So where have I been for the past month? I've been finishing my second block of medical school, that's where. I'm still pretty new to this medical school thing, and not always the greatest time manager, so I had to put blogging on the back burner. Alright, so time management may have less to do with it than does obsessive-compulsive studying so I can be absolutely sure I won't fail the tests I take. Looking back on tests, I'm pretty certain that I am still going to be in medical school, and may have done better than last block. I definately feel like I knew more this block than I did last block. Now hopefully I don't become too obsessed with doing better every time tests roll around, or I will kill myself when a really hard block comes around.
I have managed to find time for other activities besides studying however. My roommates and I, and our neighbors three doors down all celebrated Festivus. For those of you unfamiliar with this holiday, it has its origins in the television show Seinfeld. Our combined households decided to celebrate it on December 9th, the Friday before my test week began. We decided that for the Feats of Strength, a person from each household should be chosen. I was chosen for my household due to my unparalled studliness and incredible strength and dashing good looks. Because our neighbors household is all girls, and to avoid any potential awkwardness, our visiting friend Scott was chosen to fight for the honor of the girls house. We fought until we were both exhausted, and then called it a draw. A week later, as I was passing the girl's house and saw Scott on the floor in the living room, I decided to end Festivus quickly, and snuck in and quickly jumped and pinned him. And that is how Festivus ended.
Since studying and test taking has taken up the majority of my free time up until this past Friday (Dec. 16th), I hadn't had any chance to go Christmas shopping until this week. My first attempt came on Saturday, the day after exams. I made a quick run to Target in mid afternoon. The Target in my town is part of the area mall, and Saturday was not the most intelligent of days to attempt to fight the mall alone. I ended up getting a few personal items and then spent most of my time just trying to get out of the mall area.
I waited until Monday to return to the mall to conquer Christmas shopping, and this strategy worked a lot better. If you didn't know, the majority of people who work are still working early on Monday afternoon before Christmas, and don't have their vacation time started yet. I walked around Target again, and made a few phone calls to mom to attempt to get more ideas for family gifts. If there's anything that makes Christmas stressful, it's trying to decide what in the world to buy your family. And if you think that's stressful, you should try doing it at the same time as a few thousand other people the week before Christmas. The scene is akin to watching starving refugees descend on a string of buffet bar restaurants.
That is probably why more and more people are turning towards internet shopping. No matter the time of day, or the place, you can log onto the major stores and do all your shopping in the comfort and quiet of your own home. No crying babies, no pushing and shoving, no frustrating waiting on people who are hunting the perfect parking spot, no struggling to make it to the store only to find out that what you're looking for is out of stock, no trying to beat closing times or opening times. If you want to shop at 3 a.m. in your skivvies, then internet shopping is your ticket there.
So if internet shopping is so wonderful, why have big department stores at all? Well for one, not everyone has access to the internet. Secondly, shopping online won't support your local economy either. Remember that old guy who runs the jeweler's shop in the downtown district? He's got plenty of great items for you and will probably give you even better customer service than you could get at a huge chain store. Plus, he may very well live down the road, and be father to those two little girls you always see hopping onto the school bus in the mornings. Supporting that kind of business is good not only for your shopping (because those small town shops are probably a lot less crowded than the major carry-everything stores), but it's also good because the money you earned in your town will stay in your town, and will eventually come back around to your pocket when it is spent again in the community.
Sadly, I didn't do all my shopping in the local small shops. But that's ok. Target employs people who live in my own town, and pays them the money I spend. I even have a friend who works at Target, and while I was shopping, I got to join him in the mall when he was on his dinner break. I may have had to suffer the stress of searching the aisles of the stores for my items, and weaving my cart back and forth between other people, but I also got to cross paths with a friend, and know that the money I spent at the store he works at will go towards paying his paycheck, and that's a little something I can add to the Christmas spirit.
Don't forget to dump the change in your pockets in the Salvation Army buckets as you leave the malls this year. Merry Christmas.
Wednesday, December 21, 2005
Wednesday, November 23, 2005
Good night, and good luck
Tonight I went to an independent film theater here in my town called Ragtag Cinema-Cafe. Me and my roommates and two other friends watched George Clooney's Good Night, and Good Luck
It was quite entertaining, and a good break from studying (which I have done plenty of lately and is cause for the lack of updates; tests are now only two weeks away). It is about CBS reporter Edward Murrow's criticism of Senator Joe McCarthy in the 1950's for his methods of hunting communists. The result of the historical confrontation was Senator McCarthy being investigated by the Senate. I think the film is great and I highly recommend it.
