Category Archives: studying medicine

Licence to Practise…And Be Sued

Here’s some sobering news for doctors and those who aspire to be one. If you are a neurosurgeon or a heart surgeon, you’re going to face a malpractice claim at least once by the time you reach 65. Coming from the New England Journal of Medicine study published recently, even if you’re a doctor in a low-risk speciality eg  GP or skin specialist, the chances of being taken to court by age 65 is still high, at 75%.

Brain and Heart Surgeons Top the List of Those Being Sued (courtesy NEJM)

I’m not surprised at all..what with more well-informed patients, an egalitarian society, litigation-conscious families and the ever-present doubt on the quality of medical education..one can only expect malpractice claims to rise.

Medical students in particular should take note of this trend. Medical schools need to also address this issue in their curriculum. As it is well-known that, even after an untoward event, whether the patient decides to sue is largely dependent on effective doctor-patient communication – medical schools would do well to introduce communication skill as an integral part of a medical course.

Good patient-doctor communication can make the difference in whether a malpractice claim surfaces

A good doctor is more than just being adept at diagnosing and treating diseases – they have to be skilled at managing information and communicating with their patients.

Some of the Best Tests are Low-Tech, Low-Cost

Its amazing the number of patients who demand that their doctors perform tests using the newest  high-tech equipment in the belief that “the latest is the best”. Come to think of it, even some doctors  believe in this too.

In  earlier blog postings, When The Latest Need Not Be The Best and  Why The Latest Heartscans are Popular…But Not Foolproof, I had highlighted the lack of necessity for doing high-fangled tests and the dangers associated with doing them. So much so, it looks counter-productive in terms of the risks outpacing the benefits.

It may come as a surprise to many that some of the most reliable tests can be low-tech and low-cost as well. Take the measuring tape and the weighing machine, for example. With these, you can obtain the body mass index and the waist-hip ratio, the latter as important as blood tests for cholesterol and sugar in determining a person’s likelihood of developing diabetes, heart disease and metabolic syndrome.

The weighing machine is also useful for patients with heart or kidney failure who have already been put on treatment. Gaining just a couple of pounds can indicate an unhealthy buildup of fluids—a telltale sign that a patient is at risk of serious shortness of breath and other symptoms that could lead to a hospital admission. Information from the scale can lead to adjustments in diet, such as cutting back on salt, or medications to restore fluid balance without necessitating in-hospital treatment, This means extra savings in cost.

Now, a new study suggests cardiologists may want to add a stopwatch to their medical bag. More than half of patients who undergo open-heart surgery in the U.S. and Canada are at least 65 years old and growing numbers of them are in their 80s or even 90s. Timing how long it takes an elderly patient to walk five meters, or about 15 feet, significantly improves a doctor’s ability to predict whether a patient will be able to withstand the stress of surgery.

The Speed A Patient Walks May Determine Survival Chances After Surgery

 

This test, gait speed, has been used before to predict the frailty of elderly people. Now, it is used to see whether an elderly person can withstand heart surgery. Slow walkers—those who took longer than six seconds to cross the five-meter line—were about three times as likely to die or suffer such complications as a stroke or kidney failure and were twice as likely to have a prolonged hospital stay after heart surgery.(Read more on the study here).

In these days of rising healthcare costs within a recessionary landscape, it is indeed refreshing to note that some of the most useful tests need not be expensive and high-tech..

Nowadays, Doctors Stop Work As Soon As Their Shift is Over

Its not unknown  for doctors in EU countries to down their tools immediately when their shift-time is up, even if they were in the middle of performing a surgery! A 37 year-old English consultant related his experience here when the doctor assisting  him said he had to go as it was his ‘home time’…right in the middle of a laparotomy. Ostensibly, the main reason for this is the implementation of the European Working Time Regulations (EWTR) in August 2009, which resulted in a reduced working week of  48 hours. (btw, ‘conventional’ hospital doctors work at least 60 hours, including weekends).

Insufficient training posts and shorter training time..are today's doctors insufficiently trained?

Imagine the uproar if this were to occur in non-EU countries, where such a law would be considered primitive! I can imagine human rights activists decrying the ‘lack of professionalism among the materialistic-minded doctors’.

Doctors trained to be specialists in the  1990s will remember that their working hours were necessarily long because they were matched with training time – the more time you had, the more training you received. Nowadays, this is no longer valid and the path for training to be a consultant is now shortened considerably. The main reason given is that there was (and still is) a lack of training posts. Fair enough.

Sociologists have an alternative explanation for this type of behaviour – that the X and Y generations treasure their personal quality time more than just slogging away at work. They don’t live for work, they work to live“. Read more here.

