GI problems. Over the past year though I've experienced a slow, steady increase in heartburn and acid reflux, to the point that now I have a constant, dull burning sensation at all times. All foods, yawning, laying, coughing, etc exacerbate the symptoms and over-the-counter treatment has become virtually useless to me. Now, reflux just happens randomly every few minutes. The level of discomfort and type of discomfort, coupled with my medical knowledge is what finally scared me enough to see a doctor since I've been trying to deal with the discomfort with pending pregnancy/labor/delivery costs on the horizon.

So I did see the doctor yesterday who did a phenomenal job taking my history and giving me some treatment options. What she did though that has not been done for me yet in life is offer to actually go in and take a look around. What I have been wanting for some time is to know the actual cause of my health issues, not simply to treat symptoms. So sometime soon I'm going to get scoped which is a relief to me.

There is a lot of discussion in the medical community about the ordering of expensive diagnostic tests that may not be necessary. This is called defensive medicine which doctors practice to avoid lawsuits. Anyhow, my case could be argued either way and for me at this moment, I'm glad I have a doctor who wants to take the cautious road. Maybe that is because I know more now than I did before about my risks with these symptoms. What I think my doctor picked up on (whether she realized it or not) was a patient who historically does not take great care of himself actually seeking care, and thus must be pretty concerned and in need of detailed answers.

Ultimately I feel comforted. I feel like I received quality care. That's why I want to be a doctor, and now why I'm happy to be this doctor's patient.

Remembering Childhood Joys

2008-06-25T10:29:00.003-05:00

So yesterday I decided to try riding my new bike to school. Yes, I know I'm almost 29 years old but I'm trying to be more environmentally and health conscious. Our new apartment is 8 miles from campus. Coming to campus in the morning was nice for the first 5 miles until I reached what I'm dubbing "The Hill" which is a good, steep half-mile rise from the Raccoon River Valley up to the Windsor Heights neighborhood where the school is located. Being out-of-shape I had to walk my bike up the second half of the hill, but I made it to school and felt great! What I really enjoyed though was the ride home.

Remember being a kid riding around your neighborhood? I'm sure all of you had 'that hill' that you never wanted to go up, but you loved going down. That's what I re-experienced yesterday for the first time in years... that long, fast descent with the cool breeze, no cars. Beautiful!

Fresh Band-Aid for Medicare...

2008-06-25T10:00:00.003-05:00

Recall this December 2007 blog post?

Band Aids are NOT good healthcare for Seniors

Well, yesterday the U.S. House of Representatives passed yet another piece of band-aid legislation to prevent the 10.6% cut in physician reimbursement from Medicare until the end of 2009. The Senate is likely to vote on this legislation within a week and then it goes to Mr. Bush to sign (who has threatened a veto, details at Washington Post.

You know, I honestly am wondering if it might be better for this pay cut to happen... here's why:

Massive Collateral Damage! If the pay cut happens then many doctors will cut back on seeing Medicare patients, some will stop participating in Medicare all-together, some will leave their small town or urban practices for better practice environments, and some will quit medicine entirely. It will essentially be a non-unionized, non-organized strike, and boy oh boy would the fallout cause some heads to roll. Patients and their families would start a grassroots campaign of political revenge like no other.

However, the damage this would do to our seniors, their families, physicians (and their families) would be too great.

You know, despite the humanitarian values of medical students, we have to consider entering specialties where we can actually make money to pay off our student loans, buy houses, etc. Choosing a Medicare dominated specialty right now is a major risk. Physicians automatically lose money on most medicare patient visits, period. They make that loss up by billing more for services to other non-medicare patients. They have to or else they go out of business.

The system needs surgery, not a band aid. It will get surgery if we elect a President who cares about Health Care. We need a President who understands that we are THE ONLY industrialized nation without a Universal Healthcare System. We need a President who understands that you can't have a free market in health care because you lack an informed consumer (do you know if you have gall stones?), and the willingness to price shop (are you going to haggle with your surgeon over the price of your gallbladder surgery? Do you want the 'Closeout Sale' on last year's pacemakers?). Those two requirements of a free market do not exist in health care and thus any statement that market forces will drive down health care costs is a very risky statement.

5 Things You Must See

2008-05-15T08:25:00.002-05:00

I'm back! After a couple of weeks away from the blogosphere I have returned to share with you a list of 5 things (films, tv shows, etc) that you really should take the time to watch. This collection should be quite thought-provoking and stirring to your mind and emotions...

1. 'Sick Around The World' - Watch online at: http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/
(1 hour)
The World Health Organization has ranked the U.S. Health Care's System 42nd in the world, BEHIND countries like San Marino, Costa Rica & Slovenia! Can the U.S. learn anything from the rest of the world about how to run a health care system? Five Capitalist Democracies (NOT SOCIALIST) are examined to see how they do it.

