Guest Post: From Ine, HMP ’13, on exploring Canada’s health care

Touring 'SickKids' pediatric and research institution.

Linda Sun, a 2nd-year Health Management and Policy student and Ontario native, collaborated with Professor Scott Greer to organize a “study tour” of the Ontario health system in Toronto on March 30, 2012. The day began with a tour of ‘SickKids‘, one of Canada’s exemplary pediatric institutions and research institutions.

The rest of the day was organized by Adalsteinn D. Brown, or “Steinni” as he is affectionately known at the Ministry of Health; he is chair of Public Health Policy at the University of Toronto. We met with the Health Quality Branch and Health System Strategy division of the Ministry of Health and Long-Term Care to discuss the implementation of the Excellent Care for All Act (2010) and Ontario’s Action Plan for Health Care (2012).

From left to right: Nicole Jones, Ine Collins, Steinni, Linda Sun, Zoe, and Becca Chimis)

We also had the opportunity to share ideas on patient satisfaction initiatives with a consultant to the Ontario Hospital Association. Additionally, we interacted with current students at the University of Toronto’s Dalla Lana School of Public Health, getting their perspective on current issues in the Ontario health system, such as health disparities, and answering questions they had about the American health services system.

The students, as well as a Canadian doctor I met at UM’s 2012 Sujal Parikh Memorial Symposium for Health and Social Justice, invited me to the 4th Annual Students for Medicare Conference “Medicare in the Age of Austerity” the next day. The conference was filled with passionate discussions with physicians, economists, students, and community members alike about national cuts to provincial health budgets and the political debate on increased privatization of health as an alternative solution with several comparisons to the U.S. system.

Overall, the trip was an invaluable experience and Professor Greer and I look forward to expanding and continuing the trip next year.

5 Tips to Landing a Great Internship

Tasha Edwards

Let’s start by saying, I look nothing like this picture. I will post a picture of my current self below. My, how things have changed in a year. On to the point of this post, my internship. In the fall, I will be second year Master’s degree student at the School of Public Health in the department of Health Management and Policy. I believe that it is a requirement in all the Master’s degree programs to complete an internship between the first and second year of study. My internship is at Henry Ford Health System in the Web Services. The main component of my work in the development and implementations of social media strategies.

I am so lucky to have received this internship, because it is very fitted to goals and talents. The department of web services sits inside of Marketing and alongside Corporate Planning, Public Relations, Communications, and Media Resources. I live for this stuff! I feel that every project I am a part of or take charge of is helping me to hone my skills to be successful in the future. Awesome, right? I know!

So, how do you get an internship as great as mine? Here are 5 quick tips.

1. Speak up about your interest, experience, and goals. You never know who’s listening, who they know, or what they can offer you.
2. Be professional in your work, study, classes, and extracurricular activities. I am not saying you need to wear a suit everyday, but look presentable. Employers and alumni visit the school for interviews, recruitment, and workshops on a regular basis.
3. Do not procrastinate on deadlines, interviews, emails, etc. Someone else could just be waiting to take your place.
4. Have an idea about the type of internship that would best fulfill you or the place you would like to be live. If you don’t know, then no one else will.
5. Follow up with potential employers. Like I stated previously, you are not the only student trying to obtain an internship, so you have to make an effort to stay at the top of the list.

I really hope these tips helped. This is how I got my awesome internship, and hopefully you will have a similar story to tell.

His Right Knee…Her Only Appendix

Danielle Lepar

With 2011 here, Winter vacation is coming to a close.  While two weeks off never seems like quite enough, this particular break seemed especially short to me.  On December 24th, my sister was rushed to the hospital for stomach pain and remained there for several days.  While she is feeling much better now, several things took place during her stay that caused me to reflect on some important themes in public health.

My sister’s experience at the hospital reminded me of how our current medical system does not often provide patient-centered care.  I was first  introduced to this concept during a Health Management and Policy class in which we watched a speech  entitled, “My Right Knee,” by Don Berwick– former President of the Institute for Healthcare Improvement and current Administrator of the Centers for Medicare & Medicaid Services.  (A summary can also be found here.)  In his speech, Berwick highlighted 5 dimensions of quality care, which included: no needless deaths, no unwanted waiting, no needless pain, no helplessness, and no waste.  Only the first of these specifications was met in my sister’s situation. 

As far as waiting goes, it seemed to take forever for the recommendations of a provider to translate into action.  Orders for my sister’s care bounced between different doctors, physicians assistants, nurse practitioners, nurses and nurses assistants.  BAHH, talk about uncoordinated care!  It was like watching a game of telephone in that what actually happened to her was not always what she was originally told or changed in the course of communication, leaving my sister and family feeling confused and helpless.

