Health Care Reform: Medicine vs Surgery

Lost within the political debate over healthcare reform, is a battle currently going on within medicine itself. Although most if not all doctors agree that there needs to be significant changes to the health care system, there is significant debate as to what exacty this should entail. Before I get too far ahead of myself, let's go back to the opening salvos...



In response to this statement the American College of Surgeons released the following letter, which goes on to decry the gross exaggeration of what a surgeon makes on a given operation. In addition it states that misinformation regarding healthcare does nothing to further the debate, adn that the surgeon patient relationship could be damaged as a result. Also, interesting is the many surgical subspecialties that signed on to the letter. This was not just the American College of Surgeons (ACS), but it also included everything from the American College of Obstetricians and Gynecologists to most if not all of the surgical specialties (Urology, Orthopedics, ENT etc.).

More recently the American Medical Association (AMA) has come out in support of the current legislation that passed in the house relating to health care reform. In a letter to Speaker Pelosi, the AMA applauded many of the proposed changes that the bill would enact--specifically they stated that the bill would expand coverage, reform the insurance industry, and protect patient-physician decision making.

Not long afterwards the ACS shot back with this letter to the senate, cosigned by 21 other specialty organizations. It rebutted several of the points made by the AMA and focused on several key issues that it had with the bill.

Additionally they reaffirmed the need for Tort reform in this statement:

CHICAGO: The American College of Surgeons applauds Democrats – led by House Majority Leader Steny Hoyer (D-MD) – for recognizing the need for Congress to address medical liability reform as part of the overall health care reform bill currently under consideration. Over the past few weeks, we have been encouraged to have heard Democrats and Republicans across the country talking with constituents at town hall meetings about the need to address this important bipartisan issue.

The current climate in this country is one in which surgeons and other physicians are forced to practice in an environment of defensive medicine, sometimes ordering additional and possibly unnecessary tests in order to avoid lawsuits. Addressing medical liability reform as part of the overall health care reform bill will help to stem the tide of rising health care costs.

The American College of Surgeons urges President Obama to make medical liability reform a more central component of his call for overall health care reform. Further, we urge the leadership of both the House of Representatives and the Senate to include this important issue in the bills that they will take up in the coming weeks.

Here is President Obama speaking to the AMA regarding Tort reform.


Recently, the ACS has released a side by side chart of the House and Senate bills, along with what they view as some of the drawbacks.

The battle lines seem to have been drawn, with the AMA standing with the president and the majority of the Democrats (except Tort reform), while the ACS and most Republicans stand in opposition (although both groups support repealing the Sustainable Growth Rate provision--something opposed be most Republicans and some Democrats). It's interesting to me how this has happened, I wonder if the average surgeon would describe themselves as being right-leaning politically and the average medicine doctor would say they are left-leaning, or whether this is just how the chips fell in this one instance.

Surgery - The Start of Third Year (Part 1)

After two days of ortientation both to the hospital and the surgury rotation in general we were finally able to start getting our hands dirty learning the basics of general surgery. I was both extremely nervous and very excited, nervous that I would make some glaring mistake, nervous that I would ask stupid questions and be thought of as a student not deserving of the trust that was placed in me, nervous that I would not be able handle the long hours associated with the surgical rotation, but most of all just nervous that maybe I was not going to be able to cut it as a clinical medical student. At the same time I was also very...

Excited. Excited that I never again would spend days on end studying for a (mostly worthless) biochemistry test. Elated that I was now going to be working with real patients. Overjoyed that I was going to play some small role on a team that was working to help heal patients. Needless to say it was a time marked by dramatic mood swings.

Before I get too far, I should give a little more background.

The surgical rotation that I am on does mostly common general surgical procedures, for instance gall bladder removals, appendectomies, thyroid and parathyroid surgeries, some melanoma removal and emergent surgical cases.

The service that I am on is specifically a trauma service, so over the course of the next 6 weeks I'll be helping to take care of a lot of patients who have been in a car accident, or fallen and broken bones, or patients that require an emergency appendectomy or other urgent procedure.

I found all this out during the first two days of orientation, but nothing that they tell you during orientation could prepare you for the experiences and emotions that you will feel as you walk into the hospital on your first day of work.

Immediately I met the chief of the service--for the unindoctrinated, the chief of the service is a doctor who is in the final year of their residency, in general surgery this means that they have been out of medical school for 5 years. In my situation the chief resident had been a doctor for 6 years as she had taken a year to do a fellowship in critical care.

