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
Sunday, October 30, 2005
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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