Photo from Mount Royal, Frisco, Colorado.

"That is happiness; to be disolved into something complete and great. When it comes to one, it comes as naturally as sleep." - Willa Cather

Saturday, 7 December 2013

Interview Report: State of the American Health Care System 2013

Let America be the dream the dreamers dreamed— Let it be that great strong land of love Where never kings connive nor tyrants scheme That any man be crushed by one above. (It never was America to me.)...I am the immigrant clutching the hope I seek— And finding only the same old stupid plan Of dog eat dog, of mighty crush the weak. Langston Hughes - Let America be America Again

Aren't we all really Langston Hughes? As I walked out of hot yoga and ran back to my hotel in Virginia, I saw my white woman afro in my iPhone and it was good.

Yes so here we are- back in the US, 5 years later. Me, the American and my Danish husband and boys.

Here I am- applying for a residency position again - to be a doctor (with a specialty, which I can use to get a job in both the US and Denmark). Denmark recognizes US degrees but not vice versa. 6 years later. I've been through this before, matched at my first choice, got pregnant had to drop out to live with SR (living alone with a baby while working 80 hours a week with only15 days maternity leave seemed wrong in every way)- never thought I'd be granted another chance but I was.

8 interviews. That's the minimum they say you can go on to guarantee a residency position in "the match" - and how I'm spending my fall and winter (we all learn where we will go in March based on how we rank the programs and how they rank us). I am applying to Physical Medicine and Rehab - a small specialty and a field of medicine that by its very nature fights the "throw surgery at it as first line therapy, always go for the most expensive procedure (before trying to change your life)", that I am and so many others are fighting in American medicine. Only businessmen want that model, but doctors are fooled into thinking expensive is best because it is tradition and large clinical trials are funded by pharmaceutical and medical equipment companies. 

Capitalism never did much for human rights.

And even "not for profit" hospitals use their millions of dollars of extra money to build fancy new buildings and buy expensive, inspiring art, etc - rather than entering it into a shared pool of money that could provide medical care for all. 

BUT, let there be no doubt that doctors are good people. Heck, they sacrifice their lives - voluntarily work 80 hours a week at less than minimum wage (during residency) to have the privilege to heal (as one very prophetic vascular surgeon with a great sense of humor once said to me - "in residency, they break your spine, then you stop caring about your own life".) And it is a huge privilege to care for the sick and dying. We all think it, otherwise we WOULD become yoga instructors, coaches or professional athletes (to name some random examples). I think about it as I spend our money and my vacation time going from interview to interview (I just drove from Pennsylvania to Virginia yesterday) and one hour ago took my first shower in three days (don't ask me how I got out of the four feet of snow in Duluth). And I think - what are the boys doing now? How I want to just hold them. And couldn't this interview system be a bit simpler? Like couldn't I just go to an interview and then they decide whether or not I am hired like any other type of job???

On the interview trail, I have seen a sad trend: the hospitals and administrative buildings are bigger and more awe-inspiring than they were 5 years ago. There is more "state of the art" care everywhere. The rich get tailored, expensive, very expensive, often futile medical treatments, while the poor die from cancer that could have been cured - but they had no health insurance. Or the poor GET the health care and then end up spending the rest of their lives paying for it. IT IS WRONG AND I AM NOT IMPRESSED.

Is this America? Yes.

Is this what American doctors want? No. Is this what Americans want? No.

Day in and out I am struck - by how caring and passionate the young (and not so young) physicians are I meet. Healing is an art as pure as music and painting and dancing. I can't remember the last time I met a physician who went into it "for the money". I, for one, am still paying off my medical school debt.

As I asked the other residents I interviewed with today: Is medical care a human right? Well, we all agreed. Yes, yes, yes. How can America deny its citizens of a basic human right? Is America a first or third world country?

Well, in case you were wondering i HAVE the answer (and think it is better than Obamacare): extend the VA system (for veterans) to cover every American. Basic and preventive care. It works. Its cheap. Call me a socialist, I don't care. I have been a dedicated socialist since I was 19 years old. But more than this, I can't forget being in Denmark where medicine was about figuring out how to treat everyone. I can't forget it and why should I? It was the right thing to do. Medicine shouldn't be about impressing (and getting money from) the rich. It should be a basic human right. It's kind of incredible that none of the medical students interviewing with me could afford their own health insurance.

Medicine is not the flashy job it maybe used to be - but it is more competitive than ever - because at least it gives you the chance to get a job with health care. And a job where you can change peoples' lives for the better. Provided you truly care about healing and not throwing expensive bandaids at everything. And we all learned in medical school (and kindergarten) to care about the first.

Pasty mom on the interview trail - sad to see the closed and broken down Virginia Ballet Theater.  

Boonsboro, Maryland with Muktar, the fastest Ethiopian gas station attendant along the Appalachian trail to ever give me training advice and true stories of Haile. 
Blow Street (it was 70 degrees in VA today) so I pranced around in a tank top while my husband and kids couldn't get the car out of 4 feet of snow in Duluth, in -20 F, not to mention the wind chill.

Well, Christian's hand says it all. It is too bad Kaj, the frog, has to sleep like that all night, though. (I wish I had seen this in real life.)
 Song that my hotel neighbor played tonight while talking with his girlfriend on the phone about free diving (seriously, we humans have so much in common).

Sweater Weather by The Neighborhood.

Fun fact- I interviewed with a young female doc today who ran track for North Carolina State and ran the 400 meter in 55 seconds. It is always exciting to meet someone who is (was) too fast for a treadmill and is a "real" runner :-).

Obligatory Nelson Mandela quote:  "Education is the most powerful weapon which you can use to change the world".

That's right. Education and health care. Two basic human rights. Can we agree on that?


SteveQ said...

If you're going to expand an existing American health care system, better than the VA would be the U.S. Congressional Health Care System (free, lifelong and all-inclusive, I believe).

wildknits said...

I keep starting a comment and... well, am too passionate about this subject (as you well know Tracy!) to be very coherent.

We need to make the leap to a better system for caring for the health of our citizens. It is heartbreaking to watch folks suffer from something that may have been treatable (and/or lose everything to medical debt).

Even those of us with "good" insurance are just one major illness or injury from this fate.

We also need a better system for training our health care providers that allows them some balance to their lives.

In addition we need to treat the folks at the front line of health care (the CNA's, CMA's, LPNs, RNs, etc) better. These are the folks who take abuse (verbal and physical) from all sides - administration, providers, co-workers, patients and their families.

Good luck on the interview process. Impressed you made it out of town during that storm!

sea legs girl said...

Steve, thanks. I have to look into this US Congressional Health Care System.

sea legs girl said...

Wild- I was thinking about the story you told me in the car as I wrote this. There are so many stories like that and it just seems things are getting worse. I loved your comment. It is hard not to get frustrated and mad when you care so much about something. If every other first world country hadn't figured out a much better solution, maybe I wouldn't be so mad, but it seems inexcusible. You make good points about both the training system and respect for people at the front line. Nurses and doctors pretty much make the same salary in Denmark - and why shouldn't they? They are both really tough jobs and should treat each other as equals and partners. Salary is part of this. The same goes for CNA's, CMA's and LPN's: equal respect, partnership and an understanding of the different trainings each has had is so important. Well, this is starting to be a different discussion, but all of these issues are suddenly so apparent to me coming back to the American system from the Danish one. (of course I had some major issues with the Danish system as well, which in a nutshell had to do with the general xenophobia and ethnocentricity that is intrinsic in the culture there)