Hundreds of medical residents train in their specialties in the Los Angeles metropolitan area, but since the closure of the Martin Luther King Jr./Drew Medical Center, the spigot of fresh physicians who knew that area’s patients well stopped. The county-run hospital had been in Willowbrook, near Compton and Watts. The U.S. military sent their teams to the hospital for gunshot wound training. Still, it was shut down in 2007 due to too many episodes of poor patient care and chronic mismanagement.
In your second or third year of residency or fellowship, your smartphone will suddenly start buzzing at all hours of the work day. When you answer, a hyperactive-sounding millennial will chirp at warp speed: “HiDr[yourname]! IjustwantedtoknowyouravailabilitycauseIhaveanamazingopportunity60milesfromChattanooga….”
Medical students who did not match into a residency position have a difficult, stressful, and uncertain time period ahead of them, thanks to overzealous funding of new medical schools, an influx of international medical graduates and specialty-switchers competing for positions, and above all a shortage of government-funded training positions.
Google is a company that likes to simplify tasks that used to be much bigger hassles, like reading maps, sharing documents, and finding old emails. Now, recognizing that health systems have not exactly jumped to help doctors with soul-crushing levels of daily data entry, Google wants to use speech recognition to help doctors get patient histories and plans into the electronic health record, or EHR.
Hospital cafeteria food. Malignancy or benign-ness. Patient population seen in the third and fourth years. A medical school interview provides a fusillade of data points to consider, and an applicant can feel overwhelmed. But what criteria actually matter in the long run? Doctors can debate this question endlessly, but here, in no particular order, are the five criteria I believe to be essential considerations when making this all-important decision.
Boundaries, according to Raymond Richmond, a psychologist in San Francisco, are conscious and healthy ways to protect oneself from emotional harm. When people establish boundaries, the second parties in the relationships have a clear roadmap and guidelines for productive communication.
In this era of Dr. Google and rampant self-diagnosis, it’s becoming increasingly more confusing about where you should go when you’re injured or feeling sick — should you call your primary care doctor, visit an urgent care center or head straight to the ER? Often, the answer to that question isn’t always so black and white. Here are some tips to choose the right place to go, should you fall ill or be injured.
The future of the doctor’s visit is the topic of innumerable conference lectures, policy forecasts, and venture capital meetings. Will we all go to community clinics under single-payer health care? Will doctors’ offices shut down as on-demand house calls prosper? Will IBM Watson figure out what that pink mole is?
Depending on whom you ask, mobile phones and other portable electronic devices are either the single most important technological innovation of our lifetimes or dangerous, radiation-emitting devices that pose a major risk to public health in the long term.
1. She has slept for 3 hours in the last 48.
2. On his first day of residency, a vindictive doctor sent him on
an errand to a nonexistent department just to watch him suffer.
On many days after, the same doctor called him an idiot in the operating room.
3. He had to pronounce three people dead in a week; the
gentleman with the poker tricks, the stillborn baby, the 17-year- old with alcoholic liver failure who wrote poetry. There was no counseling afterward and no place to process his grief. Later, he learns that his supervising doctor will not write him a letter of recommendation for fellowship because he was “slow”, meaning he spent too much time talking to dying patients.
4. She does not have time to call her family, pay bills, go to the
grocery store, change a tampon, get an annual physical, get a haircut, or study, even though she is supposed to study every day.
She feels guilty for urinating while on call because her pager is ringing.
5. The last home-cooked meal he had was three weeks ago.
After the cafeteria closes, his meals consist of graham crackers and Doritos until sunup. He has gained 30 pounds from stress and bad food. Women do not even look at him anymore; his youth is slipping away while his finance and law friends send photos of their new homes and children.
6. He was called “weak” for hesitating while being pummeled
with medical minutiae questions about his patient while he was exhausted and sicker than the actual patient. This is called “pimping”. Before he knew it, he was required to repeat a year of residency, ensuring he would lose a year of income-earning potential as a doctor and saving the hospital tens of thousands on a nurse practitioner.
7. She had a family emergency and called out for an on-call
shift. Her chief resident told the whole hospital that she just skipped out, and ruined her reputation. The chief puts her on call for more weekends than anyone else as a yearlong punishment.
8. He went to the hospital psychiatrist for help, only to learn
that the visit was placed in his “file” and his every move is being watched.
