Doctor and patient, now at odds... is that really what is going on?
Or are things just somewhat (and not unexpectedly) different than they were in the past?
Mainstream medical knowledge is not only available to physicians and those "few" who had enough education to be able to digest medical texts. Physicians, at least it seems from some of the readings this semester, have been humanized.
Also, do internet resources replace folk remedies of the past as a burr in the physician's side? I'd guess that most people of the far past who tried folk remedies would often not seek a physican, period. The difference today is that much of the information available on the internet directs people towards treatments that must be dealt through a physician. And now some "patients" (are they really?) enter a doctor's office (I've encountered this while shadowing), printout in hand, basically demanding services based upon their own research. It'll be interesting dealing with this as I my career develops.
Monday, October 6, 2008
Sunday, September 28, 2008
Re: Arnold
When will we be exposed to end-of-life care considerations?
I found this to be interesting: "Rather than learning about diseases, students
confront complex stories and have to choose the right
symptom on which to build their differential." I look forward to having enough of a knowledge base to be able to do this.
And it is important to me to be warm in my interactions with others. This article suggests that many end-of-life care teaching/observation experiences are cold instead. How much input will I be able to have, personally, in my training encounters? Will I essentially be a static observer?
Says the article:
"As palliative care physicians who have spent
the last 20 years trying to change how the medical culture
views death, we have our work cut out for us."
And how are they trying to change how the medical culture views death? Is it a metaphysical understanding that they're looking at? Or?
I guess the issue is on my mind a bit as I'm making my way through The Magic Mountain again.
And my own personal answer to this found in the golden rule. How would I want to be treated if I were in a similar state? My own inchoate ideas will form the foundation of the development of my approach to end-of-life care; built upon them will be my experiences in clinical settings, seeing approaches that work well in the providing a mixture of some physical, mental, and spiritual comfort, along with others approaches that are not effective.
Dr. Hafferty, nice to see that you received a citation in this article!
I found this to be interesting: "Rather than learning about diseases, students
confront complex stories and have to choose the right
symptom on which to build their differential." I look forward to having enough of a knowledge base to be able to do this.
And it is important to me to be warm in my interactions with others. This article suggests that many end-of-life care teaching/observation experiences are cold instead. How much input will I be able to have, personally, in my training encounters? Will I essentially be a static observer?
Says the article:
"As palliative care physicians who have spent
the last 20 years trying to change how the medical culture
views death, we have our work cut out for us."
And how are they trying to change how the medical culture views death? Is it a metaphysical understanding that they're looking at? Or?
I guess the issue is on my mind a bit as I'm making my way through The Magic Mountain again.
And my own personal answer to this found in the golden rule. How would I want to be treated if I were in a similar state? My own inchoate ideas will form the foundation of the development of my approach to end-of-life care; built upon them will be my experiences in clinical settings, seeing approaches that work well in the providing a mixture of some physical, mental, and spiritual comfort, along with others approaches that are not effective.
Dr. Hafferty, nice to see that you received a citation in this article!
Sunday, September 14, 2008
Professionalism: From the Trenches
This article reminded me a good bit of some of my experiences in research biology in undergrad. Those negative experiences played a very important role in my attending medical school instead of graduate school in biology. I wanted no part of the academia that I was experiencing in my research. I also had some unpleasant experiences after I let my advisor know that I was attending medical school instead of grad school
I will not cross a line that I should not cross. If my third and fourth years (and residency) are filled with experiences like these, I may, too, be regarded as "unprofessional" in that I would not fit in with their expectations. Hopefully that is not the case!
I have yet to have any bad experiences here in Duluth.
What would M3s aM4s say about experiences like these being common on rotations in the cities?
I will not cross a line that I should not cross. If my third and fourth years (and residency) are filled with experiences like these, I may, too, be regarded as "unprofessional" in that I would not fit in with their expectations. Hopefully that is not the case!
I have yet to have any bad experiences here in Duluth.
What would M3s aM4s say about experiences like these being common on rotations in the cities?
