Cast & Curious

Tag: Medicine

  • How will I (probably) celebrate christmas

    Physician on call Christmas eve

    The first question really was, “Do physicians really celebrate Christmas?”.  Hardly an easy question to answer because , even here in my community, physicians are a diverse mix of personalities, cultural upbringing and religious beliefs. But a fairly common experience among physicians will give you an idea where most doctors will base their answer(s) to this posit.

    Time.

    Indeed any physician’s career is synonymous with the word “busy” and time, even if mostly it is theirs to spend,  is rarely in their control. Me for example, has had most of my adult life Christmases (and new years), in the hospital or in the operating room. Firecrackers and alcohol made it a point that I am preoccupied with mangled limbs during these times when everyone else is busy merrymaking or hearing a mass or is with their family. In other words, majority of my Christmases is spent with patients. Not a good thing for my family perhaps but yes, there’s quite a few profession with such altruistic endeavors instead during our supposed “rest” or vacation. So my answer will be “yes, physicians do celebrate Christmas but mostly, of attending to our patients”.

    More time.

    If for some reason a doctor ‘frees” some time off his busy schedule and patients, chances are, he or she’d be attending other social functions related to his profession. I remember receiving Christmas party invitations last year scheduled for almost all days of that week ! December and the Christmas season   makes us a much sought after godfathers for every living angels in this part of the world.  In the Filipino culture and tradition, saying no to an invitation is taboo. Finding gifts for all of these events are a bit too overwhelming if you don’t have a staff to handle it for you. I don’t have a staff, so now you know why I looked harassed and disheveled during Christmas season. Even that single Christmas decoration, a single ‘parol” in our kitchen has gone caput this year.!

    But this year, there will be less of these social events and more time with my family. Not even gifts, just the basic spending time with a family that for so long ago, miss me during the previous Christmas season. And for all those scrupulous patients (including careless parents)  who despite strong warning from health officials, still blow those hellish firecrackers and get injure in the process, I will make sure you get your share of ‘lessons’ learned correctly. That’s not without saying I’m charging double  for intentional recklessness that rob me of my valuable family Christmas time!

  • Chief’s Notes:Life and death tasks and physician’s perception to change

    Amongst professionals around, physicians are slow in adopting to change. By change I mean adapting  innovative ideas to handle cases, concerns and issues. In our aim to effect innovative administrative policies and changes, I’m trying to understand the behavioral reason behind this “reluctance” to adapt among physicians.

    Many physicians are not inclined on taking risks, especially when the issue on hand concerns them, their patients or their practice. An admirable trait perhaps that evolved primarily to safeguard patient’s safety and is ingrained in the professions’ dictum- “Primum non nocere“. First do no harm.

    When taking to the extreme, and coupled with an obsession towards handling ALL (medical or otherwise)  tasks as a matter of life and death, breakthroughs for innovations rarely push beyond the research stage. A physician will stick to whatever will sustain life from his or her experience. Thus, whenever an innovative solution for improvement quality of care is implemented, changing perceptions and attitudes will be a bloody issue to tackle.

    One other reason is the lack of  (new) knowledge and skills needed to adapt to change. For whatever reason we have, without the necessary new knowledge and skills, no physician will dare venture into any “unfamiliar” tasks. A seemingly slow adaptation is seen among physicians.

    It’s quite obvious then that to effect a change in perception or hasten adaptation of any new policies, innovations, or new ways of treating a particular disease, knowledge, attitude, values and skills (KAVS) should be initiated first. That way adaptation to  innovations and policy changes will be a bit faster than what we usually observe today.

  • Reviving the physician’s administrative function

    Right. I almost forgot. The medical staff do have “dual” functions.

    The medical staff has a dual and overlapping management system- the administrative which involves the activities of a medico-administrative character, and professional, which concerns of the clinical aspects of its functions.

    The physician is typically absorbed with the clinical aspects of his profession and rarely bother with administrative functions unless he or she is managing a large group practice or a hospital. Private, solo practice large reduces the physician’s administrative function to bare minimum.

    This may not be necessarily true in a practice that involves a tertiary institution.

    This realization struck me as I was tasked an administrative position of setting up clinical services for a tertiary level health care facility. While defining clinical functions is not a “breeze”, setting up additional administrative functions for the involved physician is like “walking into a storm”. Again, this is seemingly related to physician’s preference to clinical functions rather than the administrative part. In reality, most physicians shy away from ANY administrative functions at all.  I now understood why physician administrators grow (or lose) gray hairs by the hundreds each day.

    physician as administrator
    physician as an administrator, what gives?

    The reason?  My personal observation is this: As a physician, we were trained mainly on the clinical aspects of our profession. The few that got some training on the administrative skills probably got stuck in such functions. This compartmentalization of functions seem to enhance productivity on either of such functions but not on both. We were trained to specialize. Even solo, private practice seem to support this observation. The other reason is that physicians are generally slow to adapt to any change. Our comfort zone is just to comfortable to let go suddenly.  Thus, physicians tiptoes and are slow to adapt to administrative changes intended to improved  health care delivery.

    This is where I am looking for ways to get viral and enthusiastic response from the medical staff. This dual function of hospital based physicians are intertwined and complementary. Defining such functions is necessary for providing top notch health care service and the smooth operations of the health care institution. I’m not just saying this because I’m now part of a hospital administration. As I’ve said before,  have I recognized administrative functions before in a solo practice, my practice would have been smoother and productive.

    In your practice, do you really care about administrative functions at all?

