The ethics of eight (babies that is)

All over the blogosphere people are discussing the California woman who gave birth to 8 babies.  The media was quick to call it a miracle, but it seems it only took a few hours before bloggers, journalists, and doctors began to seriously question the mother’s intentions.  It seems crazy enough to want 8 kids at once, but now rumor has it that the mom is single, living with her parents in a 2 bedroom house, and already has six kids (all under the age of 7 nonetheless).

If you want to be entertained (or appalled), I recommend reading the comments section on articles discussing this woman.  You’ll see a variety of viewpoints expressed, from those who think we should just leave this woman alone, to those who think the government should mandate how many kids a person can have and restrict who can receive fertility treatments.

I guess I fall somewhere in the middle.  Read the rest of this entry »

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Money (that’s what they want)

I’ve rounded the corner of my third year of medical school, where students have to start thinking about their future since we will begin applying for residency this summer/fall.  3rd year is a chance to try out a lot of the specialties, and hopefully find your niche.  You decide what you like or dislike about each area (internal medicine, surgery, pediatrics, neurology, etc) and decide how that fits into your needs or desires.

Some students are lucky – they knew, for example, that they wanted to be a neurologist right from the beginning of med school, they were fortunate to love it during their 3rd year rotation, and can now focus on arranging their 4th year electives to reflect this choice.  Maybe they weren’t sure what they wanted to do, but they loved pediatrics and can’t imagine doing anything else.

Other students thought they knew what they wanted to do, rotated in the specialty and hated it, and are now completely clueless and a bit panicked as to how they will approach their last year of medical school. (a lot of my future-surgeon friends seem to fall into this category)

Then there are students such as the one currently rotating with me on pediatrics.  Read the rest of this entry »

When you wish patients would die

I haven’t blogged in quite a while, and my husband was harassing me to post something new.  I’m currently in my third year of medical school rotating through various specialties in the hospital.  It’s not that I’m too busy to blog (though I’m quite busy between hospital scut work and studying), it’s just that this year feels like such a whirlwind of emotions sometimes that it’s hard to put them out into the blogosphere without feeling a little exposed.  But maybe those are the types of topics that make for the most interesting read.  So I give you a topic that reflects what was going through my mind a few days ago: when you wish patients would die.

Try not to read too much into that – I don’t want to harm or kill my patients.  But sometimes you see people who have been suffering for so long, that you wish for an end to their suffering.  Unfortunately for some people, the only end that would provide this is death.

Read the rest of this entry »

More than one problem? Make another appointment

So I’m currently rotating through an outpatient medical clinic, and despite all the hand-holding, kumbaya-ing, and “the patient is a person” mentality, beneath the surface an insidious beast lurks. This “beast” is the closely held belief that the patient is only allowed one complaint for each scheduled appointment. You made your appointment to get your blood-pressure meds refilled but you also have seasonal allergy concerns? Too bad, make another appointment so we can discuss the issue on a separate occasion.

Just recently I was (politely) scolded by my resident because I presented a 7-week-old baby whose mother had 3 concerns – the child had been throwing up his milk at each feeding for the past few weeks, he had a rash across his entire body for the same amount of time, and she was concerned that he might also have an umbilical hernia. “Try to keep them to one complaint” my resident told me. But the rash and difficulty feeding were likely related (milk-allergy), and the hernia concern arose because she was a new mother and didn’t realize kids usually outgrow those things – it took 2 seconds to say “oh, that’s normal and he’ll probably outgrow it. don’t worry.”

I have difficultly understanding where this idea, that we can only allow the patient one problem per visit, comes from. I understand that the appointments are booked closely together, generally with 15-20 minutes per patient (which includes the time it takes to fill out any necessary paperwork), but have these doctors lost their minds? Do they not realize that people who come into their clinics must take off work to get there, rearrange child-care schedules, etc? Even if they are retired or stay at home to take care of their children, they still have lives and would prefer not to spend most of it at the doctors office waiting in boring stimulus-free rooms.

