Friday, December 16, 2016

A Response to the Volume Pledge

Dr. Pronovost is a leading figure in the patient safety movement, and is someone I greatly admire.  His work with surgical checklists is touted by Dr. Atul Gawande as having saved more lives than any researcher in the past decade.  However, I disagree with his latest initiative- to get hospitals who perform certain procedures at very low rates to stop performing them altogether.

On the surface, it seems like a perfect idea- hospitals that perform few surgeries of a certain type usually have worse outcomes and higher patient mortality than hospitals that perform many of them, a fact that has been known for decades.  However, the issue is more complex than it first appears.

Friday, December 2, 2016

How Much is a Human Life Worth: A Question we Need to Answer

With the election of Donald Trump, there has been much speculation about his plans for the ACA- speculation that rose again after the announcement that Dr. Tom Price, MD, is to be appointed as his Secretary of Health and Human Services.  But the reality is that any health plan in the United States- Trumpcare, Pricecare, Obamacare, Hillarycare, and someday perhaps Warrencare or Bidencare will not work because of our collective failure as a society to answer a question that every foreign health system has answered in some way:

Saturday, August 13, 2016

When will the Medical Bureaucracy learn that Performance Metrics in Healthcare can be Lethal?

Yet another scandal regarding performance incentives in healthcare has surfaced.  This time, the area is transplant medicine.  It was reported that the demands by the Center for Medicare and Medicaid (CMS) for extremely low complication and death rates (with the threat of loss of accreditation and shutting down of the program) has led to thousands of kidneys and livers being discarded while tens of thousands languish in waiting lists, desperate to escape the living hell that is dialysis.

Sunday, June 19, 2016

Questions to ask When Picking a Medical School if You Want to be a Good Doctor

I graduated medical school this May from the Keck School of Medicine of USC.  And only now can I speak about what I should have cared about when picking a medical school in the first place.  Originally, I had picked USC for a unique medical engineering program called Health, Technology, and Engineering, and because I heard colloquially that it had good clinical training since it had a major county hospital.  I was extremely fortunate that I did so.

Is the FDA's "Ban" on Gay Men Donating their Blood Discriminatory?

In the wake of the horrific Orlando shootings, there has been renewed attention given to the US Food and Drug Administration's (FDA) so-called ban on blood donations from Gay men.  A congressman called the ban discriminatory, and demanded it's repeal- a call joined by the American Medical Student Association and many others.

Wednesday, May 11, 2016

Trump's 7 point healthcare plan is actually just as stupid as everything else he says

Donald Trump's healthcare plan has started to make the rounds.  People are impressed!  It seems simple.  It seems to make sense.  It gives hope to those who hate Democrats but are disheartened by Trump's stated policies to ban Muslims from the US, build an ineffective wall to keep out Hispanics, torture prisoners, and commit war crimes by targeting the families of suspected terrorists.  I am actually no fan of the ACA, but Trump's healthcare plan is far, far more dumb than most people realize- like almost everything else he does and says.

Tuesday, March 29, 2016

Politics and Medicine: Hillary Clinton's Health Risks

This presidential campaign has been alternately amusing and terrifying, courtesy of the antics of Donald Trump.  The prospect of someone who feels the need to boast about the size of his penis during a presidential debate having his small, small hands on the button to launch our nuclear arsenal does not inspire feelings of security.

He is looking increasingly likely to be nominated by the Republican Party.  Many however console themselves by thinking, "Well, now Hillary Clinton will definitely win!", given her increasing likelihood of winning the Democratic nomination.

Unfortunately, Secretary Clinton's health records reveal some cause for concern.

Thursday, March 17, 2016

Penile Discharge Deja Vu

Yesterday was groundhog day-

About 2 months ago, I was volunteering at one of USC's free student-run clinics, located in a homeless shelter.  The last patient of the day was a guy with penile discharge and burning. After treating him, we went out for ramen in Little Tokyo afterwards, since there isn't too much else to do in LA at 9pm on a weekday.  We had a great time eating and chatting late into the night.  It would be the last time I'd ever speak normally.

Saturday, January 2, 2016

Residency Work-Hour Restrictions Ought to be Individualized

There's been a bit of kerfuffle over resident duty hours lately.

For those unfamiliar with the topic, physicians in training in the United States have traditionally lived in the hospital- hence why they were called residents- and available to patients 24/7.  Over time, concerns about patient safety led to limits on how many hours could be worked consecutively in the hospital.  In 2003, the maximum number of hours worked per week was restricted to 80 hours.  In 2011, the maximum work day for first year residents was restricted to 16 hours- for second year residents and above the limit was set at 24 hours of work plus 6 hours for handing off patient care.

Friday, January 1, 2016

The Residency Application Process suffers from Misaligned Incentives

Doctors who wish to practice in the United States must apply for and undergo a residency in a particular specialty in order to practice medicine.  Some residencies are considered more desirable and competitive than others.  I am a fourth year medical student, applying for a General Surgery residency, and I have to say the process of applying to residencies has gotten somewhat out of hand.