medicine

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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Are we PrEPared to eradicate HIV?

Source: NYDailyNews.com

In the past few months, support for HIV pre-exposure prophylaxis (PrEP; Truvada) has grown substantially. The CDC and WHO now endorse it, as does New York State Governor Cuomo who recently announced a multi-pronged plan to reduce the rate of new HIV infections in the state by 75% before 2020. However, the role of PrEP in curbing HIV transmission is still hotly debated – who should take it, who should pay for it, and whether or not it will work on a population level. Its price tag is about $10,000/year to insurers, it requires daily adherence for maximum benefit, and involves periodic testing to monitor a patient’s HIV status. Part of the concern is that PrEP’s effectiveness may be affected by two behavioral phenomena often experienced in health promotion: self-selection and risk compensation. (more…)