2. 'For the Bible Tells Me So' - Watch a preview at: http://www.forthebibletellsmeso.org/index2.htm
Available to rent at Blockbuster
"Can the love between two people ever be an abomination? Is the chasm separating gays and lesbians and Christianity too wide to cross? Is the Bible an excuse to hate? Through the experiences of five very normal, very Christian, very American families -- including those of former House Majority Leader Richard Gephardt and Episcopal Bishop Gene Robinson -- we discover how insightful people of faith handle the realization of having a gay child. Informed by such respected voices as Bishop Desmond Tutu, Harvard's Peter Gomes, Orthodox Rabbi Steve Greenberg and Reverend Jimmy Creech, FOR THE BIBLE TELLS ME SO offers healing, clarity and understanding to anyone caught in the crosshairs of scripture and sexual identity."

3. 'John Edwards Endorses Barack Obama' - Full Speech at: http://my.barackobama.com/page/community/post/stateupdates/gGBlvM
This was a very gracious and very powerful speech! About 15 minutes

4. 'Dick Cheney's 1994 Interview on Iraq'
http://www.youtube.com/watch?v=S9YuD9kYK9I
2 minutes. Absolutely astounding...

5. More on the issue of Christian Hate & Love and how we as human messengers fail and succeed to show the love of Christ:
-http://www.youtube.com/watch?v=GXvixKupm0M
-http://www.youtube.com/watch?v=LpmI_n20dNs
-http://www.dreamcenter.org/media7.shtml

Baby Talk and Prayer

2008-04-29T08:33:00.002-05:00

In the past few weeks as my wife's pregnancy has progressed, now to 24 weeks, I have begun talking to the baby here and there. Usually it is right before bed when I'm pretty tired, which causes some interesting trains of thought to run out of my mouth. Often though I find it challenging to talk to the baby and of course, being the future physician & scientist that I am I need to figure out why. That's when I realized that talking to the baby in my wife's womb has striking parallels to...

Prayer. Yes, I am comparing baby talk to praying to God Almighty. Let me explain.

1. In both cases I'm talking to somebody that I have an important, soul-level connection with yet,
2. The person is an unknown mystery to me
3. The person has great power to ultimately change my life
4. In both cases I fear my ability to hold up my end of the bargain in the relationship
5. Both provide me with infinite learning opportunities
6. Both can and will bring me moments of great joy and happiness, and moments of frustration and... frustration
7. and the list goes on and on.

Anyhow, whenever you make analogies there is always the point at which the analogy fails. God of course loves me unconditionally despite my flaws, while the baby in its humanity will have periods of conditional love for me.

Ultimately though I think that my struggle results from my inability to consistently have faith in what I cannot see. I have always said that my faith struggles with God are caused by my scientific nature of needing to observe with sight, sound, and touch. However, the baby is narrowing that definition for me. I can feel the baby kick inside Katrina. I can hear its heartbeat on the monitor. I can even see the ultrasounds and Katrina's womb growing. However, I cannot see the baby directly and that is the disconnect. That is my disconnect with God as well when I'm not in tune with other aspects of my reality with Him, which is vastly more often than I would like.

So that is the dilemma that I'm working through.

The Human Condition VS. The Human Physician

2008-04-23T16:42:00.003-05:00

As a modern medical student I am fortunate to attend a medical school that has required curriculum in medical ethics. Normally in this class we discuss the ethics of issues like medical justice, rationing of limited supplies (i.e. donated organs), spirituality in medicine, etc. Today however, we strayed a bit onto the personal side, the human side of the physician, talking openly about the skeleton in each physician's closet...

Medical mistakes have historically been something physicians do not discuss for several reasons. First, admitting a mistake means admitting fallibility in a profession that commands perfection from all angles. Second, fallibility is not too far from loss of self-confidence and loss of peer respect. Third, our society is vehemently litigious.

Most physicians make very few mistakes in any given time period and only a small percentage of those mistakes do harm to a patient. However, even a harmless mistake, once realized by the physician creates deep feelings of anxiety, self-directed anger, fear, and oftentimes depression. These more severe responses are certainly heightened as the magnitude of harm done to the patient increases. But, for the 3 reasons listed above, and many more unmentioned, the physician is not allowed to deal with those emotional and spiritual issues in a psychologically healthy way. Many spend the better part of their career carrying this baggage until they learn to deal with it effectively or unfortunately turn to alcoholism, drug abuse, divorce, and suicide.

How we deal with this problem is a topic for a different discussion. My point today is the significance that this was discussed at length by 200+ future physicians in small groups today at Des Moines University. This is a historic paradigm shift for this profession! Today students were given the opportunity to understand that we will eventually make dire mistakes despite all the best intentions and training we'll have. We learned that we need to prepare for this by having support systems in place so that these events can be properly processed, grieved, and learned from. This is a great time in medicine now that physician's are beginning to care for their own physical, spiritual, and mental health. Hopefully more take action in these areas.

Am I Chicken Little?

2008-04-05T22:18:00.002-05:00

So if I remember right, in one version of the old fable, Chicken Little is actually right about the sky falling. In this real world case I would like you to look back at my February blog, The Hole in Health Care Reform and then take a few minutes to read this NY Times article about the current health care situation in Massachussetts:

In Massachusetts, Universal Coverage Strains Care by Kevin Sack.

