I’ve said a lot of goodbyes over the past few weeks–classmates, old friends, family, exes, and now you, my dear readers. (Yes, yes, say it ain’t
so!)
I started this blog
almost 5 years ago
(wow) to document the process of becoming a doctor, write about health policy, explain medicine, and provide an outlet to process and reflect on the things that I
experienced. By all possible measures, I’d say it was a success.
The further I got into medical school, the harder it was to remember or understand what it’s like to be a patient–in terms of the knowledge and the
experience. It’s hard to remember what it’s like not to know what a drug does, or the pathophysiology of CHF, or when a patient is ready for discharge. I
think this is one of the biggest challenges we have to overcome–becoming doctors by definition requires us to enter a different space than our patients, yet we
still must communicate and explain without trying to over- or under-simplify.
And along the way, I guess another goal was to show people that doctors are simply fallible humans that are, in the vast majority, trying their best, but are prone to
the same flaws and errors and mistakes that all of us are. It just sucks that our mistakes have much bigger consequences. I will always strive for perfection in my
practice of medicine, but know I will never achieve it. I wish more patients would realize this.
Thanks for all the comments, support, criticism, and linkage over the past 5 years. This book of my life is over, but who knows, you may see me again. My goals right
now are to hit residency with a running start, learn New York, meet friends, find some love along the way, and if I find that I still have time to blog, perhaps
I’ll be back. It’s been a great 5 years!
(I’ll be moving the archives over to http://grahamazon.com/over2/ in the next week or so.)
Good Afternoon Dean Pizzo, family and friends, colleagues, The Guy Who’s Totally Uploading This To YouTube Right Now, The Undergrads Who Heard There’s Free Alcohol
Afterwards, and of course, my fellow classmates, the Graduating Class of 2008,
Britney Spears once famously said, “Hit me baby—.” That was my ORIGINAL version of the speech. You weren’t supposed to hear that. Awk! Ward! Blarg. Wow. Uhm, okay.
Let’s just pretend that didn’t happen.
Hannah Montana once famously said, “We. Need. Single-payer national health insuran—.” Okay fine, she didn’t. But, I’m kind of known for ranting about health care
reform, so everyone probably thinks that’s what I’ll talk about today. But don’t worry. I won’t. Today, I would like to talk about something that’s been bothering me:
name-calling.
During medical school (and my entire life) I’ve answered to just about any variation on the theme: Graham, Graham Cracker, Grahamazon, Grahambo, Grahamakin Skywalker,
“Hey you,” Kilo, Graham Stain, Graham Positive, Graham Negative, and even, as one attending who didn’t care to learn the names of her students called me, “a medical
student,” with the same tone one might use to ask, “Could you hand me a pen?” Man, I’m really going to miss medical school!
But lately, most people have been calling me doctor, and I’m not sure if I like it. Sure, people have said it all throughout medical school, but I always had
sufficient grounds to correct them: “No no, not yet, I’ve still got 6 more months to go,” or “Gosh, I wish, but I still have to pass my boards!” But lately, I haven’t
had a leg to stand on.
It’s almost as if I don’t want Graduation Day to be here. But too late now. Change happens. Today, we’re becoming doctors.
I remember at orientation an upper-classman saying that we probably thought becoming a doctor was a noble, selfless act—but any of you in the audience can easily
vouch for how selfish it can be. We have demanded your patience, love, understanding, compromises, and support for all these years. So up front, I want to say to each
of you, from all of us up here, I am sorry. But I promise to do better next time. Not to forget slash have to reschedule: your birthday, our anniversary, the dinner
reservations we had, or that trip to Mexico.
But truly, we could not have made it this far without you. Not to get all Mr. Rogers on you, but to us, you are special. You are why we are dedicated to this: because
our patients have their own families and friends like you. You are the selfless ones…not us. So from the deepest reaches of our hearts and souls, thank you so very,
very much. Today, we celebrate becoming doctors as much as we celebrate you.
I guess I really worry about how the title of Doctor defines you. How it changes you. That I’m becoming a little bit more Doctor Walker, and a little bit less Graham.
Sure, the title affords me some prestige and privilege—for example, complete strangers will now feel totally comfortable whipping out their strange moles at dinner
parties—but at the same time, it makes people see me as primarily—or only—a doctor, not as a son, brother, partner, computer nerd, or Trader Joe’s enthusiast.
