Physicianesque Vocabulationing and SO MUCH STUDYING!

They say studying medicine is like studying a new language... and SURPRISE! Its true.

I have been studying / in classes from 8am to 11pm or later EVERY DAY for the past two weeks, give or take a day or two off. To entertain / distract myself, I have made this list...

The following are my favorite words we have learned so far (mostly from this 3-week section of studying. Some are anatomical parts, some are diagnostic tests, some are molecules. Feel free to Wikipedia if you want to know what they are - bold ones are most interesting):

* Von-Willibrand Factor * kallekrein * arachidonic acid * calveolae * karyorrhexis * steatosis * liquefactive necrosis * calmodulin * dynein * homonymous * Hageman Factor XII * xeroderma pigmentosa * janus kinase (Jak) * rachischisis / iniencephaly (baby born with no brain / no spinal cord!) *meningomyelocoele * splanchnopleuric * gastrulation (the profs say that gastrulation is the most important part of your life) * sirenomelia * multifidus * dorsalis pedis * genu valgum * Trandellenberg gait * tensor fascia lata * neurulation * Hirschsprung's megacolon * sclerotome * Schwann cell * oligohydramnios * avulsion * trochanteric bursitis * somitomere * tunica albuginea * corpora cavernosum * hyaluronic acid * pyogenic * suppurative * pemphigus vulgaris * Weibel-Palade bodies * kwashiorkor (translates to "the sickness the baby gets when the new baby comes" in the Ga language of Ghana - CLICK ME for more info) * synaptotagmin * hallux (big toe) * Law of Bergonie and Tribondeau * Ortolani's Test *

Leaving out definition makes it much more fun, trust me!

A lot of the people who name things in medicine have weird / difficult to remember names. For example: Mayer-Rokitansky-Kuster-Hauser Syndrome is the official name for women who are born without a uterus. Why?!?!
***NOTE TO DAD - EVER SEE THIS DISEASE?***

So this is me signing out. Its 12:14am and I just got yelled at by security to leave the library. This has been a super duper ultra crazy challenging three weeks - and I have definitely tested how much studying I can take. So with caffeine (from the trifecta of coffee, diet coke, AND tea) in my veins, a sore and pen-stained right hand from transcribing outlines, and eyes glazed from staring at a computer, I am giving up on learning everything and going to sleep.

Good news: the second years said between Thanksgiving and Christmas was the worst part of medical school for them, so if I survive this (AKA pass my exams), then I can do this, and I will get an MD. Yay!

Can't wait for tomorrow - freedom for two whole weeks AND a big birthday / holiday / 1/8th doctor bash at a friends house!

Ouagadougou and Obamacare

Ouagadougou is the capitol of Burkina Faso. I learned that today. So many vowels!

I also tried to decipher my way through the US health care system and US health care reform for my Health Services course (for my MPH). Most interesting for you, my adoring blog fans (AKA my family and closest friends), is the 2010 Patient Protection and Affordable Care Act (AKA PPACA AKA Health Reform Bill AKA Obamacare). So before I attempt to summarize the most interesting and jaw-dropping points, I want to share this simple flow chart depicting how the health care system will change because of this reform:

 

BAM! Now I don't know who to blame for this horrifying flowchart, but it was in the class slides. I hope that clears everything up. 

Anyways here is what I took away from my course about the PPACA:

• The whole Act will be in effect by 2018 (maybe... see the next bullet)
• The individual mandate (everyone has to get insurance by 2014 or they get a big fat fine - with some exceptions) is being challenged in the Supreme Court before June 2012. So watch for news on that!
• Young adults, like me, will be able to remain on their parents health insurance until age 26 - phew!
• Medicaid (insurance for the poor) used to only cover children, pregnant women, and some parents - leaving childless adults insuranceless. After PPACA, Medicaid will cover anyone under 133% of the federal poverty line - this includes 16 million more people!
• Starting in 2014, health insurance companies can no longer exclude ANYONE for a pre-existing condition. 
• States are supposed to make cheaper better non-profit health insurance exchanges, and if they don't the federal government will.
• Health insurance companies have to use 80-85% of premiums on health care for the purchasers.
• Recommended preventative services will be fully covered for everyone!
• 32 million people will get insurance, but even after it is in effect, we will still have 20 million uninsured people here in the US.
• Funding:
• tax on Cadillac (super fancy shmancy expensive) Health Insurance Plans
• increased Medicare Part A tax (pays for hospitalizations for the elderly)
• new fees for pharmaceuticals and medical supply companies
• a tax on indoor tanning - sorry orange folk, its dangerous anyway!

