Tag: doctor

Categories
Clinical Patient-Centered Care Psychiatry Public Health

If you don’t ask, you’ll never know

On the first day of my first rotation as a medical student, my preceptor shared this bit of wisdom: if you don’t ask, you’ll never know.  In the nearly 18 months that have followed, I think about those words on a daily basis. To my mind, asking questions does more than just help us gather data. Asking questions establishes the type of relationship we are going to have with our patients. There are so many questions I wish I would never have to ask, whose affirmative answers are often indicative of the cruelty of this world. But when I ask about things like whether a patient has been the victim of abuse, I hope it sends the message that the relationship we are about to embark upon is one that can withstand such unpleasantness.

Not only can it be excruciatingly frustrating when other practitioners don’t share this point of view, it potentially has grave consequences. Unfortunately, patients with mental illness often seem to be the victims of physician “brush-off.” As someone who plans to devote her life to working with the mentally ill, I can only hypothesize as to why the same patients I find so much joy in working with are often given sub-par medical care as compared to their non-mentally ill peers. Perhaps physicians feel uncomfortable providing care for patients who come across as different than the norm, or perhaps their medical problems are too frequently attributed to psychiatric causes.

I recently cared for a patient who was two weeks post-partum from the birth of her first child. Though she was being seen for psychiatric admission, multiple aspects of her health were addressed during our initial evaluation.  When asked about her post-partum health, she denied having been scheduled for a post-partum visit with her obstetrician. Casually, she mentioned that she was having some malodorous green discharge since giving birth. It doesn’t take a medical degree to know that green, foul-smelling discharge is not a good sign, let alone when it occurs in the immediate post-partum time period. We were able to secure a next-day appointment with our hospital’s obstetrical practice, and with the patient’s permission, called ahead to the clinic to alert them of her complaints.

The next day, the care team gathered around to read the note from the obstetrician who had seen our patient. The note comprised all of five lines.  There were no pending labs. There was no mention of a physical exam.

There was no mention of the discharge at all.

The American Congress of Obstetricians and Gynecologists (ACOG) states, “It is recommended that all women undergo a comprehensive postpartum visit within the first 6 weeks after birth. This visit should include a full assessment of physical, social, and psychological well-being.”[1] The issue here, though, isn’t really about post-partum care. The issue here is about how we as health care providers need to provide equal care for unequal bodies and minds, and how we need to protect and advocate for our patients.

Patients with mental illness undeniably have poorer overall health. The average lifespan for an American adult with mental illness is a striking 30% shorter than for a non-mentally ill individual.[2]  While it is known that mental illness itself creates difficulty in accessing the healthcare system, for mentally-ill patients who do access healthcare, their quality of care is demonstrably lower than it is for those without mental illness. Literature consistently demonstrates that patients with psychiatric diagnoses receive fewer preventative health measures and have overall poorer quality healthcare than patients without psychiatric diagnoses.[3],[4] No matter what field of medicine you are in, you will see patients with mental illness. For these patients who sometimes cannot speak for themselves, the role of the physician in patient advocacy becomes even more crucial.

I will never know exactly what transpired during that appointment between my patient and the obstetrician, but I do know that obstetrician did not ask the questions that needed to be asked, and therefore did not ascertain the information necessary to appropriately care for the patient. At our request, a different practitioner saw the patient again. This time, the appropriate questions were asked, the appropriate testing was completed, and ultimately the patient was diagnosed with a sexually transmitted infection. Left untreated by the first obstetrician, this infection could have caused my patient systemic symptoms and permanent infertility.

As future physicians, it’s important for us to keep asking questions. So often, I have been surprised by the information I find when I ask a question about which I almost kept silent. Equally as important as asking the questions, however, is doing something with the information that you receive. The good doctor isn’t necessarily the one that stops the green discharge; they’re the one the identifies the problem in the first place and advocates on behalf of the patient to get the best people for the job.

