Let me show a glimpse of life as a Cambridge student!
Here are some photos from my first few weeks at Cambridge. Punting, formal dinners, traveling and non-stop fun with my MBA classmates and peers at Darwin College. Let me show a glimpse of life as a Cambridge student!
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While this title may apply to private equity firms at the enterprise level, it is not as applicable to businesses involving the average consumer. Nowadays, consumers expect corporations to responsibly source products and promote some sort of greater good. As an industry, healthcare has not yet fully adopted this concept, leading to suboptimal business and health outcomes. The business of consumer-focused business should rely on trust.
The American healthcare system is much akin to the Wild Wild West. Compensation for physicians is incentivized to maximize diagnostic tests and frequency of office visits. Patients constantly question whether certain steps in treatment plans are medically necessary or just for financial profit, creating mistrust. Mistrust leads to suboptimal consumption of healthcare, loss-to-follow up and poorer health outcomes. I see this happen everyday in clinic. As a healthcare provider, I visualize myself in the position of a salesperson convincing customers that the treatment plan I provide is the most sound for their long-term health. I do this in order to earn patients trust, and create customer loyalty so that they return to the doctor’s office to stay healthy, not just when they fall ill. Healthcare innovation has been a driver of brewing mistrust within the American patient population, because profit-driven models and patient outcomes are largely divergent. For example, the pharmaceutical industry is focused on developing blockbuster drugs that can generate billions of dollars in order to recoup the astronomical costs of research and development. In 2013, the five most profitable drugs were brand-name pills for which treatments have existed for over 50 years. Meanwhile, progress in HIV treatments, cancer cures and prevention of transmissible disease are largely ignored because the innovation in those specific areas does not offer much financial reward. Restoration of trust in medicine is necessary in order for the industry to survive, and it will be vital to identify companies that link profit models with good patient outcomes. An example of a company that embraces this concept, and is significantly benefiting the healthcare system is Breakthrough. This company created a platform for streaming psychiatric services over the Internet, providing many people who live in rural areas with mental health services for the first time. Because it exists entirely online, Breakthrough avoids many of the traditional operational costs that most medical practices endure. Breakthrough merges technological innovation and promising revenue model to solve an important problem in healthcare that has been previously ignored. When innovation for the benefit of the healthcare system as a whole becomes the dominant trend in healthcare, we will start to see that patients will begin to trust healthcare providers more. There is a tremendous potential for the private sector to create opportunities that are congruent with improving patient outcomes. Whether or not the healthcare sector catches on dictates the business of healthcare and the future of our health. On a scale of 1 to America, I'm as free as a bald-headed eagle with a 10-foot wingspan.
I see Veteran's Day as a one-day break from my usual routine of criticizing everything that's happening in the U.S. Government. I take this day to think positively about our country and thank the efforts of our veterans and active duty members' personal sacrifices to keep America and other parts of the world free. I'm also going to take this opportunity to reflect on my one-month Internal Medicine rotation at a Veterans Affairs hospital. Despite the criticism the VA receives for inefficiency and specific instances of monkey business, I observed some really great things happening at the VA Hospital in Washington DC. CPRS Stands for Computerized Patient Record System. Funded by taxpayer dollars, this electronic health record was launched in 1997 and is used by every VA hospital, clinic and nursing home (over 1,000 facilities.) Everything's on it- doctor's notes, lab results, imaging studies, medication orders- all the tools any provider needs. This is the best EHR system I've used so far on my clinical rotations, especially because it only takes a few days for a user to get a handle on it. Since doctors spend so much time behind the computer writing notes, reviewing records and updating medication orders, this EHR system is a salient positive aspect of the VA system. Providers The attending physicians at the VA are spectacular. They educate students, advocate for their patients, and practice medicine extremely effectively. Dr. Katherine Chretien, the GW Internal Medicine clerkship director, wrote an Op-Ed describing VA docs' motivation for working at the VA. She sums it up elegantly here: "Working at the Department of Veterans Affairs as a physician is like betting on the underdog team. Sometimes it seems the odds are stacked against you, but you still believe in what the team stands for. And you know that each win is a big one." Another thing that happens effectively at the VA is interdisciplinary rounds, which is a daily meeting between case managers, social workers and doctors. The interdisciplinary team runs the list on the patient census to ensure that their patients have proper follow-up and placement in care facilities upon discharge. The social workers face many barriers with limited spots in nursing home/rehabilitation facilities, but their dedication to making things happen for the veterans is inspiring. The social workers and case managers are the people that are responsible for making sure that people stay out of the hospital as soon as they enter, and they do a good job at it. Patients The veterans we serve are what make the VA a special place. I was surprised by the diversity of the veteran population with white, black, Asian and Hispanic men and women comprising the