It Goes Both Ways

Sometimes, its hard to get back in the swing of things.  I've been writing every day (and some of it is publishable but of the dry medical case report type) but I miss public writing in general.  I miss putting the words together in a way that makes others want to read on to the next sentence.  Sometimes, the only way to get started again is to ride in on someone else's coattails.  That's what I'm going to do today.  Hopefully it will continue to lead to more thoughtful and original content in the near future.

Hang on with me through the next sentence.  I recently read a blog post (full disclosure: written by my program director on his blog, Glass Hospital) that was an intro to a piece he wrote for Shots on NPR ... all about bedside manners.  The end of the initial blog linked to NPR's Facebook post asking what patients' want from doctors.  The answers were somewhat varied ... some were funny, some were crass, most were heartfelt.  Many simply aren't reasonable.

I spent the last 45 minutes addressing the unreasonableness of many of them.  But you know what?  None of the words I wrote really matter.  I do what I can to show patients I truly care and that their time is valuable to me.  I do what I can to show patients I'm invested in their health outcomes.  I do what I can to show patients that I am not only listening, but that I am truly hearing what they are saying.

I think most of my patients think I do a decent job.  They don't all ... but I have to be okay with that because I am unwilling to sacrifice my own morals and ethics to please everyone.  I think the majority of my patients respect this.  The ones who don't ... well, there are plenty out there who will.

However, I only think its fair if I get to respond with a few of the things I wish patients would do/bring/provide/ask/tell/etc.

1. Be honest.  I'm not going to tell anyone what you tell me*.  And if I ask you a question, its important and might change the course of treatment.  Believe me, I will not judge you and do not care about your social life (i.e. drug/sex/alcohol history) on a personal level.  
2. Bring your medications (or an accurate list) from all your doctors with you.  Include all the vitamins and alternative medications you take.  
3. If you can't afford a medication I've prescribed, please tell me.  I have no idea how much different medications cost for different people because EVERY SINGLE PERSON PAYS SOMETHING DIFFERENT.  For almost all drugs, there are substitutes.  Just let me know.  I just want to make you better.  
4. Don't be offended if I don't shake your hand.  You have the flu.  Nowhere else on the face of the earth is the expectation to shake an obviously ill person's hand.  I'm practicing self-preservation.  
5. Put your phone away.
6. If you don't take the medication I prescribe or don't implement the changes I recommend, don't be mad at me when you don't get better.  If you feel they are unreasonable, say so.  However, I can't fix you with magic.  Getting sick usually takes time.  Getting better usually takes time and effort, and the effort can't be all mine.
7. Be polite. You want me to say hello.  You want me to be on time. You want me to listen to every word you say.  You want me to ignore my phone and pager.  It's nice when you do the same.  See #5.

I could go on and on, but basically the things you want from a doctor, the doctor also wants from you.  And while I am sure that you, as a patient, do all of the aforementioned items, there are loads of patients who don't.  Basically, it all boils down to the Golden Rule.  Respect needs to go both ways.

*I won't tell anyone what you tell me unless I get the impression that you are at risk of harming yourself (suicidal), harming anyone else (homicidal), or if it involves child or elder neglect.  Legally (and ethically), I'm responsible to take those issues outside of the room.

On Gattaca

Its not often an obscure movie from 1997 comes up in conversation twice in one day, however, sometime early last week this did indeed happen regarding Gattaca.  And while there have been many things I have wanted to write about in recent weeks, they all were of a bit more heavy and involved variety.  I need something interesting, yet simple, to get the words to flow once again so here is my somewhat (very) mediocre attempt at writing again.

Initially, I was having a discussion regarding inheritance of autoimmune disease and genetic predisposition.  All of the sudden, I more or less felt like I was describing this movie.  I said as much, yet the person I was speaking with had never seen it.  The thought crossed my mind to watch it again and see exactly how close to reality it had become, but I checked on netflix, and it wasn't available unless you have the dvd to your house option (no way, jose).  And I moved on.

That afternoon, on facebook, I saw an article similar to this one mentioned and Gattaca once again was mentioned (the post has mysteriously disappeared).  If we blood test for suicide risk (premise of the article), what are the possibilities?  Will this harm or hurt people? Was Gattaca more along these lines?  I just couldn't remember.

