Residential Space A creative outlet during residency, turned ongoing virtual soap box

Thank You For Smoking  0

Posted on May 31st, 2006. About Entertainment.

We saw Thank You For Smoking over the weekend, and I am highly recommending it. I was physically laughing aloud, sides hurting and all, throughout the entire film, and when it concluded, I was ready to cheer – for the lobbyist! Go figure, right?! This is a movie that is right up Jamus’ alley – its sardonic, biting humor is most excellent.

States and Nations Visited  1

Posted on May 31st, 2006. About Ramblings.

Evan and I always have a friendly competition going when we travel to see who has visited the most states within this great country of ours. So when Jenna posted a map of her states visited, I decided to generate one of my own.

statemap.gif
create your own personalized map of the USA

I figured this did not look too bad, just a few holes in the Midwest and Northeast, along with Alaska and Hawaii. I have no idea when I’ll ever be passing through Nebraska, Iowa, Kansas, or South Dakota, though. I flew through the Salt Lake City airport in 2000, but I’m not sure if that actually counts as having visited Utah (on the way to Austin’s wedding!), so I’ll leave it blank…

Then I created a map of countries visited:

worldmap.gif
create your own visited country map

Yikes – look at all of that white, empty space (although I’m amused by how it filled in all of the northern-most islands of the Canadian Wilderness). Like the little red dot over Costa Rica? 8) Perhaps I will use marathons as an excuse to visit some of these nations – my fellow runner, Liam, just finished the Prague Marathon, and I was thinking about how it might be an adventure to plan a trip to Sweden or Estonia or Japan for such a race experience. But perhaps I should save these ramblings for my running blog

More Books Read  3

Posted on May 23rd, 2006. About Books.

I have fallen horribly behind on my reading – it looks unlikely that I will read 50 books before the year’s end; however, I will strive to read as much as I can between hospital shifts and training runs.

Book #5: Marathon: The Ultimate Training Guide by: Hal Higdon; pages: 256.

Book #6: Freakonomics by: Steven Levitt and Stephen Dubner; pages: 242.

Book #7: Devil in the White City by: Erik Larson; pages: 447.

I had read Higdon’s Marathon two years ago while considering training for the London Marathon of 2005. I revisited the book a few weeks into training for the Portland Marathon (I’ve been blogging about my progress with this on my running blog). Much of the focus is on injury prevention, which I can appreciate.

Freakonomics is a fascinating book that demonstrates, with raw data, some startling findings, such as a correlation with the drop in violent crime and the implementation of legalized abortions following Roe v. Wade; numbers demonstrating that realtors get more money for their own homes than for those of their clients; and evidence that children may not benefit from being read to by their parents.

Devil in the White City was one of the most interesting books I’ve encountered in quite some time. The author very effectively juxtaposes the construction of the Chicago World’s Fair (Columbian Exposition) of 1893 with the violence created by H.H. Holmes, America’s first known serial killer. I’m highly recommending this one. 

Stats:

  • 143/365 – 39.17% of 2006 complete
  • Books Read – 7/50 – 14.0%
  • Pages Read – 1343/15000 – 8.95%

A Busy Two Weeks  0

Posted on May 21st, 2006. About Uncategorized.

Wow, so it has been a while since my last blog posting. Evan and I have been away on several trips. I complained when I learned last June that my department put two of my three vacation weeks together at the end of the year (my year runs much like a school year, from July 1st through June 30th). The months flew by, however, and before I knew it my two weeks off had arrived. We travelled to Buffalo, NY for my sister-in-law’s graduation from SUNY – Buffalo, and then flew from this location to Houston, TX for two graduations – my cousins had finished at Sam Houston State University in Huntsville. Evan and I really enjoyed our time with our families, and I write this with great honesty. Being with our mothers near or on Mother’s Day weekend, hanging out with our siblings, and just catching up with our families – wow, what a great week.

Here are some comments about which I have wanted to blog, inspired by the trip:

A) If you must bring small children to something as monumental in a person’s life as, say, a college graduation, take them outside if they start screaming. However, under absolutely NO circumstances do you allow all THREE of your children to run and play in the aisles.

B) Uncle Randy gave us a fascinating tour of the (outside of the) Huntsville Prison in between graduations, notorious for putting more prisoners to death each year than any other U.S. facility. His grandparents lived down the street from the building, so he was able to give some interesting first-person accounts.