[1] https://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Optimizing-Postpartum-Care

[2] http://europepmc.org/abstract/med/19570498

[3] http://journals.lww.com/lww-medicalcare/Abstract/2002/02000/Quality_of_Preventive_Medical_Care_for_Patients.7.aspx

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2951586/

Photo credit: airpix

Categories
General Reflection

Gender Application Gap

Gender stereotypes are pervasive in medicine. Last year, JAMA reported on the gender pay gap in medicine, and I found myself wondering if other stereotypes in medicine were true. I have seen some of it and heard more of it – from Scrubs, to blogs, to my own preceptors – ortho-bros, Ob/gyn girls, etc. According to a report using 2015 data from the AAMC and a study in the Journal of the American College of Surgeons that used the same data, these stereotypes seem to fit. The top male-dominated specialties by resident in the GME class of 2013-2014 were orthopaedic surgery (87%), radiology (73%), anesthesia (63%), emergency medicine (62%), and general surgery (59%). Women made up 85% of Ob/gyn, 75% of pediatrics residents, 57% of psychiatry residents, and 58% of family medicine residents. What I was really interested in, though, was whether there is any sort of advantage or disadvantage in being a male or female applicant in a sex-dominated field.

Luckily, this must have been on the minds of the ERAS stats department beacuse one of the headline charts on their FACTS web page is a table of specialty application data broken down by sex. The table includes the total number of applications per specialty and average number of applications per specialty broken down by sex. The data included all types of applicants – IMGs, DOs, and MDs. In working with the data, I chose to focus on Family Medicine, OB/gyn, Urology, Orthopaedic Surgery, General Surgery, and Family Medicine based on the AAMC data for sex-dominance as well as the stereotype of the field. I’ll admit that the latter is not a scientific method, but I don’t think I’m going out a limb here to say that there are (rightly or wrongly) generally agreed-upon stereotypes in medical fields. The modified table can be found below:

Specialty Female Applicants Mean Number of Female Applications Male Applicants Mean Number of Male Applications
Anesthesiology 1268 28.5 2524 30.9
Family Medicine 7168 49.4 7260 51.8
Obstetrics and Gynecology 2019 47.7 758 41.1
Orthopaedic Surgery 193 79.2 1116 74.8
Pediatrics 4576 36.7 2490 33.6
Surgery-General 2606 37.2 4871 37.7
Urology 110 64.2 383 62

Nothing shocking here. Male-dominated specialties like urology and orthopaedic surgery have more male applicants, female-dominated specialties like OB/gyn and pediatrics have more female applicants, and more evenly distributed fields have about an equal number of applicants.

What is more interesting is the average number of applications submitted per applicant by sex to the different specialties. Urology and orthopaedic surgery, probably the two specialties most culturally male-dominated both have higher number of applications submitted per female applicant. This seems to fit. Perhaps female applicants, knowing that the culture is male-dominated, feel pressure to submit more applications in order to be more certain that they will secure a residency in the male-dominated field. Ob/gyn, though, is the opposite. The most female-dominated specialty (both culturally and by AAMC data) has fewer applications per male applicant than female applicant. Even though 85% of the residency class of 2013-2014 was female, and even though far more women applied to OB/gyn than men, men do not seem to feel the need to overcome any sort of cultural disadvantage like women do when applying to male-dominated specialties.

This trend of male advantage in overcoming residency stereotypes holds true among other female-dominated fields like pediatrics where there are likewise more female applicants, but men submit fewer applications per applicant. I should note that this data does not include matriculation – only applications – so it is possible that men submit fewer applications and then do not get residencies. Also, this trend is not universal. Anesthesia is a male-dominated field where women submit fewer applications per applicant, though culturally it is not stereotyped to the same level as orthopaedic surgery or OB/gyn.