If you are really bored you should take some time to review the testimony from the February 12th hearing of the U.S. Senate Health, Education, Labor, and Pensions (HELP) committee. In short, the same thing will happen nationwide as is happening in Massachussetts if we get the 47 million Americans insured by EITHER universal health care or free market. The title of the hearing was:

"Addressing Healthcare Workforce Issues for the Future"

I still believe in Universal Health Care variants that provide a government operated OPTION to compete with private health care insurers, but we do have to address the health care provider shortage. I certainly am saddened that there may now be true and significant examples to validate my fears from my original blog.

A Beautiful Face

2008-04-03T20:23:00.004-05:00

This afternoon Katrina and I had the amazing privilege of seeing our baby's face for the first time at our 20 week ultrasound (pics below). We held each other's hand, shed a tear or two, smiled a whole lot, and both tried to decipher as much of the images on our own as we could, still relying a lot on the technician to point out various organs, bones, etc. We also kept true to our desire to not find out the sex of the baby officially. This was a very unique experience for me because I tried so hard to only view the ultrasound through the eyes of an expectant father and not as a medical student. I guess that is the challenge I will face the rest of my life... to take the physician glasses off when necessary. Anyhow, enjoy the pictures by clicking below!

Unfortunate Reality Check - Islamophobia

2008-04-01T21:20:00.003-05:00

Please take a moment to watch the video linked below. It is a several minute clip from ABC’s newsmagazine ‘PrimeTime’. We all need to examine ourselves for how we feel about Muslims and the Islam faith. This video was both saddening and uplifting to see both responses, definitely uplifting to see those who supported this woman. I was most deeply touched by the father of an Iraq soldier who came to this woman’s aid.

http://desertpeace.wordpress.com/2008/03/31/islamophobia-is-unpatriotic/

Christianity has had a tendency to isolate and allow this type of discrimination to occur both within and outside the church. This is definitely not Christ-like and not the teachings of the Jesus that is my savior. While I and other Christians know the importance of faith in Jesus Christ, we must ensure that Christ-like values of grace and love are shown to the world and not anti-muslim, anti-gay, anti-whatever. Just a little reality check amidst our deep engrossment in the chaos of all our lives.

A Man Named Meester

2008-03-23T21:38:00.003-05:00

Today I experienced the future that is definitely now. For some this is old hat, but it was new for me and I enjoyed it. I am talking about Skype, the software that allows you to make free video phone calls online with an internet connection, webcam, and microphone. For those who are interested, my skype ID is rwrapp. Now, the actual significance of this story is the history... going all the way back to 1995 and a man named Meester...

Back in 1995 I was a freshman at Horizon High School in Thornton, CO. There was a teacher there named Ray Meester who despite being a lovable old hippie-type, also happened to be quite a math teacher and technological prophet. He had the foresight in the early 90's to get technology grants to make Horizon one of Colorado's first fully networked high schools with broadband in every room and a full service internet and technology lab. Yes, I became one of the internet lab T.A.'s and built my first website using HTML in 1995.

However, I distinctly remember a conversation with Mr. Meester about the future of internet technology. He predicted that while computers would get smaller and more portable (think Mac Air), that cell phones would actually become more powerful and computer-like (think Blackberry). He also said that a time would come when he could be sitting in his canoe fishing in a mountain lake, connected wirelessly to the internet through a cell phone card in his laptop, making a video call to his math classroom to teach trigonometry while he fished. That would be Skype. He shared these thoughts with me 13 years ago in 1995!!!

Unfortunately, Mr. Meester died of cancer in November of 1997, and thus did not see these things come to pass. I mention this whole story simply because it is an amazing memory of someone who was a good friend, great teacher, and wise in many ways. This world can always use more teachers like Mr. Meester.

A Week of Contemplation

2008-03-20T12:11:00.002-05:00

This week, Spring Break, has been refreshing for me as we have visited Katrina's family in Ohio. Oddly, I spent most of the week working, doing baseboard and trimwork carpentry in my in-laws house. For me this is exactly what I needed. I realize that amidst the measuring, cutting, painting, and nailing I've had quite a bit of time to contemplate where I am mentally, spiritually, physically, and even politically. Let me devote a few sentences to each...

Physically I am in limbo. I have regained all of the 50 lbs I lost during the Fall & Winter of my senior year at UNC. With that comes all sorts of psychological, physical, and sleep problems. But I have also been getting back into regular exercise, finding new ways to get myself motivated, and nearing a point of commitment to nutritional change. This of course has been a lifelong battle for me, but I continue to remain interested in fighting, and someday I think I'll find the right strategy.

Mentally I'm ready to get back to school and finish this semester. The change of thought process this week to visualization, mathematics, and a little creativity has been good and I know that the summer will give me the same opportunity with my research job and masters classes. I realize that I need to somehow incorporate more alternative mental exercises than I have, even though I have kept playing my guitar, writing on occasion, etc. I also realize that I'm still not feeling attached to the baby growing inside my wife which makes me feel somehow like a bad father or husband even though I know most fathers feel this way during a pregnancy and it ultimately isn't true.

Spiritually I'm distant but not detached. That is actually a positive for me because I no longer let myself go completely. God still is in my consciousness, which means hope and joy are always present to some extent in each day in my life regardless of whatever other depression may exist. Faith and Med School are not mutually exclusive but finding the right conditions for both to thrive is a challenge for me.

