August 3, 2012
By Rebecca Gao
While on the train from London to Oxford, I was discussing typical premed woes, from organic chemistry to MCATs to volunteering to possible future (albeit very far in the future) specialties with some fellow students. I mentioned that oftentimes medical students who didn’t get their first choice residency positions would go into primary care instead, one of the least popular choices, as only 2% of medical school seniors who choose internal medicine residencies become general practitioners, according to a 2008 study in the Journal of the American Medical Association.
We happened to be sitting across from a middle-aged couple, and the lady on my left suddenly interjected, “General practitioners are actually the most important doctors that exist and the best actual doctors.” Dr. Erin Quinn, who was to my left, added that “some of the smartest doctors [she knows] are general practitioners.”
The lady was a general practitioner from Australia who was well-versed in global medicine, having practiced in developing countries for many years. Her husband was from the States and is involved in the public health management post-disasters.
They emphasized how crucial primary care was to the health care system in Australia, which operates with 60% of physicians as GPs, compared to only 30% in the United States. In Australia, GPs will refer patients to specialists, but more often than not diagnosis and treat the diseases themselves. The GP follows the patient throughout his/her care and this close-knit relationship allows for more holistic and well-rounded treatment. The GPs are the foundation of healthcare system. In fact, specialists defer to GPs, as they would be out of business without their referrals.
In the U.S., however, specialists are generally more highly regarded than GPs, and patients can bypass GPs to directly consult specialists whether or not their condition actually required specialist attention. Dr. Quinn gave the example of patients with back pain seeking spinal surgeons and patients with mild headaches booking appointments with neurologists.
When we discussed why there was such a disparity in GPs between the countries, it seemed as though the U.S. healthcare system shouldered the largest burden of the blame for incorrectly incentivizing the medical field. In Australia, GPs are paid higher salaries and specialists significantly lower, and medical school loans can be repaid by working in primary care for a few years, earning both a standard salary and a set amount of loan forgiveness. Medical malpractice insurance is drastically lower, and the cost of medical school is a fraction of the U.S. cost.
The elitism surrounding American doctors also factor into an unwillingness to enter primary care, which is less “prestigious” than specialties. In fact, the Australian GP said that she refused to hire American GPs because they were the “worst” and “useless” because “they did not know enough general medicine at all.” They also “refused to even take blood pressures because they felt that it was beneath them.” Apparently, she preferred South African and French doctors.
We also discussed the U.S.’s cavalier attitude towards the botched Haiti disaster relief effort – sending in surgeons to perform advanced surgeries when the patients would die later due to lack of clean water, proper sanitation, and other basic health concerns.
However, what I really took away from the conversation (one of the only times I appreciated a longer travel time), related to primary care. Dr. Quinn, the man, and the Australian GP all seemed completely convinced that the current U.S. system would change – and soon, within 20-30 years. “It’s unsustainable,” the GP said simply.
I wasn’t quite sure where they got their confidence. Although 20 years is a long time – longer than I’ve been alive even – I wonder if we can essentially tear down and rebuild our system within a few years. Learning more about European and other countries’ healthcare systems throughout this trip, I marvel at the U.S.’s doddering, juvenile version of healthcare. As terribly as we’re doing, I’m surprised we even managed this much.
I met a native British man on the plane from San Francisco into London; he was a banker on a business trip for a few days. I asked him about what he thought about the British healthcare system, and he paused for a moment, slightly perplexed and bemused. “What do I think? I’m not quite sure…I haven’t really thought about it, since it’s not really an issue at all.”
Rebecca Gao is a senior at USC pursuing double majors in Biology and Global Health from Fremont, California.
By Jun-Gi Min
My father, raised in South Korea before it became recognized as a truly developed nation, is a strong proponent of Eastern Medicine. He is the type of person to give me herb tea instead of Nyquil when I was sick, and he frequently took me to an acupuncturist before any chiropractor when I got injured while playing sports. He is even pursuing an education in Eastern Medicine in his near-retirement, studying many of the things that I am also learning about in Biology and Chemistry classes.
My father’s reasoning for his staunch belief in the traditional methods that have been passed down from the ancient Chinese lies with the argument that this school of thought takes into account the entire body in treating its patients. He frequently compares this holistic perspective in medicine to the often narrow-minded approach of modern doctors, whom he portrays to be brutal and short-sighted. He criticizes Western medicine for utilizing invasive treatments to “solve” problems without taking into account the body’s equilibrium, whose disturbance causes continuous problems afterward.
What I learned from many of the lectures from this Oxford trip is that my father’s criticism of modern medicine, though a bit harsh, may be right in many ways. Dr. Ryan and Dr. Quinn talked about how medicine in the developed world has become largely about finding quick and complete cures to what are actually complex dilemmas that require careful intervention.