Ring article
Somehow I missed this article and blogged on the wrong subject!
And now I've read the Ring article.
I was six years old when this article was written. For all that it says about the "new" AMA, there has been little done, I'd guess, about the problem of the uninsured or the underinsured as mentioned by Ring.
Ring asks: "Are we a profession to which business interest is incidental or are we a business to which our professionalism is incidental?" I think that the concept of sacrifice, altruism, and professional runs deeper in medicine, much deeper than the organized business aspect of it.
But given the huge opportunities for profit in organized medicine, it is no surprise to me at all that much of medicine, at least on an administrative level, has much to do with profits. If there is a situation where there is a profit to be made, there is somebody willing to work that situation to their benefit. A million anonymous shareholders to which a board is responsible? Tell them about sacrifice and altruism and see what happens. Do something unprofitable about the un- or underinsured? Probably not, I'd guess.
I have a good bit of my savings (a few thousand dollars) in a health care mutual fund. It's been doing really well.
I think that there must be changes in the healthcare system soon - there are too many access issues, at least from my own experiences in rural Pine County MN. And I'm guessing that many of these changes will come through political processes, not the AMA. And these changes will possibly (probably?) decrease the profitability different medical systems... so I'm going to be moving some of that money into other funds!
Drs. Hafferty and Nordehn, what do you think about this? I do not come from a medical family; my dad drives trains and my mom helps run a small store. So my experiences in medicine, especially on the business side of things, are limited.
And now I've read the Ring article.
I was six years old when this article was written. For all that it says about the "new" AMA, there has been little done, I'd guess, about the problem of the uninsured or the underinsured as mentioned by Ring.
Ring asks: "Are we a profession to which business interest is incidental or are we a business to which our professionalism is incidental?" I think that the concept of sacrifice, altruism, and professional runs deeper in medicine, much deeper than the organized business aspect of it.
But given the huge opportunities for profit in organized medicine, it is no surprise to me at all that much of medicine, at least on an administrative level, has much to do with profits. If there is a situation where there is a profit to be made, there is somebody willing to work that situation to their benefit. A million anonymous shareholders to which a board is responsible? Tell them about sacrifice and altruism and see what happens. Do something unprofitable about the un- or underinsured? Probably not, I'd guess.
I have a good bit of my savings (a few thousand dollars) in a health care mutual fund. It's been doing really well.
I think that there must be changes in the healthcare system soon - there are too many access issues, at least from my own experiences in rural Pine County MN. And I'm guessing that many of these changes will come through political processes, not the AMA. And these changes will possibly (probably?) decrease the profitability different medical systems... so I'm going to be moving some of that money into other funds!
Drs. Hafferty and Nordehn, what do you think about this? I do not come from a medical family; my dad drives trains and my mom helps run a small store. So my experiences in medicine, especially on the business side of things, are limited.
Wednesday, September 10, 2008
A Physician's Charter
It's 11:10 PM the day before this blog is due. My brain is occupied with an attempt to memorize biochemical pathways for the Principles course along with the musculature/blood and nerve supply to the axillary region for Applied Anatomy. This is all new stuff to me. I am distracted. I'm thinking of a Far Side joke in which a student asks to be excused from the classroom because their brain is full. That's how I feel right now - but I know the information will keep on coming and that I will keep absorbing as much as I can.
Articles like this are the forest, I think. Enzymes and nerves are, I feel, the trees. Right now I look up and see the canopy. One cannot know a forest unless they understand how its components work together.
I don't know how the things in this article will apply exactly to my future practice. Sure I could generalize - for example, the statement about "physicians must be honest with their patients and should empower them to make informed decisions about their treatment" is followed by what I feel to be a "but" statement saying unless those decisions of the patient demand "inappropriate care". I'm sure I will encounter this. I agree with what the article says but I do not know personally how I would deal with this yet.