Maybe this is how it’s supposed to be. Maybe that’s the purpose of the title. To remind us and others of the Oath we take, or that patients’ needs are to come before
our own.
But if becoming a doctor will change how people view me, there are several values I’ve learned here at Stanford that should get to represent me, too. And I have
numbered these values, as I am going into Emergency Medicine, and have a short attention span. Oh, and just a sidebar: The next time you want to complain about your
hospital’s Emergency Department, please remember that we’re probably getting distracted by… oh, I don’t know, coding patients, big traumas, (mumbling) bodily fluids
being flung… at… us, or… … shiny… things.
Sorry. Back to my values:
Number one: I will continue to use objectivity, without forgetting the subjective.
Medicine is an art grounded in science. I’ll do my best to know the studies, the data, and the pathophysiology, and try to apply them objectively.
But I won’t forget the patient. I’ll listen. I’ll be compassionate. I’ll try to keep social context, “chief concern,” and patient perspective in mind.
And number two: I promise to ask questions, and on occasion dare to admit: “I don’t know.” And thank you to Stanford for encouraging this—in Gil Chu’s class, where we
weren’t allowed to leave until we had collectively asked him 10 questions; with Dr. Wolfe, who teaches students to admit their own “Areas of Ignorance.” We are a
generation of physicians who are unfortunately (or fortunately) still human. We are not gods. We still make mistakes, and we still don’t have all the answers. But,
hopefully, we’ll know where to find them.
Number three: Don’t mess with the pancreas. Or, in the famous words of master pancreatic surgeon Dr. Norton, “I’m tellin’ you, don’t mess with the pancreas! You gotta
believe me!”
And number four: I promise to be involved. Whether it’s researching, teaching, advocating, or volunteering, I will remember that health and medicine are often
advanced and affected more by time spent outside a hospital than within one.
While passing clerkships and boards and memorizing facts may make us doctors today, it’s our values that will drive us to become great doctors, like the many we have
met here at Stanford. Because the great physician is dedicated to the truth, but also to patient. She is a scientist, but also a healer. He tempers prognosis with
hope. I think Kurt Vonnegut sums up medicine’s curiosity and compassion better than I ever could: “We are here to help each other get through this thing, whatever it
is.”
So, today, fellow classmates, this is it, for better or worse. When our patients call us doctor, they’ll finally be right. (How scary is that?) While our profession
may change how we see the world, or even how the world sees us, we must keep a part of ourselves the same. That part—our goals and our values—is what has gotten us to
this point, up on this stage. You can call me Dr. Walker now, but I promise to remain just Graham. I’m too proud of each title to be dropping either anytime soon.
Thank you.
I know it’s been pretty non-existent posting lately, but I’ve been busy seeing friends, wrapping up my med student life, and trying to get ready to start
my residency one.
Congrats to all my classmates and fellow new doctors across the country. What a feeling.
So I had a wonderful trip to Guatemala overall. I learned a ton of Spanish, saw some great sights, and all.
But then the very last 5 days of my trip, spent in Antigua, Guatemala, were terrible.
(Warning, graphic description ahead.)
After eating a salad (I know, I know, I should have known better) in Antigua (very touristy, and I assumed that meant safe), I was puking. The next day I spent in bed
rehydrating. The next day I felt a bit better. The next day I had overwhelming nausea, only controlled by around-the-clock dramamine (an antihistamine). Then finally
the next day I went home.
I continued to feel sick for the next 5 or so days after I was home. About two days ago I got an appetite back and
finally
feel better.
I finished a 3-day course of Cipro, took an albendazole to de-worm, and a 4-dose course of tinidazole (anti-microbe, anti-amoeba). Apparently tinidazole isn’t
approved in the US, as a compound similar to it causes cancer in rats. Whoops.
But I feel better. Finally. After 10 days of hell. And I’m 13 pounds lighter, down to 139, the lightest I’ve weighed since I was 19. (Eternal optimist
that I am, I now get to eat whatever the hell I want to try to gain weight. Yum.)
Also: take any American who thinks this country is a terrible place (I was not one of them, I’m just sayin’), send them to a developing country for a
month, and they will come back the biggest Patriot.
I’m incredibly thrilled and honored to have been nominated by my graduating classmates to give our Commencement Speech! Thanks for everyone’s support,
I’ll do my best to say something profound, and if not that, entertaining.
Random thoughts that I’ve got to get out from the developing country that is Guatemala. And for me to rationalize wasting time on the internets, it’s in
Spanish (and then English).
