February 2012
1 post
Redefining Value: A Critique of "Value-Driven...
Everyone in the world is talking about “value-driven health care.” Or so it might seem if you pick up a medical journal or attend a lecture about health care here in Boston. “Maximizing value for patients” is on the tip of every administrator’s tongue and an interest in cost containment is de rigueur for young physicians who aspire to leadership positions in medicine....
January 2012
2 posts
Sleep/death
Karl Kerchwey once said, to a class of undergraduates, that sleep has power in poetry because it evokes death. Being twenty at the time, I didn’t really understand.
Now I see death frequently. And I work a demanding job. Sleep presents itself as a reminder of choices that must be made each day, about the balance between work, family, friends.
Though I believe he meant something slightly...
What's unfair about this?
This photo is making its way all over the social media today- I came across it on Facebook. Initially posted three months ago by a Floridian who identifies herself as “M. Turner” on her website, she describes how she was able to get health insurance through the Pre-Existing Condition Insurance Plan (PCIP) that was created as part of the Affordable Care Act. I can’t speak to the...
October 2011
4 posts
Teaching TLC... and more
“Teaching TLC,” the cover story of the Boston Globe Magazine this week, is about the Cambridge Integrated Clerkship (CIC), the unique program where I spent my third year of medical school. In the piece, Dr. Ishani Ganguli explores some contemporary challenges in medical education and considers how the Integrated Clerkship can help train more humanistic physicians. She writes about the...
Connected Health Symposium 2011: Initial...
I’ve spent the last two days at the Partners’ Connected Health Symposium here in Boston. It has been a fascinating event with a number of brilliant people from academia, clinical practice, government and business. The speakers ranged from Atul Gawande, the surgeon and author, to the Crown Prince of Denmark, who spoke about universal, high-quality, informatics-driven healthcare delivery...
Occupy Wall Street & Inequality
I’m at a conference this morning and just heard a fantastic talk from Dr. Kate Pickett. She is a social scientist who researches income inequality and its effect on society. She presented the graph above which shows the correlation between income inequality and a number of health and social ills. The index includes low life expectancy, poor literacy, infant mortality, homicides,...
September 2011
1 post
Missing longitudinality
This month I’m on my sub-internship, where fourth-year medical students do their best to act like interns (first-year medical graduates) and take care of patients on the medical service. It’s been fun, fast-paced, a lot of work and a steep learning curve. I feel like I’m getting the hang of it and, as my efficiency improves, will be able to really enjoy it.
Still, I already miss...
July 2011
6 posts
Medical student indebtedness and career decisions:...
Pauline Chen has a compelling piece on the NYT Well Blog today about medical student debt and it’s unappreciated costs. It draws on a recent publication in Academic Medicine which highlights the diverse drivers of medical student indebtedness. These include an expansion of the medical school’s research enterprise, a lack of accountability on the part of medical school administrators,...
Language training for health professionals: an...
During my first few years in medical school, I helped to launch the Harvard Medical Language Initiative (HMLI). The group was created to meet the demand among my classmates for language training during the academic year (it had previously been offered only in the summer for fourth year students). We inherited a Spanish course from the class ahead of us and during my time at the HMLI a committed...
Disappointed
In 2008, I drove to New Hampshire and knocked on doors all over the state. I wrote letters to my hometown newspaper in Pennsylvania, arguing that electing Obama would improve our healthcare system. I flew to Washington for the Inauguration. Since then, when friends have argued that Obama should be bolder, I was the one who defended him. This is a conservative country and progress is slow and hard,...
On Medicaid Cuts
I didn’t protest when we invaded Iraq: I watched the news with disapproval and detachment from a college dorm room. I don’t even remember the day when the Bush tax cuts were passed. Tonight I’m wishing I had joined the people in the streets.
Events in Washington are highlighting the choices that societies must make about how government raises and spends money. President Obama...
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Responding to comments about social media and...
The reaction to my most recent post on KevinMD has been strong. I’ve had posts there that I thought would be more controversial, but the topic of social media in medicine has drawn a lot of commentary. Perhaps I shouldn’t be surprised that online health professionals like discussing what health professionals should do online.
The comments are diverse. The response on Twitter has been...
June 2011
11 posts
4 tags
The Pager
On our first day of the Cambridge Integrated Clerkship, every student had a pager on their desk. We knew they would be there—the central idea of the clerkship was that students could be reached at any time when our patients came to the hospital. Still, it seemed to me a strange and antiquated device, only slightly less odd than a typewriter or rotary phone, and it was hard to imagine...
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Do global payments work?
“I don’t care who is paying for healthcare—what matters is how we pay for it.”
This is the hopeful argument that I made in a conversation with a friend less than a year ago. The friend was trying to convince me of the cost-controlling merits of a single-payer model and I was trying to argue that it was less important to have a single insurer to control costs...
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Louis Menand and the Purpose of Medical School
There are, according to Louis Menand, three different ways to understand the value of higher education. In his recent article in the New Yorker, he assigns numbers: Theories 1, 2 and 3. Theory 1 is that the purpose of higher education is to sort members of society to their appropriate roles. In this mode of thinking, college is an extended and demanding audition for employers who need more than...
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Link: Wellness Rounds →
I just came across this blog by Dr. Mary Brandt at Baylor College of Medicine. She shares health and wellness tips for busy medical students, residents and physicians. Check it out for some ideas on staying healthy when your schedule is constrained. It’s a nice reminder about the need for (and possibility of) balance, even when free time is short.