Also, FYI, the majority of people who are currently uninsured (close to 75%) have some type of job, or someone in their family has a job. Self-employed, young adults, and early retirees are commonly uninsured. Also, people who are poor, but not super poor, tend to be uninsured (<300% federal poverty line). And people who are uninsured have overall worse access, worse health care and worse outcomes.

Oh, and Medicare sounds terrible to me. Super terrible. According to my course, Medicare only covers about 45% of health expenses. And there are premiums. And deductibles. And its super confusing to fill in those coverage gaps. Ew.

Another interesting fact: Apparently 20-30% of health care is UNNECESSARY, and does not improve outcomes or patient satisfaction. Most docs are paid through fee-for-service.  This gives doctors the incentive to do more tests or procedures - more fees for more services! Services that you may not need... One of the public health professors says that all doctors should be salaried to stop giving them incentives to waste time and money. I'm pretty sure I agree.

Possibly and or partially because of fee-for-service payments, the US pays the highest price for health care. You'd think we'd be fit as a fiddle, but the US actually has WORSE OUTCOMES than other developed countries. The price is not right.

I tried to be neutral and accurate in this post, but obviously I have my beliefs and I also obviously have little time...so feel free to do your own confusing research and get back to me on mistakes. 

A lot of my info is from my course, which is based around the book Understanding Health Policy: A Clinical Approach by Thomas S. Bodenheimer and Kevin Grumbach. Its an amazing (and super liberal) textbook and worth a read if you are interested in this sort of thing. My professor also got a lot of stats/facts from Kaiser and the IOM.

For more information about the Affordable Care Act --> CLICK ME!!!

(or there is always Wikipedia, which may be less biased, but who knows)

Interesting and Important Stuff of the Week

1. A standardized patient reflects on experiences with medical students - CLICK HERE 
I stole this from the facebook group our med school class has - we are super dorky and share cool articles / ideas with eachother!

Here's a quote from the reflection: "Over the course of three days recently, I had 23 head-to-toe physicals from 23 second-year students at the Georgetown School of Medicine. I was the first person these would-be doctors had ever fully examined on their own. Some were shaking so violently when they approached me with their otoscopes—the pointed device for looking in the ear—that I feared an imminent lobotomy. Some were certain about the location of my organs, but were stymied by the mechanics of my hospital gown and drape. And a few were so polished and confident that they could be dropped midseason into Grey's Anatomy."

2. Here is a picture of the nerves in the brain of a brainbow mouse. Yep, as in BRAIN + RAINBOW = BRAINBOW!!! (cited in my lecture slides to be from Jean Livet/Lichtman Lab at Harvard University)

I looked up the brainbow mouse, and found these amazing pictures. Art project anyone?
GOOGLE IMAGE SEARCH FOR BRAINBOW MOUSE

The brainbow mouse was used to visualize different neurons in the brain so the brain can be mapped to create a "connectome"(figure out all the connections of all of the neurons in the brain). According to Wikipedia and the web, this technique inserts inducible genes for fluorescence into the mouse embryo, and recombination causes different neurons to express different mixes of colors, causing different hues. I may have gotten that wrong because there was no simple explanation of how it works, but for you science nerds, its technically done by Cre/Lox recombination.

3. Inner Life of the Cell - REALLY COOL VIDEO
This video shows how the cell works. I actually could explain most of the processes occurring in the video and what diseases occur if those processes failed, which is slightly exciting. But check it out, its pretty crazy to think each cell is doing all of these things. I meant to send this out a while ago, so here it is now!

4. What is a leg? I always thought, despite taking anatomy twice prior to medical school, that my leg was anything under my hip... Well I was wrong. My leg is anything under my knee. Between my hip and knee is my thigh. Everything below my hip is actually my lower limb. MIND BLOWN! I have been using the wrong term for something so simple for MY ENTIRE LIFE. Oh the things you learn in medical school...sometimes the simple stuff is just as fascinating as the complicated stuff!

5. Medical school is awesome and cool, as explained above, but it is also super stressful. I am often tired, grumpy, and feel like I don't have time to take care of myself. I am so thankful that the people with me in Boston are able to help me through these frustrations and hard times. I am also thankful for the support and understanding of friends and family outside of Boston, and feel like I could never survive medical school without everyone's help.