Tag Archives: medical students
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%.
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.
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.
- Are You a Surgeon? Sorry, You’re Going to Be Sued By Age 65. (blogs.wsj.com)
- Docs Face High Risk of Malpractice Lawsuits (abcnews.go.com)
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.
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.
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.
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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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”
- 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!
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.
With the plethora of diagnostic devices and computer-generated devices, its not surprising that some doctors can arrive at a diagnosis without 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!
This one goes to, after much thought, the incident portrayed in the following video:
Its easy to see why this one gets the award when you take into consideration the following:
- The patient waited in the emergency room for 24 hours.
- She had collapsed for 1 hour before any action was taken.
- The utter indifference shown by other patients and staff.
- To cap it all, this did not occur in a third-world country!
Just for the record, the patient died of deep vein thrombosis. Read more in my earlier posting on the incident here.
Next Posting: Healthcare Blooper of the Year – Malaysian version
“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!
-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!
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.
“To cure sometimes, to relieve often, to comfort always”
-ascribed to Hippocrates (Greek physician, 460-370 BC)
As a medical student this message would have been drummed in countless times; and, as a young doctor, one will realise that permanent eradication of illness is not always possible and that many diseases cannot be cured. One needs to not just administer pain-killers but also to devote time to understand the patient’s agenda despite a busy work schedule, offer empathy and, most important, seeing the patient as a human being, not just an object to operate on or to inject drugs in.
When treatment has failed to cure and patients are about to die, many doctors and nurses feel they have failed and give up their hands in despair. Don’t forget that that the dying patient still requires another form of treatment – palliative care.
“When a doctor treats himself, he has a fool for a patient”
–Sir William Osler (1849-1919)
Came across this statement by a doctor writing about her personal experiences, and its worth remembering for those who are studying medicine. They will teach you in medical schools not to treat your own relatives, but not many will also say flatly that doctors should not treat themselves.
The reasons are manifold : professional objectivity is compromised, proper history and physical examination is difficult( try looking into your ear canals!), diagnostic reasoning may be faulty and emotional feelings like denial may come into play.
Emergency treatment and minor problems aside, it is best to consult a professional colleague. Doctors ask patients to seek medical care from doctors, so doctors are no different. Practise what you preach!