Nicki Brodie - Patch Adams, Abortion Provision, Sexual Health

The AMSA convention was a great opportunity to learn more from leading experts about a variety of health care related issues, and also a fun way to meet other US medical students and to find out more about their schools and classmates. I wanted to share a few things that I learned and thought about at the convention that I think might be relevant to other MSIH students.

 The first keynote speaker at the convention was Dr. Patch Adams. I was especially excited for this, because Patch Adams was something of a childhood hero for me and I was really looking forward to hearing about his approach to medicine and healing. While I found his message to be motivating—he essentially advocated for a more holistic and compassionate approach to patient care and doctor interaction—I ultimately found myself unsatisfied with his method. Rather than working within our very broken health care system, he suggested that the only feasible way to affect change was to work outside of the system, which he does through his “Gezundeit Institute” a hospital/patient care center that doesn’t accept any form of payment, where doctors live in the hospital as well. I found myself feeling like this approach just couldn’t work on a national level, and so I left his talk feeling less like I would like to be Patch Adams when I grow-up, and more like I would like to take his message in a different direction.

Luckily for me, this was on the first day of the convention. On day two, I think I got my answer—in the form of Dr. Gloria Wilder, a pediatrician and political advocate. Dr. Gloria (as she called herself) spoke in an extremely poignant (and often very funny) way about being raised in Brooklyn by a single mother on welfare. She then talked about her mission as a physician to work to end health-care disparities and to fight what she called “generational poverty”. Her approach was to found Core Health, an organization which trains and educates community members to fight against health care injustices in their communities and on a national level. In contrast to Patch Adams’ approach, which seems unsustainable and very Patch-Adams-centric, Dr. Gloria’s approach appeals to me because of its focus on community and on systemic change while still working within the system.

Now that I had found a new role-model, I attended another session at the convention that was very thought-provoking and inspiring by Dr. Willy Parker on being an abortion provider. Though I certainly consider myself to be pro-choice and even worked directly in the abortion services branch of Planned Parenthood, the idea of actually being an abortion provider seemed interesting but troubling to me. It is a little bit hard to explain why—perhaps it is related to the somewhat ambivalent stance that my understanding of the Jewish texts and traditions takes towards the issue that makes me unsure about making abortions a part of my career (certainly there are other people who perceive less ambivalence here…in both directions). In any event, I walked into the event expecting to hear from an enraged woman ranting about all of the injustices to women inherent in the system, and how we should fight the man, etc etc—not that I wouldn’t have agreed with her! But, Dr. Willy Parker (who is a man, as it turns out) spoke about his own religious upbringing and his own understanding of his religious traditions and his own journey to becoming an abortion provider. He spoke about his realization that, as an OB/GYN, if he truly wanted to tend to the health (in an expansive sense) of all of his patients he had to provide abortions. This really resonated with me, and made me more convinced about incorporating abortion care into my life as a physician, in a way that I can feel proud about and not uneasy or uncomfortable.

Another highlight of the convention was meeting other medical students. I especially was grateful to be able to meet my “classmates” from the Sexual Health Scholars Program, who I had gotten to know very well over web-cam over the last 6 months. The opportunity to see my fellow “sexperts” un-pixelated was really wonderful, and provided a nice sense of closure to a course that had been eye-opening and transformative for me in many ways. I also enjoyed being able to present my final project during the AMSA poster-session. I spoke to many students about our plan to teach MSIH first-years how to take a good sexual health history in a way that is culturally sensitive. Students were really impressed that our school had given us permission to take over the pre-existing class, and were eager to learn more about how they could approach their course coordinators and deans.       

Over all, the AMSA convention was a great way to spend a weekend learning about broader health care issues than the relative location of the superior cerebellar peduncle, and to think more about some of the core values and ideals that made me want to become a doctor in the first place. I gained a lot from this experience and I would be happy to talk more about it with you, and to help you be in touch with any of the speakers from the convention.

Daniel Rhee - Foreign Affairs Budget, Policies Affecting FMGs

This is my fourth National Convention, and it has been impressive to see the organization sustain its relevance – especially in this time of reform for health care in the United States.  As with my prior experiences, the speakers and presenters in attendance were thought-provoking and inspiring; the programming covered a wide breadth of topics.  Because there are three other attendees that will be sharing about their experiences from a fresh perspective, I hope to give my reflections on two things that I have seen change during my time with AMSA; the first is in regard to AMSA’s approach toward advocacy, and the second are issues that affect the International Caucus (FMGs).

