This afternoon I was reviewing some guidelines and standards for my Family Med shelf tomorrow. One of them is to counsel any woman of childbearing age to take 0.4 milligrams of folic acid daily to decrease the incidence of neural tube defects should they become pregnant. (By the time a woman realizes she's missed a period or suspects she is pregnant, it is too late for additional dietary folic acid to play a part in reducing NTDs.)
Why not put that 0.4 milligrams into the birth control pills that most of the young women I know are taking? Not everyone who gets pregnant on the pill wants an abortion. Half of pregnancies carried to term are unplanned. That would be such a great idea...
Since cereal started getting fortified with folic acid the incidence of NTDs has decreased by 50% in Canada (probably similar rates in the US, but I'm too lazy to find the studies). There's some controversy about the fortification; some studies suggest a link between folic acid consumption and increased incidence of colon cancer. Others complain that fortifying with folic acid masks B-12 deficiency in the elderly. Why not throw a little B-12 in the cereal too?
Thursday, October 9, 2008
Wednesday, October 8, 2008
Bless me, Doctor, for I have sinned
The more experience I get with patients, the more parallels I see between doctors...an
d religious clergy.
1. Patients are often afraid that their doctor will judge their bad habits.
Probably one out of three patients makes some snarky comment when I ask them to step on the scale in clinic. "Oh, I've been bad this week!" or "Can we skip this part?" or "It's my shoes, these shoes are soooo heavy!". Similarly, when I ask patients if they smoke, or how much alcohol they drink, I'm met with a series of comments. "Only when I'm stressed" or "Sometimes I need a break for myself" or "You have to have a little fun!".
I know many of them are afraid, as I ask my questions and jot down a note occasionally, that I am forming judgments about them and their lifestyle habits. My job is to find out everything I can about their health and habits so that we can work together to make that patient the healthiest individual possible. I don't spend time judging people; most of us are guilty of the same bad habits, so it's hard to point fingers at others who overeat or overdrink.
But I can't blame them. It makes me remember Confession Day in my Catholic elementary school. I was so terrified that the priest would remember me and my sins when he saw me walking in the hall the next day at school. Even though the head priest told us that he was only a "conduit to the Lord" for our sins to be heard, I had a hard time believing they didn't get together later at the rectory to talk about all of us :)
2. Patients tell their doctors things they don't tell their friends, family, or even spouses.
While I myself didn't have any salacious tidbits to impart to my priest at age 10, nor would I be honest enough to do so if I went to confession these days, many of my patients share very intimate and sometimes shocking details of their lives with me. This to me is especially strange, since I am not functioning as anyone's personal physician. I am merely the medical student rotating through that clinic or hospital service for 2 months maximum; I find it hard to believe that anyone could trust me enough or feel comfortable enough with me to share some of the things they do. Things about husbands' affairs, or their sexual habits, or their drug and alcohol abuse. Stories about reforming their lives after years of abusing themselves and their children.
Sometimes when I am listening to patients, it feels like I have 2 separate brains. One brain is thinking about what the patient is telling me, how it applies to their health, and what else I can possibly do to help them if I can (sometimes they just need a listener, and that's fine too). The other brain is busy going "Holy crap, holy crap, holy crap, I can't believe I'm hearing this" -- not in a judgmental way, but in utter disbelief that I am privvy to such secrets. More than once I've left a patient's room feeling more like their priest than their doctor.
3. We both wear costumes to work.
Maybe priests and other clergy have more costume-y wardrobes for work, but doctors come in a close second. Surgeons roam around in what basically amount to pajamas with pockets all day. The pediatricians all have little stuffed animals attached to their (teeny tiny) stethoscopes, or wear scrubs with little cartoons on them, pockets bulging with stickers and lollipops. The rest of us wear these ridiculous white coats with all manner of papers, instruments and pocket manuals jammed into the myriad pockets. I subject my coat to a hot wash with bleach every week, but still the cuffs look a little dingy and that bloodstain from trauma surgery refuses to budge. I wonder who the hell came up with white as the color for our coats?
d religious clergy.1. Patients are often afraid that their doctor will judge their bad habits.
Probably one out of three patients makes some snarky comment when I ask them to step on the scale in clinic. "Oh, I've been bad this week!" or "Can we skip this part?" or "It's my shoes, these shoes are soooo heavy!". Similarly, when I ask patients if they smoke, or how much alcohol they drink, I'm met with a series of comments. "Only when I'm stressed" or "Sometimes I need a break for myself" or "You have to have a little fun!".
I know many of them are afraid, as I ask my questions and jot down a note occasionally, that I am forming judgments about them and their lifestyle habits. My job is to find out everything I can about their health and habits so that we can work together to make that patient the healthiest individual possible. I don't spend time judging people; most of us are guilty of the same bad habits, so it's hard to point fingers at others who overeat or overdrink.
