Week 22: Medical Economics and Ethics

Our lecturers said to us this week "So you though you were coming to medical school to help people?" it only took 22 weeks for someone to try to convince us otherwise as we were lectured to this week about some of the economics of medicine. Value, as we need to interpret it, is simply quality over cost. To increase value we either improve the quality and/or decrease the cost. The problem however is that their two processes aren't exactly mutually exclusive and we end up having to make decisions that doles out the most benefit for the whole -- even at the costs to some individuals. This reminded me of one of my interviews as a medical applicant when I was posed with the true vignette of a man who advertised that he was dying and needed a liver. Well, the man ended up getting a liver willed directly to him, got his much needed transplant, and the catch? He died about a year later. So the question here is whether or not this man Todd ethically obtained a liver? To Todd this was a life and death situation and he did whatever it took to get the liver he needed (many like him have resorted to going to foreign countries to get black market organ transplants or organs from prisoners), but to the medical community this was a blatant breach of medical economics.

UNOS, the United Network of Organ Sharing is the main sorting site in the United States for all patients waiting for organ donations. To get to the top of the list, politics aside, an individual must have a relatively good prognosis granted that they have a successful match and transplantation. In the case of Todd diagnosed with liver cancer, his prognosis was not good, and to the medical community his transplant was a waste of an organ - robbing someone else of a transplant who could use the same organ better and longer to prolong their life. Here's where the ethics comes in though, every time the medical community gets to play God and decides who lives and who dies someone is bound to be upset - and I can see why they would be upset too. In the interest of medical economics, medical ethics treads a very fine line too as we end up in these Catch-22 situations. Is Todd indeed not deserving of the organ because he will only survive a year with it when someone else could survive longer? Is Todd's unconventional way of obtaining an organ ethical and fair for everyone else who is waiting in line through UNOS? Would it be ethical to perform Todd's transplant even if you disagreed to the ethics of the situation? Tough case, and I think the interview question was meant to scratch this moral dilemma of helping with minimal hurting.

Well, I have my personal opinions about the situation and the problems that Todd has introduced but I'll let you ponder this one yourself, because no matter which way you rationalize your defense someone on either side of the balance is bound to get hurt and that I guess is the crux of the paradox of medicine. Economics and ethics to hurt and to heal.

Week 21: Complimentary and Alternative Medicine

I never really understood how Complimentary and Alternative Medicine (CAM) really could be reconciled under western medicine but apparently it can as Mayo has some physicians - even western trained that practice both western and eastern medicine. I did a short research assignment this week on chiropractics and from what I found in PubMed, contrary to the popular belief that it has quite frequent complications, while it doesn't usually offer a curative solution, chiropractics adverse side effects are extremely rare.

I've updated my mentality towards CAM to be: "if it doesn't hurt you and science (western medicine) can't help you, you might as well pursue CAM -- if that's what you want to do. I'd hardly recommend it to a skeptic though as I feel it still has a self-satisfying quality to the field in general. Now I am still extremely skeptical about such practices as reike that channels energy without even touching you, but I'm all for the massage therapy and the acupuncture that we had a chance to try and experience for ourselves this week. I opted not to try the acupuncture when one of my classmates nearly passed out after getting some pins placed in his ear, but hey, anecdotal evidence from the acupuncturist (also M.D.) was compelling enough for me to be accepting (though not advocating) of it.

On that note, to those that like to grow their own herbs and brew their health potions, check out the Mayo Clinic published Book of Alternative Medicine - one of the authors came and lectured to us and gave us each copies. They give their do's and don't to many popular home remedies out there.

Week 20: Sexual Medicine!

Now here's a topic you don't get exposed to typically in medical school so much as life in general as well. The irony here is that we have 35 hours of lecture in this one week of sexual medicine than we had for the entire six weeks of gross anatomy! I guess we're kind of delinquent in this subject that is too socially taboo to discuss.

Well the taboo nature of it is gone as we learned the ins and outs of sexual health from intimacy, healthcare, stigma, culture, slang, gender issues, sexuality, disorders, offenders, and even law in the week long first week of our block four leadership block. It was actually quite interesting as not only did we have lecturers, but more impressively panels of guests. Included in these panels was a teen panel from Planned Parenthood discussing how nearly 50% of their peers were sexually active, also a couple with sexual dysfunction and their story of it (we also received their book), a panel of a sexual assault crisis team including a rape nurse, victim advocate, prosecutor, probation officer, and police sergeant. On the flip side we also had two sex offenders come in to talk to us which really chapped my hide as these guys got off easy with only 12 months in prison. 90% of sex offenders go unreported as these guys attested of that as they admitted they were chronic offenders for decades and only got busted for their last offense a few years ago. So according to the wonderful Minnesotan legal system here they only got 12 months in prison and are now on probation. What kind of messed up system do we live in here!!? I mean to contrast, if I as a physician have a romantic relationship with a patient I face 10-15 years in prison and a $20,000-$30,000 fine and loss of licensure, whereas if I go molest little boys I get off with virtually a slap on the wrist!! I'm buying a shotgun for Christmas and Mikey's never going to have a male babysitter (as 90% of sex offenders are male too).

We had a bunch of interesting lectures on geriatric sexual health (how elderly never stop having sex), transgenderism and GLBT (very interesting panel! (the man who was born a woman had me totally deceived), and interesting hands on workshops on contraceptive usage and solutions to sexual dysfunction (sex toys). Well I'm glad those 35 hours are over, but admittedly I learned about sexual health a lot more in this one week than I ever did in my cumulative education… I mean 10th grade health was taught by Coach Barnes!? - I wonder why we didn't learn very much...