That was it.  I had to watch the movie.  For the mere price of $9.99 I downloaded it to my phone (thank you so much modern technology) and watched away.  The first 10 or so minutes of the movie were most like reality.  Its amazing to watch movies from less than 20 years ago that were more or less science fiction that have more or less become reality.

In the movie, prejudice is no longer based on race or income or any of the other typical categories we put people in.  Through genetics and IVF, parents are able to ensure that the absolute "best" embryo is the one that becomes their child.  Regardless of ability to get pregnant the old fashioned way, naturally conceived children have become the lower class of citizen.

However, they still aren't able to control fate and accidents can, and do, still happen.  The movie points out that some things will always be left to chance and no matter the overwhelming odds, a 1 in 100 chance still means there's a chance.

If you have a couple of hours, its worth it.  Not only is it an interesting take on society, the "moral of the story" is actually pretty good too.  I'm thankful for all the luck I've had in my life ... but I'm also thankful for all the hard work I've put in to make the luck work the best it can.  :)

Happy Heavenly Birthday!

credit: Adrian's wedding photographer

Month One Done

I initially started this post during my last shift of my first month of ICU.  It was a night shift and as things happen, I got busy and didn't get it finished.  Instead of deleting or even editing it, I'm going to share it because it quite simply speaks the truth in a very non- War and Peace way.  I'm looking forward to many more months of learning and growing.


Well, not quite.  I'm working my last shift of my first month of a long coat doctor.  I'll be finished at about 630 this morning.

This has been hands down one of the coolest months of my life.  I've gotten used to being called Doctor.  I've gotten used to the weight of two, sometimes three, pagers.  I've gotten used to being somewhat tired.  I've gotten used to looking forward to a day off because it means eating, sleeping, and sleeping some more.

I've had the privilege of helping to take care of some really sick people.  I've been there when people died.  I've been there when people got better.  Its pretty amazing to get to see all of it.

Its scary to write an order or make a decision about which antibiotic to use ... but it is getting less scary.  I hope I always have some level of fear because that means I'm paying attention.  I've learned so much.  So very very much.

On Independence

Today, we celebrate the adoption of the Declaration of Independence.

Today, in 1776, a group of diverse thinkers worked together to begin a revolution.  

Today, I love my country more than yesterday.  I'm thankful for those who willingly put themselves in harms way to allow us to continue to disagree.  I'm thankful for my freedom to think, feel, and say what I believe without fear of serious ramification.

Today, in 2013, I hope that our representatives in Washington, DC can see beyond the tip of their nose.  I hope they can see beyond reelection.  I hope they can see to the future.  I hope they can bravely stand and go where no one has gone for a long long time ... 

The Land of Compromise.

What is so wrong with the middle?  I venture to guess that the overwhelming majority of people in the country fall somewhere in the middle.  And even if they don't, why can't we learn to give and take?  Why can't we learn to share a little?  Why does everyone have to walk away empty handed instead of everyone getting a little bit of whats available?

I want this country to return to what it once was.  I want it to once again be great.  I want people to make informed decisions based on facts ... and not simply what they heard a single pundit saying on cable news.  

Also, I'm really excited that its almost time for the premiere of the 2nd season of Newsroom.  If you haven't watched it, you absolutely must.  Skip to about 3:15 to see the absolute best soliloquy to come out since the president's speech in Independence Day.

Its Your Birthday

Hi Lo!

Today is your 29th birthday!  Today is also the day where I enter the ICU as a real live doctor for the first time.  I don't really start until tomorrow ... but they are going to show me around today.  Can you believe it?

We all miss you very much.  I know you're with me all the time.  And just in case you were thinking about going on vacation for your birthday, don't.  You need to be in the ICU tomorrow to help me out. You've been there way more than any of us!

I sure hope you are having an absolutely amazing heavenly birthday party with lots of blue balloons and yellow cake with chocolate icing and homemade chili and drumsticks.  I know you are. 

Love you to the moon and back!

Orientation

Day one of orientation done.

Today made the first day of medical school look like child's play.  Its a good thing I have practice drinking from a firehouse.

I have a pager.  I have a badge that says I'm a doctor.

They say I'll work 12+ hour days 6 days a week for the next year.  I suppose my body will quickly realize that what the badge says is true.

Hopefully my pysche will catch up shortly thereafter.  It just doesn't seem real.

I'm a doctor.