I’ve been reading Maggie Mahar’s
Money-Driven Medicine
and wow–if you need any more evidence that our health care system is a mess of perverse incentives and profit drive, Mahar will give it to you, plain and
simple. The book makes a fantastic case from both economic as well as social justice and ethical viewpoints.
Several really important concepts that she nails, which may just have to become their own posts:
We spend almost twice as much per person on healthcare in the US than in other countries, but we clearly aren’t getting a system that’s
twice
as good, if better at all.
Economic theory demands that in order for a consumer to make a purchasing decision, he or she must have information about the good or service and its value.
“This is what makes the purchase of health care so different from any other purchase: it is a transaction based on trust.” This speaks greatly to our
duty and professionalism as physicians.
“Insurance companies possess neither the expertise nor the standing to set the nation’s health care priorities.”
Medical ethicist Daniel Callahan: “The market is far better at meeting immediate short term private interests than long-term collective needs.”
Economic theory often doesn’t apply to the health care industry. Hospital mergers, one would expect, should reduce the cost of business through economies of
scale. Instead, they often lead to duplication. Hospitals merge to improve their bargaining power with insurers, not to reduce costs or save money.
More care is not necessarily better care.
Another concept I’ve materialized myself, as the saying goes:
If you’re a Democrat when you’re young, and a Republican once you get a mortgage, then you’re for private health insurance when you’re well,
and you’re for health care reform when you’ve developed chronic disease.
In the old middle school joke style, set to the tune of “Yes, Oh Yes, This Happened To Me Yesterday”:
What’s gross?
Cadaver lab, where students learn how to do procedures on fresh frozen cadavers.
What’s grosser than gross?
Being the TA, and injecting fluid into the
ankle joint
so students can tap it easier.
What’s grosser than that?
Injecting too much fluid into the joint space, leaving the needle in place, and removing the syringe for some stupid reason, and then getting hit, from chin to
chest, with several spurts of cadaver joint fluid.
We spent $875 MILLION (that is *not* a typo) to fund abstinence-only education over the last 10 years. The results? Absolutely no differences in abstinence between
control groups and abstinence-only education groups. (Okay, actually, those in the abstinence-only group were 1% more likely to have 4 or more sexual partners. Oops.)
One of the most amazing things that I read after the killings in Pennsylvania at the Amish schoolhouse was the Amish reaction. It brought tears to my eyes, and
overwhelmed my heart.
They forgave the gunman. They invited his family to their own wakes and ceremonies for grieving.
I don’t know that I could react in such a way–especially so quickly. To be in the position of choosing revenge and anger–or on the other hand,
forgiveness–is an incredible position of power. And to choose forgiveness is one of the most selfless and freeing acts we have left.
My heart goes out to everyone affected by today’s tragedy in Virginia.
Resident Other
blogs what it’s like to be a spouse of a medical resident.
When I started this blog
I was still pretty able to look outside in to the medical world and school, but no more. I’ve drunk the Koolaid, and my perspective is shit.
An upper classman spoke at our orientation. She remarked that while most people believe medicine to be so altruistic, it’s often the most selfish career path
there is. We in the field ask so much from those we care about–our friends, family, partners–that have to tolerate our hectic schedules, stressful lives,
and times we aren’t there for them.
I am so very, very disheartened that the world has lost
Kurt Vonnegut
. I’ve read almost all of his works, and his book
God Bless You, Dr. Kevorkian
— readable in 20 minutes — is such a beautiful highlighting of humanity that it’s thus far my favorite book of all time. I actually just re-read it
again last week after feeling down and dejected, losing a young man that we coded earlier.
Vonnegut greatly influenced my perspective and world view, or at least gave words and sentiments to my thoughts about the world and how humans should treat each
other. With that, I leave you with some of my favorite quotations (many from my favorite book):
“We are here to help each other get through this thing, whatever it is.”
“I am a humanist, which means, in part, trying to behave decently without expectation of rewards or punishment after you are dead.”
“So it goes.”
“One thing which Uncle Alex found objectionable about human beings was that they seldom took time out to notice when they were happy. He himself did his best to
acknowledge it when times were sweet. We could be drinking lemonade in the shade of an apple tree in the summertime, and he would interrupt the conversation to say,
“If this isn’t nice, what is?””
And Vonnegut wrote for his own Epitaph:
“THE ONLY PROOF HE NEEDED
FOR THE EXISTENCE OF GOD
WAS MUSIC”
