Comments for DB's Medical Rants

Comment on Teaching bedside manner by Attending

Attending — Tue, 09 Feb 2010 05:45:19 +0000

I am an academic attending at a tertiary care facility….and I agree that bedside manner is not taught nor appreciated in medical education the way it should be. This is precisely what I spend a large part of MY time teaching but it is not appreciated by academia at large nor…in fact….surprisingly also by many of the residents and students who are just there to get by and get on to fellowship and making money. It is sad that people care more about getting patients out of their clinic or ER or floor bed than staying that extra five minutes to talk to a family and actually meet their needs. Now this is by no means everyone….there are those bright and shining stars who are dedicated and really do care and have that caring style….the problem is…they already KNOW bedside manner so how do we teach those who don’t? And who sometimes don’t care?
I’ve seen medicine change from a field full of self sacrifice and caring for the patient….where we’d stay that extra few minutes to talk to a mother, where we’d pick up the phone in the evening to call a parent with lab results….to one in which admissions are passed off as soon as the clock hits twelve without so much as any curiosity the next day as to what befell the patient….where no one every really follows up on “whatever happened to that patient in the ER anyway??”…and where residents actually give me attitude for suggesting they take a family’s number down and call them with results…..I get a blank stare and a look like “aren’t YOU going to do it for me????”….well yes of course I can do it…but in doing so you rob yourself of the chance to bond with the parent, to hear the appreciation in their voice, and to know of the reward of going the extra mile for your fellow man.
I wish I knew how to impart enthusiasm on all doctors….my experience is it is one of the most difficult things to teach and in this age of evidence based medicine….all that seems to matter anymore is numbers and RCT’s and QI projects that have little to do with building the human element back into medical care. Patients pale by comparison. Sad times indeed. Great article!

Comment on Do we need a new Flexner report? by Jared

Jared — Sun, 07 Feb 2010 15:38:05 +0000

DB, this line from the linked article frightens me. "These schools' defense, that even an inadequately funded medical school served a purpose by offering an opportunity for disadvantaged individuals to attend, was soundly and correctly rejected as a bogus argument."

It is true that inadequate funding, and lack of experience or knowledge have been shown to inhibit education. But, if that were a primary inhibitor of education, scholarship would have stagnated more than we think it has.

Where I believe we need to focus our efforts is to define where the mission creep has occurred throughout medicine and medical education, and provide for a new Flexner-styled report to help us understand what has happened, and bring us back to our foundations. Actually part of that has happened in an NPR program titled "This American Life".

The two-part discussion is here http://www.thisamericanlife.org/Radio_Episode.aspx?episode=391 and here http://www.thisamericanlife.org/Radio_Episode.aspx?episode=392

Comment on Do we need a new Flexner report? by Medical Contrarian

Medical Contrarian — Sun, 07 Feb 2010 15:05:45 +0000

I could not agree with you more. I just yesterday wrote a piece on a related aspect of this marriage of medicine and the university. http://georgiacontrarian.blogspot.com/2010/02/medical-knowledge-vs-medical-know-how.html

Comment on Do we need a new Flexner report? by Clinton

Clinton — Sun, 07 Feb 2010 02:26:24 +0000

Keep up the good work, DB. I am on the verge of graduating from medical school and I have been pondering going down the academic medicine professional pathway post-residency… but only if we can stick to a mission statement of "teach students and residents."

I agree that all too often, the business philosophy dominates and the students (and patients!) suffer.

Comment on Do we need a new Flexner report? by PeterW

PeterW — Sat, 06 Feb 2010 00:59:22 +0000

Good point on focusing on students, but remember that even with exhorbitant tuition, it costs still more to train students and residents. So SOME form of revenue is still needed, even if we could prune back other activities..

Comment on It’s the job – the only solution to primary care by Hospitalist Jobs

Hospitalist Jobs — Fri, 05 Feb 2010 21:50:42 +0000

I am disappointed to say that I think that the politicians are going to be interfering for some time to come.

Comment on How do we provide more coverage? by Happy Hospitalist

Happy Hospitalist — Fri, 05 Feb 2010 21:12:34 +0000

You say we spend too much on the uninsured. Perhaps. May i also suggest we spend to much in the private sector to allow the government to undercut true pricing. I suspect, based on shear volume of government patient, we spend far more subsidizing Medicare and Medicaid through private premiums than we do subsidizing the uninsured. And that's why more government is not the solution, but rather less.

Comment on Why patients stop taking statins! by Sonja

Sonja — Fri, 05 Feb 2010 20:10:14 +0000

I'm now 52yrs old and It,s been 2yrs since my Dr prescribed first Simvastatin 20mg then Crestor 5mg (Cholesterol was then 251). Both times I had very bad side effects. From the Simvastatin I developed muscle pain in my legs, arms and backand left side. The side pain lasted 8 months after stopping the Simvastatin. One year later my Dr convinced me to try Crestor taking it just 3x/week. After 4 weeks I had neck, arm and wrist cramps. The Dr thought it was Carpal Tunnel. I immediately stopped Crestor and was back to normal in about 3 weeks. About 6 months ago I started taking Red Yeast Rice 1200mg 2x/day. I thought it could not possibly be working since I had absolutely no side effects. Just got back from my annual physical – cholesterol is down to 174!!! (I had originally asked my Dr if she thinks I should try Red Yeast Rice – she told me "that doesnt do anything"). I'm glad I tried it anyway – finally my life is back to "normal"

Comment on “just a sore throat” is a dangerous phrase by darren

darren — Fri, 05 Feb 2010 16:42:54 +0000

Hi My husband presented with a sore throat on the 14th December and compained of a stiff neck and general fever.He visited the Doctor whom perscibed him cocoldamol,and tomazapane.As he was working considerably alot over this period he didnt take the Tomazapan.on the 21st Dec ,buy which time he was getting vigorous shakes and his neck had developed a lump he visited the doctor again who gave him antibiotics and told him to return on the 23rd December.He felt extremely lathergic and the lump on his neck was getting larger,also he was having hot and cold sweats and seemed to be looking very gray.He visited the doc again on the 23rd and was admitted to hospital and put on iv drips,on the 24th Dec he was moved to another hospital for scans.The lump on his neck by this time was getting extremely large but still no diagnoses was given.His condition seemed to improve on the 28th Dec and on the 30 dec he was transfered back to the 1st hospital.he had had numerous scans and needles incerted into his neck.On the 30 dec we were told he could be discahrged the following day,although the lump was still large.The doctor told us it could be lymphoma,he then got a vascular surgeon to have a look and he said he had only seen this condition once in his career and said he thought it was "no blood in the jugular vein".He was sent for another scan and discharged from the hospital with a sick note stating lemierres syndrome.He is getting better and hoping to return to work next week although he still has a slight lump on his neck and is having another mri scan next week.If anyone would like any details pls feel free to email me Helen.masheder@futuretravel.co.uk

Comment on We need health care reform by Michael Kirsch, M.D.

Michael Kirsch, M.D. — Thu, 04 Feb 2010 21:44:14 +0000

I am not certain that the Democratic plan is really better than the status quo. I think their plan made significant inroads on expanding access, but failed in controlling costs. To accomplish the latter, various stakeholders would have to sacrifice income, careers and companies. Not surprisingly, there weren't too many volunteers. Hospitals and Pharma agreed at the outset to give back, but most of the players in the game zealously protected their parochial interests. My view is that medical overutilization should be attacked. Of source, an 'overutilized' test or treatment is someone else's income. No easy solution here. Get prepared for microreform.