I think oftentimes people in power can go on such "witch-hunts", looking for opposition or attempting to find opposition in order to create a scare, and help to keep themselves in power. Sometimes it's manipulative, but what if it wasn't? What if the person in power themselves were convinced there was a danger? What if evidence did point that way? Some say that intelligence on Iraq was exaggerated, was a witch-hunt, much like McCarthy's witch-hunt of communists in the 1950's was an abuse of power and a spook. Well, what happened in the past with Iraq is already past us. What's been done is done. However, the future is still before us.
Democratic Senator and decorated Vietnam veteran John Murtha within the last week proposed a plan for troop withdrawal from Iraq that was met with fierce opposition by Republicans, and caused Republicans to force a vote on immediate troop removal. The vote failed miserably, and caused one of the greatest uproars the legislature has seen in history. Democrats accused the Republicans of misinterpreting Murtha's plan for a gradual pullout, while Republicans held strong to a "do not abandon our soldiers, don't show weakness to terrorists" front they have presented for some time now.
We got our hands in the mess, and regardless of the past, we need to clean them now. For our country to healthfully move forwards, I believe that Democrats and Republicans need to work together. I'll say it again, in italics; Democrats and Republicans need to work together. Instead of these he-said-she-said back and forth fighting about I-wanna-do-this-I-wanna-do-that politics, our lawmakers need to, simply put, play nicely and learn to cooperate. John Kerry isn't evil, he's smart, but not always right. John Murtha is not a coward, but a concerned statesman. Dick Cheney isn't the devil's advocate, but he isn't always right either. Bush actually does care about America, despite what you may think and despite what he might be doing. Probably the first step to a politically healthy America is for everyone to sit down on their hands and have a timeout until they're not so angry, and then stop pointing fingers and start producing plans to correct what problems we have.
Good night, and good luck.
It was quite entertaining, and a good break from studying (which I have done plenty of lately and is cause for the lack of updates; tests are now only two weeks away). It is about CBS reporter Edward Murrow's criticism of Senator Joe McCarthy in the 1950's for his methods of hunting communists. The result of the historical confrontation was Senator McCarthy being investigated by the Senate. I think the film is great and I highly recommend it.
I think oftentimes people in power can go on such "witch-hunts", looking for opposition or attempting to find opposition in order to create a scare, and help to keep themselves in power. Sometimes it's manipulative, but what if it wasn't? What if the person in power themselves were convinced there was a danger? What if evidence did point that way? Some say that intelligence on Iraq was exaggerated, was a witch-hunt, much like McCarthy's witch-hunt of communists in the 1950's was an abuse of power and a spook. Well, what happened in the past with Iraq is already past us. What's been done is done. However, the future is still before us.
Democratic Senator and decorated Vietnam veteran John Murtha within the last week proposed a plan for troop withdrawal from Iraq that was met with fierce opposition by Republicans, and caused Republicans to force a vote on immediate troop removal. The vote failed miserably, and caused one of the greatest uproars the legislature has seen in history. Democrats accused the Republicans of misinterpreting Murtha's plan for a gradual pullout, while Republicans held strong to a "do not abandon our soldiers, don't show weakness to terrorists" front they have presented for some time now.
We got our hands in the mess, and regardless of the past, we need to clean them now. For our country to healthfully move forwards, I believe that Democrats and Republicans need to work together. I'll say it again, in italics; Democrats and Republicans need to work together. Instead of these he-said-she-said back and forth fighting about I-wanna-do-this-I-wanna-do-that politics, our lawmakers need to, simply put, play nicely and learn to cooperate. John Kerry isn't evil, he's smart, but not always right. John Murtha is not a coward, but a concerned statesman. Dick Cheney isn't the devil's advocate, but he isn't always right either. Bush actually does care about America, despite what you may think and despite what he might be doing. Probably the first step to a politically healthy America is for everyone to sit down on their hands and have a timeout until they're not so angry, and then stop pointing fingers and start producing plans to correct what problems we have.
Good night, and good luck.