More and more, AMSA’s national leadership has made it a priority to make physician advocates out of AMSA members–health care providers who voice how policies affect their patients.  Rallies have traditionally been part of conventions, and it was almost expected for national leaders to have participated in (and even arrested for) civil disobedience.  However, in part due to the change in political climate, AMSA is now shifting its focus on getting medical students to actually visit offices of congressmen and congresswoman. 

This year’s lobby visits have been the most coordinated by far, and after a message from the main political officer of the AAMC, I partnered with a student from Northwestern Medical School to go to the offices of 3 congressmen–2 Democrats, 1 Republican.  There were a few other issues on the agenda for the day, but the current global health-related policy concern was the House of Representative’s version of next year’s budge, which would drastically reduce the Foreign Affairs budget.  This category of spending includes all funds for the President’s Emergency Plan for Aids Relief (PEPFAR, created under Pres. G. W. Bush), United States Agency for International Development (USAID), and our contributions to UN aid agencies and the Global Fund. 

While the global health community may debate the manner in which these different agencies execute their objectives, when America is one of the main contributors of worldwide funding, and when that funding is only 1% of our GDP, there would be nothing gained from a drastic reduction of resources.  In part of my own internal debate on how to address global health inequities in other countries as an outsider, it seems very logical to do the most I can from within my country of residence – both for my fellow citizens and those who we affect in other countries. 

I do realize that being a student as MSIH poses a challenge to doing this type of advocacy now, but I hope all of you will look for these opportunities as residents and young physicians.  Even amongst my fellow AMSA members, very few understood how policies are written and made into law (remember ‘I’m just a bill’?), and when we likely represent some of the most educated people in the country, it speaks volumes about how much political voice our typical patients will have.  Representatives are constantly lobbied by private interests and individuals advocating their own cause; when they encounter medical students and physicians advocating for their patients, they listen, even if their viewpoint may differ. 

The second issue I will address pertains to internal AMSA policies that will affect us as FMGs.  The International Caucus within AMSA has grown significantly in the past three years, both in size and influence; our own Liz Morgan (2012) played a significant role in these changes. FMGs were once denied full representation within the House of Delegates (HOD, AMSA’s voting mechanism), and there was one trustee and one regional director; we now have full voting representation, a trustee, and four regional directors. These are significant improvements, which I would support in the interest of equity even if I weren’t attending an international school.  However, there are two policies that were raised in the HOD during this convention that will have a negative impact on us, and though I may not be able to give a better solution, I believe it is something that all of us should be aware of.

AMSA has an internal document, along the lines of a constitution, that determines the stances we take on issues regarding medical education and health policy.  It was a policy that affirmed that limits to residency work hours improve patient safety, and that a residency match algorithm that favored hospitals was detrimental that led us to work with the AAMC to cap work hours and change the algorithm to favor students. In this past session of the House of Delegates, two resolutions were proposed affecting FMGs: 1) a resolution that advocates for termination of the pre-match system, and 2) opposition to an increase in residency placements until the number of US medical graduates matched the number of existing federally funded positions, which would drastically reduce placements for FMGs.

The first resolution regarding pre-match was voted on, and passed; this does not mean pre-match disappears, but that AMSA would advocate for its elimination if given the opportunity.  It passed with a large majority, because the premise of the resolution is that is the pre-match system does not treat all potential residents equally.  The major argument for maintaining pre-match is that it is a way in which hospitals can accept doctors for training from other countries who undergo visa applications that may take longer than time between match day and their first day of residency; not to mention, they are relocating their lives. 

The second resolution was more contested, and a decision was made to table it for review by next year’s Board of Trustees. The justification given was that it was a means to address ‘Brain Drain’–the emigration of doctors out of developing countries. I spoke out against this policy fairly strongly, as the proponents who seek to address Brain Drain are not suggesting that we should prevent doctors from being trained in the United States; there are several countries that do not have the infrastructure to train doctors well. It’s fairly accepted that the better solution involves incentivizing their return to the countries of origin.  It would be understandable if the authors of this resolution genuinely believed this was a solution to brain drain, but it concerns me that such a serious global health issue might have been used to veil a policy targeted against foreign medical graduates.