The New York Times wrote about this trend in 2001, noting that while men still made up the majority of practicing OB/gyns, upwards of 80% of residency applicants were female. But, according to the article, female OBs were taking a stand. They did not want OB/gyn to become a women-only field with some even supporting the reverse sex-descrimination argument that a few male OBs had taken to the courts. What is amazing in this scenario is that in spite of patient preference being the driving factor in making OB/gyn female-dominated, residencies see this as a problem and appear to be giving male applicants an advantage for residency positions. Meanwhile, male-dominated fields do not appear to have a problem with their male to female ratio. What does it say when women physicians are advocating for more men in their field over the preference of their patients?

Photo Credit: European Parliament

Categories
Lifestyle Public Health Reflection

#BoPo: Body positivity in the age of obesity

When I was younger, I loved watching the televised broadcasts of New York Fashion Week. I grew up in the heyday of heroin chic, which meant that the runway was a seemingly endless parade of vampire-pale, stick-thin waifs. I knew I would never grow up to look like these women, no matter how hard I tried. Even though I was perfectly happy to develop my own unique sense of style, I had an awareness that no one on television looked like me.

Fast forward two decades. The landscape of beauty has changed dramatically. I can’t yet say we’re living in a whole new world, but as a society, we’re making steady progress toward diversifying our expectations of beauty. More colors, shapes, sizes, and sexual identities are being beamed over the airwaves and into our living rooms.

The strides we’ve made toward diversifying our media did not just happen overnight. They occur as part of a larger historical context that has rebelled against normative standards of beauty for decades. The Fat Acceptance Movement, started in the mid 1960’s, is considered to be an offshoot of Second Wave Feminism. In 1967, the group held a 500 person “fat-in” in Central Park, NY wherein people carried signs of pro-fat messages and burned diet books. This was followed in 1969 by the creation of the National Association to Aid Fat Americans (NAAFA) which held a yearly summer convention until 2015. More recently, in 1996, the Body Positivity Movement was started by friends Connie Sobczak and Elizabeth Scott. Their goal was to help girls and women foster positive self-images so they could lead more fulfilling lives. Today it exists as an organization known as the Body Positive. Just a few weeks ago, this organization hosted the third annual CurvyCon. This convention was organized by two self-described plus size fashion bloggers to help women “chat curvy, shop curvy and embrace curvy.” All of these organizations and movements undoubtedly have their own platforms, but what they all share is a desire for bodies of all appearances to be accepted into society.

I firmly believe that every body is worth loving, but moreover, that every body is a body worth caring for. I see care as being a balance between the emotional and physical aspects of well-being. While I am hopeful that the shifting tide of acceptance in media translates more broadly to mean that us non-Hollywood folk also find value in ourselves and others no matter our physical appearance, as a health care provider, I am concerned that the Body Positivity Movement may be construed as an acceptance of obesity. If we accept ourselves for who we are, and who we are is unhealthy, then I question whether we are really showing ourselves the love that we claim.

I think what the Body Positivity Movement does well is emphasize self-value on the emotional spectrum of care. Where body positivity endeavors seem to lag, however, is in the promotion of physical health. Physical health can be just as challenging to realize as emotional health, yet it is just as important. Diabetes, hypertension, and hyperlipidemia are real diseases whose prevalence strongly correlates with obesity. They do not discriminate between people who love their bodies and those who don’t. They can affect and ultimately kill anyone whose body mass index falls into an unhealthy range. Our government makes the realization of physical health all the more difficult by setting up barriers for people to receive quality health insurance. Financial barriers are only one aspect of this problem. Any policy that allows for the proviso of health barriers, in the form of exclusions, special criteria, and added financial burden for people with pre-existing conditions, is a policy that does not believe all people to be equally worthy of care and is therefore an injustice.

Even though a key focus of the Body Positivity Movement is self-love, this does not mean people have to go it alone. As future physicians, we can partner with our patients and aim to help them strike a balance between their emotional and physical care. To me, this means helping our patients foster emotional self-love while also being conscious of physical health. While monitoring sensitive aspects of our patient’s physical health such as weight, infectious disease, and heritable conditions may be challenging, perhaps in part because they may draw on our own personal insecurities, we can discuss these topics using sensitive, collaborative approaches that are respectful of the patient’s emotional well-being. Ultimately, our goal should be to meet our patients where they’re at in terms of care and be a supportive force to propel them forward.