Wednesday, November 09, 2005
The $2000 monkey on my back, deferred
It’s been more than a week, and I think an update is due. Plus, I can give updates on my own status with my heart murmur, having seen the doctor this past Friday. The only thing that has kept me from updating until now is simply laziness (in other words, I was far too busy studying/eating/cleaning/sleeping to actually relax and write).
This past Friday I went to the Student Health Center to see my doctor about the previously mentioned murmur recently discovered. My doctor presumed it was most likely an innocent flow murmur, which occurs if a heart valve doesn’t close all the way or in time when the heart beats, allowing blood to flow back the opposite way, and the blood causes turbulence heard as noise. If you’ve ever heard turbulent water flowing over and through rocks and back upstream in eddies in a river, you should get the idea of what a murmur is. It was recommended that I have an echocardiography done, or an ultrasound picture of my heart. This would allow us to see exactly how the valves move as my heart beats and whether it is something requiring further work.
Now in the past, if a doctor ordered a test or procedure, I never thought twice about it. My parents flashed their insurance card, the receptionist punched a few keys and signed some papers, and I was on my way. I was approved, the doctors provided care, I went home happy. All those days are past now, however, and insurance must be discussed, especially since now, at age 23, I am cut loose from the family insurance and must provide my own means towards care. Recently, I made the change from my family’s insurance to a cheap health insurance plan where I pay less than $60 a month. It carries a $5000 deductible (in other words, until I accumulate over $5000 in medical bills, I am paying out of pocket), and the problem I ran into Friday was the fact that an echocardiogram costs $1500 optimistically. Realistically, it would be closer to or over $2000. To get around this, I am putting off getting the echo done until January, at which time I’ll be able to transfer over to a student health insurance plan offered by the university, which will fully cover the echo.
The Institute of Medicine of the National Academies currently estimates that approximately one in six Americans under 65 lack health insurance. This amounts to a little more than 15% of the current population, and with current trends, is expected to increase. The rise of small businesses, entrepreneurship, and decreased amounts of people working full time in large corporations that provide health coverage as a benefit are a few reasons to blame. Small businesses generally do not offer coverage even to full time employees, with the high cost of premiums for a small number of employees. In a larger corporation, this cost would be less per person, as it is spread out over a wider population of employees. Just to verify this fact, consider this; in 2003, a third of firms did not offer health coverage, and two-fifths of all employed persons worked for a small business firm of some kind.
Health insurance is essentially money in the pocket. Someone else’s money that is, and with that sort of mindset, it is easy to see why people who have the best insurance often receive as much medical service as they need or are recommended. But to someone in my current situation, medical care is not something you just run out and get easily. People lacking health coverage or having only marginal coverage tend to utilize less health services, wait longer before seeking medical care for illness, and have worse outcomes due to lack of care. Many times uninsured patients are hospitalized for what could have been a preventable or very uncostly condition, had medical care been received earlier.
Lack of insurance has repercussions beyond the clinic reception desk. Patients with excessive medical bills often end up being followed by collections agencies, and alter their standard of living considerably in order to pay off debt. The standing debt can impact a person or family’s ability to qualify for mortgage, be approved for home rental, or even result in eviction. Other debt can occur when a person turns to their credit card to pay bills, effectively exchanging one debt for another. Lack of coverage, leads to high medical bills due to lack of early treatment, which leads to debt, which leads to an impacted life.
How do we solve this complication of debt? Well, if I could answer that, then I probably wouldn’t be in medical school. Sorry this is abruptly ended, but I need to get what sleep is left tonight.
This past Friday I went to the Student Health Center to see my doctor about the previously mentioned murmur recently discovered. My doctor presumed it was most likely an innocent flow murmur, which occurs if a heart valve doesn’t close all the way or in time when the heart beats, allowing blood to flow back the opposite way, and the blood causes turbulence heard as noise. If you’ve ever heard turbulent water flowing over and through rocks and back upstream in eddies in a river, you should get the idea of what a murmur is. It was recommended that I have an echocardiography done, or an ultrasound picture of my heart. This would allow us to see exactly how the valves move as my heart beats and whether it is something requiring further work.
