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July 20, 2009
Working In and Out of the Cubicle
This summer I'm working at the American Medical Students Association (AMSA), the largest organization of medical students that includes pre-meds and DO students as well. Prior to coming to D.C. on July 4th (FIREWORKS!), I was in Germany at the University of Tubingen taking a course about comparative health care systems and medical ethics. So it's so far been a health care infused summer but definitely an interesting one.
At AMSA, I am the Health Care Quality and Safety Intern which means I focus on trying to get medical students excited about not just health care reform in terms of access, but also in terms of quality. Just to give you an idea about how quality is being compromised in our health care system, we rank 37th in the world based on our health care outcomes. According to the Commonwealth Fund, the US ranks last among 19 industrialized nations when it comes to "mortality amenable to health care" or in other words, deaths as a result of preventable and treatment reasons. If a black baby and a white baby are born in the same city on the same day, the black baby is four times as likely to go to the emergency room for an asthma attack than a white baby and the black baby is twice as likely to die from it. Between 44,000 and 98,000 deaths from serious medical errors are committed by doctors every year - that's more than deaths resulting from breast cancer or motor vehicle accidents. Why is this? Why do we get so little when we put in so much?
To be fair, there are some really good things about the American medical system. Unlike other countries, we don't have queuing issues - people do not have to wait long periods of time to get an elective procedure or surgery or experimental medications. We also have more technology than any other country, as expected since we spend 16% of our GDP on health care. There are plenty of MRI units and CT scanners for everyone. We spend so much money on tests and technology to make health care better, yet we are still at the bottom of the list in terms of quality and safety.
Last week, during the AMSA Chapter Officer Conference, Dr. Robert Kocher, a physician who advises Obama on health care, stated that a doctor is 8 times as likely to use a CT scanner if they have it in their practice than someone who doesn't and that it does not really change the outcome of the patient. Money is continuously poured into new technologies and new drugs, but shouldn't money be allocated to actually improving health care?
This is why I decided to become an AMSA intern. I am like many other medical students trying to do my part in being apart of the health care reform movement, but even more important at least to me, is that the quality of health care for all becomes better. In the end, it will not matter that a bill is passed that ensures health care because there is still a huge chance that the new patients will be apart of the 98,000 victims of the system.
The key areas I am working on are resident work hours and teamwork. Teamwork may sound very general but in fact, it is very tied to the efficiency and safety of health care. Regulations has been put in by the Accreditation Council of Graduate Medical Education (ACGME) to limit resident work hours to 80 per week through 16 hour shifts. Many doctors have complained that these shorter but much safer shifts limit continuity of care and are dangerous for the patient. However, I think it is more important for the resident to learn how to communicate with his team and to develop techniques to shift over care to the next resident with minimal errors. Besides this, more errors are made my residents who work longer than 16 hour shifts as they tend to make more and more mistakes due to increased fatigue rather than residents who shift a patient over to the next resident on call. I am working on trying improve these "hand-off" methods and create guidelines to ensure patients are getting the best and safest care possible. Doctors shouldn't be scarier than breast cancer or motor vehicle accidents.
Below is an amazing article by Atul Gawande about health care costs and quality entitled "The Cost Conundrum". I encourage everyone and anyone to read it. Even Obama has read it and is taking advice from it.
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
I've also posted two pictures from a press conference last Thursday (July 16th) where the HELP Committee announced that it had passed its bill including the Public Option. The other interns and I wore white coats showing our support for the bill as it is intended to provide universal healthcare through a new government plan with very low premiums that will compete with the other existing insurance plans. I'll explain what's been going on with health care and my thoughts on it in the next post.
Posted by Reshma Ramachandran at July 20, 2009 11:35 PM
Comments
Interesting post. a lot of people would say that the reason that America lags so far behind other countries is OVERtreatment, as in its not just puzzling why more care results in poorer quality, its expected. You start treating an advanced cancer patient with high dose chemo and you're bound to get a poor result. The quality argument though is a little bogus because quality is defined by the procedure you use - if you don't give a patient chemo, then the quality of cancer patient care can't be bad right?
btw...THADI
Posted by: Ravi at July 21, 2009 09:54 AM
