Over!My!Med!Body! A Medical Student Speaks His Mind

Nicholas Genes, MD, PhD


July 03, 2007

For years, Graham Walker has been using the Web to promote reform of the US healthcare system, and to chronicle his progress through medical school, in his blog Over!My!Med!Body!. His efforts have earned him a loyal following of readers as well as profiles in US News and World Report and this column. I spoke with Graham this week about his experiences and whether he feels he's making headway.

Dr. Genes: Michael Moore's new documentary about the US healthcare system, Sicko, has been released. Seen it yet? Think it'll change anything?

Graham Walker: Yes, I saw an advanced screening of Sicko.

I do think it will change things -- or at least raise a lot of questions in Americans' heads. Though Moore tends to paint the pictures as rosy in all the other healthcare systems he visits, I think the general concept is spot-on: that there are other ways to run a healthcare system than the US's method, and often, for the large majority of people, it is a much better, equitable, reasonable, and logical system than our own. I think some people may even think that some of the systems in the other countries aren't real -- because they are so unbelievably different from the way we do things in the US.

I've said it before, but I'll say it again: If I could practice internal medicine the way doctors in other countries can practice it (spending more than 15 minutes with patients, doing house calls, being free from the billing and payment systems, and really just trying to diagnose, treat, and care for my patients, regardless of ability to pay or insurance status) I'd be an internist in a heartbeat. But such is not possible in the US healthcare system, unless you practice boutique medicine, which I find too discriminatory and exclusive for my egalitarian tastes. (Score one point for the Emergency Department, the great equalizer!)

Dr. Genes: You're a long-time proponent of the single-payer model and a participant in many blog discussions about healthcare. In our last interview, you told me that "bloggers love controversies." Do you find that engagement fosters learning or just entrenches opinions? What drives you to keep at this?

Graham Walker: Oh, I don't really find many online discussions -- blogs or otherwise -- to be very engaging. People come in with their own opinions and just want to be agreed with, not to have an open mind and change their perspective. Part is the nature of the online medium -- studies have shown that people reading text on a computer screen skim and scan it, instead of actually reading it like a book. Part is the anonymity of the Internet: People say things to each other online that they would never say to that same person's face (and likewise, are close-minded about positions online that I think they would be more open to in other types of communiqués).

I'm not calling everyone else out on this topic -- I'm probably the same way. This is one of the reasons I turned off comments on my site; the discourse is so poor for so many reasons online that I felt like it was a waste of my limited time to read and leave comments to try to argue my points. (As opposed to people working desk jobs all day long and who have time and Internet access to post opinions constantly, I'm now back in clerkships and not really available.)

What drives me to continue? The belief that my perspective is the "Right One." I guess often I am writing to try to convince people, or at least get them thinking. I find my single-payer advocacy stuff quite exhausting sometimes, given the fact that I'm spending a lot of effort advocating for a big system-wide change, so I go through phases where I lose interest. (It may be the reason I like the ED so much -- it's acute, direct patient care with immediate results.)


Over!My!Med!Body! hosts Grand Rounds
July 3, 2007.

Dr. Genes: You came up with one of the first blogger-led, blogger-directed research projects and invited everyone to comment and collaborate on an EMR interface. How are these efforts turning out ?

Graham Walker: I've gotten good feedback from other people online -- it's amazing who you hear from and who has somehow found your Web site. I just got an email from a resident I had emailed a long time ago about a Palm version of [Graham's medical calculator Web software project] mdcalc.com, and he's finally completed the initial beta of the software, which is really exciting.

Dr. Genes: Are there other projects I've missed? Perhaps more video offerings, like your recent "eyes have it" video?

Graham Walker: I had lots of fun with the YouTube video stuff, so yeah, I have more ideas in the works. I'm a fairly funny guy, and humor crosses all party lines, so maybe that's where my true talent lies.

Dr. Genes: Have you written anything recently that touched a nerve or generated some heated discussion?

Graham Walker: You're right -- I did mention that bloggers love a controversy, and the biggest that sticks out would be my post taking issue with [fellow medical blogger] Scalpel, essentially referring to a patient as acting like a faggot (he technically said acting like "John Edwards," but Ann Coulter had just called John Edwards a faggot. It's the transitive property.)

I'll admit -- I've been tempted to write a fake post and use some racial stereotype and racial slur to prove my point, but that's just not my style. As the only gay medical blogger that I'm aware of, I sadly have to speak up when I feel someone is out of line -- I say "sadly" because I wish mature adult professionals would be above slurs, but better to learn it now than later.

Whatever your political background, you should join Graham Walker this week as Over!My!Med!Body! hosts Grand Rounds.Graham will highlight the best new writing on the Web from doctors, nurses, patients, healthcare experts, and students like himself.


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