MCAT Materials Review

Update: Hello readers! I haven’t posted in the last few weeks because of finals and break, but I’m excited to hit the ground running in 2017. You may notice that a few things have changed on the site since its implementation. The focus is essentially the same, with added emphasis that these are my perspectives as a prospective physician and solely my own and an added section reaching out to other pre-meds. This will be the first post in this pre-med section. In case this category does not suit your interests, please check back next week!


 

Since many people have been asking me, I thought I’d do a review of the materials I found useful while studying for the MCAT (Medical College Admissions Test). Again, these opinions are my own and you may find that other materials work better for you.

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Kaplan MCAT 7-Book Set

These were the main books I used to prepare for the MCAT. I bought this set well in advance, probably two years prior to my MCAT test date, to motivate myself by literally putting the weight on my shoulders. I structured my studying over a long period of time (9 months) because I was in school for the majority of the time (doing research, the rest). BUT, I did not study the full 9 months but instead stopped whenever schoolwork piled up. These books are well structured and give exactly the right amount of information. After comparing the material covered to the MCAT material listed on the AMCAS sections, I found that the Kaplan books covered everything to some extent. If a particular topic wasn’t covered as in depth as necessary for me, based on when I’d seen the material last, I looked up information in other books and materials. This set of books is also very visual, with lots of charts, tables, images, and diagrams–very helpful for visual learners like myself! Each section concludes with 30 or so practice questions, which are more-so to test understanding rather than to mimic actual MCAT questions. I found that the end of chapter questions were helpful in checking my understanding but did not mimic MCAT questions well. Within the set of books, I thought Kaplan’s Biology, Biochemistry, Chemistry, and Psychology books were the best. CARS was alright–had some useful strategies, but almost no practice exercises or questions, Physics I did not find useful at all because it was not very in depth, and Organic Chemistry was organized in a slightly odd way, but overall covered all of the necessary info.

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Princeton Review 7-Book set:

The reason I also had this set was because I signed up to take the Princeton Review’s live online MCAT prep class and it came with these books. The Princeton Review books were a lot more in depth than the Kaplan books which was good for topics I’d forgotten, but trite for everything else. Hence, I used these more to selectively read up on topics I needed more revision on. These books have more practice questions than Kaplan’s and the questions are harder. There were also more passage-based questions which was helpful in preparing for the MCAT questions. I found all of the books in this set to be very helpful. Again, some give too much information, but I’d lean towards recommending Princeton Review for Physics, CARS, and Organic Chemistry (and the other subjects). Their CARS book especially helped me. It has a lot of exercises to improve your CARS score. While I didn’t exactly use their “method,” my score improved a lot from their practice questions. Cons: the diagrams had a little less color and generally weren’t as nice as the Kaplan ones.

Overall, you can definitely succeed with just one set of books and you can’t go wrong with either one. I do, however, absolutely recommend that these books not be your only study tools. The best advice I have is to buy all of the AMCAS practice materials, including questions, section banks, and flashcards, and use them to study. These are the closest things to the real test. Some of the questions (especially in the section banks) are harder than the actual MCAT, but I still found them useful in diagnosing areas I needed to return to.

Other materials I used that you may find useful:

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NOVA’s MCAT Physics Book

This book was VERY helpful for physics especially since I hadn’t taken all of physics before taking the MCAT. It not only reviews, but teaches you all of the physics topics on the MCAT in a very simple way. There is no extra information that you won’t need, it is very simplistic and very accessible. Highly recommend if you’re feeling weak on Physics.

 

 

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NextStep MCAT Verbal Practice

This is a set of 108 CARS passages. I found this book very helpful in the early stages of my studying when I wanted to do practice CARS passages, but didn’t want to use all of my AMCAS materials just yet (since there aren’t very many). The passages are very similar to the AMCAS ones. Only con I’d say is that since it’s a book, it’s a very different experience doing the passages on paper vs. on the screen. That said, if you do some of the AMCAS ones, you’ll have the screen experience anyways.