Primero punto: la polucion. Respiro muchas fumas de carros y autobuses todos los dias, y la polucion no ayuda mi asthma. Estoy tosiendo con un tos seco. Ugh.
Dos: necesito una escopeta. Todos la tienen aqui… en las escuelas, las farmacias, el centro commercial… increyible. Es mas por la espectáculo que uso,
pero es un poco difficile a comprender.
Tuve un obsecion con mis intestinos por esta semana. Es completamente mejor ahora, pero al comienzo de la semana, un sonido pequeno de mi estomago me preocupe mucho.
Tuve mucho miedo de problemas gastronomicas, pero ahora soy fatalista.
1st issue: the pollution. I’m constantly breathing fumes from cars, buses… it’s awful. My cough-variant asthma is in full effect.
2: I need a shotgun. Everyone here seems to have them. At schools, pharmacies, the mall… it’s incredible. It seems like it’s more for show, to scare
people off than for actual use, but I still don’t really get it.
I have had a ridiculous obsession with my bowels this week, but now it’s better. I swear, the tiniest gurgle from my stomach would send me into a panic.
I’ll still eat safe (no street food), but otherwise I’m giving up. I hope I don’t get anything, but it’s probably out of my control.
Voy a esperar de subir archivos algos photos si yo puedo.
I’ll try to upload some photos if I can.
(Feel free to correct mi espanol si quieres… escribo a computadora muy rapido!)
I hope you’ve enjoyed
the series
and it’s made you think a bit about health care, health policy, and how difficult it is to come up with solutions to our health care problems. I appreciate the
civil discussion and debate, and continue to welcome any other feedback!
A few topics I wanted to cover but didn’t have time to:
Science education – If we want our patients to understand medicine and the science behind it, they need to understand (and accept) the basic tenets of science
— randomized studies, for example — and perhaps that’s where we’re failing. People seem to have a miraculous ability to accept the science
they have chosen to believe (antibiotics for bacterial infections, germ theory) while ignoring rigorous science that doesn’t fit with their world view
(thiomersal is not responsible for autism).
Patient Autonomy – Has it gone too far? By asking patients or their decision-makers to decide, “Do you want to keep trying failing treatments or
terminate care,” perhaps we’re putting too much decision-making in the hands of a person who clearly doesn’t want to feel responsible for
“pulling the plug” on their mother (who would?)? While no one wants to die or wants a loved one to die, is it fair to other people who have a better
chance of hope of recovery to take up a hospital bed to treat a demented 95 year-old man who won’t get any better?
And many more!
On that note, it’s been a pleasure writing about my journey through medical school, and I appreciate everyone who’s joined me and supported me along the
way.
I’m heading to
Xela, Guatemala
(aka Quetzaltenango) tonight for two months with
Asociación Pop-Wuj
to do some intensive Spanish and medical Spanish training (as well as seeing their cigar-smoking saint,
Maximón
, and hiking and exploring) before heading back to be in a friend’s wedding. I likely won’t be blogging much, but hey, who knows. Since I now have an
official job as a doctor (scary), I’ll be wrapping Over My Med Body up in time for Graduation in June. Stay safe and healthy and I’ll see you on the flip
side!
Throughout this series, I’ve documented just some of the big, elephantS in the health care room that truly concern me as a physician, patient, son, brother,
citizen, and person. I’ve suggested abstract and theoretical policy ideas for how they might improve things, while providing very little practical information
on how they might be implemented (tax hikes, law changes, policy changes). Because I’m skeptical that any of them would ever happen in today’s health care
environment.
We need a single-payer for all the reasons
I’ve stated in the previous post
. But we need a single-payer
even more
to provide some sort of direction in this damn train wreck of a health care non-system in America. Pick almost any issue I’ve mentioned–or
haven’t–that concerns you, and ask yourself if you think it’ll go anywhere without some sort of organized plan or director at the helm.
As I said at the beginning, the goal of a country’s health care system–and note, we talk about a
country’s
health care system, because the whole country’s population is affected by it–should be to make its citizens the healthiest they can be. Right now we have
a system that maximizes profit; this coinflip sometimes comes out with also optimal healthiness, but often it couldn’t care less if it makes its patients
healthy. Case in point: the Hepatitis C outbreak in Nevada at a colonoscopy center, where 40,000 people may have been exposed to hepatitis and HIV because staff were
re-using syringes to save money. Or the woman who finally sued and beat the pants off Blue Shield of California because they dropped her coverage when she started
chemo for her breast cancer. (Sick people cost money!)