I was extremely thankful for being able to attend this past convention, and the nature of these concerning resolutions has especially made me hope that MSIH will maintain our presence within AMSA national.  During elections for the International Members, Liz Morgan (2012) was elected as the International Trustee, and I was elected as the International Regional Director for Africa/Asia; we will continue to advocate from within national leadership to reverse/improve policies affecting MSIH students.  

Jamie Bleyer - Advocacy, Patient Safety and Plan B

Day 1: Advocacy Day

The first day of the convention was allocated for lobbying on Capitol Hill. There were four main issues we were advocating for: Global Health, Health Care for All, LGBT Rights, and Student Debt. The topics were divided and we set out to meet with the offices of senators and representatives from our home states. My group (Health Care for All) met with the offices of Sherrod Brown (D) and Tim Ryan (D). We advocated for the State Leadership in Health Care Act (S.73/H.R. 439), which enables states to expand health coverage and improve access to affordable health care. It maintains the standards laid out in the health reform law (PPACA) while also giving states the flexibility to experiment with cost-effective programs. For instance, it allows Vermont to experiment with single-payer health care system, which could potentially serve as a model for the rest of the country. This bill will give states more autonomy to expand health insurance coverage sooner while cutting back on the expense and inefficiency of setting up an exchange.

Day 2: “Thought Leader: David Nash, MD”

On Friday I attended a session given by Dr. David Nash, Founding Dean of the Jefferson School of Population Health at Thomas Jefferson University. Dr. Nash is an expert in outcomes management, medical staff development, and quality-of-care improvement. Dr. Nash was a phenomenal speaker who talked about the importance of evidence-based medicine, patient safety, and the clash of generations of health care providers. In the United States, 11 people die each hour due to an error in patient care. Medical students can improve patient safety and be effective change agents. We must insist on equity with the enforcement of rules and resist intimidation by the medical hierarchy. We should promote the use of simulations in student training and remember that professionalism requires constant self-evaluation. Someday, the quality of residencies will be measured primarily by the outcomes of patient care. As medical students what exactly can we do? Dr. Nash provided an action list including: promoting real professionalism in our schools and wards, acquiring academic grounding, starting a “Quality Council,” and understanding health reform. Some of his recommended reading included “Why Hospitals Should Fly” by John Nance and “Safe Patients. Safe Hospitals” by Peter Pronovost and Eric Vohr.

Day 2: “In Support of Women: Health Policy and the FDA”

Dr. Susan Wood is a professor at GW School of Public Health who resigned from her position as the assistant commissioner of women’s health at the FDA in protest of the politics surrounding the approval of Plan B (emergency contraception) for over-the-counter use. She started off speaking about the overall structure of the FDA, and how the organization regulates to the practice of medicine. She went on to discuss the history of Plan B and the events leading up to her resignation. In brief, the FDA approved Plan B as a prescription drug in 1999. In 2003, an application was submitted to switch it from prescription to over-the-counter. The problem is that this is a time-sensitive drug and women need access immediately. By the time someone gets a prescription for Plan B, it is less effective. Most requests to switch to over-the-counter are processed within a few months, but in this case the FDA delayed its approval for 2.5 years. In 2005 Dr. Wood resigned in protest of the ongoing delay due to the clash of politics and science which was coloring public health policy. When two senators announced they would block the nomination of Dr. Andrew von Eschenbach as FDA commissioner in 2009 due to his department’s blockage of Plan B, he pushed the application through at the last minute. When it was finally approved, there were arbitrary age restrictions placed which are still being discussed today. Dr. Wood also spoke about the current controversy within the FDA on regulating the promotion of off-label uses. Currently, drug companies are only permitted to promote the approved uses of particular drugs. But, the FDA does not have the authority to regulate how doctors practice, so it is left up to physicians and insurance companies to decide if off-label uses are warranted and if they will be covered. 