 

Materials I bought, but did not find helpful:

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Examkrackers 1001 Questions – ALL subjects

Preface: a lot of people find these books helpful, hence their good amazon reviews. For me, these didn’t do the trick and I didn’t end up using them much. These books all contain “1001 questions” per subject. Some of the books, such as Organic Chemistry, just have stand-alone review questions, which you’ll find in the Kaplan and Princeton Review sets anyways. Others, like the Biology book, have passage-based questions that mimic the actual MCAT. These are great for reviewing material, but I found them to be either too easy or too hard compared to the actual AMCAS materials and the MCAT, and so, they were not helpful in preparing for MCAT-style passages and questions.

And that’s a wrap! Again, overall, I’d most recommend getting one of the 7-book sets and the AMCAS practice materials. You can get an older version of the 7 book sets since they don’t change much in between years, but make sure you get a set for the new MCAT (post-2015). Of the AMCAS practice materials, the absolute must-haves are the two official practice exams and the official question pack!

Hope that was helpful. Feel free to contact me or comment with any questions. Again, these are just my experiences with these materials and you may find that others work better for you.

 

 

 

 

 

 

 

 

BODY WORLDS, Berlin: Bringing anatomy to Life

Last fall, I went to Berlin to see the BODY WORLDS exhibit. Body Worlds presents plastinated cadavers in personified forms, making anatomy accessible and captivating for all. For me, it was enchanting, not only because I love anatomy and physiology, but because it imprinted upon me a completely different view of my body.

Note: these are all real bodies that were specifically donated to this exhibit.

The exhibit is separated by system, with the skeletal and muscular systems coming first because of their essentiality to structure, movement, and all other body functions. In addition to more commonly seen skeletons, there is a muscular couple in an acrobatic position. Holding the “Mirror of Time,” they reflect on the wear of their bodies with time.

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Of course, even the skeletons are not average. Each body is carefully positioned in a realistic stance, allowing the viewer to see herself in each exhibit.

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This careful attention to detail inspires emotion. In the hands of this body, we see the tendons that allowed this person to write, the ligaments that let them walk, run, and play basketball, and the bones that held up to contusions from years of injuries and falls. When I see these hands, my own fingers move to adopt their position. With newfound X-ray vision, each fine movement is dissected into infinite complexity. For a moment, I’m struck with awe.

One of my favorite parts of the exhibit was the blood vessel configurations. These configurations are casts of all of the vessels, large and small, that bring blood to the body. Here, the arterial vessels of the digestive system and arm are shown:

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Another one of my favorite parts of the exhibit was seeing the nervous system separate from the rest of the body. The nervous system is essential to our interaction with the world and to our sense of self. All of our thoughts, impulses, and actions derive from the brain so if there is any one body system that encompasses our “selves,” none does so as closely as the nervous system.

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To me, these models are also slightly creepy–they make the nervous system looks like a parasite invading and controlling a human host. Or like some kind of aquatic centipede with a very big head. Looks better in context:

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This exhibit is very successful at bringing anatomy to life. It may initially seem creepy or strange because we don’t usually think about our bodies in this way–in terms of their individual, separate, component systems. We are most comfortable with our largest organ, the skin, and while we all know in general what lies underneath, it isn’t typically something we think about in our day to day lives.

Perhaps the idea is that if you see your body in action especially compared to one with lung cancer or a fatty liver, your relationship with your body will change. Or, if you see what bodies are capable of doing, you’ll explore your own abilities and limits. Either way, you’re sure to leave more thoughtful about your body and its relationship to you.

Why the US needs paid family leave

The United States is one of only nine countries in the world with no paid family leave. With a population over forty times that of the first eight countries combined, America is shockingly out of place. In her 16-minute TED talk, Jessica Shortall, author, consultant, and social-entrepreneur, provides a firm case for paid family leave.

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First, Shortall points out that 88% of working mothers in America have no paid family leave. Further, over half of new mothers are not even eligible for unpaid family leave. Finally, most women who do take time off, paid or unpaid, cannot take more than a few weeks off because of economic difficulties. “23 percent of new working mothers in America will be back on the job within two weeks of giving birth,” she cites.

Through the stories of ten women, Shortall explains why this is not only a moral problem, but also an economic one. Some of the stories concern societal attitudes towards working mothers with children:

“I was an active duty service member at a federal prison. I returned to work after the maximum allowed eight weeks for my C-section. A male coworker was annoyed that I had been out on ‘vacation,’ so he intentionally opened the door on me while I was pumping breast milk and stood in the doorway with inmates in the hallway.”
“I gave birth to twins and went back to work after seven unpaid weeks. Emotionally, I was a wreck. Physically, I had a severe hemorrhage during labor, and major tearing, so I could barely get up, sit or walk. My employer told me I wasn’t allowed to use my available vacation days because it was budget season.”

