Thursday, December 13, 2012

Don't Want No Scrub

No major public health lessons today, just a short personal essay about ye old medicine vs. public health debate (and no pictures until my computer is fixed):

 “Is there a doctor in the house?”  Through my high school and college years, the allure of sprinting  to answer that call (ball-point pen tracheotomy optional) got me through hundreds of hours of hospital volunteering and coursework on nucleophillic substitutions.  I was no nucelophile, but I wanted to be a doctor. 

Somewhere along the way though, I found public health.  I realized that while I will miss the scrubs and patients, I prefer to work on the population level.  Public health and medicine are often confused, and indeed, the overlap is obvious.  I work with so many great public-health-physicians mentors, like Dr. Dr. Niteesh Choudhry* and Dr. Albert Wu, that the boundaries between the 2 are often blurred in my mind.  Just as often, however, a holiday party conversation turns from Heath Bar cookies to healthcare coverage and I’m reminded again of the stark differences. 

At Michelle’s cookie exchange extravaganza (hardly public health) last weekend,  her friend Tracy, an MD-to-be, peppered the public health students with questions about the 'healthcare crisis’ and whether to pin the blame on policies, patients or payers.  She tossed out buzz words like accountable care organizations, fragmentation, and innovation, and we gamely gave our best expert (in-training) assessments of what makes healthcare tick. 

What stood out in our conversation wasn’t what was said (though I did drop the phrase “Bismarckian model”), but our different vantage points.  Like Tracy, we were conscientious kids who cared about patient welfare and loved Atul Gawande.  She told stories of impatient patients who demand antibiotics for viral infections, physicians frustrated by cost reduction plans, and hospital budgets focused on nursing wages (over physicians’).  In turn, we recalled the studies we’d read and explained what happens when thousands of impatient patients and worried doctors are stacked up and become the populations, and what we know of how they, and hospitals and insurers behave under different economic conditions.  We broke down the  pieces that contribute to healthcare cost and prices in the US, like physician salaries, and what happens when we alter each piece.

Tracy gave us compelling stories because she heeds the worries of her colleagues and teachers.  It’s her job to see patients as individuals and protect her professional autonomy.  Her stories inform and inspire public health, but they don’t govern it.  It is our job to look beyond individual bedside encounters, to see health and cost at a population level, and to provide affordable care for everyone in the economy.  It is thus our job to translate what we see into convincing stories that can change the way doctors, insurers, and patients, go about their business. 

*Doesn’t actually know that I think of him as mentor, so let’s keep this between us.

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