While my sister’s abdominal pain was being successfully controlled with medication, diagnostic tests yielded no explanation for it.  Still, her providers pushed strongly for an exploratory surgery.  Since nothing was obviously wrong and her case was not emergent, I did not understand the immediate need for a surgery.  Was it really worth such an invasive procedure when things could, potentially, clear up on their own?  If things didn’t end up getting better, would the excess pain from surgery have been needless?  The same goes for “no waste.”  Would it be worth spending all the time, resources, money, recovery time, etc on a procedure that might not even be helpful?  Not to mention that surgery would result in a wasted appendix whether it was the root of the problem or not! 

I know that people live healthy, productive lives without an appendix, but that’s not the point.  The point is that, if we truly want to serve patients, our medical system should empower patients, not make them feel helpless.  I recognize that I have described an isolated incident and also do not question the fact that most providers strive to serve their patients the very best of their abilities.  But, if public health has taught me anything, it’s that we still have much to accomplish in terms of providing quality health care.  Hopefully, greater interdisciplinary and collaborative efforts in the future will help foster the structural change necessary to move in this forward direction.

Rare Disease, Big Burden

Danielle Lepar

This summer I’m doing my internship at the Center for Managing Chronic Disease.  To lay down a little groundwork, chronic disease generally refers to conditions that progress slowly and have prolonged durations. According to the Centers for Disease Control and Prevention (CDC), chronic diseases are responsible for 70% of all deaths in the U.S.- a whopping 1.7 million each year.  The first time I came across these stats, they really shocked me.  And, while this magnitude of mortality is definitely an attention-getter, my recent exploration has revealed the importance of addressing the other (and perhaps under-recognized) dimensions of chronic conditions- quality of life, possibilities for prevention, and self-management to name a few. (I’ll be getting back to these points later.) 

Before I started working on my current project, the term chronic disease triggered a somewhat limited number of conditions to come to mind.  It’s not that I was unaware that other conditions existed, but I mostly thought of a few chronic disease BIGGIES:  heart disease, cancer, asthma, diabetes, you get the idea.  Inflammatory Bowel Disease (IBD) didn’t make the list. 

While IBD- which includes Crohn’s disease and ulcerative colitis- is rare compared to other conditions, it has the potential to have some pretty serious costs. Here are some key points about IBD that have affected the way I think about disease and burden:

1. Diseases with an early age of onset and that don’t cause a decrease in life expectancy mean that people relapse- and accrue costs- over a longer period of time.

2. Chronic conditions that start during individuals’ teens or twenties, impact them at a critical period of productivity and for developing individuals’ professional life.

3. IBD tends to be more prevalent in Western and industrialized regions.  While treatment innovation may be more available in these places, especially for people with “white collar” jobs, this also means the use of more health care resources and costs.

While the points above deal with a few of the economic costs associated with IBD, the serious psychosocial and quality of life burdens related to IBD should not be forgotten.  To learn more about Crohn’s and colitis visit The Crohn’s and Colitis Foundation of America or hear the stories of people living with Crohn’s at Crohn’s & Me.

Dreaming about the State of the Union

MB Lewis

I watched all 70 minutes of President Obama’s address Wednesday, plus the Republican response. I tuned in shortly after I logged off  my SPH online class discussion on the U.S. health care system.  So it’s no surprise that I dreamed last night about being in D.C. and talking health reform in its hallowed halls. Class this week was devoted to values, and Professor Rich Lichtenstein was a masterful devil’s advocate as he provoked us on the hard questions: Is health care a right, even for people who aren’t working? If so, who should pay for it? Should the government require individuals to get health insurance or else fine them through IRS?

“Most health policies start with a values position,” he said. Avedis Donabedian did groundbreaking work on the topic when he taught at UM SPH, and it’s as pertinent today as ever before.

Our distance learning class in the Certificate in the Foundations of Public Health had weighed in slightly more conservatively than the daytime SPH class on whether individuals or government bear responsibility for health care. Perhaps that’s because we’re older than the residential students. Many of my 25 classmates work  in medicine, social work, research, and education (one is an emergency worker, now  in Haiti). Many say they’re taking the class to find out how the complex U.S. health care system works. They know their piece, but not the big picture.

We’re getting the big picture in class, and it’s scary. The system of largely employer-funded insurance  is not sustainable. If Starbucks spends more on employee health than on coffee, and GM spends more on it per car than on steel, how can our economy thrive? And imagine how much more costly government programs like Medicare will become as baby boomers age.

I didn’t mention how often President Obama and the Republican respondent used the words “values” and “freedom” in their speeches. I noticed it though. And I have a better understanding of why.

PS: See the public letter that 3 more UM SPH professors signed urging health care reform.

Healthcare Spending

 

Valentina Stackl

 

Just a quick post, I found an interesting graph (in the article Health Insurers, Poised for Round 2) in the New York Times showing the increased spending on Health Care in the United States over the years. That graph shows that the spending is at over two trillion dollars. That is a two with 12 zeros! A trillion dollars is a million millions. A trillion dollars is a thousand billions. Just to put that into perspective, one billion seconds ago it was 1959. One billion hours ago it was the Stone Age. If you would count to one billion (and that’s not even close to  trillion, as we know) you would have to stay awake without eating for 39 years. Holy Moly!