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The Best of Times

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By Andrew V. Foley, F&M Class of 2013

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I am excited to welcome our first guest writer here on the F&M Health Professions Advising blog.  The comments below come from Andy Foley ‘13, who has aspirations to attend medical school, most likely as an MD/PhD candidate.  Andy was a Biochemistry and Molecular Biology major, involved in the Orchestra, Brooks House Congress, cross-country, VITA, and the Reynolds Middle School afterschool program.  He is currently a post-baccalaureate researcher in the lab of Professor David Roberts, with plans to begin a biomedicine masters program in Santiago, Chile next spring.  Feel free to start a dialogue by commenting below.           – Glenn N. Cummings, PhD, Director of Health Professions Advising

Could we enter the health professions at a more exciting time?  The greatest expansion of healthcare in U.S. history is less than 10 days away:  the next phase of the Patient Protection and Affordable Care Act (ACA) or “Obamacare” rolls out October 1 when new insurance marketplaces will open in every state, allowing citizens to shop for health insurance and choose a plan that fits their needs.  This massive expansion of coverage (48 million people, currently uninsured, are set to enter the health insurance marketplace) is coupled to an equally massive expansion of patient rights (insurance companies can no longer deny coverage to those with pre-existing conditions, nor can they drop patients in the middle of treatment), making healthcare professionals as much catalysts of social justice as they are providers of care. 

Furthermore, an evolution of healthcare delivery is underway, bolstered by expansions of preventive medicine, the patient-centered medical home model, and collaboration between providers.  In addition, research on human behavior and the human brain is proceeding with incredible pace.  As a result, an emphasis on “treating the whole person” is replacing old paradigms that separated mental health and body health.  How exciting to be at the forefront of this shift!  To utilize brain research to improve every aspect of our care, from pediatrics to geriatrics, stomping out mental health stigmas and leading the way on “whole person” treatment.  Just as important, we can use brain research to understand our own emotional limits and adjust the ways we approach our own mental health issues as care givers.

Lastly, our generation’s technological competence could save time, money, and even lives in the changing technological environments of hospitals and clinics.  Our typing, texting, and touch-screening should allow us to navigate efficiently and thoroughly through electronic medical records and use smart devices to find critical information in moments that count, such as correct medication dosages for ER patients (whether our technological expertise has come at the expense of both our social skills and social intelligence is still up for debate, especially among our parents!).      

Could we enter the health professions at a less exciting time?  Sure, we face an impressive expansion of healthcare, but we also face an imposing shortage of physicians:  the Association of American Medical Colleges (AAMC) estimates the U.S. physician shortage will reach 90,000 by 2020.  How can we possibly deliver quality care to more patients with approximately the same number of physicians while we currently struggle to provide adequate care?  Already, patients lament the short office visits and even shorter face-time with their doctors.  It is possible that this will get worse.  That is not only bad news for patients, but it's even worse news for health professionals who are “burning out” at high rates.  Burnout is categorized as feeling tired, stressed, and as a result, a loss of interest in one’s job.  In a 2012 article from the Archives of Internal Medicine that summarized the results from an unprecedented national study of physician health, researchers reported that almost half of U.S. physicians admitted to feeling burned out.

Just as striking are the statistics that are used to compare the quality of medical treatment delivered in the U.S. to other wealthy nations.  The U.S. is the worst out of the 19 wealthiest countries in the world in curing diseases that are curable.  We rank below Japan, Taiwan, and most European countries in life expectancy and our infant mortality rate is almost triple that of Sweden, which has the lowest rate.  Americans have lower survival rates from major diseases than their counterparts in wealthy nations.  And in a study among nine wealthy countries that compared the per capita rate of “Deaths Due to Surgical or Medical Mishaps,” the U.S. came in first…for the highest rates of death.  The ACA may help improve some of these statistics, but it is clear our delivery of care stacks up poorly on a whole compared to other wealthy nations.

Lastly, medicine has always been wrapped up with business and politics, but the influence of the latter over the former is as strong as ever.  Conservative senators and congressmen may succeed in passing legislation to defund the ACA and thus halt the forward momentum outlined in the first half of this article.  In addition, how long will insurance companies continue to control aspects of patient care and delivery?  For example, certain insurance companies cover depression medication, but do not cover therapy visits; therefore, physicians seeing mental health patients are often restricted as to the type of care they can provide or recommend.  In this case, insurance companies, not doctors, dictate care.  In another case, after strong lobbying by the natural gas industry, Pennsylvania legislators passed a law that silences PA doctors who obtain information about the chemicals used in hydrofracking.  The law states that companies have to disclose to health professionals any information that is requested about the chemicals used in hydrofracking; however, the health professionals must sign a confidentiality agreement that they will not divulge the information to anyone, not even their patient. 

Dickens’s opening to A Tale of Two Cities, “It was the best of times, it was the worst of times,” seems to apply as much to our current healthcare situation as to 18th century France.  One could make a strong argument for both the positive and negative perspectives of U.S. healthcare.  Indeed, the challenges have never been more numerous, and yet the promise and potential for a stronger, more accessible, and more efficient system has never been greater.  As much as ever, medicine cries out for deeply committed people who are prepared to be scientists, healers, community builders, team players, and advocates for social justice to catalyze this transformation.  The Liberal Arts tradition prepares us uniquely to step into these roles because it cultivates an expansive worldview, blurs the lines between disciplines, and challenges us to engage problems from novel perspectives.   As a new generation of health professionals, let us put this to work.  It is time to hitch our logic and reasoning to passion and resilience and create the system our country needs. With this in mind, it seems to me, there exists only one perspective for us: it can be be the best of times and we can make it so. 

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-Andrew V. Foley, F&M Class of 2013

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