Now in the past, if a doctor ordered a test or procedure, I never thought twice about it. My parents flashed their insurance card, the receptionist punched a few keys and signed some papers, and I was on my way. I was approved, the doctors provided care, I went home happy. All those days are past now, however, and insurance must be discussed, especially since now, at age 23, I am cut loose from the family insurance and must provide my own means towards care. Recently, I made the change from my family’s insurance to a cheap health insurance plan where I pay less than $60 a month. It carries a $5000 deductible (in other words, until I accumulate over $5000 in medical bills, I am paying out of pocket), and the problem I ran into Friday was the fact that an echocardiogram costs $1500 optimistically. Realistically, it would be closer to or over $2000. To get around this, I am putting off getting the echo done until January, at which time I’ll be able to transfer over to a student health insurance plan offered by the university, which will fully cover the echo.
The Institute of Medicine of the National Academies currently estimates that approximately one in six Americans under 65 lack health insurance. This amounts to a little more than 15% of the current population, and with current trends, is expected to increase. The rise of small businesses, entrepreneurship, and decreased amounts of people working full time in large corporations that provide health coverage as a benefit are a few reasons to blame. Small businesses generally do not offer coverage even to full time employees, with the high cost of premiums for a small number of employees. In a larger corporation, this cost would be less per person, as it is spread out over a wider population of employees. Just to verify this fact, consider this; in 2003, a third of firms did not offer health coverage, and two-fifths of all employed persons worked for a small business firm of some kind.
Health insurance is essentially money in the pocket. Someone else’s money that is, and with that sort of mindset, it is easy to see why people who have the best insurance often receive as much medical service as they need or are recommended. But to someone in my current situation, medical care is not something you just run out and get easily. People lacking health coverage or having only marginal coverage tend to utilize less health services, wait longer before seeking medical care for illness, and have worse outcomes due to lack of care. Many times uninsured patients are hospitalized for what could have been a preventable or very uncostly condition, had medical care been received earlier.
Lack of insurance has repercussions beyond the clinic reception desk. Patients with excessive medical bills often end up being followed by collections agencies, and alter their standard of living considerably in order to pay off debt. The standing debt can impact a person or family’s ability to qualify for mortgage, be approved for home rental, or even result in eviction. Other debt can occur when a person turns to their credit card to pay bills, effectively exchanging one debt for another. Lack of coverage, leads to high medical bills due to lack of early treatment, which leads to debt, which leads to an impacted life.
How do we solve this complication of debt? Well, if I could answer that, then I probably wouldn’t be in medical school. Sorry this is abruptly ended, but I need to get what sleep is left tonight.
Sunday, October 30, 2005
Role Reversal Part 1
It seems that no one ever stops to think about doctors actually being patients themselves. The patient is the one who needs to see a doctor, who is healthy and will make you healthy. But doctors are also human, just like their patients, and just as vulnerable to ill health. In fact, most aging doctors are already patients themselves to another doctor, who in the midst of treating their patients may be seeing their own doctor on the side for anything from diabetes to high cholesterol to hypertension.
How does it feel to be on the other side of the system? For most of us, we probably know what it feels like to be on the patient side, since most of us aren't doctors. As a medical student, I know that I as well as many of my class have had those "hypochondriac moments", where we suddenly believe we've discovered signs of terrible illness in our own bodies. We know just enough to be dangerous. Luckily it is just our own wild imaginations taking one minor symptom of a disease and jumping to conclusions without satisfying all the rest of the diagnostic criteria. This week however, my imagination wasn't too far off the mark.
Last Monday I was taking my regular run through my neighborhood. It was evening, and I was doing a usual out and back along the highway. I was going over in my mind all the new medical knowledge that I will later be expected to remember for test week, and trying to unwind the day. The next day we were to learn how to auscultate the heart and lungs - a.k.a. listen to a patient's heart and lungs with our brand new stethoscopes. This is a far bigger deal than you might think though; a doctor could never be convincing if he or she didn't know how to use a stethoscope, right? After my run I showered and was lying in bed attempting to practice my heart auscultation points to hear each of my heart's valves. I was listening in the quiet dark, when I started to wonder if the slight blowing sound I heard between the regular "lub-dub" sound was normal or not. To me, it sounded far more like a "thoosh-boomp" noise. I dismissed it and went to bed, assuring myself it was the same imagination that had convinced me of having numerous other maladies already.
