Discovery Health

I don’t think I’ve ever seen so many young people in the hospital before. And they’re all in the Intensive Care Unit (ICU).

Scary how many people are around my age or younger, and how really sick they are, with diseases and on drugs I’ve never even heard of. We youngin’s are generally a healthy bunch, but man, when we get sick, we tank.

And man, when us youngin’s are taking care of you, we’ve got a lot to read. Posting may be light this month. Ugh.

You know, Medpundit’s bit on salaried doctors is really insulting to all the attendings I worked with at the VA last month (salaried), who would often be around much past 5pm if their patients needed them:

Show me a salaried doctor (without a productivity bonus) and I’ll show you one who believes strongly in his right to get home by 5PM, regardless of medical problems coming through the door, or over the phones, that day.

I’m sorry, Sydney, but not everyone practices the way you think they do, even if the financial incentives aren’t there. It’s called professionalism and patient care.

Great ASL Video Dictionary, thousands of words, including a ton of words that’d be very medically applicable: “pain,” “where?” “read lips?” etc. Obviously not a substitute for an interpreter, but especially in the ER where time is often of the essence.

Dr. Centor summarizes a bunch of internists talking about the current state of residents and thoughts on work hours, but in my perspective leaves a number of things out:

• No offense to the old school, but medicine today is a lot more complex than it was even 10 years ago. I’m not saying that residency was any easier, but there’s simply much more knowledge, information, data, treatments, diagnoses, studies, and procedures that we have today than we did previously. And residents (and medical students) are expected to know them all. Granted we have better technologies to make us more efficient (12 lead EKGs with rhythm strips and telemetry and not having to use suction cups, and computers that spit out lab values, and electronic medical records and digital imaging), but medical school is still 4 years long, and most residency programs haven’t changed in length, either. In the same amount of training time, we’re pimped on which genes are involved in which diseases, expected to keep up with all the new data and trials that are constantly being published, as well as know how to appropriately use new medications, titrate them, and anticipate their possible side effects. We have to be able to do basic reads of CT scans and other imaging. It is a lot to learn. (And at the same time, we can now sustain patients and keep them alive longer, and there’s all the ethical issues that now come along with that as well.)
• Let’s say my generation does want a better balance of personal and professional life. (Just hypothesizing for now.) Can you blame us? We’re working just as hard as you old schoolers did in medical school and residency, but our average debt is so much higher! Many of us have also grown up (not me, fortunately) with parents and families who developed their professional lives at the expense of their personal and family lives, and it ended in divorce, frustration, or unhappiness–and we don’t want to repeat the mistake ourselves. And honestly, do you want an unhappy, jaded physician treating you, anyway? (Medical students are on average older now than they used to be, which also leaves fewer years to have a family or develop relationships.)
• The 80-hour work week, just like everything else, has its pros and cons–no doubt about it. But who would you want writing your orders, if you came into the ER with chest pain. The groggy resident who’s running on empty, who might just forget the heparin, or might miss subtle ST depressions or elevations?
• Or perhaps we’re just an egotistical, self-centered generation who require praise at every turn and who care more about our own happiness than our patients’ lives. (If you’ve met any of my classmates and seen their accomplishments or how they talk about their patients, I’d find this hard to believe.) But why else might our supposed “work ethic” have changed? Could it be the change in the practice of medicine? From an art and a practice to a business? From calling the preson you’re treating “your patient” to “your consumer” or “your client?” From focusing on what’s best for the patient to what’s best “medico-legally” as well?

Just some random opinions, devils’ advocacies, and thoughts.

There may be some evidence that Echinacea helps prevent colds or decrease symptom length, but either way, please spread the word (which we’ve actually known for awhile now): vitamin C doesn’t do squat!

(And remember, please tell your physician if you’re taking any herbal medicines.)