Preemptive Strike

A brief preface to some of the constructive criticism that might eventually stem from my experiences working in a giant public hospital:

Running a good hospital system is an incredibly difficult proposition. This is due in part to the fact that providing excellent health care requires a lot of different things being done well in unison. This is, as we all know, one of the hard parts of making any big system run efficiently.

Moreover, this intrinsic problem has been increasingly complicated by the development and entrenchment of our current privatized health care situation in the United States. Most health care not provided by the US government is provided by "health maintainance organizations" (HMOs), who incentive the use of exorbitantly expensive diagnostic tools and treatments for a small subset of the population (mostly the wealthy), while disincentivizing the provision of basic primary care for the everyone else.

And while many patients entering city's public hospitals ARE NOT covered by HMOs and rely primarily on insurance plans managed and paid for by the government (Medicare and Medicaid being the main programs), the incentive structure has been sufficiently warped by the influence of the private sector so as to create a similarly wacky organization of publicly financed care. This is sort of a complicated point - one which it behooves me to flesh out for you guys more thoroughly in the future.

With all of that said, there is a small but growing group of physicians (and MPHs, PhDs and JDs - and all of those degrees in combination) who are committed to figuring out how to make these public and private health systems work properly, providing excellent care at a reasonable cost. I'm meeting some of these inspirational characters in person in the hospital and reading about many more as part of my background reading for this job. In fact, I'll post up some interesting exerpts from an interview with one of the figureheads of this movement, Lucien Leape, in the near future.

Alright, that's all for now. Keep your eyes tuned to this space for more riveting (ha!) insights into (public) health care. Hopefully we'll all learn something along the way. Peace out.

hey yo, Sicko show like Mike Moore // my city ain't nothing like yours

Today I received my official Hospital ID. This may not sound like an achievement, but believe me – a celebration is most certainly in order. The process that has eventually led to me receiving this flimsy piece of plastic – with an appropriately unflattering picture of me inked on it – began in the last weeks of May and continued until 11:37am today, June 25. Here is a partial list of the things that
have happened in the interim:

I have completed two towering stacks of Human Resources forms, thesecond of which was so comically tall I laughed out loud when the clerk emerged with the paperwork;

spent approximately 40 hours in transit to and from the hospital's HR office to drop off transcripts, my resume, a copy of my passport, recommendations from former employers/advisers, and postmarked bank statements confirming my current address;

gone for a physical and taken two separate toxicology screens;

found an apartment to sublet with Jess for the summer;

and Euro 2008, a premier int'l soccer tournament, has gone from 16 teams to 4 (3 by the time you read this as Germany and Turkey have just kicked off. Go Turkey! They still probably won't let you into the European Union, but as this city hospital experience has taught me: keep working at it! Oh, and wear a goddamn tie, you slob – people take you more seriously when you dress up.)

However, it should also be noted that my lack of proper identification has not prevented me from starting my work here, sans pay. I have been coming in every day for more than a week now, sneaking past the security guards with my newly patented look of being extremely busy and excessively doctorly.

Fortunately, they have lots of work that needs to be done. I have already been given multiple potentially interesting responsibilities in the Risk and Quality Management departments, as well as the Medical Directors' Office. I have been exposed to the fascinating – while often depressing – administrative underbelly of the beast, and will share my observations from the front lines in short order.

Life and Death in the War Zone

An awesome Nova documentary on mobile military hospitals and the Physician-Soldiers who staff them in Iraq. Very intense but extraordinarily interesting. It makes me very happy that PBS has gotten on the new media distribution bandwagon and is making their content available online.

Pantsuit vs. Frosty the Snowman

Probably only postable now that the primary is over, but hilarious always.

Here I am / Morocco you like a hurricane

A quick and dirty assortment of pics from my trip to Morocco. Morocco is a wonderful - if sometimes bewildering - country and we had a fantastic time during the two week vacation. Our days were filled with of beautiful medieval architecture, magnificent wood/stucco/tilework, delicious food, and more shopping than any person on a student budget should admit to.

In no particular order:
















Lots of interesting things to think about on this trip -- my first into Le Monde Arabe. Maybe I'll take some time to write these thoughts/ideas/uselessobervations down and post them up here. I'm supposed to start my work at Bellevue hospital this week, which would make this difficult, but the paperwork processing is taking far longer than expected. In any case, you'll all be hearing more from me soon. Holler.