Politically I've realized that I'm angry and disenchanted. What started for me as hope for change, an unstoppable wave or societal revolution has now become mired in the same political sewage that sits stagnant across the floodplain that is our American 2 party system. What was a sure thing for the Democratic party has self-destructed behind the efforts of a candidate too self-absorbed to realize they've been beaten, dragging down the candidate who could secure the future generation for the party, and that candidate allowing themselves to be drawn off-topic by these efforts. The Clinton's are the political equivalent of Mike Tyson, the heavyweight fighter who won't retire or go away when they can no longer win, and Obama has become Evander Holyfield, the person known for getting his ear bit off by the Clintons... Al Gore lost because he was too attached to Clinton politics. Now, somehow Obama has allowed himself to become attached to Clinton politics. Maybe his speech on race will be a good first step back out of the mire.

I think it is time for me to focus on my spiritual, physical, and mental needs... letting the political cards play themselves.

My Baby's First Story

2008-03-08T16:29:00.002-06:00

Last night I read my baby its very first story. In my mind I know that the baby, our first child, cannot actually hear my words at 16 weeks in the womb. But deep down part of me wants and needs to bond with my child, and to begin sharing my world with him or her (we are not finding out the sex). The story that I read is called, "The Crippled Lamb" by Max Lucado. It tells the story of a little white lamb with spots of black wool and a crippled leg. These differences cause the lamb to be left out by the other lambs. It also causes him to be left behind in a stable when the shepherds take the flock to the next valley to graze. He feels so left out and lacking in purpose. While in that stable, a young couple arrives and the woman gives birth to a little baby. The night is cold and the baby begins to cry. The little lamb realizes his wool can keep the baby warm, so he cuddles up to the baby, who then stops crying. The mother thanks the little lamb for taking care of God's son Jesus. The little lamb finally realizes that God had a grand purpose for the problems that left him at that stable.

I did not know what this story was about before I read it to my baby. It seems like possibly the most appopriate and powerful first story a soul, a new life can hear!

God bless my friends!

Type rest of the post here

Phenomenal Articles

2008-03-06T21:32:00.001-06:00

Check them out!
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1824740.
http://jama.ama-assn.org/cgi/content/full/295/4/429.

A Response to Parable Comments

2008-03-06T10:40:00.005-06:00

I have received a couple of good, critical comments to my posting entitled 'A Parable to Ponder'. I encourage you to read that parable and those comments, and then review this response to those comments. It is understandable that my zeal for the cessation of direct-to-physician marketing and gifting by pharmaceutical companies may have come across as an opposition to pharmaceutical companies as a whole. That is not my position and I will explain further, and respond to other comments as you read on...

I was asked to remain open-minded about Pharma and learn more about their role and influence in medicine before jumping to conclusions. You all should know that I firmly believe the pharmaceutical industry has produced amazing medicines and devices that have saved millions of lives and improved the quality of life more millions more, including myself. I would hate to see what this world would look like without the products this industry has put forward. Pharma has created the Partnership for Prescription Assistance to help poorer patients receive medicines in this country. My issue with Pharma lies in their violation of medical ethics. When a company deals in medical products and has a mission statement stating that you want to improve patient's lives as much as possible, they have put themselves under the constraints of medical ethics. Therefore you violate medical ethics and your stated mission by:
-Intentionally trying to influence physician's to prescribe your product more than a competitor by giving them free gifts.
-Saying you are helping educate physicians but providing research data that only SUPPORTS the product, providing data that only compares the product to placebo and not others in the same drug class
-Saying you are giving free samples for distribution to poorer patients but only providing free samples of the newest, most expensive Tier 3 drugs that a poorer patient would never be able to afford.
-Advertising to consumers with coupons for __# of days free of a medicine if your doctor will prescribe it for you.

So many great resources relating to these issues can be found at http://pharmedout.org/topic.htm. Different companies participate in these practices to different degrees, but the practices are highly prevalent in every major Pharma company like Wyeth, Pfizer, Amgen, etc.

Physicians are ALSO a part of this medical ethics violation. By accepting free gifts no matter how small, you are creating a conflict of interest. Find the time and take it to do your own research. Don't even risk the appearance of a potential ethical violation. Don't accept the gifts. This is the mission of PharmFree. To help physicians and future physicians see the conflict for what it is, and to change their personal behavior. My personal opinion is that a pharm rep could come to my future office leave their research data and free samples at the front desk and leave. I will not see them. I will review the data as a part of a larger literature review, and I will only give the samples to the patients who will benefit most from that drug AND cannot afford it, but will also educate them on how to get prescription assistance.

Another commentor posted a thought about eliminating all Pharma marketing. I do not think this is feasible. Remember that these companies are operating in a unique business arena where they can only hope to get physicians to write prescriptions. They do not have many options within their federal regulation constraints to get the word out about complex products that they have invested billions of dollars and 7-15 years of research and development in. I believe that direct-to-consumer advertising does get patients to see their doctors more for conditions that need to be treated, while also generating a fair share of hypochondriac syndromes. I also think in a minority of cases these patients put pressure on the doctor to prescribe the medication they heard about. That is pressure doctors should be able to resist through good communication and patient education based on the physician's personal research. Yes Doctors also see the ads on T.V., but in this case they do not have the subconscious drive for reciprocity of the gifts back to the Pharma company. This is a tougher issue because, as I said before, we need Pharma to survive and progress in this world. Ultimately we just need to find a way to get both Pharma and Physicians to interact ethically so that patients get the most possible benefit and Pharma survives economically.

