As we discharge another patient from the intensive care unit, we celebrate a job well done. “Can you believe how far she’s come in the past few weeks?” or “I didn’t think he would be able to go home so soon.” With the use of modern technological advancements, we are able to bypass the heart and lungs of patients, and push the limits of life to as early as 22 weeks gestation.
She was talking to another attending when I recognized her voice from around the corner. As a third-year medical student, I wanted to look busy, so I moved briskly, avoiding eye contact, trying to make it seem as if I were headed somewhere important.
One of the most poignant and gut-wrenching examples I’ve witnessed of the interplay between the social determinants of health and clinical practice arises in a particular patient population: those who suffer from addiction.
As a child of immigrant parents, I had limited exposure to the American military. Ironically, my sole memory of the American military exists outside of America — in Japan. I spent part of my childhood in Tokyo and fondly recall the excitement that came from visiting the American Naval Base in Yokosuka to buy “American groceries,” specifically Eggo waffles.
“Direct Admit: bounceback 72M recurrent pleural effusion, new diplopia,” my pager beeped with our new admission. As a “bounceback” admission, this 72-year-old male would be returning to our service after recently discharging from the hospital. This type of admission often indicates that a problem recurred or an issue was not fully addressed during the most recent hospitalization.
I remember ranting to a friend one night about the terminology, lingo and semantics that run through medicine. When I started studying medicine, I found the language fascinating. Most physicians seem to appreciate the language of medicine because truly understanding it is proof that after years of studying, working, and putting nose to grindstone, you made it in to the exclusive club that utilizes this jargon.
Double-booking. Concurrent surgery. Procedural overlap. However it is named, the once clandestine practice is now under public scrutiny.
In April, I had the pleasure of attending the 4th Annual Lown Institute Conference in Chicago. The Lown Institute was named after and inspired by Dr. Bernard Lown, a renowned cardiologist who also championed social change by co-founding the International Physicians for the Prevention of Nuclear War, an organization to prevent nuclear war during the Cold War. The theme of the conference was promoting “right care” by addressing overuse, underuse and misuse of medical services through a coalition of patient advocates, community organizers and medical professionals.
Albert Einstein said, “Compound interest is the eighth wonder of the world. He who understands it, earns it … he who doesn’t … pays it.” The whole idea of investing is to take advantage of compound interest. Here are a few general principles to live by.
His eyes were as wide open as his mouth as he slowly placed his beer on the bar without looking away from me. Making no effort to wipe the thick foam from his upper lip, the man continued to stare in disbelief, “That’s the coolest thing I’ve ever heard.”
As the anesthetic wore off, the doctor looked at me and said, “We found a tumor and we think it’s cancer.” I struggled to make sense of that nightmarish phrase and even yearned to be put back under. I was terrified and uncertain about what the coming months would bring as a 36-year-old with a new diagnosis of colon cancer.
In the past two months, a group of Harvard medical students have launched the “End Step 2 CS” campaign, an effort to do away with the portion of the U.S. Medical Licensing Exam that tests clinical and communications skills in a hands-on, day-long clinic simulation using standardized patients. Not only is the Step 2 CS exam a necessary public safeguard, it has greatly strengthened the curriculum of medical schools nationwide.