Old-time surgeons will have difficulty understanding the work ethics of their junior counterparts unless they fully grasp the workings of the minds of the Y generationers. Already, there are fears that the new EU rules are going to produce a generation of European doctors who will be  “lazy, clock-watching junior surgeons”.

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A Tale of Three Doctors

Woke up one day this week to read about how the medical profession was  put in a rather unfavorable light, in various parts of the globe.

In Los Angeles,USA, it was reported that the late Michael Jackson’s doctor, Dr Conrad Murray, who practises in Houston was going to be charged in a few days time  for involuntary manslaughter. It was alleged that the doctor had administered the powerful anaesthetic drug, propafol, plus two other sedatives in a concerted attempt to make the pop star go to sleep. Propafol needs to be administered intravenously by an anaesthesiologist in a hospital setting and requires continuous monitoring as the drug can cause suppression of breathing, lowering of heart-rate and blood pressure. See my earlier posting “MJ’s Death Explained for details.

Dr Daniel Ubani - still practising in Germany

In Cambridge,UK, a foreign-trained doctor, on his first work assignment for the NHS after arriving in the UK the day before, administered an injection of diamorphine (an opioid used for pain relief) of twenty times the recommended dose to an elderly patient at his home for relief of kidney pain. Not surprisingly, the patient stopped breathing soon after the doctor had left. At the coroner’s enquiry, it was discovered that the doctor, originally from Germany, had failed his English test earlier and had never given the drug before. It was also not possible to extradite the doctor from Germany to face charges, where latest reports say he is still practising.

Dr Suresh Nair -1991 Sydney Uni graduation pic

Meanwhile, in Sydney,Australia, a neurosurgeon has been charged over the cocaine-related deaths, in November 2009, of two young women who had visited his apartment. Post-mortem results showed both women had died of cocaine toxicity. Having been suspended by the New South Wales Medical Board, he now remains in custody pending trial. Some unanswered questions remain, like having been a known cocaine abuser since 2004, why was he still allowed to practise by the Medical Board?

Having read these stories, I just wonder whether this is a trend of things to come, or whether the virtues of a noble profession are being eroded in the face of changing times? Perhaps, most tellingly, when I asked a student who had aspirations of being a doctor, why he had chosen the profession, his answer was, So that I can make a lot of money!”

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A New Tool In The Doctor’s Bag

They say the Internet has revolutionised the way the world is doing business and undergoing education. That’s true in medicine as well – gone are the days that medical students cut up human cadavers and lug around Gray’s Anatomy. The use of virtual 3D models and optical discs has made studying medicine a bit more bearable; but even these technologies will fall by the wayside in the future.

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Smartphones..the most important tool after the stethoscope

A recent study Taking The Pulse v9.0 issued by Manhattan Research found that 64% of doctors, more than double the number eight years ago, are using smartphones — iPhones, BlackBerrys, Treos and other hand-held devices.

Smartphones

How can smartphones help? Some examples:

  • A doctor seeing a patient for the first time can be astounded by the variety of pills given by previous doctors. By feeding in the shape, colour and probable use of the pill into a software called Epocrates, one is able to obtain a list of medications and images that match those criteria, allowing the doctor to identify the pill.
  • While dining in a restaurant, a doctor can receive an attachment by email showing an ECG done by a colleague of a patient about to get a heart attack. Previously, he would have had to stay at home and wait by the fax machine.
  • By the bedside, a doctor can check immediately the dosages of medicines, drug interactions and even show images to help the patient understand better.
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My favourite - the Blackberry Bold - largely because many medical programs are Windows-based

Such is the popularity of these devices that some medical schools, like Georgetown University in Washington DC  already require their students to each use a smartphone. This is a trend catching on fast and it looks like a matter of time before they are used in all med schools.

But with any new technology, there are reservations. Take privacy concerns, for example..all this patient stuff in a smartphone can fall into the wrong hands and create confidentiality issues. There are concerns too by some patients that it would be quite annoying talking to a doctor who’s busy peering into the small screen and apparently not paying attention to what is being said!

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Stress & Burnout…Even Doctors Get It Too

Met a colleague the other day in the hospital corridor who appeared uncharacteristically aloof and disinterested when we were discussing about a mutual patient we were managing. Taking into account his body language, it didn’t take too long to realise that he was exhibiting symptoms of burnout. A recent issue of the Archives of Surgery highlighted that as many as 38% of surgeons get burnout. It lists 10 reasons why doctors get burnout:

  • Length of training and delayed “gratification”

    burnout1

    Burnout...A Common Condition Among Doctors Too

  • Long working hours and enormous workloads
  • Imbalance between career and family
  • Feeling isolated / not enough time to connect with colleagues
  • Financial issues (salary, budgets, insurance issues)
  • Grief and guilt about patient death or unsatisfactory outcome
  • Insufficient protected research time and funding
  • Sex- and age-related issues
  • Inefficient and/or hostile work environment
  • Setting unrealistic goals or having them imposed on oneself

I can add one more…the increasing threat of medical litigation!