Tuesdays are when my small lab group has class to learn physical exam. Our tutor is Dr. Randolph*, a bona fide M.D. He asked if I would be comfortable with my shirt off in order to demonstrate the physical exam of the heart and lungs this week, to which I agreed. While lying on my back and having my heart listened to, I started wondering about the sound of my heart the night before; would it turn out to be something serious? When Dr. Randolph took off his stethoscope and announced, "Well we have a surprise, he's got a heart murmur!" I felt both surprise and the feeling of finally having your suspicions realized. I gladly allowed my classmates to take turns attempting to hear the murmur, and Dr. Randolph did not seem to appear the least bit concerned at the discovery. However my imagination had now been realized with the sound I could hear in my heart. That night with the house to myself, I became fixated on attempting to self diagnose my murmur via audio resources I had available to me.
A medical student with access to medical literature attempting to diagnose a problem they have is a very scary thing. A large amount of diagnosis comes from having seen what you are diagnosing before, and that only comes with real world clinical experience. A student doctor has little if any clinical experience before beginning their medical education, and so a description of a vague symptom or rare disease could be interpreted in so many ways it is not useful until a living example is seen, and the description suddenly realized. In my own case, I began to read about mitral valve prolapse, mitral valve regurgitation, aortic and pulmonic stenosis (you can look those up yourself if you’d like) and the corresponding treatments and problems associated with the condition. Of course, there’s a high likelihood that my murmur may be innocent, but then I ask a large number of other questions. Why wasn’t this found when I was a kid? Or when I was in highschool and had yearly athletic physicals, why wasn’t it heard then? Is this somehow a newly developed problem? Is it a problem? Will the doctor blow me off as a medical student with a wild imagination when I go in on Friday? That can give you a pretty good summary of where my mind has been going lately.
I made an appointment with the student health center for this coming Friday to talk about my heart murmur and determine if it is anything to be alarmed about. I am only a student doctor at this point, but to be put in the role of patient will mean giving up my sense of control. It will also mean trusting the doctor, despite the knowledge that they may be incorrect. I will have to be careful not to try to look for disease in me that isn’t there, and be assured that it may be of no concern at all.
*The name has been changed in order to protect the privacy of the physician
How does it feel to be on the other side of the system? For most of us, we probably know what it feels like to be on the patient side, since most of us aren't doctors. As a medical student, I know that I as well as many of my class have had those "hypochondriac moments", where we suddenly believe we've discovered signs of terrible illness in our own bodies. We know just enough to be dangerous. Luckily it is just our own wild imaginations taking one minor symptom of a disease and jumping to conclusions without satisfying all the rest of the diagnostic criteria. This week however, my imagination wasn't too far off the mark.
Last Monday I was taking my regular run through my neighborhood. It was evening, and I was doing a usual out and back along the highway. I was going over in my mind all the new medical knowledge that I will later be expected to remember for test week, and trying to unwind the day. The next day we were to learn how to auscultate the heart and lungs - a.k.a. listen to a patient's heart and lungs with our brand new stethoscopes. This is a far bigger deal than you might think though; a doctor could never be convincing if he or she didn't know how to use a stethoscope, right? After my run I showered and was lying in bed attempting to practice my heart auscultation points to hear each of my heart's valves. I was listening in the quiet dark, when I started to wonder if the slight blowing sound I heard between the regular "lub-dub" sound was normal or not. To me, it sounded far more like a "thoosh-boomp" noise. I dismissed it and went to bed, assuring myself it was the same imagination that had convinced me of having numerous other maladies already.
Tuesdays are when my small lab group has class to learn physical exam. Our tutor is Dr. Randolph*, a bona fide M.D. He asked if I would be comfortable with my shirt off in order to demonstrate the physical exam of the heart and lungs this week, to which I agreed. While lying on my back and having my heart listened to, I started wondering about the sound of my heart the night before; would it turn out to be something serious? When Dr. Randolph took off his stethoscope and announced, "Well we have a surprise, he's got a heart murmur!" I felt both surprise and the feeling of finally having your suspicions realized. I gladly allowed my classmates to take turns attempting to hear the murmur, and Dr. Randolph did not seem to appear the least bit concerned at the discovery. However my imagination had now been realized with the sound I could hear in my heart. That night with the house to myself, I became fixated on attempting to self diagnose my murmur via audio resources I had available to me.