The Appropriation of Gentility & Power

2008-02-29T13:09:00.005-06:00

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!

The Hole in Health Care Reform

2008-02-25T21:58:00.004-06:00

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.

A Kitten in a Boot

2008-02-19T22:54:00.004-06:00

I would like for all of you to take a moment and view this video:
http://video.yahoo.com/watch/1805112
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.

A Parable to Ponder

2008-02-13T15:09:00.004-06:00

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 http://www.pharmfree.org 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!

Super Tuesday Observations

2008-02-05T21:40:00.000-06:00

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!

Yes We Can!

2008-02-03T13:24:00.000-06:00

Superbowl & Superbugs

2008-02-03T08:43:00.000-06:00

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!

The Routine

2008-01-23T09:30:00.000-06:00

It is 9:30am on a Wednesday. I am in the library just now beginning to study for my Microbiology exam on Friday. 2 days to learn somewhere between 50 bacteria and viruses, what disease they cause, how they cause it, etc. It would appear that I am the epitome of procrastination but for once in my life... I'm the norm...

You see, it is 9:30am on Wednesday. At 8:30am I finished a Physiology exam that I had studied for since last Wednesday's Microbiology exam (a week between exams was a luxury and I did do some skimming of Micro last week). So 8:30am-9:30am was my reflecting period on the Phys exam, and now begins my focus (post-blogging of course) on Micro. That makes me normal because all these other 1st year med students sitting around me are doing the exact same thing. I can guarantee none of us touched Micro this week until now, and now none of us will touch any other class until Friday morning at 9:30 when Micro is over.

That is the routine. The beauty that I'm regaining consciousness of is that God has given us the ability to make the routine work. Those who choose to balance the routine with school/work, life, family, faith are able to succeed in this environment as much as those whose rent checks might as well go to the Library. That has to be God!

Bootcamp, Bugs, and Brain-fry

2008-01-15T22:33:00.000-06:00

I do not often blog without a significant and self-declared 'profound' purpose out of respect for my readers. But tonight I'm breaking my own rule to detail what happens to a human brain and body during a typically atypical 18 hour med school day.
Read on my friend, read on...

My day started at 5:30am as I awoke to prepare for the first session of 'Beach Body Bootcamp' at DMU's wellness center. No, I am not trying for a 'Hasselhoff-ian' Southbeach lifeguard physique, but I am trying to establish a LIFESTYLE of better health. Of course, better health means pushing myself precariously close to the vomitous cliff, but man I felt good most of the day!

I also had to miss some morning classes to go get my 3rd vaccination in the Hepatitis B series that all healthcare workers (and med students) are required to have. If you didn't already know, County Health Departments are THE place for affordable immunizations. But you do risk getting your immunization done too high where more nerves are. It worried me that the immunization was given right through the middle of my right shoulder tattoo, thinking that it could pose an infection risk of some sort. Of course I had to research this and while there is not a lot of info in the medical journals, and most doctors/nurses have never had a problem puncturing through tattoos, there is a recent journal article out of Alberta noting that 3 women in labor received epidurals through lower back tattoos without incidence. So now all I have is soreness in both shoulders from Bootcamp pushups and vaccination side effects.

Since it was Tuesday I also had a Christian Medical Association club meeting today. No free lunch at this club meeting, but some great spiritual nourishment!

Tuesdays this semester also means Physical Diagnosis lab! Yeah for actually learning something about medical practice while in medical school! I was a bad lab partner today I must admit. It seems that my 'excess tissue' makes it hard for an inexperienced student to find many pulses, palpate certain structures, get different sounds during percussion, etc. Don't worry though... my lab partner was skinny, so it worked out for me...

Oh, if your doctor ever tells you he needs to "percuss or pat your kidneys for tenderness or pain" we actually call the technique a "kidney punch". You might have thought kidney punches were only intended to cause pain, but NO, they can be diagnostic too! (It's not really a punch so don't worry)

So I spent my evening cuddled up with my laptop in various positions of temporary relief from bootcamp and vaccination pain, studying for my Microbiology exam in the morning. This is the first exam of the semester and I definitely have struggled with getting back into the study swing. I must admit that I've come to a conclusion. The battle for survival between the humans (and their immune system) and Microbial species is simply amazing. Example: Some bacterial species have a prominent cell wall in addition to their cell membranes. Penicillin is an antibiotic of the Beta-Lactam class that stops the formation of the cell wall around some of these species and they die, ideally. Penicillin worked great at first until a species of bacteria with Anti-Beta-Lactam capabilities shared those genes with other species, and yes bacteria are capable of changing their genome 4 different ways. So in the case of Staph Aureus bacteria we came up with Methicillin which worked great UNTIL a Methicillin-Resistant Staph Aureus (MRSA) came up. Now we have Vancomycin to treat MRSA and there now appears to be VRSA. By the way, Staph Aureus is a small but normal part of the flora on our skin, so our body does a great job of fighting it naturally the vast majority of the time.