I have to believe that if we actually had a free-market health care system many of these problems wouldn’t exist. Our society is accustomed to getting it all done at once – this is why stores such as WalMart or Target have achieved their level of success – you can get your grocery shopping done and stock up on anything else you need in one trip. People expect the same thing from their doctors, and I’m siding with the patients on this one. There is no reason why our system couldn’t adjust to accommodate the person who has a couple different medical problems going on. A more market-based approach would simply charge a bit more for the larger amount of doctor’s time the visit uses. As it sits right now the system is too rigid to adjust to these demands – everything must fit neatly into a 4-5 digit “code” for what the visit accomplished, and the doctor is paid according to that code. I understand doctors don’t like it when a visit they thought would take 15 minutes all of a sudden takes 45 because the patient has a lot of issues to bring up, but if you took your car to the mechanic to get the oil changed and they found a problem with your engine, wouldn’t they offer to fix it on the spot while you waited? Wouldn’t you be pissed if the mechanic told you to make another appointment (which would be at least 2-4 weeks from now) to get your engine fixed, and that in the meantime you would just need to deal with it and keep your fingers crossed while hoping that your car doesn’t break down? I would be pissed. No wonder people don’t like going to the doctor.

~ Lily

3rd year medical student extraordinaire (at least in my mind)

Ethics in medicine – real life experiences

I haven’t been posting very regularly on this blog since starting my third year of medical school because I’ve been a bit busy adjusting to the new routine of seeing patients every day. I must say that although the hours required during the clinical years of med school are worse than the classroom years (overnight calls, long shifts of standing, etc), it is also much more interesting seeing patients every day and applying everything we’ve learned up to this point (hello steep learning curve!). With this intense clinical exposure comes a lot of scrutiny of my future colleagues – I look at each of the doctors I work with and see traits I would like to possess, and also those I do not. While I can say that most of the doctor’s I’ve worked with have been fantastic both with their patients and with their interest in teaching us students, a few have been downright awful and possibly unethical. Here is a sample of the worst that I’ve encountered these past few months:

The first is a doctor that takes no interest in the students and barely listens to what we have to say after we interview her patient and give a report before she examines them. I have to wonder why someone like this doc is working for a teaching hospital if she obviously despises the students. To make matters worse, a few of the students who have worked with her more frequently have commented on how she treats patients differently depending on their race. While I haven’t witnessed this first-hand (I’ve only been with her on a few occasions), I can’t say it would come as much surprise…I understand everyone has personal biases, but when you care for such a diverse patient population as ours it is necessary to work extra hard not to let your biases influence care. I hope I don’t turn out like her.

The second involved a primary care physician who was treating a morbidly obese patient with osteoarthritis of both knees. This patient’s insurance would not cover a particular injection the doctor wanted to give to alleviate the pain/inflammation of her joints, so the doctor was in the process of setting up a situation where she would order the injection for another patient whose insurance would pay for it, but give it to the first patient. I’m pretty sure that counts as some form of insurance fraud, but my guess is a lot of people would look the other way because of the general public perception of the “evil insurance company.” While I certainly sympathized with the pain this patient must be going through with her knees and the impact it has on her quality of life, I couldn’t help but think that if she would lose even a little weight she would feel a lot better all around. Perhaps the insurance company wouldn’t cover the shot because it likely wouldn’t make much difference given the severity of her obesity and arthritis. But what do I know?

The third doctor was a specialist performing an endoscopy-type procedure on a middle-aged woman. If you’re not familiar with how those procedures work, you are basically putting the patient under partial anesthesia so that they are awake but heavily sedated. Most people don’t remember much afterwards, though their eyes are open and they can talk a bit throughout the entire thing. This doc was chatting with his fellow nurses and technicians when politics came up. I was always raised never to bring up “religion and politics” while at work, but I figured since these people worked together for so long they must be comfortable discussing their views. The doctor was a republican, while most of his coworkers in the room were democrats…to be honest I think they were all a bit stupid when it came to understanding federal policy, as none of them sounded very educated on the issues (but I digress…). Of course Barack Obama comes up, to which the doctor makes some remark about how “Obama’s a muslim, and I just don’t think it’s right to have a muslim in office with terrorism being such a issue” etc. I’m probably wording things a bit more eloquently than what came out of this guy’s mouth. I am not an Obama fan for various reasons, but I couldn’t stand by quietly while this doc was spouting lies. I made some comment about how Obama is actually a christian, but how some keep trying to spread the rumor that he is a muslim because they think it will deter people from voting for him. Then the doc starts rambling about muslims, saying what essentially amounts to “muslim = terrorist”. Suddenly he becomes aware of what he’s saying, and he looks down at the patient and asks, “are you a muslim, ma’am?”. This poor woman, in her drugged state shakes her head “yes” and says something unintelligible. The doc’s face loses a bit of color, and then he turns to one of his nurses and asks if she would please administer more of the drug that produces amnesia (so the patient won’t be able to remember the offensive things he said). The nurse looks at him thinking he’s joking, but the doc is entirely serious, so she administers more of the drug. Would the extra dose of this drug harm the patient? Probably not, though it is still plausible that it might have. I guess “first do no harm” goes out the window for this guy when you say something offensive to your patient who is completely incapacitated. It made me really sick to my stomach to witness the entire thing, and I hope I’m never paired with this doctor in the future.