References:

The Body Positive: http://www.thebodypositive.org/about

Brief History: The Fat-Acceptance Movement: http://content.time.com/time/nation/article/0,8599,1913858,00.html

The Curvy Con: http://www.thecurvycon.com/about

Overweight and Obesity: Signs, Symptoms, and Complications: https://www.nhlbi.nih.gov/health/health-topics/topics/obe/signs

Photo Credit: Crystal Coleman

Categories
Clinical Emotion Public Health

The Day I Took off my White Coat

The man in scrubs stands in the middle of the room. He has a blood-filled syringe in one hand and hand-written lab notes on the back of an envelope in another. He scans the room, looking for someone or something. I follow his gaze. A young man is curled up in a ball on the floor, rocking himself back and forth while groaning in pain (gangrenous wound on leg). A man is throwing all his weight on his wife and yelling in pain (renal colic). A woman is holding a piece of red, soaked gauze tightly on the hand of her screaming 7-year-old son (amputated finger). An older woman in a wheelchair is drooling from one side of her mouth and has a drooping shoulder (stroke). A young man, handcuffed to a police officer, has circular marks around his neck and blood dripping from his mouth (suicide attempt with hanging and ingesting barbed wire). A young woman sits limply in a wheelchair, eyes rolled back, and blood on her clothes between her legs (severe anemia – abortion days prior). In this room no bigger than my mother’s walk-in closet, the suffering is palpable and audible, but the man in scrubs does not find what he is looking for, and begins to walk out. Before he reaches the door, an unconscious man is carried in to the room (antifreeze ingestion). Without missing a step, he reaches over and gives the man a rough sternal rub to wake him up, to no avail. He exits the room.

The man in scrubs is the sole medical resident in charge of the stabilization and triage of incoming patients at this Emergency Department situated in a Low and Middle Income country. As a visiting medical student, I am wearing a white coat, and although I should fit in, my general ignorance about the majority of relevant things makes me feel like an imposter. I shouldn’t be here. I shouldn’t be wearing this white coat.

‘You! You can help me!’ exclaims a woman in a wheelchair as she reaches towards me. Her face is covered, but somehow I know that she is in pain. Reluctantly, and with as much grace as a fish on land, I walk towards her. I walk towards her knowing that the only care I can provide is a hug, a tear, or a smile; the only prescription I can write is a kind word, and the only order I can put in is a prayer to the heavens.

I came to medical school to gain the skills that I need to better care for my neighbors, to share moments of humanity, of suffering and healing with my neighbors, to be meaningfully curious – to ask and answer questions that benefit my neighbors and our community, and to use medicine as a platform to implement meaningful social change. The irony is, I see none of that now; all I can do is stand defeated as I watch my neighbors suffer. I watch because I don’t have the money to cover the 15 pounds admission fee for every patient that is turned away at the door of the ED. I watch because I don’t know whether that comatose child who was just intubated is in trouble because his stomach is inflating instead of his lungs. I watch because I don’t know if that medical student just injured that woman’s radial nerve while trying to get an arterial blood sample.

With tears in my eyes, I fumble out of my white coat and head for the exit. I’m done watching, I tell myself. I’m done watching and I’m ready to learn. I’m ready to learn how to care for the suffering. I’m ready to be a part of the change I want to see in the world. As the door of the ED closed behind me, I managed to catch a final peek of the chaotic scene, as if to tell myself, ‘I will return when I’m ready.’

Looking back, I wish I had kept my white coat on, even if just to care with a tear, heal with a kind word, and pray for the well-being of my neighbors.

