Rookie Docs Talk Health Reform

Originally published on Youthradio.org, the premier source for youth generated news throughout the globe.

By: Emily Beaver

Youth Radio reached out to young doctors and medical students around the country to get them to weigh in on the health care debate. They talked about how health insurance impacts patients’ care, “socialized medicine,” and more. Will they agree more than members of Congress? Does being a health care professional change the way they think about health care debate?

Take a look at their responses after the jump.

Adam Green, MD, Chief Resident of Pediatric Medicine at the University of Colorado/ The Children’s Hospital

Youth Radio: Have you experienced any situations where a young person not having insurance or adequate coverage meant you couldn't give those patients care?

Green: Working in an academic setting, our hospitals see a large number of uninsured kids as part of their missions. But when kids don't have insurance, it definitely makes it harder to treat them -- we have to jump through a lot of hoops to get them care, especially treatment at home after they're discharged, which is something many of our kids need because they have long-term or chronic illnesses.

YR: How does an emergency situation play out in the ER if a person comes in needing care who doesn't have coverage?

Green: ERs are required by law to treat everyone who comes in, regardless of their insurance coverage, so we treat everyone equally. But this becomes a big problem when families start using the ER as their kids' primary pediatric setting -- ERs get too busy with kids who don't really have emergency problems and can't focus on the real emergencies. We need to get more kids hooked up with primary pediatricians.

YR: Do you see the current health care debate as something that actually has the potential to change the way you do your job?

Green: Yes -- I would be very excited to practice in a system in which we, as providers, worry less about patients' insurance coverage or lack thereof, and more about providing the best care for kids and their families. To get to that point, however, we're going to need to make some deep changes, including putting more emphasis on preventive and primary care medicine so that we can prevent diseases from progressing so far and draining our healthcare resources.

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Kurtland Ma, an emergency room resident at Jacobi and Montefiore Hospitals in the Bronx, New York

YR: How would you like to see health care coverage run in this country--do you fear the 'socialized medicine' scenario?

Ma: I would like to see the patients taking much more responsibility for their own health outcomes. Obviously, our health care system is very wasteful, but a great deal of the responsibility can also be blamed on irresponsible patient behavior. Many patients call ambulances and come to the emergency room on a whim, wasting lots of time and money when they could just call their own doctors or do not need any care. Also, they do not fill their prescriptions, do not take care of themselves, and take no responsibility for themselves. This is also a huge waste of resources.

YR: Do you see the current health care debate as something that actually has the potential to change the way you do your job?

Ma: I'm not sure that lack of health care access or lack of coverage is the big problem. Tons of people come to the emergency department every day and are treated regardless [of whether they have coverage]. I think we need to put rational limits on how we distribute the resources we have and make individuals more responsible for their own health--if they do not learn to take care of themselves, then they have to be held accountable.

Andrew Rudikoff, a 28-year-old anesthesiologist at University of California Los Angeles Medical Center

YR: Do you see the current health care debate as something that actually has the potential to change the way you do your job?

Rudikoff: I think so… I think we will have a more systems-based practice rather than more individual-based practices. Health care will be delivered by larger groups, rather than individual clinics. These larger groups will have more standardization and goals for treating the population as a whole—for example, setting glucose [blood sugar] goals for diabetes, making sure patients with coronary artery disease are on the accepted standard litany of medications, and so on.

As an aside, I don't buy this preventative medicine idea. While you can live a healthier lifestyle, you can't really prevent all diseases. Sure, I practice yoga and am a Monday through Friday vegetarian, but I can still get a brain tumor that cannot really be prevented. Sometimes disease just happens and no one is culpable. While we can make tobacco and corn syrup illegal to try to prevent certain diseases like diabetes and cancer, I'm not sure that will curb the costs of health care.

Mike Miller, fourth-year medical student in Denver, Colorado

YR: How would you like to see health care coverage run in this country--do you fear the 'socialized medicine' scenario?

Miller: I would like to see health care run very differently in this country. I think that our current system is shameful, and even criminal in its neglect of our citizens and their right to health. I would like to see a system that is based on existing systems that are successful, rather than on theoretical systems. I believe that it makes sense to take a model of something that works and try to emulate it! I hear, and even support, the call for something "uniquely American." But, we must decide if we are willing to let our pride stand in the way of the lives and the health of our citizens. I would like to see more socialized medicine in this country. This is something that we know will produce better outcomes, as has been demonstrated in our country and many others. One of the biggest difficulties in cost containment (especially in the private sector) is in controlling overhead costs. Medicare has done a remarkable job of eliminating overhead and our country could save billions if the private insurance industry was forced to become as efficient as it's socialized counterpart. The VA [the health care system for veterans], for all of it's shortcomings, which mainly have to do with funding and distribution of available services, provides us with an exceptional example of comprehensive and effective care. Their health outcomes are frequently some of the best in the nation, and this is because their employees are required to practice evidence-based protocols whenever possible.

