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.  :)

CFF New Leaders Speech

Here's my speech to the 500+ people who chose to come and support the CFF at Tulsa's New Leaders. It was a great night!  Enjoy!  :)

On Feeling Like Patootie and Developing Empathy

Empathy is an incredibly powerful emotion.  An important part of being a doctor is understanding what its like to be a patient.  Understanding what it feels like to have the flu.  Understanding what it feels like to be stuck in a holding room without the ability to leave and get a drink or a snack.  Understanding what its like to not know what is wrong with you.  Understanding what it feels like to have to wait for a phone call from the doctor's office.  Understanding what it feels like to not be able to breathe, etc etc etc.  I wish no one ever had to experience any of these ... but then I'd be jobless.  I feel like when I get the chance to experience them, its increasing my ability to be a more caring, well-rounded physician.

Apparently, its in the cards for me to have an empathy building day.  Today, I feel like crap.  I have a legit fever of 101.5 and I'm doing my best to simply let the fever play its course and not knock it down with drugs.  Fevers are the body's way of fighting infection, so I'm miserably letting my body fight.


While having a virus doesn't really require any healthcare beyond fluids and time, I only know that because I'm months away from being a doctor myself.  Five years ago, I would have called my doctor first thing simply to make sure I wasn't dying of ebola or something.  Now, I actively avoid making that call lest I find out I misdiagnosed myself with a virus that is actually ebola.  (Don't worry, I haven't been exposed to ebola.  I just find it one of the most amazing viruses on the planet and am absolutely fascinated and hope to get up close and personal with it some day.  I'm weird, I know.)

Not everyone has a doctor.  Not everyone has the money to make the simple appointment.  Not everyone has the ability to pay for a prescription in the off chance its a bacterial infection.

Why am I thinking about this today?  And by this, I mean the distribution of healthcare in the US.  This month, I'm working in the ER and I'm constantly reminded of what happens when primary care isn't made readily available to everyone.  I'm not advocating handouts and I'm not advocating any specific plan, I'm simply pointing out a terrible flaw in our system.  When people don't have access to basic primary care outpatient resources, they end up clogging the hospital system with problems that could have been thwarted much earlier.

Taking care of healthy people is much less expensive than taking care of sick people.  As a country, we have to find a way to take care of people before they get sick.  We owe it to ourselves and our children and our parents and everyone's collective future.  Somehow, we have to find a way to help our fellow humans who by chance or choice are in less than ideal circumstances and don't have the opportunities we have to receive the care we do.

Empathy.  I feel like patootie today and I'm thinking about how to keep others from feeling like this tomorrow.  :)