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Demystifying Medicine One Week at a Time

Category: reminiscence (page 1 of 6)

Match Day 2017

Click on the link below to see an essay from NPR on learning from and working with foreign medical graduates.

All in honor of St. Patrick’s Day, which this year is also Match Day — when medical students learn where they will match for residency — the next chapter in their training.

Wrestling with My Inner Trump

medical-deportation_wide-d8d3587daba3c4885aabbfe681ada9e50a893091-s800-c85In a new NPR column I recall a time when my team and I had to decide on the best hospital discharge plan for a newly disabled, undocumented immigrant.

Immigration is always a pretty hot-button issue, never more so than during Presidential elections.

Wonderful accompanying art by Lorenzo Gritti.

When medicine and commerce collide, who is lost along the way?

Posted by NPR on Sunday, April 10, 2016

Costs of Care

Getty Images

Getty Images

Ever received a bill for a health service that troubles you? Does it seem too much?

Is it hard to understand what you owe from what insurance pays? Does it seem like the share you pay always goes up?

Medical costs are a universe unto themselves. How doctors and medical facilities (hospitals, radiology practices, etc.) come up with their charges seem to lack any rational basis.

Famously, in his article that became a book, author Steven Brill challenged the CEO of a big health insurance company to explain his ‘explanation of benefits’ (the bill-like statement you get that is NOT A BILL), and the CEO couldn’t do it. Here Brill recounts the story in an interview with Minnesota Public Radio. Context — Brill had a big operation for an abdominal aortic aneurysm, so he decides to use himself as a test case:

After I got home, about 2 or 3 days later, I received in the mail 36 different explanations of benefits from my insurance company, in 36 different first class envelopes, which tells you something about how inefficient the system is.

As I started to open them, I thought to myself: I’m the world’s leading expert on hospital bills and insurance bills, this is going to be fun. When I opened the third envelope, it said the following. This is an explanation of benefits from United Healthcare, which is headquartered in Minnesota: Amount billed: $0; amount paid by insurance: $0; amount you owe: $154.20. I looked at it and I looked at it. If nothing was billed, how could I owe $154.20? I turned it over, I tried to decode it, I couldn’t figure it out.

As it happened, before I went into the hospital, I had scheduled an interview with the CEO of United Health out in Minnesota … So as soon as I was able to travel, I went out to Minnesota and I did the interview. … And then at the end, I reached into my pocket and took out that explanation of benefits and handed it to him. I said: “I’m wondering if you could just help me understand this, I’m having trouble figuring out what this means. How could I be billed $154 if nothing was billed?”

He looked at it and he looked at it, he turned it over, he looked at the coding, and finally looked up and said to me: “I could sit here all day and I could not explain that to you. I have no idea what it means. I don’t know why they sent it to you.”

I said, “Aren’t you they?

That explanation of benefits is the single most common form that consumers receive in what is by far the largest industry in the United State: The healthcare industry. Tens of millions of those explanations of benefits go out from United Healthcare every year, and the head of the company can’t even understand what it means, so how are the rest of us supposed to understand what it means?

As an entree to discuss the issue of health costs in the U.S., and people’s disparate reactions to them, I share with you the story of Mrs. Sutton, a patient of mine who had a somewhat atypical reaction to the cost of her colonoscopy — even though she owed nothing out of pocket. I also want to emphasize how poorly doctors do in helping patients anticipate their costs of care. Reliable pricing information is hard for us to come by, too — as some commenters note. But some new companies (apps, of course) are trying to tackle this issue head-on.

Click on the box below to read it. Feel free to add your own story to the mix.

Evidence shows that in spite of mutual doctor-patient desire to discuss drug costs, we docs usually shirk the duty, writes Dr. John Henning Schumann.

Posted by NPR on Saturday, January 16, 2016

Thanks for reading.

No, Not Painless

Both the movie and the TV show M*A*S*H share the same theme song. Even if you can recall the music in your head, many people don’t know the song’s strange title: “Suicide is Painless.”

My latest piece for NPR’s Health site, “Shots,” recalls my mother’s death by suicide from my viewpoint as a son and someone entering the medical profession.

In thinking about my Mom’s death, I’ve always remembered the title of the M*A*S*H theme, but had never really thought about its meaning. Here’s the refrain:

That suicide is painless
It brings on many changes
And I can take or leave it if I please.
I try to find a way to make
All our little joys relate
Without that ever-present hate
But now I know that it’s too late, and…

It’s interpreted to mean that compared to the horrors war, suicide is the less painful alternative.

I’m OK with the thought for soldiers and as a literary device, but I’m here to tell you that suicide is most definitely not painless to those it leaves behind.

Are we in a Medical Economic Bubble? [UPDATED]

In the roaring 1990s I completed both four years of medical school and three years of residency. Day after day I read accounts of my contemporaries starting or joining Internet startups to great fanfare and loads of stock options.

Dot-com-bubbleThere were many times I thought to myself, “Why should I continue on this slog?” I fantasized about pitching my idea for an Internet company that would wow investors by providing not only crackers, but slices of cheese varietals on those crackers for people logging into the website and entering a credit card number.

Stock options!

Glowing media coverage!

Super Bowl commercials!

In a scene reminiscent of the those go-go 90’s, Chrissy Farr of KQED (public) radio in San Francisco reports that Stanford and University of California-San Francisco medical students are abandoning the traditional practice of medicine to join Internet companies in the hopes of creating the killer health care app.

Here’s the data:

Bay Area-based medical students from Stanford and UCSF have among the very lowest rates of pursuing residency programs after graduation compared to the rest of the country. Stanford ranked 117th among 123 U.S. medical schools with just 65 percent of students going on to residencies in 2011, according to Doximity, a physician-network that generates data for the U.S. News Best Hospitals rankings. UCSF is 98th on the list, with 79 percent of its graduating students going on to residency.

Pretty easy to pooh-pooh this — these med school graduates, for all their smarts, haven’t had enough training (actually being in the hot seat) to know what practicing medicine in the current climate is like.

Maybe that’s the point. They are not encumbered by notions of things being “the way they are.”

I envy their opportunity — proximity is important, even in a digital economy. But if their companies don’t pan out, I do wonder if they’ll be able to “get back into” medicine. Residency is the orthodox pathway, and if a young physician leaves the straight and narrow path, medicine is a challenging profession to re-enter.

I also wonder what’s going on at those other schools near the bottom of that list — i.e. why so many graduates aren’t choosing residencies. Is it for the same reasons or due to another cause?

CORRECTION: From Public Information at UCSF, in response to this and other stories about this phenomenon: The main reason that the ‘match rates’ for these schools is reported so low is that many students are not going directly into the match, instead taking ‘gap years’ to pursue research or other degrees, e.g. Masters’ in Public Health. Per an information officer, “Between 2011 and 2015, 816 medical students graduated from [UCSF]. Among them, 803 matched into residencies (98.4 percent match rate). An additional six students matched after taking a gap year, bringing the match rate for the period to 99.1 percent.”

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