Perspectives, the start of my Spring blog

Hello All,

This Spring, I was lucky enough to continue shadowing with one of the world's (no exaggeration here, it's a fact) greatest neurosurgeons Dr.--- I was lucky to have two different types of clinical experiences this quarter because I received two very different perspectives of the multifaceted field of medicine. I was introduced to specialty care medicine through my shadowing days with Dr. ---. I was able to see that speciality care medicine (a major part of academic/private medicine) contributes immeasurably to society and is essential because it has allowed us to advance the field of medicine by focusing on specific problems and their uniquely complex pathologies; It's the field of medicine which is responsible for pushing the boundaries of health care through the innovation of specific treatments, techniques, and research tailored at tackling sub-specialized pathologies. For example in neurosurgerical research, the recent break-through in the discovery of neuronal stem cells has now given hope to cure degenerative diseases such a Parkinson's. The theory is that by inserting neuronal stem cells into the substantia nigra (Dopamine producing neurons which degenerate resulting in motor dysfunction), we can hope to restore neurons in this area by inserting these stem cells, which may then grow into new neurons and take on the dopamine producing functions of the neurons which have degenerated. The discovery of these stem cells is literally a revolution for the medical field because it offers a potentially viable cure for degenerative diseases which are incurable and can only be temporarily inhibited by current treatment strategies i.e. L-Dopa supplements to restore dopamine levels in the brain for Parkinson's patients. The unique thing about neurosurgery (and many other types of surgery and internal medicine specializations) is it requires specialization due to the complexities of various neurological diseases. Due to the emphasis of sub-specialization we are seeing progress occur at a faster rate. Doctors can now be trained to focus on a particular problem, thus dedicating more of their time and energy in researching and understanding the nuances of their sub-field; the result of sub-specializing is that doctors become experts in dealing with particular diseases or problems. Subs-pecialization translates into higher recovery-rates for patients who choose doctors trained specifically to deal with their disease. For example, a neurosurgeon (i.e. Dr. ---) who specializes in removing pituitary adenomas (a technically-difficult surgery) will fair better than a general neurosurgeon due to the sheer amount of practice and exposure he has with that surgery. Likewise, a neurosurgeon specialized in neurovascular trauma will be able to have more successful outcomes than a neuro-oncologist because he/she will understand the nuances of neurovasculature, and can more effectively use new developments in that field to benefit their patients because they are constantly working in that sub-field, aware of anything new that occurs. Each sub-specialized doctor will gain a technical yet intuitive knowledge of their field and can better track progress in terms of what works and what doesn't. This is all a reflection of what I've learned from Dr. ---, a master in the field of neuro-oncology. He has shown me the real benefits of being trained at a world-renowned institution, where he was able to gain wisdom and insight on what to focus on and how to apply his focus for the benefit of his patients.

My experiences at Bayanihan clinic really opened my eyes of how medicine is practiced for underserved populations, a vastly different perspective than found in academic or private medical institutions. The plight of the medically underserved has tested the practicality of our nation's health care model, and revealed the limitations in the goal of health care delivery for everyone. Medically underserved care is unique because it's progress is dictated by what occurs in the private/academic sector. New drugs and treatment techniques (developed my corporations or universities) are initially available at high cost, and are unavailable to low-income demographics. Even for many common treatments, patients are required to have insurance to avoid bills that range from 500-20,000 dollars. However, in the pharmaceutical industry, if a drug is out long enough and the research costs of the drug are paid off, corporations can sell patents to generic manufacturers such as Target or Wallgreens, which can then sell the drug at a lower cost. I know this because uninsured patients who come to Bayanihan Clinic can get Lipitor (a drug that controls LDL) for cheap ($4) from Target. Glucometers are very cheap these days being that they've been around for a long time and can be made with cheaper materials and simpler technology than before. Unlike pharmaceuticals, treatments and check-ups will always be expensive which is what makes community-free clinics so essential for low-income patients. Medical preceptors at clinics can offer check-ups, which would normally be billed for 150-200 dollars, for free to patients. My experiences in community-free clinics have really benefited me because i was able to see the humanitarian and service aspects of medicine; it has shown me that advances in medicine should be available to everyone because life and its quality is the most precious thing that we have.

Underserved and Academic/Private health care aren't mutually exclusive; they depend on each other to advance health care delivery for the future. Academic/Private health care research and development has given rise to new treatments which can eventually be streamlined to be available at low cost to underserved populations, however the development of such treatments requires cutting edge research and funding from patients and donors who can afford advanced health care. Eventually underserved populations would be able to obtain this care if effort is put forth in streamlining treatments for availability at low cost. For example, when glucometers were first released they were too expensive for general public to access due to the cost of production and research; however, as corporations have refined the device for mass distribution, clinics like Bayanihan can afford to buy them in large quantities. Also, as drugs become generic, companies such as Target can offer them at extremely low prices through contracts with clinics like Bayanihan in turn allowing low-income diabetics with a solution for their disease.