Catch Up

Sorry about the long delay since the last post! I am playing catch up in school and my exams start in less than a week. This will be the end of block 6, my 11th straight month of medical school with only 2 weeks off for Christmas. Needless to say, I am ready for a break and thankfully it is coming up soon. For the month of July Lisa and I will be flying back to MI on the 6th, leaving with my family for Disney World from the 11th until the 19th, and then staying around until we head back to Texas on the 1st of August.

Besides the fact that vacation time is almost here, some other good news is that I just found out yesterday I was chosen for a spot on Baylor's Curriculum Committee. This is a group of administrators at the school who consider changes to the curriculum, organize feedback from students, and sometimes even advise the AAMC on what should be required course work for pre-medical students. There are two student representatives from each class, and I was picked out of the maybe 14 students who applied. It should be a fun thing to do, and the time requirement is really not too bad.

I also have posted some albums to my picasa site (click the my photos link on the right). There are a bunch of pictures from the graduations and a few shots of when Lisa's parents came down to visit.

One thing I discovered when we went to Galveston is that the octopus water slide thing at Moody Gardens is gone! This was one of the highlights of visiting Houston each summer growing up. Some of its arms were stairs leading up to its head, and others were water slides. Underneeth there was a sub marine with cool stuff inside. Now they have replaced it with a silly, generic looking water slide. Sad.

Paying for Health Care

I just read an excellent article in the New Yorker by Atul Gawande, one of my favorite doctor/writers (his previous two books, Complications and Better are both fantastic). He explains that the question that is being debated right now in Washington, who should pay for health care, is the wrong one. Whether a public plan exists or not does not solve the real problem, the ballooning cost of delivering medical care. An expanded medicare-type system might save some money through administrative efficiencies, but the real problem, as Gawande outlines, is over-utilization of services by patients and doctors.

Gawande shows in his article why McAllen, Texas has one of the highest per-capita spending rates in the nation, but doesn't necessarily deliver higher quality care. It turns out that the doctors in that area have developed a culture that creates high volume, high profit practices that generate much of their income from ancillary services. When doctors own testing facilities and equipment, they tend to order more tests and recommend more surgery because it augments their income. Plus, most patients still believe more is better when it comes to health care, so they agree to whatever battery of tests their physician orders (and their insurance pays for all of it too).

I agree that reducing health care consumption by restructuring the way physicians get compensated would do more than anything else to reduce health care costs. However, Gawande didn't really outline a detailed way in which this might work. Defining what a successful outcome is for a given patient and then coming up with a way to compensate appropriately is a very difficult thing to do. The team model, where a group of doctors is held accountable for the quality of their work and given a portion of the money they save by reducing over treatment would probably save lots of money, but who wants to go see a doctor who makes more money by giving you less care? The pendulum would swing towards under treatment, which Americans would never tolerate.

It is a very complicated topic and it will be interesting to see what Obama's health care bill will look like once it is done.