These stories reflect the attitude in the United States that child-bearing is inconvenient to employers, that maternity leave is a “vacation” and not medically or emotionally necessary, and that since child-rearing is a choice, it is no one’s problem but the mother’s. The last of these is cause for our attitudes and inadequate policies, she says.

Shortall foils this sentiment by breaking down its two assumptions: that women in America choose to work and that women choose to have babies so the consequences are their responsibilities alone. First, women do not choose to work, she argues: “Today in America, women make up 47 percent of the workforce, and in 40 percent of American households a woman is the sole or primary breadwinner. Our paid work is a part, a huge part, of the engine of this economy, and it is essential for the engines of our families.” Second, while an individual woman’s choice to have a child is optional on a personal level, it is by no means optional on a national scale. Without enough children to sustain our population, our work force will be significantly impaired by the time the babies come to be working age, with both fewer workers and a higher proportion of non-working people that need to be supported (namely, the elderly). She points out that this is not a problem for the future, but for the present: the birth rate needed to keep our population stable is 2.1 live births/woman, but we are currently at 1.86.

In addition to the economic consequences, not having paid family leave has many personal and social ramifications. Mothers who have less time off are at greater risk for postpartum disorders; children whose mothers had less time off are less likely to receive their vaccinations and well-checks in their first year, leaving them more vulnerable to disease. Never-mind the importance of the first year of life in a child’s development.

If every other large-scale economy in the world has found a way to make paid family leave work, then there is no excuse for America, Shortall argues. This is not a mother’s issue or a women’s issue; it is an American issue.

Thankfully, president-elect Donald Trump has a plan to address this issue. He plans to guarantee six weeks of paid maternity leave for all new mothers. While running opponent Hillary Clinton’s promise of twelve weeks of paid maternity leave was very appealing, six weeks would still be a substantial, much-needed accomplishment.

The Ward Election

Every Tuesday, I battle Palo Alto’s workday traffic to get to the Menlo Park Veteran’s Hospital. There, I have the opportunity to escape the Stanford bubble for two short hours. The ward we volunteer in–the long-term psychiatric care wing–is its own bubble. Inside, those who fought for our country now wage silent battles for their lives and their minds. Some veterans are medically limited to the confinement of their hospital rooms. Most, however, are capable of at least being wheeled around through the Y-shaped corridors of the ward, bisected by the lounge and dining area. Usually, our 120 minutes are spent talking to the patients, reading to them, making art, or playing board games. This past Tuesday was different.

“Does anyone know what day today is?” spoke the young recreational therapist at the head of the table where we’d gathered the ten or so most lucid veterans from wards D and E. “Table talk” was the name of the game.

“It’s Tuesday,” quiverred Ron, the oldest but most formally dressed of the bunch, from the far end of the table.

“That’s right, Ron, and do you know what’s special about today?” she asked patiently.

“It’s election day,” spoke Steven from my side, relieving Ron’s perplexed complexion. “Hillary Clinton and Donald Trump are competing for president,” he confidently elaborated.

“That’s right, Steven. Hillary and Trump are candidates for the presidential election,” the therapist clarified for the rest of the table. “So today, we’re going to talk about the candidates and have our own mini-election.”

Distant stares slowly refocused back to the present as Maria, the recreational therapist, handed out a ballot and a sheet summarizing the candidates’ positions to each of the veterans. The two other volunteers and I paused refreshing our phones with streams of voting data in order to participate. Opposite me, a proud Michigander wearing a ‘Michigan’ sweater quickly marked his vote. “Trump is stupid in the head, I tell ya!” he yelled, gesturing to his forehead with his partially clamped hand, much to the amusement of the under-30 Hillary supporters at the table (i.e. us).

“Alright, Robert, that is your opinion,” moderated the recreational therapist. “Now, can anyone tell me–what characteristics would you want your president to have?”

“TO NOT BE TRUMP!” blurted Robert in bewilderment. I released a chuckle, glancing to my fellow volunteers in amusement.

“I value honesty,” spoke Steven, calmly, showing restraint and composure.