veteran population. Despite the diversity, there's a distinct commonality among the patients, which was the degree of gratitude that each veteran expressed. There is a tangible mutual respect between the healthcare provider and the veteran. As Dr. Chretien explains, providers feel a sense of fulfillment for serving patients that made a selfless sacrifice for our country. The veterans never failed to let us know that they were extremely grateful for their care and were extremely patient and pleasant people to work for. And they can tell a damn good story. Wrap-up Listening to a patient's story is the most important lesson I learned at the VA. I wouldn't have learned this if it weren't for a humanities project that medical students rotating at the VA were required to complete. Taking the time to hear about what patients think defines them eventually has an unmeasurable benefit in terms of rapport and compliance. I'd love to share with you a story that one of my patient's told me, but I'm waiting to hear back from her to obtain permission. I miss working with vets on a daily basis, but I'm confident that I'll be back at the VA again soon. I truly believe that the quality of healthcare delivery at the DC VA is at the level of comprehensive care that every veteran deserves. I'm optimistic that our new Secretary of the VA will be able to standardize this across the country. Here's some photos of me being an American. I spent over twelve months at a company called Crowdmed, and gained tremendous exposure into the intersection of medicine, technology and business. This post I wrote in Summer 2014 sheds some insight into the value I see in challenging the way traditional healthcare is delivered, and how doctors should embrace this concept. Read: Diagnosing Medical Cases Online: Threat to Traditional Medicine? I'm excited to announce my next move. Still in med school for the time being. (Currently, I am just over halfway on my journey to getting a prescription pad.) Two reps from GenYize, an organization dedicated to empowering Generation Y, approached my group of friends and asked us to give them a quote that our generation should live by. Assuming that they would eventually want to solicit a donation from us, I kept my mouth shut. However, my friend, Neil Okey, (holding the sign) came up with this great slogan at the top of his head: "Be realistic. Stay idealistic." Needless to say, I am content being the token Indian for the cover photo for this website. I am equally excited/terrified to see what will come of Generation Y representatives in Congress. Today, I made my first Kiva loan. Kiva is an organization that connects people in developing countries with loans to do whatever they want- whether it's jumpstarting their family business, buying solar energy for their home, or paying tuition for a trade school or university. My cousin, Anuranjita, gave me a Kiva gift card this past Christmas and, almost one year later, I finally got around to giving my first loan. I lent $25 to Marivic, a 37 year old Filipino farmer who needs to purchase fertilizers and other supplies for her rice farm. The other loan recipient is Beatrice, in Kenya, who is using her loan to purchase a 5,000 liter clean water tank for her local community. I'm satisfied to know that I've helped jumpstart Marivic and Beatrice's goals and made a difference in their lives. For me, the coolest thing about Kiva, and other microfinance projects, is that they aren't charities. Eventually, I will get my money back and use it to make another micro-loan to finance other projects. This is a sustainable way of promoting economic development in areas where individuals have little access to banks or loans. I am thankful for Anuranjita for giving me the gift of participating in our intimate, global economy. I had a fun-filled week outside of the library. On Friday, I attended the American Medical Association (AMA) Medical Students Section national conference to network with med students from other schools and learn about the AMA. I went to one workshop that focused on hospital-insurance company contract negotiations, which turned out to be really cool. We divided into small groups and role-played as hospitals and insurance companies and duked it out in order to achieve our case objectives. My team, the hospital, aimed to increase reimbursements for vaginal deliveries and C-sections and decrease the time interval for contract negotiations. The insurance company aimed to cut down reimbursements for surgical procedures and screw us over in other domains. Unfortunately, my team got squashed in the negotiations and ran out of time before we could secure any of our goals for contract negotiations. Nevertheless, I learned a few negotiation strategies and the importance of properly negotiating my own employment contracts in the future. Anyone on the other side of negotiation table from me better look out, because I'm going to be the next Mark Cuban. I also attended a business pitch contest, called Pitch George, where undergraduate and graduate student-contestants competed for $50,000 in funding from venture capitalists. I definitely benefitted from listening to the contestants pitch their ideas. My med school buddies that I attended with sat in the back and brainstormed ideas for new medical devices during the event. (The only thing I came up with is a speculum that has XM radio built into it. Imagine how cool it would be to listen to Fox News Radio or BPM Radio through your vagina during a gynecological appointment!) The cool thing about this contest was the contestants gave their elevator pitches in an actual elevator. See a snapshot below. This was a fun week in learning tidbits about some business aspects of medicine. Given how awful my first medical invention idea is, I'm bound to get better at this stuff. Time to be a med student again. Back to Pathoma! I have seen several of my classmates post an editorial on social media over the past week, titled: I just finished my 87 hour work week and have 230000 in medical school debt. It is the story of an intern who has accrued a significant debt and is feeling overworked. Read it if you want, I personally couldn't get through reading the entire thing.