C) Continental Airlines fed us breakfast on the flight to Buffalo, and they fed us lunch on the way to Houston. All flights and connectors were on time. No complaints!

Once we returned to Seattle, we packed the car and headed to Montana for our camping trip. After a night at a small campground in Clinton, MT, we made it to Yellowstone National Park the following day. Gorgeous sites! My favorites were a sapphire pool and the “Artist’s Paint Pots” (those of you who have seen the park will know what these are). Our trip also included a day through Glacier National Park, a night of camping in a wide-open field in Alberta, Canada (with 50+ mph wind gusts, this was an interesting experience). We ended up coming home a day early and are now watching our recorded final episode of Will and Grace.

Good to be back – more to come later!

What’s On My Mind Today  0

Posted on May 9th, 2006. About Ramblings.

First of all, I’m consumed by the thought that, after 8:00 tonight, I am officially on paid vacation for two weeks. I look forward to seeing my sister-in-law, Catherine, graduate from SUNY – Buffalo on Thursday (to progress on to medical school at Columbia P&S in the fall!), and then to seeing my two cousins, Nathan and Katherine (this one with a “K”) graduate from Sam Houston State U in Huntsville, TX on Saturday. Evan and I will have the chance to see our mothers during this week, appropriately since Sunday is Mother’s Day. Once we return to Seattle, we are embarking on a week-long camping trip to some of the Northwest’s national parks – Yellowstone, Grand Teton, and Glacier/Waterton. On the way home we fully expect to stop at some of the Washington vineyards in the Yakima Valley. Then, I will have one month remaining of my intern year, and will become an upper-level resident on July 1st. Life continues to be swell.

However, I digress – the purpose of this post is actually to blog about a couple of things that captured my attention. First, I ordered an official copy of my birth certificate to have for my personal records. I noticed that there is a line with my father’s full name, and beneath this is a line designated for describing his occupation. Then, there is a line for my mother’s name, and NO LINE FOR HER OCCUPATION. Ahhh, Texas in 1978 – I suppose women weren’t expected to have careers at that time. I think if I were my mother, a college-educated high school teacher, I would have written my occupation beneath my name with arrows in the margins highlighting the lack of space for this information.

Second – I found this article very exciting. To continue my health and fitness diatribe, the article describes an obese man’s journey as he walks across the United States. He began his journey last year in California at well over 400 pounds and is expected to arrive in New York next week, having lost about 100 pounds along the way. I hope he inspires at least a couple of people to start walking to work rather than driving, or convinces them to start exercising even just three days a week for 30 minutes at a time. He alone, by inspiring three people to get in shape, could, by preventing three cases of diabetes, save the healthcare system literally millions of dollars. Of course, I definitely thought he deserved mention in a blog post.

Finally – along those same lines, I decided not to pack my lunch today because I’m leaving town for two weeks and didn’t think it was worth it to buy a loaf of bread, fresh fruit that would go bad, etc. The free lunch today at our Chairman’s Lecture was pizza – very tasty, but extremely greasy (soaked through the bottom of the three paper plates it was stacked on) pizza, with only soda to drink. I had two slices (after doing the middle school thing where I patted napkins over the top of each slice to soak up the orange oil) and felt happily satiated, and not too regretful because I ran this morning, but just weird. I recently posted on how easy it is to eat healthily – and I think, for those willing to pack lunches and to invest in the right foods, it is, but for those who try to find food once they have already left their homes, it can be a bit more challenging.

Have a lovely rest-of-the-week, and if I don’t post while I’m on vacation, there should be much to say once I am back.

National Healthcare System – The Way To Go  3

Posted on May 4th, 2006. About Health Care, Money, News and Politics.

I attended a conference this morning during which one of my colleagues, a graduating third year internal medicine resident, gave an excellent presentation on the pros and cons of a national healthcare system. Prior to graduating from medical school, I was quite hesitant about this idea. After a year of practicing medicine as a physician, I am in favor of it, because I honestly believe it would provide better care to more people at a lower overall cost.

Let’s be honest – healthcare inflation is drastically out of control in this country. It’s only getting worse – it will not get better. I think that is worth re-stating for emphasis – IT WILL NOT GET BETTER. Healthcare is >12% of our GDP and is rising. More than 40 million Americans are uninsured, and this does not include those on Medicaid and Medicare – also funded by tax dollars. In short, I do not think our current system is sustainable.