Also on the trauma team was a first year resident, aka an intern. At many hospitals, about half of the interns are on a track to become general surgeons while the other half are either in a year-long "preliminary surgery" program or are in a "transition year". For the most part, those in those in the "preliminary surgery" program are either US or international students that didn't match into the surgical specialty they wanted to (ortho, ENT, general surgery, etc). Students in a transition year have already been accepted into other programs, but as part of their training they rotate through different specialties for their first year. For the first month we had a transition year student who was accepted into the Radiation Oncology program, and the second month we had a Preliminary Surgery resident.

I was very fortunate in that I was on a relatively small team for my surgery rotation. In other hospitals, 4 medical students would be assigned to teams of 10 residents. The major difference between our 3 person team and the larger teams seen at other hospitals was the lack of mid-level residents on our team. In other words the 10 person team would have a number of 2nd, 3rd, and 4th year residents sharing the workload. The downside to a small team is that when there are 40 patients on the rounding list for a Saturday you only have the three of you to see them all. The upside is that many times in the OR it was just me, the attending and the chief resident doing a case. Which for me was the most interesting.

Start of a New Chapter

A week ago I started a new chapter in my medical life; 3rd year rotations. It has been a huge adjustment, but a very fulfilling one at the same time. No more speding days on end with my nose buried in a book. From now on the majority of my learning will be hands on.

When I have the time I'm going to be writing about the experiences that I have while on rotations so that I can someday look back and remember what it felt like to be just starting out.

For my first two months I am rotating through surgery (which I first saw as a curse but am now really enjoying) at one of the busiest surgical centers in the country (in terms of # of surgeries at this hospitals three sites).

How to Stop Sunburn Itch

My life was almost cut short by a terminal case of surburn itch this afternoon. In my desperate state I couldn't find a good source on the internet regarding how to stop sunburn itch. Because of this (and its remote connection to the medical nature of this blog) I decided to describe my own experience and create a "comment forum" on how to possibly remedy the condition.

Before I continue, let me clarify something: this is regarding the pain-from-getting-burned-just-stopped sunburn itch, not the my-skin-is-peeling sunburn itch.

Here is the backstory:

After spending some time near the equator, I developed a whopper of a sunburn. For a few days I had some difficulty sleeping secondary to the pain the I experienced any time that I moved. Lathering up my back with aloe and other mosturizers, by Sunburn Day 3 the pain was starting to abate and I figured that I was just about out of the wood. Then the unthinkable happened.

I was minding my own business (standing on the street corner when these two guys started to make trouble...wait that's another story), sitting by the computer when out of the blue my back starts to itch.

So naturally I reach around and scratch it. And would you believe it, that didn't seem to help. I keep scraching, but I'm quickly realizing that I need something bigger as I can't scratch my entire back at once, so I run into the bathroom and start frantically grinding my back up against one of the towels that we had hanging up. All this seemed to do was create a kind of itch/pain wherever I last scratched.

This seemed to help for a few minutes, but I was quickly leaving the this-is-mildly-annoying part and entering the I'm-at-risk-for-losing-my-mind phase.

I then tried laying face up in bed and moving up and down, but of course that didn't work. Then I tried arching my back as much as possible (is that decorticate or cerebrate?) as if I was going to do a backwards cartwheel, then curling up into the fetal position--zero help whatsoever.

All the while the itchiness was coming in ever greater waves. My heart was racing and my entire body began to pulsate with each heartbeat. You may think I am exaggerating, but until you have suffered through a good case of sunburn itch, you'll never understand. There were times where I actually considered going into the emergency room, I was that concerned that something serious might be going on.

So here was the one thing that helped: put about an inch of aloe vera gel on your back. I'm assuming it is your back that got burned because, unless your a nudist, chances are you went to the beach with skin white enough to make the Amish proud and decided to spend most of the day face down. Here's the important part: lie completely still, facedown on the bed. I'm sure that after a lot of itching you will be having some involuntary back spasms with how bad the pain is, but the only way to feel better is to keep from moving the burned part.

At first, putting gel on your back is only going to make the itching worse, and you'll still have some lingering itchiness, but it will pale in comparison to how miserable you were beforehand.

Addendum: My wife couldn't believe that I was in as much agony as I was letting on--feel free to point to the comments section of this post when your friend/parent/significant doesn't believe you.

Drag Me to USMLE Step 1

I'm stuck in a never-ending Step 1 studying, phase of life, I'll post some more once I emerge.