“Thank you, Steven, that is an excellent suggestion–honesty. Anyone else?”

The suggestions trickled in: integrity, assertiveness, preparedness. Then, after a brief candidate overview, it was voting time. After we’d helped the veterans mark their votes, Maria collected and counted the paper ballots. “The results are in,” she declared. “The winner of our ward election is Hillary Clinton! By three votes.” Our three votes, I thought to myself. Without us three volunteers, the ward was evenly split.

Anger: “Hillary Clinton is corrupt!” Bradley asserted from the end of the table.

Frustration: “Obamacare is the worst thing to happen to this country. Mr. Trump must win the presidency,” Steven rationalized.

Resentment: “Trump is stupid and anyone who supports him is stupid! Hillary deserves to win,” Robert contended.

“Hillary is the bad one. She is just like Obama. Our country is in trouble, we need Trump to win, not Hillary Clinton!” Bradley replied vehemently.

I glanced to Steven at my side. I’d helped him cast his vote for Donald Trump. I was surprised to find not anger, but sadness, in his eyes, as he watched the exchange before him. Here were men who both clearly love their country, deprecating each other instead of arguing for their party‘s platform. Once, they stood together in defense of America’s principles, values, and institutions; now, they stood opposed.

Careful to contain the dialogue, Maria reminded the table that the winner of the actual election was yet to be determined. “Yeah and Trump is leading right now in the polls,” Steven explained tranquily. One by one, we escorted the veterans back to their rooms, Robert and Steven the last to leave, one shaking his head, the other, staring off in deep thought.


No matter which way the election went, half of America would have been personally offended. The pain of the misogyny, racism, islamophobia, and homophobia associated with select Trump supporters was felt even stronger after Hillary’s concession of the race. But if Hillary Clinton was the president-elect, Trump supporters would’ve also been hurting: hurting that their voices continued to be ignored, that their economic concerns were still unaddressed, and that their desperation to improve their livelihood had automatically termed them to be “deplorables.”

Hillary supporters include people like Robert, who were disgusted by the offensiveness of the Trump campaign. Trump supporters include people like Steven, who feel that our country is broken and who feel their voices haven’t been heard. At the end of the day, these are all people with real fears and concerns who all want what they think is best for America.

Currently, the two political parties have become synonymous with more than a platform; they have become synonymous with a certain people and a certain way of life, which to members of both parties is “the other.” The danger of this is that instead of seeing the fears and concerns that make people act in certain ways or inspire them to vote for a particular candidate or political party, we only see the deprecating image we’ve cast over each other as a defensive mechanism against our own pain.

Trump supporters may be racist, homophobic, sexist, or islamaphobic, just like Clinton supporters might also be, but this is not the reason (or the only reason) they voted for Trump. They voted for Trump because they don’t feel heard and because they believe that President-elect Trump will provide them and their families a better future than their current reality. This absolutely does not excuse ANY racist, homophobic, sexist, or islamaphobic behavior. It is absolutely unacceptable–America is for everyone, not just for a particular person or group. Its expression, however, does reveal that there is pain, resentment, and fear throughout America. The only way we can hope to resolve this pain is to treat each other with utmost kindness and respect even in the face of hateful comments and even in the face of threatening actions.

As Michelle Obama said, “When they go low, we go high.” This is one of the first lessons we learn when we are young; treat other people how you wish to be treated. And this is exactly what we need now. Like Steven, we must take the high road: support each other, organize, protest–yes; keep tearing each other down–no. If we want respect, we must not only demand, but also give respect.


Note: All identifying information, including names, that could be used to identify patients has been changed.

A very helpful article: What this means, How this happened, What to do now

What would happen if we repealed Obamacare?

In my last ‘Health & Society’ post comparing the two presidential candidates’ healthcare platforms, I outlined the main changes made by the Affordable Care Act (ACA). Since it was signed into law in 2010, the ACA has been subject to many repeal efforts by Republicans in the House and the Senate. None of these have been successful. Over the years, several amendments to the ACA have been passed into law with bipartisan support (See here, Table 1). Still, the law’s original main provisions remain into place.

But what does repealing the ACA actually mean?

First, the ACA expanded Medicaid eligibility for non-elderly adults to an income at or below 138% of the Federal Poverty Level (FPL). If the ACA is repealed, 8 million Americans who are currently insured under Medicaid due to the ACA will lose their healthcare coverage. 