A medical student with access to medical literature attempting to diagnose a problem they have is a very scary thing. A large amount of diagnosis comes from having seen what you are diagnosing before, and that only comes with real world clinical experience. A student doctor has little if any clinical experience before beginning their medical education, and so a description of a vague symptom or rare disease could be interpreted in so many ways it is not useful until a living example is seen, and the description suddenly realized. In my own case, I began to read about mitral valve prolapse, mitral valve regurgitation, aortic and pulmonic stenosis (you can look those up yourself if you’d like) and the corresponding treatments and problems associated with the condition. Of course, there’s a high likelihood that my murmur may be innocent, but then I ask a large number of other questions. Why wasn’t this found when I was a kid? Or when I was in highschool and had yearly athletic physicals, why wasn’t it heard then? Is this somehow a newly developed problem? Is it a problem? Will the doctor blow me off as a medical student with a wild imagination when I go in on Friday? That can give you a pretty good summary of where my mind has been going lately.
I made an appointment with the student health center for this coming Friday to talk about my heart murmur and determine if it is anything to be alarmed about. I am only a student doctor at this point, but to be put in the role of patient will mean giving up my sense of control. It will also mean trusting the doctor, despite the knowledge that they may be incorrect. I will have to be careful not to try to look for disease in me that isn’t there, and be assured that it may be of no concern at all.
*The name has been changed in order to protect the privacy of the physician
Saturday, October 22, 2005
Fallibility is characteristic of every human
In my junior year of college, I had the opportunity to shadow a family doctor for half a week. Sitting in his office one day, looking at his medical school degree, I noticed the degree read “Doctor of the healing arts”, or something similar. At the very least, I remember clearly that it read healing arts – and not medicine.
When people go to the doctor, they generally expect that the doctor will have the answer for their problem. The doctor is the expert, and is the person to go to when you have a medically related problem you need taken care of. For many people, health care is a lot like any other service industry: consumer driven. The fact that the service is on me, rather than on my car, my house, my back deck, computer, etc., only makes it more personal. In the end, I have a problem, I go to the expert, I get it fixed, and I pay the expert. However, just like the service industry, if the service rendered is insufficient, doesn’t fix the problem, or worse still, damage or destroy the item, then we expect some sort of compensation. When that service is being rendered on your body, it becomes a very personal matter indeed when things go wrong.
This week’s case featured a baby girl with a congenital anomaly of her heart. In reality there were two anomalies (it’s hardly unusual, in some medical problems, for bad things to come in twos or threes). One of the anomalies was initially found, surgery was performed, and the doctors (the experts referred to previously) pronounced her cured. But the baby girl remained symptomatic for the next year. The mother fought with the heath care team that initially operated on and treated her daughter, telling them her daughter was not well and being told in return that her daughter was fine and had been fixed, that she was crazy, and when she began pursuing care outside of the first health care team accused of endangering the child. The mother pursued angiography of her daughter’s heart and vessels, which revealed finally the true problem, and next pursued corrective surgery against the wishes of her daughter’s health care team. Surgery was performed in Chicago by a surgeon who had already done several identical procedures that year alone with high success. Today, that daughter is asymptomatic and healthy, and appeared yesterday during our week’s case wrapup meeting with her mother, who answered any questions we might have.
One of the questions asked of the mother was whether any legal action was pursued on the original health care team that operated on her daughter for failure to fix the problem. I was both surprised and glad to hear that her answer was no. The mother’s reason, which had a large part to do with the fact that she worked for University Hospital and understood healthcare, was that her daughter had not been harmed by the first surgery and because failure to find the cause of the problem is not unforgiveable.
I think the mother’s thinking is contrary to what a lot of people think when they think of medical care. For one, medical care is incomparable to fixing a computer or car or house. Items designed by man are obviously fixable since their complete working mechanics are understood (I sure hope my computer doesn’t work solely because some junkie threw together a pile of transistors, capacitors, and circuit boards, but at times I think that may be the case. Anyhow…). The human body, however, is so very complex and to this day still stumps the scientific community with how it works. How then can doctors be expected to know precisely what is going wrong in an unwell body, when we’re not even sure about all the details of a well functioning body? But this is exactly how doctors are treated, and it is not the ignorant who hold this mindset, it is pervasive all the way to the very top of the scholarly circles.