We currently have a system where each health care player is trying to pull the system in a different direction, and it really leads us to gettiing nowhere, fast. The
private health insurance companies certainly have no interest in bigger national goals, since they for the most part don’t have huge national markets. 30% of
people change health insurance each year (no surprise when people change employers so often these days). So it’s no wonder that the HMOs aren’t interested
in having comprehensive preventative care or an electronic medical record: long-term benefits of long-term programs aren’t ever seen by these
companies–their patients have gone to another HMO!
There are a ton of perverse incentives in our current health care system, and at least in health care, it’s worse for all of us. Hopsitals currently advertise
that they have the best heart centers, the fastest ERs, etc.–hoping that they can make more money and often just keep themselves open (rightly so: what good is
a closed hospital to its community)? So hospitals have invested heavily in profit-making centers–heart centers, new scanners, etc–while providing fewer
resources to other more broadly-useful services like primary care. But since there’s no one at the helm analyzing the data saying, “Wow, this community
could really use a new rehab unit, since it has a very high number of returning Iraq war vets,” no hospital has any reason to build a rehab unit–unless
they can make it profitable. Again, money/profit is a top priority, not health care needs.
And when hospitals aren’t able to compete, they close. And hospitals over the past 30 years have typically closed in the poorest neighborhoods (which often have
the sickest patients). So then these patients are now without a hospital and without a doctor. Which eventually makes it worse for all of us.
People Want Reform.
Look,
take a gander at any recent poll on health care
, and you’ll see that people recognize that this system is in trouble. Whether it uses the words “single-payer” or “national health care
system” or “significant change,” significant change is going to happen. It’s just what kind of change. And as I’ve said before, if we
don’t take an active role as the nation’s health care providers saying what we think is best for Americans’ health, some system worse than what we
can even imagine will fall into place.
It’s not just the uninsured that are voting in these polls–it’s the insured, too. And I believe for people with insurance to put their faith in a
new system, it has to offer them something better than what they’ve currently got. And that’s why I’ve made the case for single-payer: it would
provide some level of leadership and direction for our health care system, and, because of that, I believe would drastically improve our health care system.
Why Would It Be Better
Better health service, policy, and epidemiological research. We could use some nationalized system to collect anonymous data to see how people do with condition X
or treatment Y. Currently a lot of this data is confined to the Medicare or VA populations, which are often not good representations of the entire populations.
Doctors would have more time with patients. Currently so much time is spent with paperwork that doctors spend less time with patients, and have less time to keep up
current data and research in the journals.
All the reasons stated above, including people never going without health insurance. I find it interesting that we can be frustrated with
Medicare’s “never events”
at an institutional level, but don’t apply that same perspective to individual patients. In a perfect world, should no one at a hospital fall and break their
hip? Sure, but it’ll happen, no matter how hard we try to stop it. Similarly, should people never get sick when they’re uninsured? Sure, but it’s
going to happen, and should they be forever punished for it? I don’t think so.
Single-Payer Won’t Solve Everything Throughout this series
, I’ve presented a number of concerns for this health care system, without really mentioning “single-payer” as a solution, because it alone is not.
Health care financing alone will not solve all the problems of health care in this country, but it will be a big step in the right direction. With a single-payer
system there would motivation to fix the health care system, as we would have a publicly-financed system whose goal is to optimize our health care system in every way
possible.
I don’t buy the argument that “all government is bad.” There are certainly good laws out there, and certainly bad ones. The No-Call List law has
been amazingly successul; the NIH is a government organization that divides up billions of dollars a year for medical research; fire and police departments keep us
safe, and libraries provide their communities with access to books and information. I certainly don’t believe that any of these would be greatly improved by
privatizing them and adding a profit component.
Would single-payer (or any big health care reform change) cause massive changes in our health care system? Absolutely, but I believe to solve or improve many of our
health care problems we need massive change. Massive change happened when we gave women the right to vote, or decided that segregation wasn’t acceptable, but
I’d argue we all now view these things as fundamentally improving society.
Many of you I’m sure will not be convinced by my arguments. That’s fine. But if that’s the case, it’s
your
job to come up with a better answer that also has the ability to address the other issues this country is facing besides just paying for health care.
(For example: ED docs love to bitch about EMTALA and people taking ambulances because gas is expensive, but I have yet to see other reasonable ideas for solutions
from them.)