Second, the ACA marketplaces, where individuals can buy insurance independent of employers, have insured over 13 million Americans (as of February 2016) who were not previously insured before the ACA. They will also lose their healthcare coverage if the ACA is repealed.

Third, because the ACA mandates employers with 50 or more full time employees to offer adequate and affordable healthcare coverage, an estimated 10-15 million additional Americans will potentially lose their healthcare coverage if the ACA is repealed. The current uninsured rate is 8.6%, the lowest in over 50 years. If Obamacare is repealed, that rate would climb at least to what it was in 2010–around 15%.

The Kaiser Family Foundation’s 2016 report provides an excellent summary on the current uninsured population:

How has the number of uninsured changed under the ACA?
In the past, gaps in the public insurance system and lack of access to affordable private coverage left millions without health insurance. Beginning in 2014, the ACA expanded coverage to millions of previously uninsured people through the expansion of Medicaid and the establishment of Health Insurance Marketplaces. Data show substantial gains in public and private insurance coverage and historic decreases in uninsured rates in the first and second years of ACA coverage. Coverage gains were particularly large among low-income people living in states that expanded Medicaid. Still, millions of people—28.5 million in 2015— remain without coverage.

Why do people remain uninsured?
Even under the ACA, many uninsured people cite the high cost of insurance as the main reason they lack coverage. In 2015, 46% of uninsured adults said that they tried to get coverage but did not because it was too expensive. Many people do not have access to coverage through a job, and some people, particularly poor adults in states that did not expand Medicaid, remain ineligible for financial assistance for coverage. Some people who are eligible for financial assistance under the ACA may not know they can get help, and others may still find the cost of coverage prohibitive. In addition, undocumented immigrants are ineligible for Medicaid or Marketplace coverage.

Who remains uninsured?
Most uninsured people are in low-income families and have at least one worker in the family.  Reflecting the more limited availability of public coverage in some states, adults are more likely to be uninsured than children. People of color are at higher risk of being uninsured than non-Hispanic Whites.

How does the lack of insurance affect access to health care?
People without insurance coverage have worse access to care than people who are insured. One in five uninsured adults in 2015 (20%) went without needed medical care due to cost.  Studies repeatedly demonstrate that the uninsured are less likely than those with insurance to receive preventive care and services for major health conditions and chronic diseases.

What are the financial implications of lack of coverage?
The uninsured often face unaffordable medical bills when they do seek care. In 2015, over half of uninsured people (53%) said that they or someone in their household had problems paying medical bills in the past 12 months. These bills can quickly translate into medical debt since most of the uninsured have low or moderate incomes and have little, if any, savings.

The uninsured rate affects us all–it costs us more when people without access to medical care avoid treatment until they become seriously ill and it impairs more people from being contributive members of society.

Beyond increasing the uninsured rate, repealing the ACA would also mean losing a number of crucial guarantees we currently take for granted. Without the ACA, insurance companies would be able to deny or limit coverage to anyone (including children) on the basis of a pre-existing condition alone. It would also allow insurance companies the power, once again, to stop your coverage when you become sick. Insurance companies would no longer be subject to federal review of premium prices so your premiums could rise unchecked. The marketplaces would disappear so there would be nowhere for people to buy healthcare insurance independent of their employers.

If the ACA were repealed, there would be no laws in place to ensure that women cannot be charged more by insurance companies on the basis of gender alone. Young adults could no longer stay on their parents plans until they turn 26, as the ACA provisions. And finally, drug prices for seniors would rise because of the elimination of current discounts for them.

The ACA is not perfect, but it has successfully expanded healthcare accessibility and affordability to the greatest number of people ever. Its cost-control mechanisms appear to be working for now; surprisingly, health care cost growth has actually slowed to 0.8% per person in 2012 compared to an average increase 2.3% greater than GDP growth since 1960. And, because of the ACA, health insurance companies cannot refuse to cover anyone on the basis of a pre-existing condition alone. These are huge advances. Going back at this point is not an option.

