I should be reading but I need to get some things off my chest.
1.) Today I did my first intravitreal Avastin injection. If you understand that, you know that I mean that I injected medication into a patient's eye. Can you believe it? I hardly can. Most patients, upon hearing about "an injection in my eye??" are bewildered and interested at the same time. Kids in elementary school used to give their word in an agreement by saying "Cross my heart, hope to die, stick a needle in my eye." Meaning... that sticking a needle in the eye was the second worst thing a kid could think of aside from dying. Well, it's not nearly as bad as dying, and in the case of severe vision loss, sticking a needle in the eye is actually a very necessary and helpful thing to do. I hope to check up on this gentleman and find out that he's doing much better. I also hope that in the future I am less nervous and shaky with the steps. I can do it! I just need practice. This is what I've been wanting to do in life... and I plan to do it very well. What a day!
2.) Had an ethics conference this evening as well. It was interesting to say the least. One thing I learned about and am still pondering is the political movement to change physician reimbursement into a payment per patient episode of care instead of the current fee for service structure. This would mean, possibly, that one patient episode of care would encompass 1 year worth of care by a certain physician for a certain condition. A glaucoma specialist seeing a primary open angle glaucoma patient would be reimbursed a fixed amount for caring for this particular patient. This reimbursement would not change whether the physician elected to do 4 OCTs (optic nerve/retina imaging modality) that year or none at all. This puts the decisions regarding allocation of testing and other resources squarely on the shoulders of physicians. Those physicians who want to maximize efficiency towards profit will likely try to test as little as possible or even prescribe the cheapest medication if this is factored into the payment.
While on one level putting pressure on physicians to deliver cost-effective and more efficient care sounds like a good way to stop our unbelievably high level of health care spending in this country, I'm troubled by the idea that our culture doesn't seem ready for this kind of change. Americans, including myself, gravitate towards and outwardly express desire for the latest and greatest medicine and technology. By pushing the idea of cost-containment, will we be squashing innovation and use of medications that may be good (but that are very expensive)? It's a lot of responsibility to put onto physicians, something that may require all physicians in the future to hire consultants just to help with cost-benefit analyses. And perhaps its a bad thing having physicians involved in semi-financial decisions like this. Will it erode patient trust for physicians if they know that they may not be getting tested in certain ways because the physician will lose money by ordering it? People don't seem to be bothered by being over-tested, but they sure do holler (and sue) over undertesting. How will this play a role?
It's a lot to think about.
3.) It's getting late and I'm getting sleepy. It's been a long day. I will try to update more often. Lots going on, lot to talk about. Until then, goodnight.
Wednesday, August 25, 2010
Sunday, August 8, 2010
Boom Boom Pow
Hi! Still here! Working hard but right now I'm hardly working so I thought I'd update. Just got back from the gym. Felt good to get the old blood pumpin.
Work is going ok, just the feeling of always needing to learn more is always weighing on me. It feels like second year of medical school all over again, complete with unbelievable amount of notetaking and knowledge volume that needs to be memorized before TUN TUN TUN - OKAPs. Back then it was Step I. Apparently the OKAP is just as big a test. Sigh. I guess I'll keep on chuggin along... it's gotta come to an end sometime. All the stuff during M2 year felt overwhelming (and often was accompanied with the feeling of "when will this actually be important to me??") but by M4 year, all the repetition of the stuff made me feel more and more comfortable with it. I actually had some confidence during intern year with applying the material. So I'm hoping a similar thing happens with ophthalmology... except much faster, because I'm over this feeling.
What's interesting here in ophthalmology residency is that I not only have to learn the book-type material, but I also have to hone surgical skills. It's something that attracted me to the field in the first place -- the fact that I'd be providing (what I thought of then as) comprehensive - medical and surgical - care of the eye. And it is true, to a point. Well anyways, I've had 1 wet lab so far in addition to my several trips to the OR for retina cases... and it's not very much like breast or abdominal surgery. The suture isn't even visible by the naked eye; you need a microscope to see and work with it. Every tie is an instrument tie (you don't / can't tie it with your hands). You have to get used to moving your instrument up / down / right / left in a way that's different than just using your naked eye. Somehow the scope makes it a bit of a challenge to learn these movements. It's really neat, but like I said, I've got a lot to learn.