Jess Wilson - Convention Day-To-Day

Thursday: 

This was “advocacy day,” in which we lobbied our representatives on the hill. We registered in advance and AMSA set up appointments with staffers from our states (that’s Texas for me) so that we could speak to them about some current issues. There were various issues on which to speak- I chose “Health Care for All” and talked to the staffers of both of my senators about a bill affecting some of the state-specific policies that will go into effect in 2014. If you’re interested in the specifics, ask me! It was great to talk to staffers- lobbying is not something I had ever done and it was a great experience. Perhaps I should live in DC so I can do it more often…

Patch Adams was the opening keynote speaker! It was fun to actually see him in person. He talked about compassion in medicine and fun in medicine. He also talked about how clowning lets him into people’s lives in a way that walking around without the clown suit doesn’t- he can hug people any time he wants! He also talked about how if he’s at the store and hears a parent/child yelling at each other, he hikes up his (crazy) pants and puts on a nose or some other ridiculous clown-type thing… and no one can keep arguing because no one argues when there is a clown present; so basically diffusing the situation through humor. It was a good talk!

 

Friday:

I went to a talk by Tao Le, author of First Aid! He gave a talk on “First Aid for the Wards”- I attached the handout from his presentation in case you’re interested.

There was a talk by Marshal Ganz, a long-time community organizer who spoke about leadership. The thing that most stuck out to me from his talk was a comment he made about “raising awareness.” I’m paraphrasing, but he basically said that awareness does nothing if people don’t actually act. So while making people aware of injustice is a start, if those people aren’t empowered and encouraged to DO stuff, there’s pretty much no point in awareness alone. Made me think!

Next I went to a talk by Gloria Wilder, who grew up in a very poor community in NYC and now advocates on behalf of impoverished communities in DC. It was a good reminder of the health discrepancies that exist in the US. She spoke about her work as a pediatrician and how hospitals in impoverished areas lack resources- she talked about a particularly frustrating situation in DC in which, if a child from a certain community (I forget which) has an emergency asthma attack, it is better for the parent to take a taxi to the middle of the a certain bridge, because the ambulance for the hospital which can adequately treat the child will only come as far as that location. Otherwise, the parent could the take the child to the hospital in their home community, but the hospital is not equipped to deal with pediatric emergencies, and the child might die due to lack of equipment and staff training in peds.

I also went to a talk about the history of Plan B (aka the morning-after pill) in the States, which has been filled with a lot of political will and misunderstanding about what Plan B is. While I knew that it was a struggle to have it as an over-the-counter medication in the US, I never knew just how much! 

Next I went to a talk by the medical director for Partners in Health, Dr. Mukherjee. She talked about the work of PIH and all of the social factors that go into creating a good system of healthcare in impoverished communities. It was a very inspiring talk! 

Friday night, there was a poster session- it was fun to see what research students at other schools are working on, and made me want to encourage students at MSIH to pursue research. When I think about doing research, I just kind of groan… pipetting? Yuck. But a lot of students had done research examining attitudes of patients, or curriculum and educational research. So, we can too! Also during this session, Nicki and the other sexual health scholars presented their projects, which were really interesting! Looking forward to the implementation of Nicki’s project at our school!

 

Saturday:

I went to a presentation about promoting health for the LGBT community. It’s surprising and disappointing to me that we don’t have anything about LGBT healthcare at MSIH, so I wanted some info! As it turns out, LGBT patients are at higher risk for cardiovascular disease, among other things. Check out these fact sheets: 

Top 10 Things Transgender Patients Should Discuss w/ Healthcare Providers

Top 10 Things Gay Men Should Discuss…

Top 10 Things Lesbians…

Next I went to a really great talk by the director of Planned Parenthood in DC. He spoke about his (long-time-in-the-making) decision to make abortion provision part of his practice. He also spoke about the need for abortion care and about making it part of a career as a physician. Did you know that not just ob/gyns provide abortions? Primary care providers can also provide them!

I was part of the Nominations Committee for this year’s national elections, so Saturday afternoon and night I mostly did election-related stuff, but I also managed to sneak in one more talk:

Actually, I don’t really know how to describe the last talk, because it made my head spin… but basically it was about physics and non-Gaussian distributions and fractals and network integration and systems theory and bioinformatics and many other fascinating things. Naturopathic Dr. Peter D’Adamo talked about how systems biology can be used to study medical interventions- it was awesome!

Sunday I headed back to Beer Sheva! Again, I would encourage everyone to go- it was a great experience!

2011 MSIH-AMSA board

2011 MSIH-AMSA board