Aspiring Surgeon Promotes "Unbounded Medicine" Around the World

Nicholas Genes, MD, PhD


October 05, 2006

Dr. Jon Mikel Iñarritu is a physician in Mexico, working toward the goal of becoming a surgeon someday. In his spare time, he runs Unbounded Medicine, a Web site that exemplifies his beliefs about open access to healthcare and medical information. By discussing conditions and diagnostic tests in plain language, he's hoping to reach as many patients as possible and, in a small way, change the world.

I had a chance to correspond with him this week and hear his thoughts on medicine as well as the differences between American and Mexican healthcare and training.

Dr. Genes: What do you mean when you say that medicine must be unbounded? Is it a reference to the cost of medicine, or to the differences in medical care in different countries? Or do you mean that it should be openly and freely discussed?

Dr. Jon Mikel Iñarritu: What I was trying to emphasize is that the Internet gives people access to information of any kind, and medicine is no exception. The issue is whether the information is right or useful, and whether you know how to apply that information. There's a solution to this problem: have professionals write about their field, and explain it in plain language -- not a specialized blog, but one "readable" to anyone.

Also, "Unbounded Medicine" is a reference to the accessibility of healthcare services. I would like to give readers my own perspective of what is going on in my country regarding the health subject. My site tries to reflect the feelings that I have about what is happening in Mexico, my homeland -- which, by the way, is very different from other countries' situations.

Certainly, there is also something motivational about my site. I firmly believe that many of the problems with patient expectations, and many of the deficiencies in medicine, could be addressed with education. So, for that reason, the main focus of my site is education.

Dr. Jon Mikel Iñarritu at Unbounded Medicine hosts Grand Rounds
October 10, 2006

Dr. Genes: Some of your posts seem written for other physicians and residents. Others seem geared toward patients. Maybe that's the nature of Unbounded Medicine -- a free-form discussion between patients and doctors.

Dr. Jon Mikel Iñarritu: In part, yes, it is. How nice would it be that any patient looking for information on the Internet had personalized answers by different specialists in each medical area -- with no monetary motivation? Sounds great to me.

Dr. Genes: Have you been to the United States or other countries and observed their healthcare? What do you think are some of the differences?

Dr. Jon Mikel Iñarritu: I've been in the United States many times, but unfortunately for me, I went just one time as a medical observer (at the Methodist Houston Medical Center). I did learn many things there and found others quite interesting. What I like about medical attention in the United States is the system, for example, whereby patients spend less time in the emergency room, have more quality attention, and have more access to medical technology (for diagnosis and treatment purposes). On the other hand, I don't like the medical training (it is more difficult to do things by yourself, like procedures) and defensive medicine (some American doctors have forgotten classic medicine because of a fear of being sued).

For example, here, because of a lack of personnel and equipment, we have to base our diagnosis on a clinical examination and history; all the laboratory and radiologic studies are for confirming purposes. People say that the best cardiologists in the world are Mexicans. I don't know whether they are right, but it could be because of that reason.

Ninety percent of hospitals in Mexico are public, and in the majority of cases, patients have a very distinct attitude. Because they are not paying for the service, they tend to be a little submissive.

Dr. Genes: From your posts I thought that you were a surgery resident -- already done with school, in training, assisting on some exciting procedures. Many Medscape readers are also in training or school, around the world; can you give any insight into this process in Mexico?

Dr. Jon Mikel Iñarritu: The Mexico process to become a doctor: 2 years of basic sciences, 2 years of clinical sciences, 1 year of internship, 1 year of social service, for a total of 6 years.

I'm not a resident yet; I recently graduated from med school and am now a primary care physician who wants to be a surgical resident. I'm working as a surgical assistant. One of the things that I dislike the most is the selection process. Things are very difficult and statistics are not favorable for anybody.

The USMLE-like exam (called ENARM) takes place every year, with 30,000 aspiring residents and just 3000 vacant spots in 22 specialties. The exam consists of 700 clinical vignette questions. It costs about $200 (do the math). Corruption reigns in this exam. So, lots of hopefuls are disadvantaged and have trouble getting into a residency program. I always say that "I can compete against smart ones, but against the corrupt ones it is impossible." I took it this year and will have my results on October 30. I hope to be selected.

Dr. Genes: We wish Dr. Jon Mikel Iñarritu good luck, and are anxious to see what he selected as the best of the week's online medical writing when Unbounded Medicine hosts Grand Rounds (the link goes "live" on October 10, 2006). Be sure to read the thoughts of doctors, nurses, students, patients, and other healthcare professionals -- an unbounded array of provocative opinions and enlightening writing.


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