Whetting my appetite

We had lots of excellent lectures today. A little more break time in between them would have been appreciated, but it was really mostly fantastic quality so I can't complain. An MD/JD came to speak with us about public insurance (Medicare/Medicaid) and the uninsured, and I enjoyed that presentation a lot. I learned so much stuff that I didn't know... did you realize that states spend, on average, 20% of their budgets on Medicaid? And that of that 20%, fully half of it goes to only 5% of the Medicaid population? The amazing upshot of this is that basically what this works out to is that less than 1% of each state's population consumes 10% of the entire state budget. I was aware that a vast amount of money goes to a very small amount of truly sick people, but I had no idea it was this ginormous.

We also had a presentation by two social workers who explained a little bit about what they do as far as addressing disparities, and we heard from a researcher who is studying free clinics in the US. We also had a lecture from the ACCESS group that runs the clinic that I visited yesterday... the more I hear about their organization, the more impressed I am. Rounding out the morning were lectures on breast cancer and hypertension in the African-American population, both of which were excellent. Dr. McDade told us about a current theory (as yet unproven, though there is some evidence in support) that one of the reasons that African-Americans are disproportionately affected by hypertension is that the ability to concentrate and hold on to sodium may have had a protective effect during the slave trade which caused a differential survival across the Middle Passage, thus concentrating those genes in this population (people of African descent from other areas are not nearly as affected by hypertension). Really interesting to think about.

In the afternoon we visited the emergency department. Except for when my mother had her thyroid surgery in January, it's the first time I've been in a hospital for a year. It completely felt like going home. The smells of the cleaning solutions mingled with the smells of the patients, the sounds of the pages and the tele monitors and the shift report going on, the cadence of the movement of the staff around the station and in and out of the rooms and the curtains... it was all so comfortingly familiar. Of course, in keeping with the course, our tour was focused primarily on policy and public health sorts of things -- nothing clinical at all, really -- but I'm afraid to say that I pretty much tuned that all out and let my attention wander to the rest of the environment. I absolutely did not want to leave. In a week that's been full of new things and new people and new places and new stresses, it was sort of jolting and strange to feel like I belonged there. While it wasn't my home exactly, still, I understood it.

Gah, I'm doing a bad job of describing what it was like. All I can say is that it was really powerful for me and I really cannot wait to get back into some sort of clinical environment, and preferably a hospital. Cannot possibly come soon enough.