  • Notes to the knife II: The opposite of humility

    Again? Yes. Again and against.  I will write about humility in knife wielders until this amazement transforms into a virtue. In the professions of demigods, any opportunity to get enlightened on humility doesn’t come by so easily .  So when it knocks, one should not wait for two or three knocks before opening the door.  The great student doesn’t need the winds to howl before opening his heart to learning. Humility, I should say, comes right into your face before you even knew it did. Like what happened to me recently. When I took the role of patient..

    My mortal lessons
    Notes to the Knife II

    It probably was just a viral infection but before the lab result got out and the diagnosis made, I took the role of the patient religiously and found time to interest myself with observing people around me. A physician admitted in room 204 is something a phenomena to everyone else. Including myself. Not the fondest role any physician would want, but certainly the most engaging. Of course, not until some real patients ask you about this ‘anomaly’.

    Being the patient, in the reversal of roles, is it really that easy for you? You know, relative to us, real patients, you (the actor patient) have almost everything you needed within your reach.(Unlike us patients, where we often cry for help on this and that..)- real patient X.

    Hell, NO.

    When this  knife wielding body go awry for one infinitesimal  reason, our chaotic hordes of Hippocratic knowledge put more distress on thyself than any other patient could ever think. Let me exaggerate. A hundredth decimal change in our body temperature would trigger a bazillion neuro impulses on our cerebrum that would then, extrapolate a gazillion more differential diagnosis that are rarely confirmed that is true. In short, we have more worries because we knew a bit more. Yes, my dear patient, sometimes, ignorance is bliss. Knowing something worse than just cold, flu or skin allergy as a differential diagnosis is no fun! It burns our distress horns more than you can imagine.

    Knife wielders are good actors. But we are not that good as a patient. We are the worst patient a doctor can get. Of course we really wanted to act like we’re patients when we are the patient. But it ain’t easy when you know for example, that a skin test is more painful than a deep laceration. I for one would rather sew myself up  than have someone stick a needle into my arm. There’s too much pain when you know whats coming right into your skin.

    IV bottle
    Opposite of humility

    Okay you try to act like the patient, but does your doctor treat you like your the patient?The nurses?The x-ray man?How many times did you peek at your own chart? In fact, most physicians of physician-turned-patients never mutter a single piece of conjecture to this patient until he or she is 101% sure about the diagnosis. The convoluted fear of the so many possibilities is staggering.   Easy patient huh?

    Last, and probably the most interesting phenomena I’ve noticed- when the knife wielder gets sick,  other people  would then say “he’s got it!he’s got it! We’ll get it too!’ This ‘when-doctors-get-sick, its going to be doomsday-on-us’ charade is very annoying. Exaggerated? Maybe. Got something related to the profession’s supposed infallibility. But then again, is it really that way?

    Where does humility stand in all of these?I’d say below your humility our dear patients. Doctor turned patients swallow a large chunk of their infallibility grid to be treated adequately. It takes humility to accept diagnosis a mile away from what you knew. It takes a hundred more strength just to keep shut your mouth instead of whining in pain  receiving a cut not from your own knife. It takes humility to be just a patient for even one second. It takes more humility than just humility.

    Bottom line is this. When doctors get sick, the implications creates waves more than what a regular patient will. Sort of a celebrity thing but more than that. The ripples are often beyond entertainment. Some even wreck havoc on some patients perception of their health. So maybe this is why some knife wielders need to be good actors and actresses whenever they exchange roles with their patients. Celebrity easy?!Obviously not.

  • Mortal Lessons for a surgeon, my notes on the knife

    I rarely write book reviews.  For one, I don’t read reviews myself before reading any book I’m interested. Two, I  usually end up not flattered of the books I’ve read, something like bitin and wanting for more. Thus, recommending (or not) any book I’ve read is difficult for me.

    Before I got into med school, I use to read (everywhere-rest room, bus ride, nooks etc) books to entertain. Then the rigors of medicine reduced this reading to a scientific exercise– that rigid, boxed, get-the-gist-then-memorize-acumen needed for medicine man like me. Now into semi leisurely private practice, I’m slowly picking up what’s left of my literary inclinations by reading books that entertain. Books, that put medicine in a literary perspective.

    So when Gilbert Tan gave me this book- Mortal Lessons: Notes on the Art of Surgery, I was in for my big ‘reawakening” read. Time to jump start those comatose, literary brain cells that hibernate in my right hemisphere. I told Gilbert I would wait for my reading ‘groove” before starting to read this book. As soon as I got inside my car however, I took a sneaky a peek on some pages of the book.

    Richard Selzer, is in fact, one of the author of our anatomy bible, that large book that could qualify as a 10kg dumbell,- Grays Anatomy Vol II.  Selzer also wrote for the New York times on one occasion, pondering about the tribulations of a malpractice ordeal.  The fact that he was a medicine man didn’t surprised me. I can name a few good books written by doctors turned famous writer. What brought my eyebrows up was the fact that Selzer is a surgeon. These steel cold knife wielders are one hell of writers. This is aside from the fact that there are only a few of them who actually writes about medicine in a modern Shakespearean (is there such?) style.

    Well, try to read the table of contents or the introduction. The introduction page is entitled “The Exact Location of the Soul“. That got me into a frenzy of reading.

    I’m not going to narrate what I read here. Go find yourself a copy. Or find your own Sir Gilbert. But I will tell you my thoughts when I’m done reading it. It would aptly be titled “post mortem of a literary corpse”.