Photo Credit: Alex Proimos

Categories
The Medical Commencement Archive

“A Good Job”: Dr. Elizabeth Dreesen, 2017 Commencement Address of the University of North Carolina School of Medicine

I am pleased to present this week’s Commencement Archive piece: Dr. Elizabeth Dreesen’s keynote address at the 2017 University of North Carolina School of Medicine Commencement.

Dr. Dreesen grew up in a Navy family. Before earning her M.D. at Harvard Medical School, she completed a B.A. in History and African Studies from Boston University after spending a year at the University of Nairobi. After a year as an Obstetrics and Gynecology intern, she elected to train in General Surgery and graduated from the New England Deaconess residency program in 1994. She pursued further training in Surgical Critical Care at the University of Maryland Shock Trauma Center. After training, Dr. Dreesen and her husband started a rural General Surgery practice in western North Carolina. Dr. Dreesen has been at the University of North Carolina since 2006 and currently serves as the Chief of the Division of General and Acute Care Surgery there. She is known for her many years as a column writer for the Raleigh News and Observer, exploring experiences and issues in the world of medicine.

 

“Medicine isn’t just a good job, it’s a great job. It’s a complicated, bloody, hilarious, exhausting, inspiring job that will challenge you every day for the rest of your life. And jobs don’t get any better than that!”

What a unique set of adjectives to describe a job! When you think about it, few professions accommodate such diversity. We are truly blessed and privileged. Dr. Dreesen continues, discussing the features of this amazing career:

  • Dress comfortably—“At any given moment in medicine, somebody could throw up on you. So, as a group we dress respectably, but nothing too fancy.”
  • Excellent coworkers—“You’ll have coworkers who will amaze you.”
  • Enormous variety—“Every day is different in medicine, because every day you will meet a patient who surprises you… The breadth and variety of human experience will enrich you every day.”

Dr. Dreesen provides a unique perspective. We often view physicians as patient advocates and leaders in their field, however we may not fully appreciate the role they can play in their communities.

“In my own case, medicine made me a pillar of the community, a leader in my town. I’d been kind of an outsider through college and medical school – the protestor demographic. I was picketing the Dean’s office over my school’s labor policies, arguing with the administration about curriculum.”

As physicians we are privileged with a voice and a podium to make meaningful change. We should not shy away from these opportunities.

Finally, Dr. Dreesen echoes what I believe to be the most fulfilling reason that medicine is a “good” job.

““[Good jobs] change who you are, how you see yourself, and how others see you…In fact, a good job, a really good job, your new good job is one in which you have the opportunity to do moral good. And that is not an opportunity that every job affords.”

Photo Credit: Hamza Butt

Read the full speech in the Commencement Archive: https://www.themspress.org/journal/index.php/commencement/article/view/299/315

Categories
Clinical General Public Health

Medical Residents: A Dream Career Can Be Yours If You “Choose Sleep”: Dr. Ilene Rosen, President of the American Academy of Sleep Medicine

Now is the time that many medical residents are considering future plans, and hopefully giving thought to a sleep medicine fellowship. The truth is, we need you. Millions of Americans suffer from chronic sleep disease, and now more than ever there is an increasing demand for sleep physicians. As awareness of sleep health increases, millions of new patients will be seeking evaluations from sleep physicians.

Sleep medicine is an intriguing field with long-term growth potential and the opportunity to have a positive effect on the health of a huge population of patients. By diagnosing and treating sleep disorders, you can directly improve patients’ health and quality of life. In addition, because sleep is still a relatively young field, many research questions still exist. These questions can lead to involvement in cutting-edge basic, translational, and clinical research.

As a new sleep medicine physician, you may have the opportunity to practice in diverse settings. Opportunities abound in teaching hospitals, community hospitals, and independent sleep centers, allowing you to cultivate a work schedule that best fits your lifestyle. In addition, you can expect a call schedule that is quite manageable, as trained technologists at an accredited sleep center monitor most overnight sleep studies, and patients often self-administer their own sleep studies at home.