I think an adequate example of this would be the anti-malarial medicines that have been derived from plants used in traditional treatments. After discovering anti-malarial properties in Chincona plants that have been effective for 300 years, modern medicine attempted to make a faster and more potent cure by isolating the active compound quinine from the plant. Of course, this refined product was more effective in dealing with the parasite Plasmodium, but what the scientists did not take into account was that isolating quinine also stripped off many of the collaborative compounds in the plant that had prevented the parasite from developing resistance to the treatment. Ultimately, quinine became useless in combating malaria that quickly became immune to it. This was obviously a blunder of Western medicine, which sacrificed too rashly the complexity of the whole for the possibility of an instant cure.
What this and many other examples brought up in class showed me was the importance of collaboration and integration of different schools of thought. Not only will collaboration make modern medicine more appealing to the extremely diverse cultures of the world, incorporating the knowledge that has been passed down through generations will prove beneficial in bringing progress to healthcare. The incorporation of herbs and yoga in treating Elephantiasis in India, using poppy plant to reduce the effects of Malaria in Africa, and the development of Artemisanin from a Chinese herb are great examples how this is to be done.
I don’t think that one type of medicine is better than the other; frankly, I don’t think it even matters. In my pursuit of being a doctor I will strive to keep myself open to all forms of medicine, not sacrificing scientific integrity but also conceding to the fact that I will always have a lot to learn.
Jun Gi Min is a sophomore Biology major from Dublin, California.
By Jun-Gi Min
The 2012 Global Health seminar at Oxford University taught me many things. I gained insight on what it means to be a premed student, the responsibility of the medical career that extends far beyond the States and into the developing nations that are struggling to provide the most basic forms of healthcare. I realized just how little I knew about the world around me, about the struggles of infants to survive to age five and the fraud drug companies that take advantage of the poorest and the weakest. I even learned that it is imperative to take an umbrella with you to London in this time of the year, no matter how sunny and how certain you are that it cannot possibly rain.
But most importantly, this class has taught me that the bane of contemporary efforts to improve global health lies not necessarily with the amount of money that goes into saving lives (which is obviously short of the amount needed to deal with this global issue), but rather with the modern outlook on how this is to be done. The western world has made the development of medicine into a search for the “silver bullet,” a crusade for the miracle cure that will rid the world of its problems. It is an incessant climb to the top, as governments pool money on expensive technology for research on the newest cure that the majority of the world cannot even afford. What the developed nations don’t realize, however, is that this gargantuan edifice that represents the history of medicine, formed purely out of desire for progress, ignores the importance of a strong base and ultimately cannot sustain the rest of the world that do not have the resources to benefit from these advances.
Take, for example, the situation in Africa. The reason why so many are dying of Malaria is not that the antimalarial medicine is not potent enough, but rather that there is none available to patients due to its relatively high price. The reason that so many children are sick is not solely due to complicated and incurable diseases like AIDS, but due to malnutrition that has nearly the same effect in terms of diminished immunity. The reason that villages succumb to common diseases is not because not enough technology is available, but because there are not enough health care professionals to care for the sick.
What I really appreciated about the speakers in this seminar is that they understood that the solution to the problems in the developing nations did not lie in the newest technology but in the adaptations of the old. Dr. Sullivan taught us that before spending so many resources on trying to eradicate complex diseases like Leukemia, it would be more plausible to pass out inexpensive iodine pills that would promote metabolism and save just as many lives. Dr. Ryan showed us that instead of relying on expensive cures for Elephantiasis that the Indian villagers cannot even afford, resources should be diverted to research on traditional medicine and yoga, which are effective treatments readily available to the natives. Dr. Merlin Wilcox suggested that more than trying to combat diseases using technology that we do not have yet, it is important to improve the basic healthcare system of the developing regions in order to equip the people to deal with any disease. These speakers understood that in order for the world to obtain an adequate level of healthcare, the solutions must be inexpensive and broad enough to be readily accessible to the developing nations.
In the world today, 150 million children are malnourished, and of those 5 million will not make it to age five. There are still 500 million cases of Malaria per year, a fully preventable and curable disease that still wreaks havoc on populations world-wide. Most villagers don’t even have a trained doctor available to them, and those that do have medical facilities face severe shortages of both time and space. To even begin solving problems such as these that the developing nations face in achieving healthcare, we must put on hold our desire for technological progress and be willing to take a step back. We must search for solutions that may not necessarily be new or the most advance, but the ones that are effective in each individual region according its resources and needs. Only then can we say that we are truly making progress in providing medical attention for these impoverished nations.
Jun Gi Min is a sophomore Biology major from Dublin, California.