I wonder whether those people who choose to blame the doctor for any failure to get well are merely looking for someone to blame. There are indeed some situations where malpractice suits are warranted; if a doctor blatantly refuses or fails to provide necessary and proven care and injury or harm results as a consequence, then malpractice may indeed be warranted, although every case must be investigated individually. If a doctor does everything within their power to help a patient, and because of countless other factors that are unknown in a time of emergency or at all the patient fails to become well or fails to show improvement, malpractice does more harm than help.
As technology improves, and our understanding of the human body and the myriad disease processes that harm it increase, maybe one day it will be possible to practice medicine in black and white, with problem-solution efficiency. Until then though, if that day even comes, medicine will be practiced almost at all times within the grey, and healing will remain an art form to be learned and practiced to the best of one’s abilities.
When people go to the doctor, they generally expect that the doctor will have the answer for their problem. The doctor is the expert, and is the person to go to when you have a medically related problem you need taken care of. For many people, health care is a lot like any other service industry: consumer driven. The fact that the service is on me, rather than on my car, my house, my back deck, computer, etc., only makes it more personal. In the end, I have a problem, I go to the expert, I get it fixed, and I pay the expert. However, just like the service industry, if the service rendered is insufficient, doesn’t fix the problem, or worse still, damage or destroy the item, then we expect some sort of compensation. When that service is being rendered on your body, it becomes a very personal matter indeed when things go wrong.
This week’s case featured a baby girl with a congenital anomaly of her heart. In reality there were two anomalies (it’s hardly unusual, in some medical problems, for bad things to come in twos or threes). One of the anomalies was initially found, surgery was performed, and the doctors (the experts referred to previously) pronounced her cured. But the baby girl remained symptomatic for the next year. The mother fought with the heath care team that initially operated on and treated her daughter, telling them her daughter was not well and being told in return that her daughter was fine and had been fixed, that she was crazy, and when she began pursuing care outside of the first health care team accused of endangering the child. The mother pursued angiography of her daughter’s heart and vessels, which revealed finally the true problem, and next pursued corrective surgery against the wishes of her daughter’s health care team. Surgery was performed in Chicago by a surgeon who had already done several identical procedures that year alone with high success. Today, that daughter is asymptomatic and healthy, and appeared yesterday during our week’s case wrapup meeting with her mother, who answered any questions we might have.
One of the questions asked of the mother was whether any legal action was pursued on the original health care team that operated on her daughter for failure to fix the problem. I was both surprised and glad to hear that her answer was no. The mother’s reason, which had a large part to do with the fact that she worked for University Hospital and understood healthcare, was that her daughter had not been harmed by the first surgery and because failure to find the cause of the problem is not unforgiveable.
I think the mother’s thinking is contrary to what a lot of people think when they think of medical care. For one, medical care is incomparable to fixing a computer or car or house. Items designed by man are obviously fixable since their complete working mechanics are understood (I sure hope my computer doesn’t work solely because some junkie threw together a pile of transistors, capacitors, and circuit boards, but at times I think that may be the case. Anyhow…). The human body, however, is so very complex and to this day still stumps the scientific community with how it works. How then can doctors be expected to know precisely what is going wrong in an unwell body, when we’re not even sure about all the details of a well functioning body? But this is exactly how doctors are treated, and it is not the ignorant who hold this mindset, it is pervasive all the way to the very top of the scholarly circles.
I wonder whether those people who choose to blame the doctor for any failure to get well are merely looking for someone to blame. There are indeed some situations where malpractice suits are warranted; if a doctor blatantly refuses or fails to provide necessary and proven care and injury or harm results as a consequence, then malpractice may indeed be warranted, although every case must be investigated individually. If a doctor does everything within their power to help a patient, and because of countless other factors that are unknown in a time of emergency or at all the patient fails to become well or fails to show improvement, malpractice does more harm than help.
As technology improves, and our understanding of the human body and the myriad disease processes that harm it increase, maybe one day it will be possible to practice medicine in black and white, with problem-solution efficiency. Until then though, if that day even comes, medicine will be practiced almost at all times within the grey, and healing will remain an art form to be learned and practiced to the best of one’s abilities.
Wednesday, October 19, 2005
One "block" laid on a growing foundation
Sometimes you find that you're right where you're supposed to be. That might be the right city or town to live in, or it might be in the right kind of relationship with the right person. Maybe it's as simple as the right place at the right time, and events around you seem to be working solely for your favor. For me recently, it is finding that I am heading in the right direction on that oh-so difficult path known as a career.