Before I continue in my response to this editorial, I agree with many of the sentiments that the writer presents. I too am concerned about going a quarter of a million in debt and earning a less than a minimum wage salary for four years of residency training after I graduate. But the author's tone makes me viscerally uncomfortable. He sounds self-righteous, delusional and downright complainy. The following passage exemplifies this: You may ask why do we do all of this? It’s because we have pride in what we do. We truly care for the well-being of the human race. We have been conditioned to think, act, talk, and work as a very efficient machine, able to handle emotions, different cultures, different ranges of intellect, all to promote the health of America. We are doctors. This is a narrow-minded, overly-idealistic string of ideas that makes it seem like the author thinks that doctors are the only people in this fight to "promote the health of America." What about nurses, physician assistants, physical therapists, medical technicians? If this individual were truly passionate about the aforementioned ideals, and equally concerned about his amount of debt and work hours, he should have considered attending a PA program, which requires 2 years of post-graduate education, and in practice, PA's have for a similar amount of autonomy as physicians in many states. Then, the author goes on to say, "Had I invested my talents in other pursuits such as law school, I would not have built up this level of debt." This sentence makes me sick to my stomach. If this guy is going to throw out a hypothetical scenario about how glamorous the life of a lawyer would be, then he is truly deluding himself. It requires an entirely different skillset and intelligence to be admitted to law school, succeed and, oh yeah, get a job after law school. His comparisons to other careers demonstrates a gross misunderstanding and disrespect toward what other professionals dedicate their lives to. The bottom line is that the amount of debt that a doctor-in-training accrues is temporary. With an average attending physician's salary ranging from $150,000-200,000, with some basic financial planning, loans can be paid off four to five years after completing post-graduate training. The job stability of being a physician is nonpareil to other careers. It's an active choice to definitively start off one's career in debt, but essentially have a guaranteed job for the rest of one's working life. No one is coercing a doctor to enter medicine. If being over-worked or incurring too much debt is a problem, and one genuinely cares about promoting the health of America, then pursuing an equally important career as a physician assistant, physical therapist or nurse, where one would have spent less time training, and more time earning, is a more logical choice. Physician compensation reform is one of my main interests in health policy. There are several things that can be improved to better pay for physician services. The things I cannot tolerate is when people like the author of this article disrespect the integrity of other careers in healthcare by ignoring them, disrespecting outside sectors by saying he could have pursued another career, and overlooking the longitudinal earning potential of a physician who works for 40-50 years. Tx for our frustrated resident: Get a little perspective. The New York Times came out with a status report on the e-cigarette industry, which is currently in a watershed period as the FDA and CDC are about to release health warning statements on the products. In pharmacology, we learned that e-cigarettes are a a relatively healthier alternative to real cigarettes because they don't contain a lot of the toxic chemicals that are added to cigarettes. E-cigs are essentially vaporized nicotine, which has minimal harmful effects on the body relative to the other ingredients in cigarettes.
This article brings up a good point in mentioning that switching to e-cigarettes from real cigarettes may not be beneficial in smoking cessation as the nicotine rush is less potent than smoking cigarettes. The experts say this increases the risk of relapsing during a quit attempt. While this concern is valid, smoking cessation devices work by this exact method of only delivering nicotine. Another consideration that this article brings up is the increasing prevalence of trying e-cigarettes among youth. This is something that could potentially catch on to a large-scale and become a gateway drug for tobacco use. The growth of the e-cigarette industry is rapid and the makers of the product are ambitious about eventually making real cigarettes obsolete. At this point, we don't know the harmful effects of e-cigs. It's going to be interesting to see what the FDA has to say about e-cigarettes in the coming weeks. |
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November 2015
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