Category Archives: Education

Med School Gap Year: One Student’s Journey Advocating for Health Care

Stanford Tran

Stanford Tran

While my medical school classmates were deep in their sub-I’s, I took a year off and spent my days being chased off parking lots by grocery store managers. I often wondered what I was doing and how did I manage to drift so far from medicine.

I found myself in this unenviable position by trying to change the health care landscape. Health care in America is fragmented, expensive, and often ineffective. This has been self-evident for 20 years, yet the problem is getting worse. We have a health care system shaped largely by government policies and government dollars, and, conversely, we have a federal budget that is shaped largely by health care spending. Since I wanted to be an agent of health care reform, I thought the obvious way to do that was to run for a seat in the House of Representatives.

Sure, it is unconventional to run for federal office as a first-time candidate, to have no money or donors, and to have lived in the district for less than 3 years, but these are, in medical lingo, soft contraindications. The mechanics of running for public office is pretty much the same no matter which office—you spend your days begging for votes or for money, which in turn helps you beg for votes. You get the distinct feeling of being a panhandler, replete with being chased off from grocery stores. The only difference is that as a candidate, you are better dressed. People innately realize this because while many are politically opinionated, few ever imagine slumping to the level of a political candidate.

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Risks, Benefits, and the “Invisible Bag”

mitchell-f-richard

Richard F. Mitchell, MD, MS

“Did you discuss prostate cancer screening with your patient?”

“I did, but…”

“But what?”

“Well, it was strange, but as I was discussing the risks and benefits, the patient just looked at me and said, ‘This is confusing, can’t you just tell me what I should do? What would you do if it was you?’”

Has something like this happened to you while you were precepting residents? Has it happened to you when you were talking to your own patients? In this age of patient-centered care, we teach our residents to involve patients in shared decision making. How do you counsel a resident working with a patient who doesn’t want to buy into that program? How do you teach your residents to respond to the question, “If it was you, what would you do?”

You might find the answer in an invisible bag.

“There is an invisible bag right in front of you. Think ‘Santa Claus sack.’ Would you like to reach in and take something out?”

“Why would I do that?”

“It’s full of $100,000 bills.”

“Yes! Can I take two?”

“No. But there’s something else you should know. The bag also has blank pieces of paper that feel exactly like $100,000 bills.”

“That’s OK—can I put my hand in now?”

“One last bit of information before you do—it’s also full of razor blades.”

“…Ah.”

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Video and Direct Observation Precepting: Time to Remove Our Head From the Sand

Keith Foster, PhD

Keith Foster, PhD

Advances in technology have made direct observation by video recording or live-feed easy and affordable, allowing the most financially limited programs to conduct direct observation this way. It is not surprising, then, that a large number of family medicine residency programs use some form of video recording or live-feed direct observation.

What is surprising is the absence of or only passing reference to the issues of informed consent, patient authorization, and procedural guidelines related to video recording and live-feed precepting in the examining room, particularly in the age of HIPAA.

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