Another great thing about sleep medicine is the constant collaboration. As a sleep specialist, you will work closely with physicians from other disciplines and lead sleep teams of other health care providers – including nurses, physician assistants, psychologists and technologists. You may find many opportunities to collaborate with multidisciplinary teams, treating patients in coordinated efforts using the latest technology. I think you will find these collaborations eye-opening and educational.

So, the choice is yours and the options are plentiful to pursue your dream career, just as I did. There are 83 sleep medicine fellowship training programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). Learn more at www.ChooseSleep.org.

Categories
Empathy

Properly Unprepared

It was late afternoon, and the current nursing shift would be relieved in less than ninety minutes. The feeling of impending Friday freedom was palpable on the floor of the intensive care unit. I was on my way to meet with my last patient of the week, who had been brought in for an unintentional drug overdose. My goal was to determine whether the overdose was truly accidental, and if she was a candidate for compulsory psychiatric hospitalization. I passed by a large bank of computers without stopping, and knocked on the patient’s door. When I walked in that room, all I knew was the patient’s name, her age, and the reason for her hospitalization. Other than those preliminary facts, she was a complete mystery to me. I spent fifty minutes with the patient, and had a relatively pleasant conversation. When I walked out of her room, I opened her medical chart for the first time.

Unfortunately, that day, the story that I received from the patient and the information that I got from her chart told two different stories. Numerous providers had noted that she was irresponsible with medications, and I got the sense from the chart that she only sought medical care to gain access to controlled substances. Now that I had established a good relationship with my patient, I would have to re-interview her in an attempt to reconcile the information I had seen in her chart with the picture she had painted for me in the moments prior. My Friday freedom would just have to wait.

I would not be surprised to find out that the ICU staff was laughing at me that day. After all, I ended up spending more than two hours with this patient when I could have conducted only one brief interview. Even though the majority of my first hour with the patient was pure confabulation, I viewed it as a valuable component of my assessment. That first hour represented my sole opportunity to get to know my patient without any bias. Had I looked at her chart before walking into the room, I unquestionably would have written her off as an irresponsible, drug-seeking troublemaker. I would have asked her pointed, perhaps accusatory questions about her behaviors, and worse, I would have known exactly when she was lying to me, further eroding any respect I may have had for this patient.

Electronic medical record systems help to facilitate the sequestration of large amounts of information about our patients with minimal effort, and it’s largely considered taboo to meet with patients without first researching their medical record.  The information physicians can learn from the medical record can be undoubtedly beneficial in many situations, but extensive chart reviews can also lure us into a false sense of security, allowing us to preconceive an identity for our patients before ever having met them.

Had I read my patient’s chart that afternoon, I am certain that I would have made judgments about her that would have influenced my interview. Instead, I learned about my patient by allowing her to tell her own story. I thought about the information she shared with me, and, perhaps more importantly, what she failed to tell me. Because the patient never discussed her well-documented mishandling and possible dependence on prescription medications, I felt confident in making an assessment that this patient had relatively poor insight about her problems.

Featured image:
hGraph: patient + clinician looking together by Juhan Sonin

Categories
General Public Health

The Doctor as the Advocate

Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.
– Margaret Mead

Doctors are at the forefront of society. They see the dark pits and abysses of humanity that the rest of us try to forget – those depths of despair that many of us will never experience.

As Medicine continues to change, so too does its definition of illness and what it means to be ‘sick.’ Illness means more than just a set of symptoms or a mark upon an X-Ray; it resides within the choices we make every day, the people we welcome into our lives and the jobs we labor for decades at a time. As medicine continues to encompass more and more of our everyday lives, so it takes on greater responsibility.

Advocacy was defined by Earnest et al. in the January 2010 issue of Academic Medicine as an ‘action by the physician to promote those social, economic, educational and political changes that ameliorate the suffering and threats to human health and well-being that he or she identifies through his or her professional work and expertise’ (3).