But I can't blame them. It makes me remember Confession Day in my Catholic elementary school. I was so terrified that the priest would remember me and my sins when he saw me walking in the hall the next day at school. Even though the head priest told us that he was only a "conduit to the Lord" for our sins to be heard, I had a hard time believing they didn't get together later at the rectory to talk about all of us :)
2. Patients tell their doctors things they don't tell their friends, family, or even spouses.
While I myself didn't have any salacious tidbits to impart to my priest at age 10, nor would I be honest enough to do so if I went to confession these days, many of my patients share very intimate and sometimes shocking details of their lives with me. This to me is especially strange, since I am not functioning as anyone's personal physician. I am merely the medical student rotating through that clinic or hospital service for 2 months maximum; I find it hard to believe that anyone could trust me enough or feel comfortable enough with me to share some of the things they do. Things about husbands' affairs, or their sexual habits, or their drug and alcohol abuse. Stories about reforming their lives after years of abusing themselves and their children.
Sometimes when I am listening to patients, it feels like I have 2 separate brains. One brain is thinking about what the patient is telling me, how it applies to their health, and what else I can possibly do to help them if I can (sometimes they just need a listener, and that's fine too). The other brain is busy going "Holy crap, holy crap, holy crap, I can't believe I'm hearing this" -- not in a judgmental way, but in utter disbelief that I am privvy to such secrets. More than once I've left a patient's room feeling more like their priest than their doctor.
3. We both wear costumes to work.
Maybe priests and other clergy have more costume-y wardrobes for work, but doctors come in a close second. Surgeons roam around in what basically amount to pajamas with pockets all day. The pediatricians all have little stuffed animals attached to their (teeny tiny) stethoscopes, or wear scrubs with little cartoons on them, pockets bulging with stickers and lollipops. The rest of us wear these ridiculous white coats with all manner of papers, instruments and pocket manuals jammed into the myriad pockets. I subject my coat to a hot wash with bleach every week, but still the cuffs look a little dingy and that bloodstain from trauma surgery refuses to budge. I wonder who the hell came up with white as the color for our coats?
Monday, September 29, 2008
Thankful
Since starting my clinical rotations, I've begun to appreciate much more the level of human suffering that normal, everyday people are experiencing. Not third-world-starvation suffering (although there is that, too, in areas of this city) but the kind you might not ever know about unless you were that person's family, friend, or doctor.
Consider these patients (identifying details changed of course):
A 70-year-old man who buried his 45-year-old daughter yesterday after nursing her through a horrible battle with lung cancer.
An elderly woman who told me that "being alive is hell on earth" (over a dozen suicide attempts in the last 5 years).
A kid barely out of his teens with terminal cancer. He told me he would be relieved to die since his life had been so full of suffering from his illness.
The teenager who lost her two sisters, her unborn child and ultimately the womb that carried him in a horrible car accident. (That case had all the surgery attendings in tears at rounds that afternoon.)
It makes me feel like an ungrateful whiner, and rightly so, when I catch myself complaining about the price of gas or someone choosing to pay by the method of the check in the grocery line in front of me (props to anyone who caught the reference there! MK I'm looking at you).
Consider these patients (identifying details changed of course):
A 70-year-old man who buried his 45-year-old daughter yesterday after nursing her through a horrible battle with lung cancer.
An elderly woman who told me that "being alive is hell on earth" (over a dozen suicide attempts in the last 5 years).
A kid barely out of his teens with terminal cancer. He told me he would be relieved to die since his life had been so full of suffering from his illness.
The teenager who lost her two sisters, her unborn child and ultimately the womb that carried him in a horrible car accident. (That case had all the surgery attendings in tears at rounds that afternoon.)
It makes me feel like an ungrateful whiner, and rightly so, when I catch myself complaining about the price of gas or someone choosing to pay by the method of the check in the grocery line in front of me (props to anyone who caught the reference there! MK I'm looking at you).
Saturday, September 27, 2008
Genital Infections: Everyone's Favorite Blog Topic
I started this year off with Surgery as my opening rotation, and now I'm in Family Medicine. Very different ballgame. On Surgery, it was hernia, appendicitis, cholecystitis, lather, rinse, repeat. This week on Family Med it was chlamydia, balanitis, and yeast infections.
Not all genital infections or ailments are sexually transmitted. Balanitis, bacterial vaginosis, and yeast infections can occur in people who have never had sex (by any definition of the word). On the other hand, it is pretty much impossible for anyone to get syphilis, chlamydia, or gonorrhea without having had sexual contact with an infected partner. Incidentally, you can get infections not only in the genitals but also in the throat or rectum from any of these lovely organisms :) I wonder if all the kids wearing "chastity rings" know about that...
