Medicine From The Trenches

Experiences from undergradute, graduate school, medical school, residency and beyond.

Challenges to Come in Medicine

As everyone takes a much-needed holiday break, it would be good to look at some of the challenges ahead, the greatest of which is adequate delivery of health services to all of our patients. We continue to hear that the wealthy have adequate access but numbers those who are in the world of adequate access  to good health care are getting smaller. Even two years ago, the solid middle-class had tools available for access to health care but those tools are getting scarce. This scarcity of health care resources will increase largely from increased costs for everyone. The wealthy will weather these changes but more and more of our patients will not.

What do these changes mean for us who are charged by profession, to deliver adequate health care? These changes mean that we must take valuable and scarce time to study the political consequences of closing clinics, increased cost of insurance premiums and the disappearance of the mandate for having health insurance. Mandates are only a tool but they were decreasing the numbers of the uninsured in this country. More patients who are uninsured has always translated into increased costs for facilities that must provide health care. Those increased costs are passed onto patients who are more and more on the fringes of not being able to afford increased premiums.

We are charged with increased efficiency in the delivery of health care in today’s world of practice. These efficiency mandates have resulted in increased pressure for us to see more patients in a shorter period of time. While decreasing the time I can spend with a patient, my patient’s problems haven’t changed. When one is attending to a patient problem with potential life-altering consequences, adequate time must be given to those problems.

Mid-level practitioners are physician extenders and not substitutes for physicians who have dedicated themselves to years of training and hours of continuing medical education post training. While there is a role for all of us, physicians by training will and must continue to remain at the helm of delivery of health care to all. In some locations the middle class and the poor have been priced out of being evaluated by a physician which is not a sound practice.

As we head home to celebrate holidays, we all have to strive at every level not to take shortcuts for efficiency. We all have to give our best and make sure that our patients receive the best care possible. Currently the health of patients in this country, while we are at the forefront of medical device and scientific discovery, lags behind other developed countries. If even one person comes into my clinic with Stage 4 cancer because of lack of access to even basic preventative services, our whole system suffers.

Most of us entered medicine with the compassion to work long hours for our patients without regard for social, insurance or financial status. A child from Appalachia who barely finds regular food deserves the best medical care that can be provided in this country. Families are under increased pressure to take valuable income resources to provide food and shelter by putting of much-needed preventive services; often the parents skip important screenings for their children.

If I sound as if I am a socialist, perhaps I am by the standards of this country. My belief is in a basic level of health care for all humans regardless of ability to pay. One’s health is key to one’s life, well-being and quality of life. When I see a patient with uncontrolled hypertension who doesn’t take inexpensive medication; which can result in permanent loss of renal function or stroke,  I am disappointed and sad.

As a physician, I can’t settle for allowing human beings, my patient’s to suffer because of lack of access to health care. I have challenged myself to be proactive in anticipating the affects of lack of health care funding on the health of my patients. I have challenged myself to find solutions and to keep finding solutions for my patients, all of my patients. For me, this is my holiday present to those I serve not because this will make my life easier but because it’s my challenge.

Read, evaluate and educate yourselves in the political aspects and the business of medicine. If you don’t have classes in medical school that offer this, form groups that can advocate this practice. I can’t say that it will be easy but I can say that your present and future patients will have better health because of you actions. It’s not too late to make a start and it won’t be easy or quick but this must be done by the greatest health care minds on the planet.

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21 December, 2017 Posted by | medical school, practice of medicine | | Leave a comment

Teach Your Eye to See

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In becoming a physician, one of the adjustments that must be made in medical training, is teaching your eye to “see” what needs to be seen. There is no medical test or radiographic imaging study that can replace what the human eye powered by the human brain can see and process by looking at a patient who comes into your care. It’s important to see the extraordinary in the ordinary.

One of my favorite exercises this time of year, is to find a point of observation in a crowded shopping mall and observe the shoppers. I look for musculoskeletal pathology in terms of gait abnormalities. I look at who uses those shopping scooters, usually young morbidly obese or elderly people. I look at how parents, children, friends and others interact as they hurry about their shopping. I allow my brain to observe as much as I can in the short period of time that people move past me.

I look at the complete environment of the mall such as the location of security cameras, the noise level, the composition of the floor as well as how many people can pass my observation point. I note the location and characteristics of security guards who are likely observing me as I observe shoppers.

The point of learning to observe is to allow your brain and eyes to focus in order to hone your observational skills. If you set the f number high on the lens of your camera, everything comes into focus. If you set the f number lower, the object in the center of your photo comes into focus but the background is blurred for emphasis on the intended object. This is often how one’s attention can be directed but as a physician, I have to look at everything, much like the higher f number.

Take everything into the context and get a complete picture first but then focus on what needs the most care. Learn to use all of your senses especially your vision and hearing as you put your patient’s story into context. Learn to see posture, gait, and overall affect as you interact with your patients. If family members are present, look at their interactions as well. In short, learn to see the whole picture, evaluate it and see the extraordinary in the ordinary.

In photographing the ordinary document clip on my desk, I see aspects of it that I don’t usually evaluate. I see the shadows along with the background as the clip rests upon it. Today, I never saw the small black dots as I think of my computer desk as only non-reflective gray. Today, as I look at my photo of one of many clips, I see something that I hadn’t noticed before. This is another exercise that I often engage in with my camera which is becoming an extension of my eye.

Along with visual observation, I attempt to hone my mental processing by using my daily morning distance runs to enhance my meditation skills. As I run along, generally after warm up, taking my attention from how my body moves, I allow my mind to go where it will. Thoughts enter and leave or stay with my like a song that I can’t get out of my head. This is a great reason to take 30 minutes each day to do something aerobic for your mind and body.

Along with training my eye to see beyond the ordinary, I strive to train my mind to consider all possibilities. The more possibilities I consider, the better my diagnosis. As my experience in medicine/surgery has increased, I want my mind to absorb as much of those experiences possible. Take some time over these holidays and observe, evaluate and enjoy the processing. Observation is a practiced and honed skill; good for any physician.

18 December, 2017 Posted by | medical school, medicine | | Leave a comment