This is my life. It is now 11:30pm. I woke up at 5:30am.

Hardest Working Person on the Planet

2008-01-10T21:34:00.000-06:00

So this morning when I worked out on the stationary bike, I got my working heart rate up to 145 BPM. Vastly more exciting though was seeing & hearing the first ultrasound of Katrina and I's baby, now at 8 week's gestation. I am now able to say with clear conscience that a developing fetus is the Hardest Working Person on the Planet... and here is why.

First off, I know many of my friends and I have differing opinions on the 'personhood' of a fetus but we can get past this by identifying this particular blog post as 'cute' and not 'political'. Sound good? Good!

Back to the story. So at the ultrasound our baby had a healthy 170 BPM heart rate, which got me thinking about why such a high heart rate is necessary for such a small thing. That, of course, led me into scientific thought. The heart rate is so high because of the mass amount of gas exchange needed to support the unfathomable amount of metabolism occuring in the fetus. Think about this:

-At 8 weeks our fetus is 2cm long.
-At 40 weeks normal gestation a newborn is about 51cm (20 inches) long.
-This is a 2500% increase in size over 32 weeks.
-Should I grow 2500% between now and baby's due date, I would go from 75 inches (6'3") to 1905 inches or approximately 160 feet tall.

By the way, baby is not just getting bigger during these 32 weeks; he/she is also developing most every body system and structure from this point forward. Almost equally impressive is the growth of the mother's womb and adaptation of her anatomy to pass "a camel through the eye of a needle".

Babies are neat! Mommies are neat too!

Iowa Caucuses 2008!

2008-01-05T12:54:00.000-06:00

So Thursday night, 1/3/08 was simply amazing, at least for me being the political junkie that I am. I was able not only to participate in the Iowa Caucuses, but so much more...

First off, you can see videos and pictures of my Caucus experience at:
http://www.youtube.com/profile?user=rapp9736
http://viewmorepics.myspace.com/index.cfm?fuseaction=user.viewAlbums&friendID=50384107

So, my caucus precinct location was a high school cafeteria not far from our apartment. The turnout there was 471 which was more than double the previous record turnout for this precinct. Our precinct includes a prominent neighborhood and the Governor's mansion, so Iowa Governor Chet Culver and Attorney General Tom Miller were both there and I got to meet Mr. Miller and chat with him for awhile. Governor Culver even stepped in at one point to calm down one caucus-goer regarding the rules of the caucus. I was also interviewed by a reporter from the Chicago Sun-Times, although I don't think I made any articles.

Ultimately though, I think I may have been a part of history! I am a Barack Obama supporter and our precinct went 60% for Obama (He won the state with 38%). His victory speech in Iowa was so very inspiring! I encourage you to listen to it if you haven't already at: http://www.youtube.com/watch?v=yqoFwZUp5vc&feature=bz301
I stood among this packed crowd of people chanting for Obama and saw Clinton and Edwards supporters looking very dejected. It simply was an amazing experience, and somehow I ended up becoming one of the Obama delegates to the county convention where the final votes actually happen. Wow! Wow! Wow!

Rick and Katrina - 2007 year in pictures

2008-01-05T12:36:00.000-06:00

Type rest of the post here

Winter Days Free-Write

2008-01-01T20:13:00.000-06:00

Bitter cold outside
tightening the lungs
as wind whips by
and sunlight deceives

A day to hide
in the blanket warmth
of home and love
and an old sweatshirt

Movies and football
drama and... drama
stealing glances
at my beautiful wife

Smiles and joy
heartwarming day
catching my wife
stealing glances at me

Winter days
have a warmth
of their own.

Band Aids are NOT good healthcare for Seniors

2007-12-19T07:41:00.000-06:00

While most of the country was completely unaware, a very important piece of legislation was passed by the U.S. Senate yesterday. However, it is only a short-term band-aid to a major gash in the U.S. health care system... a wound affecting over 44 million Americans plus 1500 new Americans every day. What is it? Read on my friend!

Medicare reimbursement for physicians. Now, I know that may sound selfish coming from a future physician, but let me explain the facts. Physicians in this country were due for a 10.1% reimbursement cut on January 1st, which has now been pushed back 6 months to give legislators more time to resolve an issue that they have stalled on, and band-aided every year for the past 6 years. While medicare reimbursement rates to other types of health care providers have gone up over the past few years, the rate for physicians and private insurers who provide medicare type benefits to seniors have stayed flat. The only reason they have stayed flat and not decreased is the repetitive band-aid approach. The problem is that the cost of operating a medical clinic is going sky high, so if reimbursement rates do not follow it becomes very difficult for a physician to give time to medicare patients or to accept new medicare patients (think Baby Boomers hitting retirement...). As a future physician, and the son of parents getting closer to medicare age, I am deeply concerned about the impacts of medicare reimbursement on quality of care for our seniors!

Many physicians are practicing in areas where their patient base is 30, 40, or even greater than 50% medicare! So many physicians are facing the ethical dilemma of not seeing Medicare patients, or having to charge them an extra fee to make up the difference, or reducing their visit time with medicare patients to see more patients total. None of these options are good options, especially if you know somebody who is on medicare, will be on medicare in the near future, or if you are on medicare yourself.