9. She miscarried while on duty in the ER and her co-resident
would not come in to take over, nor would her attending see patients, letting her writhe in pain for hours as she ordered morphine for the ER patients.
10. Her psychiatry patients adore her but she knows that
disclosing her anxiety will brand her as “weak” in the hospital, so she does not go to therapist appointments and drinks vodka every day after work instead.
11. His girlfriend of five years broke up with him over text for
“never being around”.
12. Her attending physician in family medicine failed her on a
rotation for “lack of clinical skills” after she refused his sexual advances.
13. He was a resident bullied by a racist doctor and made
mistakes from stress; now he’s unemployed with $600,000 in debt and every regular job tells him he’s “overqualified” for retail, but not qualified enough to get a job as a doctor.
400 doctors kill themselves every year. Who will be next
American medical trainees dog-paddle every day and night through a swamp filled with bullying, sexism, racism, fatigue, tiny computer screen checkboxes, loneliness, hunger, penury, and unmet spiritual and emotional needs. At the other end, their patients wait for them, dismayed as the residents’ and students’ faces fall from excited to fearful, as they run back to their computers and call rooms instead of spending that extra time at the bedside. Sometimes, the patients receive the wrong medicine. Sometimes, the wrong leg gets amputated. Sometimes, a residency program mysteriously advertises an “unexpected opening”, and the patient in Room 109 asks, “Where is that nice young doctor who has been seeing me?”
Their supervisors, scarred from being forced to stay up for hours on end themselves, crow that no medical training can be complete without work shifts that tear one’s circadian rhythms apart and that there is no such thing as a good doctor who was not bullied. But a system that produces one of the highest professional suicide rates in the nation cannot remain; we are lying too far to the right of the bell curve. There are other options. Whether this includes improving handoff procedures in the hospital, quickly firing the racist attending doctor or the lecherous surgeon, lengthening residencies to reduce weekly work hours, adding more residents to help with the patient loads (and facilitate actual taking of breaks and naps), or requiring teaching hospitals to provide free and unbiased counseling along with a morning off to actually use it, programs that purport teaching and education should follow the lead of those already working to face the problem of young physician suicide head-on.
For patients worrying about their safety under the care of depressed doctors on little sleep, supporting lawmakers like Rep. Kathy Castor (D-Fla.), who has presented bills in favor of expanding funding to increase residency positions, is a start. At the hospital level, speaking to the residency and medical student rotation leaders about the trainees seeming overworked or overwhelmed can be a start to a healthier training program, giving a voice to the voiceless. Demanding happy doctors may be exactly how to save a life.
Support the upcoming film ‘Do No Harm” http://www.donoharmfilm.com and raise awareness of physician suicide.
One of the saddest outcomes of the Republican moves against the Affordable Care act was that revelation that many ACA enrollees didn’t know Obamacare was the same thing. Patients tweeted things like “Down with Obamacare! I’m on an Affordable Care Act plan!” The same patients may well have voted for the current president and for anti-ACA Republicans, not realizing that they themselves would lose their health insurance.
How did this branding mishap happen, in a world where everyone knows that Luxottica makes every single pair of machine-made sunglasses in the country and Lancome mascara comes from the L’Oreal people?
The Affordable Care Act missed key opportunities to market itself effectively. Because President Obama was so tightly linked with Obamacare, the Republicans had extra motivation to kill it, while anti-Obama patients have decided to hate the concept of a mandate for insurance with penalties. Let’s take a look at the core principles of marketing, contrasting the Affordable Care Act/Obamacare with another big brand, Louis Vuitton (maker of handbags and clothes), and see what ACA planners could have done better.
Health insurance is a service, while Louis Vuitton might sell a carryon bag, but the principles are the same. A product has to satisfy a perceived need and offer features and accessories that fit the terms the customer group demands. Name and packaging are major considerations.
Who needs a LV bag? Exactly no one—they can cost thousands of dollars. The key is that the need is perceived—because celebrities carry the bag in real life and in magazines. The actual need is not a bag. It’s the wealth, beauty and status of the celebrity.