How's that for repetitive themes? I'll try to stop talking so much about how much I have to learn. Maybe I can even mention the cool things I've learned instead. Ok, I'll do that.
Lollapallooza was this weekend and it was fun to at least go just outside the fence and watch the jumbotron and listen to the music. Maybe next year we can buy tickets and go. The weather right now is sunny and hot - to die for! We've been keeping the windows open almost all weekend and it's been a great way to get a taste of the outside while we're inside working.
I'm missing the fam while they're away in Canada, but the pics they're sending me from over there are great. Every pic looks like a Bob Ross (Joy of Painting!) original with a family member of mine in the foreground. Haha it's great. I'm looking forward to having them back so that I can call them whenever I want again. Not having them in the States has taken a major part of my daily life out of the picture!!
Quick story about Bob Ross's Joy of Painting -- when I was little I watched Sesame Street A LOT. In fact, at times eating was a no-go unless SS was on. Well as I grew older (and after I learned to feed myself and turn on the TV myself) channel 13 (PBS) was my go-to channel. And certain afternoons they played these marathons of Joy of Painting. I'd be disappointed but at the same time transfixed by Bob Ross's soothing voice and the beautiful creations he made. And EVERY time -- I fell asleep. Like clockwork. I'd always find myself waking up when the credits and music began to play. A couple of times I was sick and stayed home from school... and his show would be the beginning of my afternoon naptime. It's a nice memory.
OK! More later!
Work is going ok, just the feeling of always needing to learn more is always weighing on me. It feels like second year of medical school all over again, complete with unbelievable amount of notetaking and knowledge volume that needs to be memorized before TUN TUN TUN - OKAPs. Back then it was Step I. Apparently the OKAP is just as big a test. Sigh. I guess I'll keep on chuggin along... it's gotta come to an end sometime. All the stuff during M2 year felt overwhelming (and often was accompanied with the feeling of "when will this actually be important to me??") but by M4 year, all the repetition of the stuff made me feel more and more comfortable with it. I actually had some confidence during intern year with applying the material. So I'm hoping a similar thing happens with ophthalmology... except much faster, because I'm over this feeling.
What's interesting here in ophthalmology residency is that I not only have to learn the book-type material, but I also have to hone surgical skills. It's something that attracted me to the field in the first place -- the fact that I'd be providing (what I thought of then as) comprehensive - medical and surgical - care of the eye. And it is true, to a point. Well anyways, I've had 1 wet lab so far in addition to my several trips to the OR for retina cases... and it's not very much like breast or abdominal surgery. The suture isn't even visible by the naked eye; you need a microscope to see and work with it. Every tie is an instrument tie (you don't / can't tie it with your hands). You have to get used to moving your instrument up / down / right / left in a way that's different than just using your naked eye. Somehow the scope makes it a bit of a challenge to learn these movements. It's really neat, but like I said, I've got a lot to learn.
How's that for repetitive themes? I'll try to stop talking so much about how much I have to learn. Maybe I can even mention the cool things I've learned instead. Ok, I'll do that.
Lollapallooza was this weekend and it was fun to at least go just outside the fence and watch the jumbotron and listen to the music. Maybe next year we can buy tickets and go. The weather right now is sunny and hot - to die for! We've been keeping the windows open almost all weekend and it's been a great way to get a taste of the outside while we're inside working.
I'm missing the fam while they're away in Canada, but the pics they're sending me from over there are great. Every pic looks like a Bob Ross (Joy of Painting!) original with a family member of mine in the foreground. Haha it's great. I'm looking forward to having them back so that I can call them whenever I want again. Not having them in the States has taken a major part of my daily life out of the picture!!
Quick story about Bob Ross's Joy of Painting -- when I was little I watched Sesame Street A LOT. In fact, at times eating was a no-go unless SS was on. Well as I grew older (and after I learned to feed myself and turn on the TV myself) channel 13 (PBS) was my go-to channel. And certain afternoons they played these marathons of Joy of Painting. I'd be disappointed but at the same time transfixed by Bob Ross's soothing voice and the beautiful creations he made. And EVERY time -- I fell asleep. Like clockwork. I'd always find myself waking up when the credits and music began to play. A couple of times I was sick and stayed home from school... and his show would be the beginning of my afternoon naptime. It's a nice memory.
OK! More later!
Subscribe to:
Posts (Atom)