tag:blogger.com,1999:blog-6760873683081651675.post8068382390658898311..comments2024-01-18T04:16:57.545-06:00Comments on Orthopaedic Residency: The attending perspective: If only I could hit the ball straight, I would be a great golfer ...Anonymoushttp://www.blogger.com/profile/18071954032609414825noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-6760873683081651675.post-52548903974815600772007-04-10T15:35:00.000-05:002007-04-10T15:35:00.000-05:00I've seen a lot of speeches over the years. By fa...I've seen a lot of speeches over the years. By far the best was by a medical school dean at an academic center on the west coast. It was his retirement party, and he tearfully apologized to all the younger physicians, nurses, and even healthcare administrators for what his generation was leaving behind. It was the most honest speech I've ever seen, it came straight from the heart. He didn't blame anyone in particular, but definitely blamed his generation as a whole. <BR/><BR/>As I embark on this new career, I face the extremely challenging decision between the path of least resistance (decent hours, decent salary, home life, and time) and that which would consume my entire being with trying to improve the way in which we provide healthcare. Only time will tell if there are enough of us willing to make that sacrifice.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-6760873683081651675.post-55306006231049360712007-04-07T14:54:00.000-05:002007-04-07T14:54:00.000-05:00A growing sentimentI appreciate your reply to my c...<A HREF="http://www.detnews.com/apps/pbcs.dll/article?AID=/20060928/LIFESTYLE03/609280388/1148" REL="nofollow">A growing sentiment</A><BR/><BR/>I appreciate your reply to my comments.<BR/><BR/>The above link should be added to my list of issues. There is a growing voice knocking the quality of US medical care. Like all things, there are elements of truth and elements of opportunity.<BR/><BR/>Clearly, there are medical errors that cost patients health, life, quality of life, etc. They also cost money. I do not trust any quantification. During my residency it became beneficial to meticulously document every "complication" on d/c summaries for the sake of DRG compensation. So everyone d/c'd in '02 with the dx of "failed total hip" was d/c'd in '06 with "failed total hip", acute blood loss anemia, acute hypokalemia, some form of respiratory distress to describe atelectasis, gait dysfunction... I think you get my point. Nothing really changed other than the documentation.<BR/><BR/>Second, perks that GM offered (i.e. legacy funds) are more costly than they know what to do with. A national plan could save them I can only assume billions. The same is true as the election approaches and candidates look to distinguish themselves with issues over than the war.<BR/><BR/>Knocking the quality of care in the current system is a great way to gain public support for a large overhaul in the system. It is a sort of bait and switch since the overhaul will really be meant to control how health care is made available and paid for - not quality. Truth is, we really don't have great quality markers. "Pay for performance" measures such as everyone off abx 23hr after elective surgery is probably not the greatest measure of actual quality of care yet those types of benchmarks are likely going to be more common than how many hips are put in varus or dislocate 3 times in the first year.<BR/><BR/>I anticipate hearing a lot about the 747 jet worth of patients who die daily b/c medical errors over the next 5-10 years.<BR/><BR/>I could not find a good single link, but googling "medical errors" and "bill bradley" will return a fair amount of hits that describe some of sentiment growing among lawmakers.<BR/><BR/>Stories like the one about the specialty hospital calling 911 are great fuel to this fire. But that's the thing about fuel. Its great because it burns for anyone who uses it to build their argument. We may not like that physicians all get tagged as greedy because of those investing in specialty hospitals, but it doesn't change the validity of that story and the factors that went in to allowing that to happen.<BR/><BR/>Despite my reservations about why and how this topic gets attention doesn't change that it deserves attention on our part. The most common explanations discuss how no one error is accountable and that there are larger system problems. I really do not understand that in concrete terms i.e. how to build solutions. I hope someone does because taking the steps control iatrogenic morbidity is our responsiblity.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-6760873683081651675.post-18330463352873998092007-04-07T13:58:00.000-05:002007-04-07T13:58:00.000-05:00I would first like to say "hello" to my friend and...I would first like to say "hello" to my friend and comment that I am continually amazed at your diverse talents. Second, I would like to respond to this blog which comments on the current state of medicine.<BR/>If I described a profession in the following way to a high school or college student, do you think they would be eager to sign up? In the profession of which I speak, you must train at least 7 years past college - most people train for longer. At each step in this path, you must be in the elite of your class in order to have the priviledge to proceed to the next level. When you finish with this training, you will likely be in debt anywhere from 100-250 thousand dollars. During your life after training, each service you provide could result in serious harm or death to another individual. Heaven help you if you do have a bad outcome because the judicial system is waiting to pounce, making your life pretty miserable in the meantime. These facts are in addition to an attitude found in the people you serve that your work and their outcome must be near perfect or someone must pay. You also participate in a profession which charges a fee for a service but receives a much lesser compensation. Not only do we receive a lesser compensation, but we expect it and are thankful because of that pesky training debt which must be paid. In addition, our collegues are generally disgruntled and ask young people like us why in the world we ever would choose this field. Many days we leave our best at the office and our family gets what is left over. As a profession we are generally fatigued, stressed, worried, fearful, angry, and resentful of the profession we freely chose a few or many years ago. I could go on, but I think you get my drift.<BR/>The fact is, that many aspects of medicine suck. I personally have never known a different system. This is a good thing because I have no idea how good the old guard had it and I quite honestly do not care. There are lots of things in my profession I do not like and when given the opportunity, I try to participate in changing them. But the fact is that my student loans will eventually be paid just as sure as I will eventually be sued multiple times. My patients will likely not appreciate the efforts I make for them and the time I spend away from my family. There is no rule that says they have to. No one said this was going to be easy and I can tell you for a fact that life could be alot worse. Some may think this attitude is similar to "giving in" or "settling for less." I disagree. My advice to potential or current residents is this: Chuck "the Iceman" Liddell loved mixed martial arts before he was ever on TV or made any real money. He enjoyed knocking people out when he drove a Ford Ranger just as much as now when he drives a Ferrari. He is passionate about what he does. In the medical field there are enough negatives to destroy your spirit if you are not at least somewhat passionate about what you do. If you are in this for other reasons, my suggestion would be to stop now while you are ahead. Find another way to spend your days. But if despite all the negatives you can still find that passion, if that one straight 300 yard drive still lights your fire like it does mine, then put on your gloves and step in that cage - Let's get it on!<BR/>Thanks for reading my ramble.<BR/>Taylor's DadAnonymousnoreply@blogger.com