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Medical Student Perspectives: Health Care Reform: How Does This Affect Me?

I attend a daily Surgical Morning Report, during which the department discusses the patients on our service as well as cases of note. On one particular morning, however, our rousing discussion on small bowel obstruction was interrupted by unwelcome guests: the billing department. I watched each doctor’s eyes glaze over while we were lectured to about the virtues of billing code 5521 versus 5526 to maximize compensation to the hospital. Some of these physicians didn’t know how to work a Blackberry, let alone a complicated billing system for patients. After our guest speakers left, I heard grumblings of “I’m a physician, not a billing clerk!” and other variations on that theme. We all shuffled out of the room shaking our heads and went about the rest of our day.

That night, I had a sobering thought: maybe the health care crisis is our fault.

Why is it that physicians happily schedule one hour to discuss the plethora of possible causes for left lower quadrant pain but refuse to learn the billing system through which they get paid and ultimately generate resources for the hospital to provide life-saving health care? Why is it that most of my classmates can spit out the mnemonic for the 12 causes of pancreatitis but do not know the difference between Medicare and Medicaid? My colleagues tell me, “Because that’s just not important to my daily life.” Standard medical school curricula do not train us in health care policy, and as a result, we are lulled into thinking that medical knowledge alone will promote health care. The only way meaningful health care reform will be achieved in this country is if physicians become savvier with the way it already works in order to think of how to make it better in the future. The best way to do this is to become involved as a medical student.

The first thing we should do early on in our medical careers is to get involved with national organizations to become informed on the issues. It is hard to be a health care advocate if you aren’t aware of the issues for which you should be advocating. It’s also difficult to care about health care unless you find an issue that has personal meaning for you. For example, ACP has an annual Leadership Day on Capitol Hill during which physicians from all over the U.S. discuss relevant medical issues with law makers in Washington, D.C. Legislators know we are busy, but by spending one day discussing policy matters, physicians are allowed to help many more potential patients than the ones they physically see each day. It also shows politicians that we wish to be leaders in the national discussion on health care.

Taking an interest in preventive medicine is another way to learn more about how to be an informed health care advocate. No matter which area of medicine you enter, it is essential to know general recommendations for patients. Colon cancer screening recommendations are different for a 50 year old man versus an 80 year old man, for example. National recommendations change frequently, so it is important to critically analyze new research in order to give our patients the most effective care.

Health care reform is about much more than increasing physician salaries and lowering insurance premiums. We seldom realize, as students, how much power we already have to positively impact the system. Not enough attention is given to the issue of how much we as professionals are contributing to the overall cost of health care. For example, how many redundant lab tests and imaging studies are ordered in order to confirm a diagnosis which we can test clinically? How many times do we suggest experimental therapy to patients without considering its cost-to-benefit ratio? Patients buy into this à la carte style of medicine as well, demanding MRI’s and EKG’s because they assume that a clinical workup is incomplete without a battery of expensive tests. Effective communication between specialists and primary care physicians can decrease repeat tests and over-prescribing of medication.

Managing our health care spending drives down cost, so it can be more affordable for more people. This doesn’t require legislation; rather, it requires careful study of patient management strategies and knowledge of the system early on as students. By doing what is clinically right instead of trying to work patients up as much as we can, we can build more credibility in the national forum as we suggest ways to be compensated for our skills as well as how reform can be passed to help more patients.

The most popular answer medical students give to the question, “why do you want to be a doctor?” is to “help people”. Health care policy is the framework within which we help our patients, and it deserves our attention as students. Like much of medicine, becoming a health care policy advocate is a self-motivated endeavor, and there are many more questions than answers. Instead of complaining that there is nothing we can do to change health care, we should become stewards of our profession and start by taking control of the things we can do. Perhaps the next time the billing department holds an informational session for us, we can offer suggestions for making the system more user-friendly rather than ignoring them and choosing to do nothing but complain. As one of my patients said to me the other day, “when we know better, we do better.” Sometimes, that’s all it takes.

Lavanya Viswanathan, MS, 2LT, USAF
Military Representative, ACP Council of Student Members
American Association of Medical Colleges Representative
Uniformed Services University of the Health Sciences, Class of 2011
E-mail: Lavanya.Viswanathan@usuhs.mil

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Back to September 2009 Issue of IMpact

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