The 10.1% pay cut that was due on January 1st will still take place at the end of June if Congress doesn't finally act to fix this thing. In fact, the next 8 years are scheduled for 5% cuts each year under the current algorithm that bases physician reimbursement on whether or not spending growth is more or less than an economics-derived target rate. If spending growth in health care exceeds the target rate, physicians get a pay cut. The problem is that everything in health care is getting more expensive, at a rate faster than economic inflation. So ultimately we are looking at a 40% pay cut from Medicare by 2016. It is pretty much a guarantee that Physicians will not see Medicare patients regularly if that is the case. Best-case scenario is that they have their mid-level providers like Physician Assistants and Nurse Practitioners see them, but -40% will still make that virtually impossible from a business standpoint.

Medicine should not be a business and physicians should not have to worry about what patients they can and can't see in order to stay in business. The medicare system as it stands is going to force Physicians to put business ethics above medical ethics and that is wrong. We need our congressional and senatorial leaders to make this change for the future of our seniors and our health care system. We need our next president to care about health care for seniors, reducing health care costs (reduce costs for physicians and reimbursement cuts are not a problem), and improving the quality of health care in America!

Crawling to the finish line

2007-12-14T09:49:00.000-06:00

Well, I've met my match. Throughout my collegiate career I always managed to hold off until Christmas break to get sick. But not this year! Not only am I breaking my trend, I'm now on my second cold in the last month. Of course my mind has decided to try and formulate some reasons for this new found immunological breakdown...

1. I'm 28, not 25, or 21. Apparently I'm not invincible... who knew?
2. The 4 month long finals week.
3. 5 exams over a 10 day period just wasn't enough challenge... "Go big or go home!"
4. Woot. (certain people will understand)
5. Several months of sniffing formaldehyde in the anatomy lab has convinced my body that it is, in fact, dead.
6. Speaking of anatomy lab... a thorough dissection of the male genitalia has been shown to have all sorts of side effects in male medical students (i.e. mild-to-moderate depression, lower abdominal/inguinal pain, deep feelings of disloyalty to one's team).
7. Bacteria and Viruses thrive in moister environments... There's more humidity in Des Moines than Colorado... THEREFORE... humidity kills! There, I said it.

I need a cough drop... and a hug.

Disco Doctor?

2007-12-06T09:39:00.000-06:00

Check out this article: http://www.msnbc.msn.com/id/21599495/

"Associated Press -
updated 1:42 p.m. CT, Fri., Nov. 2, 2007
SYRACUSE, N.Y. - A dentist was dancing to a song on the radio while drilling on a woman's tooth, and she wound up in the hospital when the drill bit snapped off and lodged near her eye, a lawsuit alleges." And what song was he dancing to...
1976 hit song 'CARWASH'!!! What the heck??? We all know that the only appropriate disco song for the doctor's office is 'Stayin Alive' by the BeeGee's! I hear that they're going to make a movie about this Dentist, and John Travolta will be playing the lead...

The Myth of Medical School

2007-12-06T09:34:00.000-06:00

Have you ever wondered what medical school really is like? I did before I got here. There is this social myth or mystique or urban legend or drunken monologue in our world about the secret society of medical school. While it is hard and challenging, it definitely is not what you think it is... so let me reveal to the world the truth... and it all starts with free lunches!

"Free lunches???" is what you are saying. Yes, free lunches are near and dear to the medical student amongst many other things. You see with our class load and debt load combining with the requirement of extracurricular activities (to get into a good residency), clubs and other organizations wishing to get a portion of our time are limited to the lunch hour. Essentially, Free lunch = attendance. Of course by "free" I mean that my club dues OR my tuition pay for it, but "FREE" sounds so much nicer. That is a nice segway to the fact that aside from our classes and studies we do have to be involved in clubs and community service/outreach both to satisfy the humanitarian values that most of us have and to help us get into that all important but completely and subjectively undefined "good residency" after medical school. In my case I am a member of 4 clubs and am an active 1st year leader for one of them; the Student Osteopathic Medical Association or SOMA.

Another vital aspect of medical school is your ability to acquire the prime study spaces. Many students think this is an acquired or teachable skill, but I happen to think it is a gift bestowed by God upon a select few individuals. Seeing the sad, longing faces of other students wander past the closed door of the room that you just snagged, knowing that they will make 2 or 3 more passes by your door just to be sure it is occupied is both shaming for a few seconds yet mostly exhilirating. Away with you to the glorified cherrywood voting booths we call 'study carrels'!

So let me get to the point. Medical school is hard academically and somebody must have some intellectual and intestinal fortitude to get through. But really it isn't just classes and studying. It is a lifestyle that is unique and there is camraderie that is so enjoyable! You do have to find joy in the little things like free lunches and stumbling upon the one open study room, but is that really different than a co-worker proactively smiling and saying hello, or getting a compliment from your boss, or realizing they're serving your favorite lunch in the cafeteria?

Elections and Healthcare Reform

2007-11-30T22:44:00.000-06:00

While next year's election has much bigger issues at hand than healthcare reform (i.e. Iraq!) I have had quite a few people ask me about my views on candidates, their healthcare plans, and what the issues are in the healthcare system. Remember that I do live in the capitol of Iowa and we are one month away from the Iowa caucuses that will make or break many of the campaigns. In fact, two presidential candidates (Joe Biden & Mitt Romney) have spoken at my school regarding their healthcare plans. Being a political junkie this is like candy for me.