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Stress or Burnout? There Are Vital Differences Between The Two

So what is burnout?

Burnout is a state of emotional, mental, and physical exhaustion caused by excessive and prolonged stress. It occurs when you feel overwhelmed and unable to meet constant demands. As the stress continues, you begin to lose the interest or motivation in your work, leading to loss in productivity and  leaving you feeling increasingly helpless, hopeless, cynical, and resentful.

The negative effects of burnout spill over into every area of life – including your domestic and social life. Burnout can also cause long-term changes to your body that make you vulnerable to illnesses like colds and flu.

Its also important to differentiate between being stressed and burnout…those under stress are aware that if everything is put under control, things would be better; whereas those who are burntout often don’t realise they are there already and often don’t see any hope of positive change in their situation.

On the road to burnout?

You could very well be if you agree with the following statements:

  • Every day is a bad day.
  • Caring about your work seems like a total waste of energy.
  • You’re just plain tired all the time.
  • The majority of your day is spent unproductively on tasks you find dull or overwhelming.
  • Nothing you do makes a difference or is appreciated.

Take this quiz to see if you are suffering from job burnout here.

For Those Studying Medicine…(7)

With the plethora of diagnostic devices and computer-generated devices, its not surprising that some doctors can arrive at a diagnosis examining-a-patientwithout  coming into physical contact with a patient, other than by entering the room with a cursory greeting and a customary “how are you?”.

Physical contact  includes  simple things like hand-to-hand contact and actual physical examination of the patient. True, there are limitations as to what can be achieved by using your five senses, what with high-fangled scans and sophisticated devices being able to get to the root of the problem with hardly any sweat being raised.

My contention is that the physical examination is an important ritual in establishing a good patient-doctor relationship. This ritual sets the stage by which the person being examined transforms his role to that of a patient and also, places his trust in the hands of the doctor examining him.

And just in case you think rituals are not important, we might as well have not had the Presidential swearing-in ceremony for heads of state!

For Those Studying Medicine…(6)

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Good communication skills increase rapport with the patient

“What’s happened to the enlarged spleen in Bed 10?”

How often have you heard a doctor say this to medical staff?  Engrossed in the technicalities and the medical paraphernalia of the disease and its cure, many doctors tend to forget that behind the medical problem is a live human being, with emotions and real feelings. Unconsciously, they have depersonalised the patient and treated them just as an object.

One of the qualities of a good doctor is that they do not forget that they are always communicating to another fellow human being with emotions and feelings. And this includes good bedside manners like greeting the patient on approaching the hospital bed..each time and every time!

For Those Studying Medicine..(5)

“A journey of a thousand miles begins with a single step.”

-Confucius (551-479 BC), Chinese philosopher and founder of Confucianism

Its often been said that studying to be a doctor is a calling, as opposed to many other professions when its just involves studying to obtain an occupation. To become a doctor not only involves studying hard but it involves a change in one’s lifestyle and attitude towards life, in the pursuit of the maxim ” to cure sometimes, to heal often and to comfort always”.

Many medical students appear daunted at the long tortuous years of study ahead of them but this is often made easier if, before taking that first step, that you have the right aptitude and attitude. In my book, you do need some brains (though not as much as a rocket scientist), but more important, the three paramount qualities that you need are :

  • a desire to help others
  • a love for learning
  • a curiosity towards how diseases affect people

If its money you’re after, there’s a lot of other careers which are more lucrative; minus the sacrifice, effort and responsibilities of becoming a doctor!

For Those Studying Medicine..(4)

The superior doctor prevents sickness;
The mediocre doctor attends to impending sickness;
The inferior doctor treats actual sickness;

-Old Chinese Proverb

Comments: This saying exemplifies the holistic concept of Chinese traditional medicine, whereas Western medicine focuses mainly on curative treatment. If there’s an infection, the Western-trained doctor would focus on antibiotics to knock off the bug, but Chinese medicine would attribute it to imbalance of forces in the person and focus on their general wellbeing and rectifying the imbalance. There is a greater emphasis on prevention; as seen by the omnipresent barefoot doctors promoted by Mao Tse-Tung in the 1960s.

Medical students should not forget that preventative medicine is the backbone of their role as doctors and not over-emphasize curative treatment. The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, in diet and in the cause and prevention of disease, so said Thomas Edison.

Management staff can learn from this too : it is important to pre-empt any problems from arising; by looking out for warning signals, rather than allow untoward events to eventually happen.

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