I still think most doctors are good people, and this has been confirmed numerous times for me in the past couple of months as I’ve worked with a variety of different practitioners, but it’s hard to look at them the same way when there are a few rotten apples spoiling the perception. I may not know what kind of doctor I want to be at this point, but I’m starting to get a good idea of what kind I don’t want to be. From your perspective, what are traits that make a doctor good or bad? Any comments are appreciated!

~Lily

iPhone 3G goodness

I caved to the pressures of society and bought an iphone yesterday. There was no camping out or waiting in line to get one of the first phones, but I’m glad I made an effort to get to the AT&T store relatively early yesterday morning since I got the last iphone in stock at that particular location. I’ve never owned an apple product in my life, but thought since I was going to have to buy a smart phone or PDA to run the highly useful Epocrates program (a drug reference library – particularly handy for medical students, though more and more doctors are also on board these days) I might as well get a cool one.

After about an hour or so of fiddling around with it, downloading the latest version of iTunes, and synching it with my computer, I finally got it to work and started looking for cool applications. Even then I was having some problems getting a few of the apps to load, which I chalked up to the boatload of other people sitting at home trying to do the exact same thing. Fortunately as of late last night they were all up and running, and everything has been smooth sailing ever since.

So what do I have on my phone so far? First and foremost I downloaded Epocrates Rx…I figured since it’s the reason I wanted a smart phone in the first place I should at least make it appear as though I’m using my phone for “educational” purposes. 🙂 Hopefully Epocrates will adapt their entire product line for the iphone in the next few months, so I can start surfing diagnoses and treatment plans from the convenience of my hand-held device. The other more practical apps I added include Zenbe lists (which I used this morning for my grocery shopping) and YPmobile (yellowpages, which I might delete since you can search for businesses through the GPS that comes with the phone). For fun I added Pandora (finds radio stations for you to listen to based on your favorite artists or songs), TapTap (sort of like guitar hero or dance dance revolution for your phone), PhoneSaber (a light saber…while this one doesn’t really do anything, it is fun to swing at my husband as it makes the cool sound effects), and UrbanSpoon (sort of like a magic 8 ball that takes advantage of the accelerometer to randomly pick a restaurant near your GPS location).

So far I’ve enjoyed the apps (including ease of installation), and I’ll definitely be testing out Epocrates this week to see whether it is easier than hunting down a free computer and checking for drug dosages or interactions (plus the iphone version of epocrates includes a pill identifier – pretty cool, though I’m not sure how many times I’ll actually need to use it). I also noticed, while depositing a check this morning at the atm, that my bank has an online banking system set up to access from the iphone, so I’ll probably try and install that in the next few days. Seems like a good investment up to this point. Any suggestions for other cool or useful applications that I should add to my new phone?

~Lily

Why you should avoid hospitals during the month of July

I haven’t posted in awhile, mostly because I’ve been so busy studying for (and hopefully passing) Step 1 of the US medical licensing exam. But I thought this would be a good time to write a post – for one, I have the day and weekend entirely free, and two, I start rotations in the various clinical specialties next week and am not sure how much free time I will actually have at that point.

So, why should you avoid hospitals during the month of July? To avoid run-ins with new interns and 3rd year medical students like me! No, I’m not trying to be self-deprecating…just realistic. Interns started at the beginning of this week – these are students who just graduated medical school and are starting the first year of their residency. Many of them are at new hospitals in a new part of the country, and have not had to assume a whole lot of responsibility up to this point. They’re nervous and still learning the ropes, and it will take time for them to feel comfortable with the situation.

Then there are 3rd year medical students like myself – we’ve had limited patient contact up to this point, but now we are thrust into the hospital and assigned patients to follow as we rotate between specialties like surgery, medicine, pediatrics, etc. We have limited clinical skills, but are expected to hone them as we complete the year (this includes things involving needles and patients – such as inserting IV’s and drawing blood…scary thought). We may not have much say (read: almost none) in what happens to the patients, but since we are new to the hospital we inevitably don’t know much about what’s going on and will slow the well-oiled machine down.

These factors contribute to longer stays and higher rates of mortality during the month of July (http://www.nber.org/papers/w11182). Just another reason to be careful this July 4 holiday.

~ Lily