Wait, I'm going to have to admit something here first. I just spent about 15 minutes coming up with that catchy opening. Don't worry though, at least a third of that time was in retyping it after it suddenly disappeared for reasons known only to...well, no one really. Alright, now back to telling you just where I'm going with this new blog of mine.
My name is James, and I'm a first year medical student at the University of Missouri - Columbia. I just graduated college this past May. It was in college, between my first and second years, that I decided I was going to try and head towards medical school. I didn't really know much about medicine other than it was science-oriented, they were paid well, and got to poke around on people and deal with the human body. I progressively gained experience volunteering, shadowing doctors, and having other involvements on campus to pad the good ol' application to medical school, but hasn't been until now, in medical school, that I realize that it truly is what I have been made by God to do with my life. And that being said only 10 weeks into the whole endeavor.
Ten weeks and a few days ago I began the first week of block one of the first year. I was a wetback, a fresh fish, a full blooded rookie. That doesn't stop them (a.k.a. the faculty) from throwing medical cases at you and expecting you to teach your classmates medicine, as you learn it yourself, on day one. On day two they hand you the scalpel and tell you to start cutting skin off your cadaver and memorizing muscles. Day three your right back where you were on Monday, doing more cases, teaching your classmates whatever you learned or think you learned since Monday, and....well, you don't really need to hear my week-by-week schedule. But anyhow, in the last ten weeks I went from, “I think it’s cancer,” to “It seems like she’s got a problem reabsorbing amino acids in the kidney which is leading to a nutritional deficit.” I don’t know if you realize this, but when you don’t know much about medicine, really strange (or even very simple) medical problems make you want to say cancer. In your list of suspicions, it’s almost always on there until you finally know better.
So now that I’m a little bit wiser, and a little bit smarter, I thought I’d start this blog to keep you informed of what’s going on in my medical school life. I will write about medicine as a profession and a science, what it’s like to be a medical student, and anything else that I think about that was originally inspired by something medical or health related. Maybe, if so inspired, I will write about whatever crosses my mind, medicine or health related or not. After all, without some other sort of interests that normal sane people share, I would quickly sound insane, or worse, boring.
Enjoy, and please comment profusely.
Wait, I'm going to have to admit something here first. I just spent about 15 minutes coming up with that catchy opening. Don't worry though, at least a third of that time was in retyping it after it suddenly disappeared for reasons known only to...well, no one really. Alright, now back to telling you just where I'm going with this new blog of mine.
My name is James, and I'm a first year medical student at the University of Missouri - Columbia. I just graduated college this past May. It was in college, between my first and second years, that I decided I was going to try and head towards medical school. I didn't really know much about medicine other than it was science-oriented, they were paid well, and got to poke around on people and deal with the human body. I progressively gained experience volunteering, shadowing doctors, and having other involvements on campus to pad the good ol' application to medical school, but hasn't been until now, in medical school, that I realize that it truly is what I have been made by God to do with my life. And that being said only 10 weeks into the whole endeavor.
Ten weeks and a few days ago I began the first week of block one of the first year. I was a wetback, a fresh fish, a full blooded rookie. That doesn't stop them (a.k.a. the faculty) from throwing medical cases at you and expecting you to teach your classmates medicine, as you learn it yourself, on day one. On day two they hand you the scalpel and tell you to start cutting skin off your cadaver and memorizing muscles. Day three your right back where you were on Monday, doing more cases, teaching your classmates whatever you learned or think you learned since Monday, and....well, you don't really need to hear my week-by-week schedule. But anyhow, in the last ten weeks I went from, “I think it’s cancer,” to “It seems like she’s got a problem reabsorbing amino acids in the kidney which is leading to a nutritional deficit.” I don’t know if you realize this, but when you don’t know much about medicine, really strange (or even very simple) medical problems make you want to say cancer. In your list of suspicions, it’s almost always on there until you finally know better.
So now that I’m a little bit wiser, and a little bit smarter, I thought I’d start this blog to keep you informed of what’s going on in my medical school life. I will write about medicine as a profession and a science, what it’s like to be a medical student, and anything else that I think about that was originally inspired by something medical or health related. Maybe, if so inspired, I will write about whatever crosses my mind, medicine or health related or not. After all, without some other sort of interests that normal sane people share, I would quickly sound insane, or worse, boring.
Enjoy, and please comment profusely.
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