So here's the short, sweet version of the healthcare reform issues:

1. Democratic universal healthcare concepts are NOT socialized medicine like Canada and Europe. All of the major democratic candidates are proposing a national health insurance payor AS AN ADDITIONAL OPTION to private insurance companies.

2. How do we get the 47 million uninsured people in this country insured?
-We need to deregulate the health insurance industry to allow more competition and the reduction of insurance prices. Adding a governmental national payor to the mix can drive competition and drive costs down.
-We need to require insurance companies to insure everybody regardless of pre-existing conditions for a fair and equitable price.
-We need consumers to have access to these different companies' pricing structures
-We need to have regulations in place regarding employers carrying catastrophic insurance so that major medical costs for one member of a group plan do not raise rates for all members.
-We need to require those individuals who can afford health insurance (at the newer competitive rates) to buy insurance like we require car insurance.
-We need to ensure that every person who qualifies for medicare/medicaid is aware that they are qualified and are enrolled.
-For those that do not qualify for medicare/medicaid and do not make enough to buy private insurance (about 15 million people) we provide a stipend for that insurance (and ensure that they use it to buy into the national payor program. Our government currently pays hundreds of millions of dollars annually to hospitals to cover the cost of free care given to those who are not covered under insurance. We can redirect this money to the stipends and get everybody covered.

3. We need tort reform in medical liability and legal reform in medicare reimbursement. Did you know that a family practice doctor has to spend tens of thousands of dollars annually for malpractice insurance (an anesthesiologist may pay $100,000 annually!)? Setting liability limits and monitoring liability insurance companies will reduce this single largest expense of physicians which we can pass on to the patients. Also, our government keeps allowing medicare/medicaid reimbursements to physicians to decrease (10.1% next year unless congress acts to change it) leaving physicians to be forced to increase rates to non-medicare patients and subsequently higher health insurance rates. Health insurance companies follow whatever medicare does and drops their reimbursements along with medicare.

4. Prescription drugs. I hear all this talk about the government buying drugs from Canada so we can get the cheaper rate. Why don't we look at the pharmaceutical companies??? These companies create a phenomenal product, but they spend billions and billions of dollars annually on marketing paraphernalia (pens, notepads, etc), free lunches for physicians/nurses/etc, and paying physicians $500-$1000 to give a one hour lunch talk to other physicians about a drug. Granted these physicians are making a questionable decision regarding medical ethics, but when a pharmaceutical company is offering you $30,000 a year just to give 30-35 free lunch talks... how hard would that be for you? Some of us are fighting this infiltration of pharm companies into medical ethics (http://www.pharmfree.org/)

So which presidential candidates do I think have it right in their healthcare plans? Barack Obama on the Democratic side and Mitt Romney on the Republican side. What I've described is the Obama plan, and also very similar to what Mitt Romney put in place successfully in Massachusetts, however he doesn't believe the federal government should mandate this system nationwide ("Let the states decide"). So that's the long and the short of it. Check out:

http://www.ama-assn.org/ama/pub/category/17712.html

http://www.barackobama.com/pdf/HealthPlanFull.pdf

http://www.nytimes.com/2007/11/25/magazine/25memoir-t.html?_r=1&ei=5087&em=&en=14f86674a4b9bfd7&ex=1196226000&adxnnl=1&oref=slogin&adxnnlx=1196486558-vP9f3Z6CHCRLvNIQN5uSBQ

Thanks for reading and God Bless! E-mail me at richard.w.rapp@dmu.edu with any questions!

Why a Blog?

2007-11-30T20:35:00.000-06:00

Well I believe that if you have something to say then somebody out there is probably willing to read a few sentences of it. But really what this blog thing is about for me is sharing my thoughts and experiences regarding my life as a husband, friend, non-friend, etc who happens to be a medical student. That way those that I care about and those who stumble upon this blog can understand more about this world I live in. You will probably get glimpses into my academic life, spiritual views, political views, and poetic sides. Regardless, just know that I appreciate the opportunity to share, and you taking the time to read!

God Bless!

Ahhh, Welcome to the insanity!

2007-11-30T20:10:00.000-06:00

So welcome to my world! My name is Rick and I am medical student. If that sounds like an A.A. introduction well, it almost is. You see, many people might find a personal flaw in somebody who is intentionally forking over $150,000+ over four years so that they can:
1. Study all the time
2. Spend less time with their family, friends and hobbies
3. Take 1-3 'final equivalent' exams each week
4. Dissect and learn every (and I do mean every) part of a noble (and I do mean noble) body donor.
5. Learn a job where the majority of their income comes from health insurance companies and the government.

But the kicker is that I am going to be a doctor, hopefully even a healer. I take that seriously despite my joking. In the future people will come to me at their weakest points and I will have the amazing privilege of helping guide them back to strength! Not only that, but I get to educate them about the miracles taking place every second within their bodies! To me, that makes it worth the hardships of applying to, and surviving medical school. Thus, you have now seen my heart fully exposed!