And so it is with most things in articles like this. I generally agree with everything stated. This article speaks of altruism, social justice, community involvement (community defined in many ways, from local to medical peer groups). I think that these things are engrained in me. But what opportunities will I have to act on them? One time things? Lifetime committment things? I am excited to find out.
But now, back to biochemistry.
Articles like this are the forest, I think. Enzymes and nerves are, I feel, the trees. Right now I look up and see the canopy. One cannot know a forest unless they understand how its components work together.
I don't know how the things in this article will apply exactly to my future practice. Sure I could generalize - for example, the statement about "physicians must be honest with their patients and should empower them to make informed decisions about their treatment" is followed by what I feel to be a "but" statement saying unless those decisions of the patient demand "inappropriate care". I'm sure I will encounter this. I agree with what the article says but I do not know personally how I would deal with this yet.
And so it is with most things in articles like this. I generally agree with everything stated. This article speaks of altruism, social justice, community involvement (community defined in many ways, from local to medical peer groups). I think that these things are engrained in me. But what opportunities will I have to act on them? One time things? Lifetime committment things? I am excited to find out.
But now, back to biochemistry.
Sunday, September 7, 2008
Re: The Hidden (Real) Curruclum
What is the real curriculum of a medical school? I think it is a mixture of all three areas mentioned in the article: technical knowledge, procedural knowledge, and behavioural knowledge.
And I think that the hidden (real) curriculum found in this article is actually a pressure (prestige, money) that preys on student's predilections.
And I think that Duluth does things differently than the way many other medical schools do, at least according to how Von Gunten treats the subject. My professors who are researchers? I, for one, do not view them as the "rock stars" of the medical realm. Nor do I view those physicians who make goo goo dollars through minimizing patient contact (and with it effectiveness of treatment, in some cases) as being worth of emulation.
Hopefully I find here in Duluth a "hidden curriculum" which supports good people becoming good physicians who genuinely care about the health, comfort, well-being, and peace of their patients. Not only that, but one that fosters the graduation of physicians who are effective communicators. From my initial experiences here, I think I will.
And I think that the hidden (real) curriculum found in this article is actually a pressure (prestige, money) that preys on student's predilections.
And I think that Duluth does things differently than the way many other medical schools do, at least according to how Von Gunten treats the subject. My professors who are researchers? I, for one, do not view them as the "rock stars" of the medical realm. Nor do I view those physicians who make goo goo dollars through minimizing patient contact (and with it effectiveness of treatment, in some cases) as being worth of emulation.
Hopefully I find here in Duluth a "hidden curriculum" which supports good people becoming good physicians who genuinely care about the health, comfort, well-being, and peace of their patients. Not only that, but one that fosters the graduation of physicians who are effective communicators. From my initial experiences here, I think I will.
Wednesday, September 3, 2008
Re: Kirsner article
This article, like the last, worked to drive home the point that there is more to medicine than memorization, hard facts, reasoning, and "science" - whatever that may be.
At its core, medicine is a human to human interaction, something which we should not lose sight of. I think that this is essential to the work of any primary care physician.
I like hearing from people like Dr. Kirsner who have experienced medicine over a long period of time. He received his M.D. in 1933, I think. Last fall I spent a while talking with the physician who was present at my birth, a man who started practicing in rural western Nebraska around 1960 and who continues to practice today. I think that both Dr. Kirsner and Dr. Ruffing experienced medicine when the doctor's empathy and caring were a more central part of the average patient's experience. I hope to be able to emulate this in my future practice.
At its core, medicine is a human to human interaction, something which we should not lose sight of. I think that this is essential to the work of any primary care physician.
I like hearing from people like Dr. Kirsner who have experienced medicine over a long period of time. He received his M.D. in 1933, I think. Last fall I spent a while talking with the physician who was present at my birth, a man who started practicing in rural western Nebraska around 1960 and who continues to practice today. I think that both Dr. Kirsner and Dr. Ruffing experienced medicine when the doctor's empathy and caring were a more central part of the average patient's experience. I hope to be able to emulate this in my future practice.
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