The Cost Conundrum

Mon, 15 Jun 2009 15:23:00 -0500

This was written by Elliott on elliottandlara.com.

Today's Lunch Break:

The Cost Conundrum, by Atul Gawande

I started to summarize my favorite points from this piece, but I decided against it. Because...you need to read the article in its entirety [1]. It's that good.

Yes, I am a soon-to-be-medical-student, so naturally this is a topic of great interest to me. But I hope that by reading Gawande's article, you too are convinced that health care reform is the most important issue in America today, with great personal relevance to each citizen and with far reaching fiscal implications for our country. It is not an issue that can be solved with simple solutions, talking points, or finger pointing. I am beginning to see that the usual points of debate (i.e. private vs public insurance) are largely irrelevant to many of the fundamental problems. Like Gawande, I believe that we must lay aside ideology for empiricism if we are ever going to succeed.

Today Obama addressed the American Medical Association (and for the first time I followed live tweets [2]). There is much that could be said, good and bad, about Obama's speech, but I was happy to learn that he (President Obama) had also read Gawande's piece.

While I continue to worry about health care reform, that in itself is a reason for hope.

[1] When you're done with that, a great commentary on Dr. Gawande's article can be found here. An interesting take on Obama's speech can be found here. For more insights by Dr. Gawande, check out Better (a must read) or watch the lecture he gave to us at the National Institutes of Health. Also, an interesting piece ("The Isolationism of Health Reform") was posted on Slate last night.

[2] Yes, I am one of those users...and I read more about Twitter in tech news than actually use it.

Paradigm Lost

Fri, 13 Mar 2009 13:55:00 -0500

This was written by Elliott on elliottandlara.com.

Today's Lunch Break:
http://bits.blogs.nytimes.com/2009/03/10/using-technology-to-skip-the-doctors-office/

My grandfather, a retired pediatrician who shares my first and last name, speaks fondly about going on house calls, black doctor bag in hand, to checkup on children and calm worried parents. In the past few years, I have run into multiple people who, upon recognizing our shared name, speaks of him in glowing terms like "my doctor" or "our pediatrician." My grandfather says that such relationships were the most rewarding aspects of his career.

Like my grandfather, I expect much of my satisfaction as a physician will come through direct interaction with patients--email, phone, office visit, house call, whatever form it ultimately takes. On my mission, I spent much of my time in regular, intimate visits with individuals and families. Many were wanting to make lifestyle changes, such as overcoming addictions, and were often very open despite my being almost a complete stranger. During our visits, as I listened to their fears and doubts, I developed for them a kind of love that I had not experienced before. I expect medicine to be similar.

I realize, however, that such satisfaction will not be guaranteed. It only takes a quick web search with the terms "physician disillusionment" to realize that there are real challenges facing doctors today. My greatest fears as a physician include being caught in a situation where I am bound by the dictates of an insurer and not the available best evidence and my own conscience--or worse, I fear that my idealism will sour into cynicism amid a daily grind of paperwork battles, malpractice fights, and business decisions. Even my grandfather has noted the changes to the health care system with managed care and wonders if he would still choose medicine, were he and I to switch places.

How do we fix health care? That is the million dollar question...well, no actually, it's the two and a half trillion dollar question [1].

We're not short on solutions. Today's featured article, as an example, points to the merits of the use of secure email and electronic records, as evidenced by doctors in Hawaii. In the age of Google and Facebook, this idea seems incredibly obvious--and frankly, a bit shocking that it is newsworthy at all. But sadly, this simple, small innovation is made nearly impossible by the present "fee for service" paradigm that doctors find themselves in.

I'm glad that health care reform has remained in the public consciousness and in the current administration's agenda. Hopefully when I'm done with medical training--nearly a decade from now--I won't have to deal with the worst of our current problems. In the meantime, you'll probably be hearing a lot more on this subject from me.

[1] And it's not paying off.

Elliott and Lara - Medicine

The Cost Conundrum

Paradigm Lost