The republican party is on quite the tirade recently. The machine is trying it's hardest to throw every possible roadblock up to prevent the new democratic majority from appearing successful. No doubt this is what the democrats were busy doing over the past eight years, though the republicans have a certain vigor about themselves that always seems to outshine democratic outrage.
This republicans must be drooling over this stimulus bill like a dog over a t-bone steak. Not only do they have the opportunity to shout that Pres. Obama isn't being bipartisan, but they also have the chance to try to blame the collapse of the economy on his tenure. Though there's something to be said for subtlety, something that is completely lost on our conservative friends. You see, bipartisanship implies two sides sitting down and compromising, and despite the President's pleas for compromise and closed door sessions with republicans, they kept at the "tax cuts or be damned" line. You see, there is no compromising after devastating losses in the house and the senate, only bruised egos.
Then there's the whole "let's vote 'no' as a block" strategy. What a better way to send the message to the American people that you're sour grapes. They couldn't get their ice cream after dinner, so now they kicked the plate on the floor and sulk. I refuse to believe that of the hundreds of republicans in Congress, only three thought "hmm, tax cuts didn't work for the past decade, maybe we should try social outreach and corporate crack down."
But that's right, republicans don't really want the government to get any bigger; but wait, what's that? George Bush drastically increased the size of the government while in office? Dept. of Homeland security? What? That's right, if the government grows out of the fear of terrorist attacks then it's fine, but the government growing to create green public programs and limit our dependence on oil? Forget about it. No, its much better to spend nearly a trillion dollars on banks that are failing anyways and don't seem to be all to interested in giving out new loans. And while we're at it, lets give the top 1% of the country some more tax cuts. Surely their lavish lifestyles will trickle down to everyone else. I mean, someone has to build their private jets, wash their boats, and clean their bathrooms.
Maybe to the Hannity/Limbaugh crowd the republicans are perfectly justified in their actions, but the rest of the country, I hope, would rather give the republicans a "time out" so they can quit their whimpering. Honestly, they want to complain about pork spending? Helping cities build new roads, or buy green cars, isn't pork spending, it's called modernization (a concept lost on our senior members of the senate, that haven't quite mastered email yet). Pork spending is the "wooden arrow" money that found its way into the first bailout. You see, Mr. and Mrs. Republican, pork spending is defined as seemingly incongruent dollars being added to a bill in order to assure its picks up the votes it needs for passage. This is what creates the non sequiturs like wooden arrows in a bank bailout plan. If a bill funds public works to create new construction jobs, then its not pork, its just the bill.
Pork would be adding money to a public works bill to fund wooden arrows. Do you see how that worked? I just added something meaningless onto the bill because someone promised to vote for the bill if I added on their wooden arrow provision. Didn't get it? I wouldn't expect you to, Mr. and Mrs. Republican. You've had a hard day yelling until you're blue in the face. You guys should relax, kick back and grab a drink at the Airport bar, I think Sen. Craig might already be there....
Sunday, February 15, 2009
Tuesday, February 3, 2009
Egos in the hospital 8:51 PM
Today us medical students had a chance to sit down and talk with healthcare professionals outside of the strictly "MD" field, and I have to say that it was quite enlightening. There is, though, one thing I noticed that I find intriguing, the rise of doctoral students in the healthcare team on the wards other than MDs. Two professionals gave me two very different pictures of how this could impact a patient care.
The first encounter I had was with a doctor of pharmacy, known as a PharmD. From the minute we sat down with him, he made it very clear what his role is, to monitor, adjust, and suggest medications for patients. He stated that with the ever-growing complexity of meds on the market, he was there to ensure that side effects are avoided and the best drugs possible are being used. He also made it very clear that it was not his job to diagnose or come up with a differential on a patient. He gave the example of a patient with a cough; in his mind a cough=possible drug side effect while in a doctor’s mind cough=tens of physiologic derangements.
The second Dr. we saw was from the physical therapy department. She presented a very different case for the role of the doctoral physical therapist. She envisioned being the front line for patients with any ache/pain complaints. She also had a mouthful to say about when it was and wasn’t acceptable to bother the PT in the hospital (“my time cost 700 dollars an hour” she kept repeating).
Unlike the PharmD, who had a clear purpose and limits on what he was and wasn’t capable of, the PT seemed to want to be a doctor. And to some extent, what are you to expect from someone with a doctoral level of education? They have acquired a vast amount of knowledge that they feel is being underutilized. But herein lies the problem; she learned mountains about PT, but not as much on clinical pathophysiology, as she would have in a medical program. I think its clear that her role isn’t to compete with the physician for who will make that primary diagnosis, but rather to complement the physician’s work as a primary caregivers. I mean, after all, if she wanted to diagnose and treat, why didn’t she get an MD?