 


Selected sources:

https://www.fas.org/sgp/crs/misc/R43289.pdf                         http://obamacarefacts.com/sign-ups/obamacare-enrollment-numbers/ http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/ http://www.aflcio.org/Issues/Health-Care/What-Would-Repeal-Mean-to-Me http://www.nejm.org/doi/full/10.1056/NEJMhpr1503614

Academy Award Documentary Short Nominee, ‘Extremis,’ and the Realities of End of Life Care

Netflix Documentary Short, ‘Extremis,’ is a captivating 24-minute film about the harrowing realities of end-of-life decisions made in the Intensive Care Unit (ICU). The film mainly follows two patients, Donna and Selena, along with their families and physicians. The patients in the ICU require the most careful observation and intensive treatment due to their conditions.

 

The film portrays the ICU as a form of limbo. For Donna and Selena, this is quite literal–the machines are the only things keeping them alive. They face an unimaginable decision between waiting to see if their bodies will ever recharge enough to be disconnected from the outlet and accepting nature’s course without further intervention.

For some, this decision is more difficult than for others, but in no case is it easy.

“Here’s the reality – we’re all going to die. Everyone standing in this room is going to die one day. It’s good to have a little bit of a say in how.”      -Dr. Zitter

One of the difficulties for the physicians in the documentary is determining whether the patients are lucid enough to make their own medical decisions. If they aren’t, a surrogate decision-maker needs to step in. In the film, both Donna and Selena’s families are asked to decide whether or not to “pull the plug” or ride it out. They look to the doctors for medical advice and to the side and we hear doctors discuss their approach and work to resolve their disagreements. “We’re not the ones making the decision, but it is guided by what we say,” Dr. Bhargava points out. Through the doctors’ discussions, we see that part of debating what to say to the patients’ families is explaining the finality of their family members’ states. It is very difficult, they explain, to articulate to families that their family members will never wake up from their state in a meaningful way, especially when families want to do everything they can for their sick family members. Family members are torn.

“It would feel like murder to pull the plug,” Selena’s daughter says.

“I have to be right for her,” Donna’s son cries, unsure of his mother’s wishes.

In the end, Donna and Selena’s families end up making very different medical decisions for them.

‘Extremis’ is heart-breaking, but it is also very important. It brings to light the complicated ethics of end-of-life care decisions. In doing so, it encourages sympathy for both the family that decides to wait out an inevitable death with hope and the family that accepts a natural, peaceful, and ultimately unavoidable passing. We don’t discuss death a lot in our culture, which can make these decisions even more difficult. How do you decide what is best for you or for your family members if the opportunity to discuss and discourse with other people, families, or physicians is not present?

In medicine, ethics does not provide an easy solution. Medical ethics falls into the category of applied ethics rather than normative ethics. This means that ethical debate is focused on examining how different ethical principles can be applied to a medical dilemma, rather than on determining a universally appropriate medical decision. So, instead of deciding formulas for what the best thing to do in every case is, medical ethics focuses more on the thought process behind medical decisions.

In order for a medical decision to be ethical, it must align with four main principles outlined in the oath physicians take: (1) beneficence – do what is best for the patient, (2) non-maleficence – do no harm, (3) respect for autonomy – respect patients’ rights to make their own medical decisions, and (4) justice – treat everyone equally and distribute resources fairly. Problematically, these principles often come into conflict, so there is often more than one ethically sound decision. With respect to end-of-life care, this means that there are no universal formulas to guide patient decisions. As long as family members and physicians are acting in the best interests of the patient, their decisions are accepted; what is in the “best interests” of the patient, though, can again be debated.

In ‘Extremis,’ Dr. Zitter recalls a former patient’s story that illustrates this gray area:

“When I was a young attending, I had been asked to go put a large catheter in someone’s neck. She was dying. And, I went into life-saving mode. Right before we were getting ready, I look up and see this nurse in the doorway and she looked at me …and said, “Call the police. They’re torturing a patient in the ICU… [I realized:] what I am doing right now is not going to help her; it’s not going to get rid of this disease that’s killing her.”    -Dr. Zitter

Here, the physician is torn between her duty to help the patient and her duty to do no harm. She says: “…there are very few things that you can be 100% certain about [in medicine] and you risk hurting people if you’re wrong.” Yet a decision has to be made; either way, something is sacrificed.