I was against this notion for a long time because I possessed several fears: A) Huge waiting lists would arise and it would take months to have a simple procedure done. B) Research and development would be stifled because drug company profits would fall and thus there would be less incentive to fund research. C) Physicians would be paid little for the amount of training they have undergone. D) The quality of care would be compromised.

I will address these points individually, as I believe many people share these concerns:

  • Waiting Lists – I, as an individual with excellent private health insurance, had to wait over two months for an esophagogastroduodenoscopy (EGD). I have had patients this year who have had CT scans in the ER demonstrating masses in their colons, and if they are not admitted to the hospital, then the soonest they can be worked in for a colonoscopy is three months. The truth is, we have horribly long waits today, and if anything a national system will be more uniformly funded in such way that some of these waits can be reduced.
  • Research and Development Dropoff – A national plan would likely involve bargaining with drug companies to label certain drugs in specified classes as “formularies,” that is, first-choice selections that can be obtained at lower cost. I am all for R&D, but much of the funding, even in private companies, comes from the federal government already. The National Institutes of Health (NIH) gives huge grants to the pharmaceutical industry for scientific investigations. In addition, 85% of new drugs are what we call “me toos,” drugs that are not new or innovative, but just different forms of what already exists and offers no added benefit to what is currently available. If anything, I believe that this new system would encourage true R&D – why develop yet another statin when three others, the three that are supported with clinical trials, have been shown to be more effective? They would be motivated to then focus their efforts on creative new approaches to, say, amyotrophic lateral sclerosis (ALS), a disease where no good treatments currently exist.
  • Physician Compensation – There are many models that exist for a national system, including one that supports single-party payer reimbursement. Under similar systems physicians are well-compensated without the hassle of having to jump through twenty different hoops with hundreds of insurance companies (and each company selects their own hoops) to try to get a procedure covered that may end up being denied – and if denied, the financial burden falls on the patient, or if the patient will not pay, the healthcare provider. On the other hand, under our current system, we see many patients without insurance who will never be able to pay the bill. The hospital, or the physician’s office, eats the cost. We are required to treat “emergencies” whether the patient has funding or not – and while this may seem okay to some, why should the hospital, a business, have to eat the cost? Under a national system, the hospital and physician are reimbursed for every patient, patient’s don’t have to worry about hospital bills, and the system comes into better balance.
  • Quality of Care Compromise – It is now difficult for me to imagine the quality of healthcare being compromised. For some of my patients, when they realize that their funding is about to run out, or if they worry that they can’t pay their bill, they leave the hospital prematurely before their treatment has been completed. Because physicians spend so much time on paperwork, there is less time to provide patient care – eliminate the papers, and suddenly we have more time to spend with each patient, or we have time to see more patients to reduce the waiting periods for appointments.

Perhaps the biggest reason I am in favor of this system is because it would bring preventive healthcare to the forefront of medicine and reduce the cost of catastrophic medical complications. For example, in Quebec a $2 copay was added for each prescription picked up at the pharmacy and a small copay (don’t know the amount, but it was similarly small – less than $5 per visit) was added to each visit. The number of ER visits shot up dramatically and the number of dollars spent on inpatient hospital admissions skyrocketed. Now, a system is in place with no copays for anything, and their healthcare spending overall is back down significantly. I have seen several studies outlining this and it really does appear to be effective.

There are multiple propositions on how to fund such a system. For starters, the taxes we pay for Medicare would go to the new system. It has also been estimated that the amount of tax required would be anywhere from 8 to 17%. It sounds expensive, and it is, but consider that employers providing health coverage (even with copays) pay anywhere from 7 to 25% of each employee’s annual salary to provide this benefit. Employers could still bear this cost, or else be able to increase salaries such that the federal tax could be removed from the employee’s paycheck.

Consider this – uncontrolled diabetes over years often leads to kidney failure, blindness, non-healing skin wounds that lead to amputations, and premature nursing home placement. If I have a patient with early diabetes and without insurance, she can either A) go to her physician for her checkups every two to three months and obtain her oral medication or her insulin free of charge, or B) she can act noncompliantly with her recommended care because she has no money and no insurance – and then, 15 years later, we have a woman in florid kidney failure, on dialysis three days a week (hugely expensive), going blind, in a nursing home at the age of 60, and draining the system of thousands of dollars a month. It sounds dramatic, but I cannot count the number of cases I have seen almost exactly like this one. I know people often think of a nationalized system as a “liberal” idea, but I insist that it is a fiscally conservative notion, and one that must be considered before being cast aside. Over a ten year period, it is estimated by healthcare economists that a nationalized single-party pay system would save over a trillion dollars – yes, that actually says trillion. A thousand billion. That’s $100 billion dollars a year.