Now I know that this probably comes off as a really snobby sounding post, but I swear it’s not meant to be. I just want to draw attention to what I see as a potential conflict that could lead to negative outcomes for patients. The idea of a healthcare team is not one where egos and degrees clash over the diagnosis of a patient, rather, where each brilliant mind complements one another given their respective training. Like the PharmD, it seems that the PT needs to define their role and then best apply their skills in that role, just as a pharmacist focuses on drugs, a doctor on diagnosis, a dentist on oral hygiene, etc. etc. No doubt, however, that physicians need to also step down from the podium and define their limits and bolster their weaknesses with those that choose to go into PT, pharm, nutrition, occupational therapy…food for thought, I suppose.
The first encounter I had was with a doctor of pharmacy, known as a PharmD. From the minute we sat down with him, he made it very clear what his role is, to monitor, adjust, and suggest medications for patients. He stated that with the ever-growing complexity of meds on the market, he was there to ensure that side effects are avoided and the best drugs possible are being used. He also made it very clear that it was not his job to diagnose or come up with a differential on a patient. He gave the example of a patient with a cough; in his mind a cough=possible drug side effect while in a doctor’s mind cough=tens of physiologic derangements.
The second Dr. we saw was from the physical therapy department. She presented a very different case for the role of the doctoral physical therapist. She envisioned being the front line for patients with any ache/pain complaints. She also had a mouthful to say about when it was and wasn’t acceptable to bother the PT in the hospital (“my time cost 700 dollars an hour” she kept repeating).
Unlike the PharmD, who had a clear purpose and limits on what he was and wasn’t capable of, the PT seemed to want to be a doctor. And to some extent, what are you to expect from someone with a doctoral level of education? They have acquired a vast amount of knowledge that they feel is being underutilized. But herein lies the problem; she learned mountains about PT, but not as much on clinical pathophysiology, as she would have in a medical program. I think its clear that her role isn’t to compete with the physician for who will make that primary diagnosis, but rather to complement the physician’s work as a primary caregivers. I mean, after all, if she wanted to diagnose and treat, why didn’t she get an MD?
Now I know that this probably comes off as a really snobby sounding post, but I swear it’s not meant to be. I just want to draw attention to what I see as a potential conflict that could lead to negative outcomes for patients. The idea of a healthcare team is not one where egos and degrees clash over the diagnosis of a patient, rather, where each brilliant mind complements one another given their respective training. Like the PharmD, it seems that the PT needs to define their role and then best apply their skills in that role, just as a pharmacist focuses on drugs, a doctor on diagnosis, a dentist on oral hygiene, etc. etc. No doubt, however, that physicians need to also step down from the podium and define their limits and bolster their weaknesses with those that choose to go into PT, pharm, nutrition, occupational therapy…food for thought, I suppose.
Monday, February 2, 2009
Money to burn 1:37 PM
As of late, the papers have been filled with stories about how our bail out money is being spent by corporate America. Jets, vacations, sponsorships, bonuses, you name it. But forgive me for saying that it's getting a little repetitive.
So I get it. We want the banks to do their job and lend money like a good bank should; but that's no fun to report on. Instead we hoot and holler about employees getting bonus checks and a company sponsoring sporting events and taking clients on vacation. But really, isn't that what a business has to do to, well, get business?
I understand that there's an extravagance issue here. Bonuses don't need to be in the multi-millions and it wouldn't kill these guys to fly a commercial airline every once and awhile. But we can't persecute these guys for getting things (bonuses, vacation time) that we expect from our own places of business. Sure it would be nice to see a little penitence on their part, but, really, even if they did make changes no one would read about it.
I'm not suggesting that things aren't out of hand, because they are, big time. But just remember that the answer to big bonuses isn't no bonus at all. And the last time I checked, most government stimulus packages mail a check to every American for nothing more then some extra pocket cash.
So I get it. We want the banks to do their job and lend money like a good bank should; but that's no fun to report on. Instead we hoot and holler about employees getting bonus checks and a company sponsoring sporting events and taking clients on vacation. But really, isn't that what a business has to do to, well, get business?
I understand that there's an extravagance issue here. Bonuses don't need to be in the multi-millions and it wouldn't kill these guys to fly a commercial airline every once and awhile. But we can't persecute these guys for getting things (bonuses, vacation time) that we expect from our own places of business. Sure it would be nice to see a little penitence on their part, but, really, even if they did make changes no one would read about it.
I'm not suggesting that things aren't out of hand, because they are, big time. But just remember that the answer to big bonuses isn't no bonus at all. And the last time I checked, most government stimulus packages mail a check to every American for nothing more then some extra pocket cash.