The future of American health care remains uncertain. It was only a few weeks ago that the Affordable Care Act narrowly evaded the congressional guillotine a mere seven years after its installation.
In medicine, there is a saying that the training is onerous but the rewards are many. More often than not, these rewards come coated in a myriad of shapes, including lucrative incentives, personal gratification, warm contentment and sated joy. For some physicians, a last wound-closure of the day, a smile on their patients’ faces, or warm, heartfelt regards from the people they care for carry immense significance. Yet, for many others, lucrative incentives seal their fate, becoming a bane to the integrity of the medical profession as a whole.
In December of 2014, one week after the non-indictment of Michael Brown, in-Training published an article entitled “A Lack of Care: Why Medical Students Should Focus on Ferguson.” In it, Jennifer Tsai argued that the systemic racism rampant in our law enforcement and criminal justice systems also permeates our health care system, affecting both access to care for black patients and the quality of care black patients receive. Lamenting that the medical community was largely absent from the Ferguson controversy, she cited startling statistics of disparities in health and health care as part of her call to action. In light of the events last week in Louisiana, Minnesota, and Texas, it’s time to revisit this message.
A very simple but interesting phenomenon in health care is the concept of “white coat hypertension.” Initially, if you take a patient’s blood pressure, it may be abnormally high. This is simply because they’re nervous about the situation. If you just wait a few minutes and then take the patient’s blood pressure again, it has often decreased a fair amount. It’s a simple enough concept — the patient is worried that something is wrong and this makes their blood pressure increase. However, this leads me to the question: why do we make our patients so easily nervous? That is not our place in the health care equation.
There’s a lot of talk about mindfulness these days — its importance, its effectiveness, the benefits of meditation and even the structural changes in the brain that result from it. (Do you want a less reactive amygdala and increased neuronal density in the hippocampus? Meditate!) It’s one thing to read about the benefits of doing something, but as many know, it’s another thing to actually apply it and understand it. So how can medical students use stress reduction strategies “in the context of the high-stakes, high-stress and time-limited environment of medical school.”
I’m an ePatient blogger, academic, educator and breast cancer survivor. I write about my patient experience in hopes that medical professionals may achieve a better understanding of the patient’s perspective of the medical system. Like any profession, physicians are the experts of their field, but no doctor is the expert of all human pathophysiology. Because of this, the emerging interdisciplinary team of specialists has become a pragmatic step.
Four years. I had gone four years without crying in a faculty member’s or an advisor’s office. And there I was, sobbing all over myself, as I tried to explain the situation. A couple of days prior, I received a terse email from the training director, saying I needed to come in to meet with her. She was not happy with my most recent feat as a doctoral student.
Do you remember the last time your insurance denied payment for a visit or procedure you had? Or your gym double charged you for your membership fee? What did you do? Did you sit back and say – “Well, they must know better than me – I’ll just accept their decision.” Or did you call up and say, “Excuse me, but I believe there has been an error and I’d like you to fix it.” My guess is, you did the latter. What you did was advocate for yourself.
I’m an academic and an educator. When I was diagnosed with breast cancer, I chose to be treated in a university setting. It felt right to me, that if I had to go through the experience of breast cancer, that my body would become a teaching tool. It helped provide some form of meaning to the experience. It is with this lens that I found myself regretting not calling out to the clearly first-rotation medical student while in the emergency room.
The loudest sound I heard was neither the punctuated laughter of youthful teenagers nor the whispered voices of lovers holding hands, but the wind.
As I take off my glasses / and rub my sore eyes / I realize I have / myopia / in more ways than one.
The sarcophagus before me dominates the exhibition. Intricately carved animals, including a line of fierce lions, arise from the slab of marble. Peering more attentively, I even notice the Greek goddess of wisdom, Athena, wielding her characteristic shield and helmet. A horse pulls a chariot, and perhaps that is Hector there on the ground, the Prince of Troy now fallen.