An article written in the 2014 edition of the AMA Journal of Ethics further divided the definition into two: agency which refers to working on behalf of a specific patient, and activism which is directed towards changing social conditions that impact our health (6). Although many doctors are comfortable with the direct care of their patients, what can often be forgotten is our social responsibility. Not only do we need to treat patients as individuals, but also as a group – as a community.

The doctor’s role goes beyond the hospital walls. The patient is not just the person sitting in the clinic, but the person next door, the young lady who goes to the shops, the schoolboy who drags his bag over his sullen shoulders every morning. Illness takes place in more than the patient’s body; it takes place in society, in the neighborhood, in the schools that cannot provide support and the families that can no longer cope.; what impacts our health? Is it a parasite within our bodies, a virus that has entered so far into our habitat? Or is it unemployment, poor housing, discrimination, social isolation, loneliness, and abuse? These types of vulnerabilities lead to much higher rates of both morbidity and mortality in those affected (4).

The doctor is the voice of those who do not have one. The status of the medical doctor has been respected throughout the centuries; the curer of ills, the bringer of life. While this is gradually changing in the new era of patient-centered care, it is still a prevalent idea.

The doctor should use this privilege and rank within society to fight for those who cannot. As a group, doctors can hold a lot of power within society. Here in the UK, several Royal Colleges have voiced their opinions in the mainstream media over a number of issues already; in 2015 the Royal College of Psychiatrists spoke out about the long distances many of their patients had to travel for support (8), while in 2013 the Royal College of Physicians highlighted the need to tackle obesity more rigorously (9).

These days it is much easier to be an advocate. All it takes is a few clicks on the laptop and you can enter into the sphere of social media. A quick search on Twitter will highlight numerous debates that are occurring amongst patients and doctors, nurses and pharmacists, families and politicians. The battle is no longer held in the debating arena, but within the public sphere.

There is another side to advocacy. Once one decides to expose themselves to the public sphere, they open the door to a hailstorm of criticism and disapproval. By stepping outside of their niche practice and showing their faces to the world, they invite a whole host of attacks. To counter such negative experiences, many medical organizations have offered advice for healthcare professionals who wish to take a bigger role within society.

For example, the Canadian Medical Protective Association (2) recommends doctors:

  • Approach the issue with transparency, professionalism, and integrity.
  • Work within approved channels of communication.
  • Discuss concerns, suggestions, and recommendations calmly.
  • Provide an informed perspective, and attempt to include the perspectives of patients and other healthcare professionals.
  • Persuade rather than threaten or menace others.
  • Remain open to alternative suggestions or solutions, and try to build on areas of consensus.

Another critique against advocacy is the question of the doctor overstepping her boundary. Is advocacy within the remits of the doctors’ role? There is after all a social contract between medicine and society; it is society that holds up the profession to the highest esteem, expecting them to abolish disease and alleviate suffering. A person does not take off their professional cloak the minute they leave the hospital grounds – rather, its presence can be felt in every setting, whether it be the local shop where they grab their newspaper or the primary school where they pick up their children; it is a type of respect that is rarely be found in other professions (4). Medicine and society are intricately linked, and to claim that the doctor’s job ends once the patient leaves the room is to be blind to the role of healthcare in people’s day-to-day lives.

Yet the role of advocacy is not a role that every doctor may wish to take on. Some doctors may fall into advocacy with burning desire to change the world, while others would prefer the calming atmosphere of the hospital room, with just themselves, their patient and a piece of paper in between. I believe advocacy was described best in 2011 when Dr Huddle, Professor of Medicine at the University of Alabama Birmingham, said that it “must remain an occasional and optional avocation in academic medicine, not a universal and mandatory commitment” (3).

On another level, we must be careful not to politicize medicine too far (5) – medicine is for the public and not just a puppet dancing on the strings of politicians. Medicine must speak for those who cannot, yet still maintain its autonomy. Certainly many of the issues that impact our health are heavily politicalized areas – from housing to employment to funding cuts. Doctors must be careful when speaking for their patients. They must not allow their words to become blinded by their biases. We must remember that the doctor’s duty is first and foremost towards her patients – to the public.