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Barbara Melendez, MSIV, fourth-year medical student at the University of Colorado School of Medicine

YR: Have you experienced any situations where a young person not having insurance or adequate coverage meant you couldn't give those patients care?

Melendez: As a third year medical student I did my internal medicine rotation at a local hospital. During this rotation, a 23-year-old female was admitted to our service for hemoptysis [coughing up blood]. During her admission, we diagnosed her with lung carcinoma [cancer], non-small cell. This diagnosis, for patients with limited stage disease, has a reported median survival range from 15 to 20 months, and the reported five-year survival rate is 10 to 13 percent. The treatment consists of chemotherapy and surgery, which has been showed to improve survival. However, neither service would do anything, as she was uninsured. She had to discharge her with no plan for follow-up and the diagnosis of non-small cell lung carcinoma. This is possibly the worst experience I've had in medicine.

YR: How would you like to see health care coverage run in this country—do you fear the 'socialized medicine' scenario?

Melendez: I feel we should have a government-run system. The word socialized, despite the best efforts of some politicians, does not scare me. Access to appropriate health care should be a right, and we need a health care system that protects that right while allowing us to practice evidence based medicine [medical techniques demonstrated effective through research].

Ramnik Dhaliwal, third-year medical student pursuing JD/MD at the University of Colorado Denver Medical School and CU Law School

YR: How would you like to see health care coverage run in this country--do you fear the 'socialized medicine' scenario?"

Dhaliwal: If you look at the statistics right now, the government, whether federal or state, and taxpayers are already one of the largest providers of health care in this country. Programs like Medicare, Medicaid, and CHIP [Children's Health Insurance Program] are all government run and funded. I believe that creating a scenario where the government drives the competition will not only allow more to be covered, but also will help drive prices down as private insurance companies will be forced to decrease costs through streamlining and becoming more innovative to be able to compete with the government programs.

Currently, insurance companies have no incentive to change. They are making billions of dollars in profit with a system that is so inefficient. Health care does not follow the normal economic model of supply and demand where increased demand brings in more players. Because the initial cost of starting an insurance company is so high the big players that have always been there pretty much have a monopoly.

Doctors are unable to really negotiate a great deal because any way they look at it, they must accept the insurance companies' demands since they are the only ones offering the product, which in this case is payment for [medical] services.

Everyone fears such large changes, but without change we will just run further into debt and more Americans will be unable to obtain needed medical care without incurring devastating debt.

If you’re a young medical professional and want to share your perspective on health care reform, contact Youth Radio.

Also From:

• A 'Tonik' for Your Pain
• Facing Health Care on My Own
• What Doc Mom and Dad MD Taught Me About Healthcare

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Comments

[bmull]

I agree with Rudikoff. A more efficient, affordable health care system requires less solo and small group practice. Not only do large groups have lower overhead, they can afford the best information technology, which is key to implementing best practices.

The problem is doctors are resistant to giving up autonomy, and state laws make it difficult for integrated health systems to enter the marketplace. The two smartest reforms government could do would be: (1) require new medical graduates work in large group settings, (2) lower regulatory barriers to establishing more of these groups.

[jtc1977]

I think that the big picture is that these young professionals get the "big picture." They are going to have to deal with whatever system or non-system is left when the dust settles. I think that we should be paying much, much more attention to what these folks (and the uninsured folks) are saying. They have so much more of a stake in this than the birthers, the so appropriately named Tea-Baggers and the death panel nut cases.

i used to be a healthcare professional in the Philadelphia area (not far from the previous commentor, SonofLiberty1). I got out of it for the same reasons mentioned in this article (as well as many unmentioned issues). The thing that bothers me the most is the fact that decent, hard-working Americans are literally DYING from our greedy, for-profit driven healthcare system. Roughly 22,000 people died unnecessary deaths in 2008. Why isn't THIS the biggest discussion point? Our healthcare system is supposed to keep people healthy and most importantl­y...ALIVE! We are failing 22,000 times a year.

If you live in the Philly/Delaware County area...or if you want to hear some of my more controversial thoughts ...check out these articles that were published in my local newspaper the Daily Times.

http://delcotimes.com/articles/2009/09/02/opinion/doc4a9de182c256c523664731.txt
http://delcotimes.com/articles/2009/07/17/opinion/doc4a600d53a6220044728321.txt

[PlaceboStudman]

Good. These kids get it. At least to a point. I think they see first hand how having insurance isn't necessarily the big bad cure all answer that everyone around here believes it will be

[SonofLiberty1]

Not true...

Som ER's wil NOT treat you if you do not have insurance!
Thankfully I had insurance and that is what I was told...I would never have
gotten any help at St. Mary's Hospital in Newtown, PA.