Millions of people did sign up for health insurance under the ACA, but millions of eligibles didn’t, as well. The ACA created a perceived need of avoiding a penalty and getting health insurance. However, these have negative connotations in most people’s minds. Few people adore their health insurer, and who wants to be reminded of a financial penalty imposed by the government? Instead, the product could have been sold as a perceived need to save money. The website certainly made it easy to see whether insurance premiums would be cheaper using healthcare.gov, but case studies showing how real or imaginary people would have saved money on the overall cost of care had they had insurance drive the point home harder.
People love free things, and the free aspects of care under the ACA could have been sold more, especially to young, healthy patients. I would envision a marketing plan less “get your health insurance today” and more “Your friends have free birth control pills…do you?”2
Allowing the ACA to be referred to as Obamacare in the press and popularly also created negative consequences, as seen by the confusion on Twitter. A concerted effort should have been made to shut down the use of the name, in order to focus attention on affordable care, not President Obama.
Louis Vuitton prices seem astronomical—but not to women with a little money in the bank and a copy of Vogue magazine. The price is set by demand and perceived value. For many bags in the luxury market, there is also low supply—they are limited-edition, driving up their prices and especially their secondary market prices (see: women who make an entire living reselling purses in China).
Because insurance isn’t a tangible good apart from a little white card, pricing needs to not be a barrier. While formulas calculated premiums for families that were affordable on paper, the formulas didn’t account for recent depletions of savings due to a car accident, spouses with credit card problems, needing to pay for Grandmother’s surgery in another country, child care expenses, or outstanding loans. Because of this, the ACA would have benefited from an even more inexpensive option (with correspondingly limited coverage) so that financially strapped patients could feel like they chose to pay instead of being forced to pay, and still see the benefits of free mammograms and physicals. Also missing were tools to remind patients to set up a savings account to pay off potential deductible costs. Yes, health savings accounts exist; and virtually no one knows how to use them properly. Making it easy and integrated to set up a health savings account along with a high-deductible health plan would have alleviated much of the backlash about out-of-pocket costs associated with the ACA.
- c) Place
Where will you sell your product? What’s the distribution channel? Louis Vuitton often pays for the most expensive real estate to make itself easy to shop for—the first boutique as you walk into an upscale mall, or a prominent location on a fancy shopping boulevard. N
Countless clinics received funding due to Medicaid expansions. This should have been obvious to anyone walking into those clinics. Quick, what’s the logo of the ACA? I don’t know either. Just like Yelp.com sends a sticker to each business doing well on its website, clinics should have a prominently displayed indicator of their funding. Patients—who are also voters—aren’t mind readers. Clinics running in part due to the ACA are operating more like unmarked bars—without the cool-kid buzz. Similarly, doctors and nurse practitioners who accept the insurance should have something to display as well, especially to counteract the negative association of the ACA with poor pay. There’s an opportunity to turn taking ACA insurance into a point of pride.
- d) Promotion
Promotion requires an understanding of the media and of the priorities of potential buyers. Why does LV spend so much money on Vogue ads, runway shows, fancy events, and Jaden Smith? http://people.com/style/jaden-smith-is-the-new-face-of-louis-vuitton-womenswear-wearing-a-skirt-comes-naturally-to-him/ Because it leads to purchases and profit!
The Affordable Care Act, via the healthcare.gov website, did a good job of sending out emails with signup deadline reminders, putting up billboards, ad engaging community centers to sign people up for health insurance. An even more comprehensive strategy could have been to provide signup and marketing materials free of charge to doctors and to create ways to sign up in post offices, grocery stores, and banks. Louis Vuitton is a completely unavoidable brand. The ACA should have had a goal to be unavoidable as well.
You can bet that LV executives were smiling when Sarah Jessica Parker gifted Jennifer Hudson a LV bag in the “Sex and the City” film. Product placement is key. Where were the Victoria’s Secret models advocating for mammograms while selling bras? Good promotion leads to great branding. A good brand is desirable, aspirational, and feels worth it. Some celebrities were indeed enlisted to sell patients on the ACA, but their message was intangible. Their hashtag of choice was #getcovered. “Coverage” sounds a lot less exciting than a purse. Instead, the messaging could have been directed toward getting a physical exam free of cost, getting your refills, getting free flu shots, or protecting your savings. Even #gethealthy is more interesting than #getcovered.
Policymakers and promoters of health care coverage should think long and hard about how to sell their product.