This case, and others brought up in the short film (such as treating homeless patients who cannot make medical decisions on their own and have no family to act as surrogates), do not have easy or definitive answers on what is best for a patient. Since all decisions are uniquely situational, they must be made on a case-by-case basis. Ultimately, ‘Extremis’ does an excellent job of highlighting these many complexities, ethical and personal issues, and starting a conversation about end-of-life care and medical ethics. It is well worth the 24 minutes to watch.

Hillary Clinton and Donald Trump on Healthcare

Voting day is now coming up in less than a week. In an election mired with personal attacks and riling commentary, it has been difficult to sort out the candidate’s platforms, especially on healthcare. Healthcare was a main pillar of the Obama campaign; in this election, healthcare has taken a back seat, but it is still just as important.


For brief background:

Obamacare, or the Affordable Care Act (ACA), was passed by the house and senate and signed into law by President Obama in 2010. The ACA had three main results: it expanded Medicaid to low-income individuals and families without children, reformed Medicare by introducing marketplaces making private insurance more affordable to millions, and implemented a number of measures to promote cost control and maximize the delivery of effective care (Jost, 2015; Emanuel, 2016; McMorrow et. al., 2015). So far, research shows that it exhibits preliminary success in its aims: the marketplaces have made private insurance affordable to millions and the Medicare and Medicaid expansions have increased accessibility and coverage for millions more (Jost, 2015; Emanuel, 2016; McMorrow et. al., 2015; KFF New Estimates of Eligibility for ACA Coverage among the Uninsured, January 2016). For example, the percentage of adults who are uninsured has dropped from 18% in 2013 to 11% in 2016 (Gallup Polls). Preliminary data also show that the ACA has succeeded in down-shifting health care expenditure projections, though further progress remains to be made.

There are three main criticisms of the ACA. One criticism of the ACA is that it is not going to solve our budget problems related to healthcare cost. To address budget concerns, critics argue that we should reduce the government’s share in public health expenditure. Another criticism of the ACA is that it rations healthcare more than before it was implemented. Finally, the third main criticism of the ACA is that the marketplaces have reduced competition between insurance providers and so, give people fewer choices. 


Hillary Clinton and Donald Trump have very different healthcare plans.

Hillary Clinton plans to expand the ACA. Secretary Clinton plans to make a “public option” possible–an alternative healthcare plan offered by the government (note: this is NOT the same as government-funded healthcare. She also plans to let those over 55 buy into Medicare, which currently covers all seniors over 65 and disabled individuals under 65 (following a two-year waiting period).

Secretary Clinton’s goals are to improve healthcare accessibility and affordability. She plans to demand lower prescription drug costs and hold drug companies accountable for price changes that are unjustified. She also plans to simplify enrollment through Medicaid and the ACA. Hillary Clinton also plans to expand access to healthcare to immigrants regardless of immigration status and to rural Americans. And finally, she pledges to defend women’s access to reproductive health care, including preventative care, affordable contraception, and safe and legal abortion (note: this is NOT the same as federally funding these initiatives).

Donald Trump’s healthcare plan centers on repealing the ACA. Mr. Trump’s goals are also to improve healthcare affordability and accessibility and quality of care. His view, however, is that no one should be forced to buy healthcare coverage if they do not want it. First, he plans to modify insurance regulations so that health insurance can be sold across state lines. Second, he plans to allow individuals to fully deduct their health insurance premium payments from their tax returns like businesses do. Third, he plans to allow people to use Healthcare Savings Accounts (HSAs), where they can set aside money to be used for healthcare expenses in advance. This money will be tax-free. Fourth, Mr. Trump also plans to require price transparency from all healthcare providers to allow individuals to “shop” for the best prices. Fifth, Donald Trump plans to block-grant Medicaid to the states with the goal of giving states the power to determine the program’s local qualifications and provisions, in exchanged for a fixed amount of funding. Finally, he also plans to remove barriers blocking imports of drugs from overseas in order to open the US markets to foreign pharmaceutical companies with lower prices.

Hillary Clinton and Donald Trump’s healthcare plans predict very different futures for all American residents. The purpose of this overview is not to be fully comprehensive in outlining each candidate’s plans and goals, but to provide a summary of their respective platforms. Using this information, you–the voter–can research more on the details and repercussions of Secretary Clinton and Mr. Trump’s healthcare policy plans. Remember that what sounds great isn’t always the best and what is the best isn’t necessarily flawless.

Vote wisely!


Image Credit: Nigel Parry, CNN