Models and Mentors
In Conversation with Medical Student Graham Walker
Graham Walker is currently working with the Ravenswood Family Health Center to develop a more efficient system for accessing the privately organized Patient Assistance Programs offered by most drug companies. Walker's work is serving to reduce clinic costs and keep patients on their medication regimens.
What drew you to work at the Ravenswood Family Health Center?
I've always been interested in working at a community health center like Ravenswood, so it was already on my mind before I even started med school. I'm also a health policy wonk (or wanna-be), and really liked learning about the pharmaceutical pricing policies as background for the project. It also gives me an opportunity to talk with patients, and learn how to be a better communicator and listener in a health care setting. With all that, how could I resist?
What have you learned about pharmaceutical companies, or about prescription drug benefits, that you did not know when you started?
I've developed some healthy skepticism of pharmaceutical companies—they spend twice as much on administration and advertising as they do on research and development--and it's become even clearer as I've worked at Ravenswood. Don't get me wrong, I think the patient assistance programs are very important, but I just wonder how necessary they would be if we had a more rational pharmaceutical-purchasing scheme in this country. Right before the Medicare prescription drug benefits program went into effect, prescription prices increased much faster than inflation. So with the new benefit, people are still paying the same amount for their drugs.
What would you say has been the greatest challenge of this project thus far? What has been the most rewarding?
I think the greatest challenge has just been integrating the program into Ravenswood. I haven't had much experience with program implementation, and it's tough. You have to explain the program to everyone that will be involved in it, work out kinks in the system on-the-fly, deal with miscommunication. And add to that the complications of health care in general--drug interactions, missed appointments, lots of paperwork--and it can be difficult to get off the ground. It's been really rewarding, however, to be able to provide patients with medications. Being able to hand someone $500 worth of pills is a really tangible sign that the program's working. Slowly, but working none the less.
What do you see as the ultimate goal of this project? How will your system work in the context of the clinic?
Ultimately, I'm hoping that my pilot program version will work out all the kinks in the system, so that the clinic can take it over with as little confusion as possible. We're hoping to get the program running with undergraduate volunteers from Stanford, who can take over the work I'm currently doing, and automate some of it with some software that will fill out most of the paperwork. Hopefully it's easy enough that the paperwork can all be completed and all the provider needs to do is review the chart and sign the form to authorize the medications.
Were you interested in community health before you came to Stanford, or did this interest arise from some experience during your first year of medical school? What kind of community health/public service work have you done in the past?
I've definitely been interested in community health. I had a number of service-learning experiences that really solidified not just my interest in communities and community health, but medicine in general. I've done some public health/advocacy work before as an undergraduate and at a health care reform organization before I started medical school, but it's mostly been in the policy arena. It's really refreshing to do something so hands-on, with tangible, immediate results.
What do you see yourself doing ten, twenty years down the road? Do you know what specialty you'd like to pursue, or in what setting you'd like to practice (or teach, do research, etc.!)?
I don't really know about specialties right now; I'm just trying to keep as many doors open as possible right now. Who knows where I'll be in ten or twenty years--I tend to think I'll just end up where I'm supposed to end up. Call me a fatalist. I love teaching; I hope I'll get to do that in some capacity. If not with medical students or residents, my own kids.
Are there any particular people or experiences that have shaped your career plans?
Quentin Young, a progressive doctor in Chicago, really influenced my life. I worked with him before coming to medical school, and he taught me a lot about standing up for what's right, what's just, what's fair. Social justice, equality. Striving for those ideals. He's done a number of great things in medicine, and I think if I could do 10% of what he's done, I'll be grateful. My father's also been a big influence. He's a psychiatrist, and I don't think I really appreciated how hard he works to provide for our family but also to try to do his part to help the community. He spends a day at the hospital's free clinic every week, and mental health is a big issue, especially for the uninsured.
Do you have any hobbies?
I'm kind of a big computer geek. I spend a lot of time in front of my computer. I like to weblog (grahamazon.com), do digital photography, play the guitar, read. Basically, anything but study pharmacology, really.
What is your favorite book?
God Bless You, Dr. Kevorkian. By Kurt Vonnegut. Vonnegut can summarize the human experience in fewer words than anyone I've ever read. His simplicity speaks volumes. If you haven't read it, come borrow mine. It's a 30 minute read, but a powerful one.