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Are pit crews enough? Here's what my health...
These are the rates for my student health insurance coverage for the coming year. I’m newly married, so my spouse and I will be enrolling together. That means that the total cost of health insurance for our family of two will be $7,522. Even though I’ve been paying $3,000 a year for my own insurance, $7,522 inspired some sticker shock. Our care is pretty heavily “managed”...
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Green space and well-being
There are many things to love about Cambridge, Massachusetts. Cambridge Health Alliance, the city’s public health system, which takes care of a diverse and underserved patient population is high on my list. Memorial Drive is near the top too. I have been riding my bicycle home from Boston along “Mem Drive” this past week and I’m rejoicing that it’s there. Just a few...
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Link: Data Breach at Alabama's Trinity Hospital... →
“Trinity is offering one year of free credit monitoring to all affected patients.”
This is too bad. We need to do a better job of securing medical records. As I’ve argued before, though, we can never completely guarantee that a breach won’t occur. The poor distribution of risk in our health insurance system makes a serious event like this worse. Individuals and employers...
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A Year for Balanced Living
As a third-year medical student, I sometimes felt like a hypocrite. I spent much of my time advising my patients on how to take care of themselves, discussing in depth the best ways to care for our bodies and relationships. And yet, the schedule and intensity of my work often prevented me from following my own advice. I was not getting recommended levels of exercise or sleep and I was...
“The word health has been hijacked by the medical/sickness industry. But it...”
– Interview: Dr. Jay Parkinson | Made by Many
(via jayparkinsonmd)
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Medical record breaches and universal health...
Instead of my usual solitary commute, I’ve been walking to my closest T stop this week. More often than not, I’ve had to run through a crowded station to jump on a train just as the doors were closing. It has been amusing to commute with so many other people and each morning I can’t help but wonder where everyone is going. There are typically a few people in fine suits, who I...
May 2011
6 posts
5 tags
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Career directions after the CIC
Friends, colleagues and mentors have been asking if the Cambridge Integrated Clerkship (CIC) has changed my career goals. The answer is yes and no. I chose to do the CIC because it aligned with my interests, so the experience reinforced many of the goals that brought me to medical school in the first place. Following patients through the healthcare system for an entire year, though, and knowing...
jayparkinsonmd:
My heart as recorded by my...
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The Urbano Project
Imagine a place where teen artists from Boston’s neighborhoods are given tools and space to express themselves. That place is the Urbano Project in Jamaica Plain, which I had the opportunity to visit with a friend yesterday. The goal of the project is to empower “urban teens and professional artists to effect social change through visionary works of art and performance.” We...
New insights into the physician salary gap, and...
Results of a new survey have found that primary care doctors, despite making less than half the median salary of some specialists, aren’t the only doctors who feel underpaid. This is according to Medscape’s latest Physician Compensation Report. In February, the organization sent an online survey to 455,000 physicians in the United States and collected results from nearly 16,000 doctors in 22...
April 2011
5 posts
1 tag
Medical student mistreatment
How to address the mistreatment of medical students is a hot topic in medical education right now. The LCME, the body that accredits medical schools, is interested in this and their attention seems to be lending credibility to the issue and leading to some soul searching. It’s a difficult topic to approach for many reasons, especially since defining it is incredibly difficult. Medical...
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Ilha de Mocambique, 2006
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A Disconnect on the Internet
In the last three years, less than fifteen minutes of the formal medical school curriculum at my school has been dedicated to social media. During our orientation, a faculty member showed us a series of images that she had found online, publicly available on Facebook, that showed what she considered to be inappropriate behavior: students drinking, dancing and in revealing clothing. She warned us...
A (re)Introduction to the Longitudinal Clerkship
I am about to finish my third year of medical school, which I’ve spent in a program that is very different from the traditional model of education for students in their clinical years. It is called a “longitudinal integrated clerkship,” which is meant to differentiate it from the traditional block clerkships in which students spend discrete amounts of time in particular disciplines like...
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Failure of imagination
There is a New York Times piece today about a young doctor from northeastern Pennsylvania, not far from my hometown. Dr. Kate Dewar speaks with the NY Times about her decision to not join the primary care practice of her father and grandfather. I don’t have an issue with her choice to enter emergency medicine instead of primary care. I hope that young doctors will enter the fields that they...
March 2011
5 posts
4 tags
Medical schools don't need social media policies
We’ve recently seen a lot of concern in the popular press and the medical literature about the behavior of medical students and physicians on social media sites. Concern that students and physicians may act unethically online is justified, but we need to be precise in our conversations.
My opinion is that the same standards apply to social media as apply to the general behavior of medical...
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Three patients
I spent this afternoon in my beloved Medicine clinic, where I’ve been learning and taking care of patients for nearly a year. Almost everything I know about medicine I’ve learned in this clinic, from our patients and my preceptor.
I’m amazed to find that more and more frequently I know how I should care for a patient in a given situation. A lot of the time, I feel confident in my clinical...
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“We must reject the idea that student behavior be transformed into strictly...”
– Adapted from The Chronicle of Higher Education
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Movement
Welcome to A Stranger in this World at it’s new location.
The principle purpose of this space is to encourage reflection and writing as I train to be a physician. I hope that readers will be interested in my thoughts on health, medicine, education and technology along the way. I look forward to sharing the journey.
A reminder about me: I’m a medical student, about to finish my third...