It's Friday, and life here is good. This past week I worked Tuesday and Wednesday, and was supposed to work yesterday, but Wednesday was such a frustratingly crappy day that I fervently prayed before bed that they would call me off, because I didn't feel like my blood pressure could take another 12 hours of it. The good Lord must have agreed, because sure enough, despite what looked like a skeleton crew scheduled for Thursday morning, they called me at 5:30am and told me they didn't need me. Hallelujah!
I'd already finished up my Pathophysiology class, figuring the test was the easiest part of wrapping up the semester and then I could get down to concentrating on the two papers I had due. I actually managed to knock one out yesterday, and I'm embarrassed to admit how much I'm actually getting into the assignments I was purportedly dreading. The one I did yesterday was a health management plan for the primary care of an 18-year-old female patient. The goal of the assignment is to get us to look at ALL the screenings/tests that are currently recommended for patients by various organizations, and then figure out which are actually justified by what's called "evidence-based practice" (EBP), which is just what it sounds like. The opposite of CYA ("cover-your-ass") medicine, which is what's currently practiced by a majority of doctors today and involves ordering every test and procedure imaginable in a twin effort to line their own pockets and prevent being sued. EBP says that to order a test, you have to have a valid reason for it and the evidence has to show that the benefits of the test actually outweigh the risks. Surprise, surprise: many don't. Even old standbys, like the breast self-exam (BSE) we've all been made to feel guilty for not doing, get stamped with an "I" for "Insufficient evidence to recommend as helpful" by the US Preventive Services Task Force, which is like the gatekeeper of evidence-based medicine in the United States. EBP is a relatively new topic here, but it's huge in places like Britain, where a single-payer healthcare system means that the country has a vested interested in preventive services, but only to the extent that they actually prevent, detect, or treat disease.
On a very related note, the CEO of UnitedHealthcare New Jersey (a major insurance carrier) has published an 0p-ed in a NJ paper about the true costs of early elective C-sections. One of the most memorable (and chilling) quotes from the article:
Anyway, I had a couple of questions about that assignment and ended up calling one of my professors to ask them, and we ended up having a wonderful dialogue about EBP and the frustrations of working in the current healthcare system and it really made me feel glad to have found a school that's working so hard to produce efficient, thoughtful, and effective healthcare providers. It makes me feel proud to be a Frontier student and a future midwife.
Having wrapped up that assignment, I've moved on to my last class, in which we're slowly working our way through a proposal to open a midwifery practice in the state in which we'd like to practice. Hometown girl that I am, I chose Iowa, and while sifting through the various documents and regulations initially filled me with dread, I'm enjoying it in spite of myself. The assignment really gives credence to the idea that someday I am really going to do this (somewhere), and I'll be glad I did a lot of the legwork (figuratively speaking) when I was working part-time and only 10 weeks pregnant, as opposed to a fledgling midwife with a two-year-old (and who knows what else!). So, yeah--for anybody looking into midwifery (or nurse practitioner, for that matter) school, Frontier has really got its crap together.
So that's what I'm up to. This weekend should be a good one; we don't have anything major planned, but we should start packing and preparing to drive back to the midwest in a week! We can't wait!
I'd already finished up my Pathophysiology class, figuring the test was the easiest part of wrapping up the semester and then I could get down to concentrating on the two papers I had due. I actually managed to knock one out yesterday, and I'm embarrassed to admit how much I'm actually getting into the assignments I was purportedly dreading. The one I did yesterday was a health management plan for the primary care of an 18-year-old female patient. The goal of the assignment is to get us to look at ALL the screenings/tests that are currently recommended for patients by various organizations, and then figure out which are actually justified by what's called "evidence-based practice" (EBP), which is just what it sounds like. The opposite of CYA ("cover-your-ass") medicine, which is what's currently practiced by a majority of doctors today and involves ordering every test and procedure imaginable in a twin effort to line their own pockets and prevent being sued. EBP says that to order a test, you have to have a valid reason for it and the evidence has to show that the benefits of the test actually outweigh the risks. Surprise, surprise: many don't. Even old standbys, like the breast self-exam (BSE) we've all been made to feel guilty for not doing, get stamped with an "I" for "Insufficient evidence to recommend as helpful" by the US Preventive Services Task Force, which is like the gatekeeper of evidence-based medicine in the United States. EBP is a relatively new topic here, but it's huge in places like Britain, where a single-payer healthcare system means that the country has a vested interested in preventive services, but only to the extent that they actually prevent, detect, or treat disease.
On a very related note, the CEO of UnitedHealthcare New Jersey (a major insurance carrier) has published an 0p-ed in a NJ paper about the true costs of early elective C-sections. One of the most memorable (and chilling) quotes from the article:
It turns out that in an audit of all UnitedHealthcare-insured babies admitted to the NICU in one market, 48 percent of all newborns admitted to NICU were delivered by elective admission for delivery including scheduled C-sections (cesareans), many taking place before 39 weeks of pregnancy, or full term.So almost HALF of babies in intensive care are there because their parents, or their parents' doctor, chose to induce labor or perform a Cesarean BEFORE TERM. Note that he specifies that this is ELECTIVE ADMISSION FOR DELIVERY--completing excluding medical reasons for C-section or labor induction. I always like to tell my patients "The fruit falls when it's ripe." Imagine that! Kind of reminds me of the butterfly story. (And of course, I give the caveat: Cesarean can be a lifesaving operation and I'm glad that it's available. My dear husband was born by such a Cesarean and clearly I would be lost without him. We're talking here about purely elective inductions/C-sections before term, done only for convenience reasons.)
Anyway, I had a couple of questions about that assignment and ended up calling one of my professors to ask them, and we ended up having a wonderful dialogue about EBP and the frustrations of working in the current healthcare system and it really made me feel glad to have found a school that's working so hard to produce efficient, thoughtful, and effective healthcare providers. It makes me feel proud to be a Frontier student and a future midwife.
Having wrapped up that assignment, I've moved on to my last class, in which we're slowly working our way through a proposal to open a midwifery practice in the state in which we'd like to practice. Hometown girl that I am, I chose Iowa, and while sifting through the various documents and regulations initially filled me with dread, I'm enjoying it in spite of myself. The assignment really gives credence to the idea that someday I am really going to do this (somewhere), and I'll be glad I did a lot of the legwork (figuratively speaking) when I was working part-time and only 10 weeks pregnant, as opposed to a fledgling midwife with a two-year-old (and who knows what else!). So, yeah--for anybody looking into midwifery (or nurse practitioner, for that matter) school, Frontier has really got its crap together.
So that's what I'm up to. This weekend should be a good one; we don't have anything major planned, but we should start packing and preparing to drive back to the midwest in a week! We can't wait!
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