This week in clinic I saw two patients with concerns about STDs. The more interesting of the two was a middle-aged man arriving with symptoms suggestive of gonorrhea. He had been treated the previous year for the same infection. His boyfriend was also treated; he had passed it to my patient. My patient was visibly dismayed as I asked him about his symptoms. "I know what I have; I've had it before. Let me ask you this: is it possible that last year the antibiotics didn't work and I just now am getting sick again? I mean, that's possible, right?" His eyes were searching mine and begging for me to tell him that yes, it is possible, and no, your boyfriend's not cheating on you with the bus-boy at his restaurant. I hemmed and hawed a bit, trying to buy time while my mind scrambled for some explanation other than the obvious one that would explain this man's having gonorrhea for the second time in 6 months. I quickly concocted a reasonable-sounding explanation. "Well, sir, it's possible if you and your partner did not take your antibiotics at exactly the same time last year, and you were still sexually active with each other, you could have re-infected each other during that time period." I didn't know then that my reasoning was actually scientifically valid, but it certainly seemed logical to me at the time. (Please know that I always have an M.D. who comes into the room at the end of the visit to discuss diagnosis and treatment with the patient and also answer any of the questions the patient has.)
At any rate, my patient was tremendously relieved. I cautioned him to go home and have a long talk with his partner about the issue, and also to send his partner in for treatment since he was probably also infected.
That day I was a little bit Sex Talk with Sue, a little bit Dr. Phil (who I hate; I'm not linking to his website to give him more traffic. I'm sure everyone know who he is).
The CDC has an excellent section on their website about STDs. Check it out if you're feeling nervous.
Not all genital infections or ailments are sexually transmitted. Balanitis, bacterial vaginosis, and yeast infections can occur in people who have never had sex (by any definition of the word). On the other hand, it is pretty much impossible for anyone to get syphilis, chlamydia, or gonorrhea without having had sexual contact with an infected partner. Incidentally, you can get infections not only in the genitals but also in the throat or rectum from any of these lovely organisms :) I wonder if all the kids wearing "chastity rings" know about that...
This week in clinic I saw two patients with concerns about STDs. The more interesting of the two was a middle-aged man arriving with symptoms suggestive of gonorrhea. He had been treated the previous year for the same infection. His boyfriend was also treated; he had passed it to my patient. My patient was visibly dismayed as I asked him about his symptoms. "I know what I have; I've had it before. Let me ask you this: is it possible that last year the antibiotics didn't work and I just now am getting sick again? I mean, that's possible, right?" His eyes were searching mine and begging for me to tell him that yes, it is possible, and no, your boyfriend's not cheating on you with the bus-boy at his restaurant. I hemmed and hawed a bit, trying to buy time while my mind scrambled for some explanation other than the obvious one that would explain this man's having gonorrhea for the second time in 6 months. I quickly concocted a reasonable-sounding explanation. "Well, sir, it's possible if you and your partner did not take your antibiotics at exactly the same time last year, and you were still sexually active with each other, you could have re-infected each other during that time period." I didn't know then that my reasoning was actually scientifically valid, but it certainly seemed logical to me at the time. (Please know that I always have an M.D. who comes into the room at the end of the visit to discuss diagnosis and treatment with the patient and also answer any of the questions the patient has.)
At any rate, my patient was tremendously relieved. I cautioned him to go home and have a long talk with his partner about the issue, and also to send his partner in for treatment since he was probably also infected.
That day I was a little bit Sex Talk with Sue, a little bit Dr. Phil (who I hate; I'm not linking to his website to give him more traffic. I'm sure everyone know who he is).
The CDC has an excellent section on their website about STDs. Check it out if you're feeling nervous.
Welcome!
I'm not sure who I'm welcoming, since if I tell anyone about this blog it will probably be only my parents and sisters who read it!
I'm Liz, a third-year medical student (class of 2010). I'm working/learning in the clinics and wards of Urban Hospital of Urban University. If you don't recognize that name, it's because I made it up. Blogging about medical issues and real patients, even when identities and identifying details are changed or omitted, is tricky territory. The last thing I need is for some whistle-blowing classmate with an ax to grind to report me to the Urban Authorities.
Anyway, I plan on posting at least weekly and hopefully a bit more often than that. Topics will include interesting patient cases (for the most part) and my opinions on various bioethicalmedicolegalfinancialpersonal issues. That should cover it.
Please note my Patient Privacy disclaimer on the right sidebar! If you somehow think you've identified yourself or your ailments in a post on my blog, please leave a comment with your concerns, but I can guarantee that it will be a coincidence.
I'm Liz, a third-year medical student (class of 2010). I'm working/learning in the clinics and wards of Urban Hospital of Urban University. If you don't recognize that name, it's because I made it up. Blogging about medical issues and real patients, even when identities and identifying details are changed or omitted, is tricky territory. The last thing I need is for some whistle-blowing classmate with an ax to grind to report me to the Urban Authorities.
Anyway, I plan on posting at least weekly and hopefully a bit more often than that. Topics will include interesting patient cases (for the most part) and my opinions on various bioethicalmedicolegalfinancialpersonal issues. That should cover it.
Please note my Patient Privacy disclaimer on the right sidebar! If you somehow think you've identified yourself or your ailments in a post on my blog, please leave a comment with your concerns, but I can guarantee that it will be a coincidence.
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