Peru: Medicine is People Treating People

For the past few weeks, I have been living in Iquitos, Peru and rounding at the regional hospital (Hospital Regional de Loreto) as part of a Global Health elective that I applied for through a foreign university.

Hospital Regional de Loreto

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Things I’m Reading: Bad-News Edition

Here’s a quick run-down of some of the things I have been reading lately:

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If Guns Were a Disease, This Would Be An Epidemic

I’m not really going to be able to add anything to this discussion that hasn’t already been said, but there is a gun safety issue in this country. We need to address it.

Dr. Michael Davidson, a cardio thoracic surgeon at Brigham & Women’s hospital, was shot yesterday by the son of one of his patients.

Source: Google Images

Source: Google Images

Adding onto the tally of late (2,160 incidents since 2015 so far), (more…)

Palliative Care and the Lost Art of Communication

The following is Part 2 in a series about end-of-life care. For Part 1, see here. This article addresses my own experience on a Palliative Medicine elective in my fourth year of medical school.

Despite the growing number of U.S. hospitals with Palliative Care teams, there remains a real lack of understanding about the benefit that specialized Palliative Care providers can bring for patients with advanced illness. This form of care is especially valuable in patients with end-stage illness (and has even been shown to extend life by several months), but it can also help any patient at any stage of illness (regardless of prognosis). Indeed, even prescribing an NSAID for headache can be considered a form of palliation. The focus is about improving quality of life now instead of later. (more…)

Is there a doctor on board?

I have been traveling a bit for residency interviews over the past few weeks, and given that planes, trains, and buses have become my new home, I have been thinking a lot about what I would do if a fellow passenger needed medical help. As we go into the holiday season, I imagine many people with medical training will be traveling, as well.

I was once called upon to assist a passenger in an in-flight medical emergency. It was when I was leaving for vacation after completing my third-year clerkships, and my relatively minimal hands-on experience put me as the highest-ranking medically trained person on the plane. I was thrust into a relatively unfamiliar situation and forced to apply my medical knowledge in the “low-resource” setting of the airplane.

Thankfully, the passenger was stable and didn’t require more than a history and basic physical, but the experience left me wondering how I would have responded if the situation had been more serious.

After the trip, I took it upon myself to learn as much as I could about airline medical emergencies, and what my role would be in one of those situations. I am writing this post to share what I learned. This will be especially helpful to any doctor, nurse, EMT, or other medically trained personnel who reads this and finds themself called upon to respond in the future (an in-flight medical emergency is estimated to occur about once in every 10,000-40,000 travelers).

If you are a medically trained person who has responded to a medical emergency on a plane, train, or in a restaurant, or if you are a person who has been helped by a medical person while traveling, please feel free to share your experience and insight in the comments. (more…)

False Rape Accounts are Exceedingly Rare

The recent resurgence of sexual abuse allegations against Bill Cosby led to some interesting family discussions at the Thanksgiving table recently. In case you have not been following the news, Bill Cosby has allegedly throughout the course of his career sexually assaulted female coworkers; many have now come forward to make their stories public, and the resulting commotion has led to cancellation of new projects that Cosby had been about to launch, as well as a general tarnishing of his iconic reputation.

One of my cousins (let’s call her Allison) works in a support shelter for survivors of domestic violence, and she and another relative (let’s call him Roger) were arguing over how the public and the media should respond to the many allegations. The crux of the debate came from the fact that so many women have been coming forward all seemingly at once. They certainly couldn’t all be telling the truth, Roger asserted. Certainly some of them were doing it for the fame and/or potential money, he guessed. (more…)

The Checklist Itself Doesn’t Matter

Anyone who understands systems will know immediately that optimizing parts is not a good route to system excellence.…We connect the engine of a Ferrari, the brakes of a Porsche, the suspension of a BMW, the body of a Volvo. What we get, of course, is nothing close to a great car; we get a pile of very expensive junk.” – Chapter 8.

I just finished reading Atul Gawande’s The Checklist Manifesto, which was first published in 2009 and spent some well-deserved time on the New York Times Bestseller List. Written by an attending general surgeon at Brigham & Women’s Hospital in Boston, this book tells the admittedly “unsexy” story of how a simple tool such as a checklist can improve the quality and consistency of outcomes in a wide range of fields: aviation, building construction, venture capital, and (even) medicine. All of these fields are complex systems – involving many moving pieces and players, and an inherent unpredictability of conditions, materials, personnel, and complications. In addition, these arenas assume a certain level of skill and require a high standard of consistency and safety, but errors and complications still plague us. We have reached a point in many fields where the problem isn’t ignorance (we do understand a lot about the world around us) but rather ineptitude (we fail to apply the knowledge that we have consistently and correctly). A checklist can help us improve our “eptitude.”

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Medical Students Don’t Learn About Death

The following is part 1 in a series about death and dying in the medical context. This reflection was written by me earlier this year, before I sought out a Palliative Medicine elective. Part 2 will follow soon.

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Until the last week of my sub-internship, I had never had a patient die on my watch. To be sure, I had patients on the cusp of dying – and some who did die, of course, when I was already on another rotation. I have been around dying patients who were on our team but were being taken care of by the other resident/medical student. But never a patient of my own, until my final year of medical school.

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I can’t let my patients see

I almost broke down in the theater tonight.
I fought back tears as the main character tried to navigate a confusing, capricious world.
I fought back tears when his parents argued about how best to care for him.
I fought back tears as he bravely sought answers to tough questions.
I almost broke down in the theater tonight.

I started an elective in Palliative Care last week.
I remained supportive but stoic as my patients tried to navigate a confusing, capricious existence.
I remained supportive but stoic when their families worried how to best care for their loved ones.
I remained supportive but stoic as they bravely sought answers to tough questions.
I started an elective in Palliative Care last week.

I almost broke down in the theater tonight.
I can’t let my patients see.

It’s the only model I have learned.
This is how a doctor behaves.

Right?

Think and do: How to change the world

One of the questions that I am often asked is why I chose to study public health in addition to my medical training. The answer is simple: I believe that the therapeutic relationship can and should exist outside the four walls of the doctor’s office. While medicine and therefore physicians will always be necessary to cure disease, I see problems in the world that must be solved on a structural level — from the environments in which we live and work that promote unhealthy behavior, to the very real disparities in access to and quality of care.

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