If you have read this far, I applaud your attention span. If you would like to learn more about a national single-party pay healthcare system, one website many of us like is that of the Physicians For a National Health Plan. I am also including a link to the Physicians’ Proposal for such a plan that was published in the Journal of the American Medical Association in 2003. There are many excellent resources listed in the bibliography for more information. I welcome comments on this issue, as always, and hope to hear what you have to say.

Thoughts on Nutrition  0

Posted on May 2nd, 2006. About Fitness, Ramblings.

I have been thinking a lot lately about overall fitness – not just exercise, but also stretching, strength building, getting enough sleep at night, and particularly, about nutrition. Perhaps this is because I am currently in the midst of Week 3 of 24 of Portland Marathon training (follow my training progress on my running blog). Or perhaps it is because I am a year into my medicine residency and have seen the horrible effects of diabetes and heart disease. The conclusion I have reached is that eating healthily should be easy for 98% of the population.

I began subscribing to Fitness last fall, and the recipes alone are worth the $19/year. Two nights ago I made Thai Coconut Shrimp Curry from a recipe in their April 2006 issue (with my own tweaking, of course). Basically, lightly stirfry thinly-sliced zucchini and chopped carrots in olive oil. Add minced garlic, ginger, and curry paste. Add 1 cup of reduced fat coconut milk, 4 oz water, and 4 oz white cooking wine. After cooking for about two minutes, add 1/2 pound of frozen shrimp, 1/2 pound scallops, and fresh spinach leaves. Garnish with fresh cilantro. Granted, the scallops can add to the price (frozen shrimp is relatively inexpensive and tastes just as good), but when done correctly, it probably only takes about 15 minutes to prepare this meal. I had a cup serving for lunch with fresh strawberries and purple grapes, and for dessert (since I have a sweet tooth) I ate a prepacked cup of fat-free chocolate pudding. I am stuffed, and feeling quite nourished!

There are so many wonderful foods that can be integrated into a vast array of meals – pureeing skinless tomatoes in the blender, for example, can be an excellent source of vitamins and minerals while functioning as a soup base, a stew medium, or as a sauce over pasta. Baked chicken goes well on salads, over pasta, or as a baked potato topping. Chicken can be flattened with a hammer, have ricotta and garlic spread over the flat surface, rolled up, covered with fresh tomato sauce and oregano, and baked. A large filet of salmon at Costco can run as low as $11 and can be cut into at least 8 individual salmon steaks – an awesome way of absorbing omega-3 fatty acids and protein. Marinated in low-fat Greek salad dressing, baked, and then tossed over steamed brown rice is an excellent way to enjoy salmon.

I fear I could ramble on about this for hours. There are so many tasty foods just dying to be consumed by the American public, and instead – I’m saddened to see how many people walk around with their Whoppers, french fries, potato chips, and Biggie-size Cokes. I’m saddened when a diabetic patient has his other leg amputated and is found to be covered in bed sores that won’t heal, but remains alive on dialysis three times a week. I’m saddened when a man who has just become a grandfather dies from a huge myocardial infarction stemming from coronary artery blockage. It is horribly sad when a 55 year old woman has a stroke that leaves her paralyzed and unable to swallow or communicate. I often wonder – did anyone ever teach many of patients about how fun it can be to eat well? What difference could it have made?

I would support an effort to teach the upcoming generation in this country more about nutrition – not dieting, but just how enjoyable it can be to savor a well-balanced, wonderfully filling meal that also happens to provide excellent nourishment. Home economics, for example, should not be a nothing high school course – it should be required of all students graduating from high school, and they should have to learn proper food preparation. Schools should have vegetable gardens and fruit trees that the students tend, the products of which they can then enjoy with monthly parties of food preparation to celebrate their efforts. At Halloween let’s focus on making sweet bread from the pumpkin and savoring the roasted seeds while bobbing for regular Red Delicious Washington apples (plug for the WA apple industry here). Alas, who am I kidding?

If only I ran the country… :-)

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