There are plenty of examples of advocacy out there –doctors who blog about the daily struggles of their patients, Twitter discussions about mental health and social care, and the clinicians who write books and articles pursuing public policies with an aim of building a more just, equal and ultimately healthier society.

So, how can you get involved? Grab a book, read a newspaper; join the debates on Twitter, pen an article, start a discussion – go out there and let your voice be heard.

Below are some examples:

The Seven Social Sins:
Wealth without work.
Pleasure without conscience.
Knowledge without character.
Commerce without morality.
Science without humanity.
Worship without sacrifice.
Politics without principle.
– Gandhi, 1925 (7)

References

  1. Oxford Dictionaries. Advocacy [Online]. Available at: http://www.oxforddictionaries.com/definition/english/advocacy[Accessed: 4th January 2016]
  2. The Canadian Medical Protective Association. 2014. The physician voice: When advocacy leads to change [Online]. Available at: https://www.cmpa-acpm.ca/-/the-physician-voice-when-advocacy-leads-to-change[Accessed: 4th January 2016]
  3. Kanter, S.L. 2011. On Physician Advocacy. Academic Medicine. 86:1059-1060
  4. Dharamsi, S., Ho, A., Spadafora, S., Woollard, R. 2011. The Physician as Health Advocate: Translating the Quest for Social Responsibility Into Medical Education and Practice. Academic Medicine. 86:1108-1113
  5. Huddle, T.S. 2011. Perspective: Medical Professionalism and Medical Education Should Not Involve Commitments to Political Advocacy. Academic Medicine. 86:378-383
  6. Freeman, J. 2014. Advocacy by Physicians for Patients and for Social Change. AMA Journal of Ethics. 16:722-725
  7. Easwaran, Eknath(1989). The Compassionate Universe: The Power of the Individual to Heal the Environment. Tomales, CA: Nilgiri Press.
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  9. BBC News. 2013. NHS obesity action plea by Royal College of Physicians [Online]. Available at: http://www.bbc.co.uk/news/uk-wales-20878210 [Accessed: 17th January 2016]

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Speak up, make your voice heard by Howard Lake

Categories
Emotion Opinion Poetry

A poem

With our white coats on we feel the aura of pressure.
Pressure to be professional, to act accordingly.
We walk through the hospital with our heads held high, knowing we have a duty.

Tossing our white coats aside, true personalities shine through.
Most are gleaming of kindness and enthusiasm to learn,
Others are tainted.
These souls strive to reach a level of professionalism behind their white cloak,
but fail to reach expectations while unhidden.

What I see frightens me,
because these individuals will one day be responsible for the lives of others.
They lie to professors to get what they want.
They come to mandatory sessions, only to depart minutes later.
They cheat.
They sell prescription drugs.
They abuse prescription drugs.
They get intimate in the study spaces.
They do it all with a cheerful face.

What I see frightens me,
because I never want to be like them.

What can be done?
I’ve tried to approach them,
it ended friendships.
Administration knows,
yet I see no change.

Perhaps most terrifying,
these individuals exist at all medical schools.
They hide amongst the rest of us,
polluting the image of our profession.

So here I stand, turning a blind eye,
but what can I do?
I can’t change the mindset of others.
I can’t change their actions.

I only hope they aren’t my doctor.

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Rainbow pollution by gambler20

Categories
Opinion Reflection

Dear Doctor

Dear Doctor,

I hear you when you speak of that girl in the hospital ward. The ‘overdose in bed three.’ I hear the harsh judgements sneering through your lips, the sighs and the mutterings of ‘what a waste of life.’ As a student, I am all too privy to such remarks made in the corners of these hospitals. I have fallen upon them again and again.

Please do not be so quick to stereotype. Do you know how it feels to have your mind infiltrated by such intense emotions of self-hatred and loathing? Do you know how lonely it can be to lie curled within the four walls of your bedroom, just you and your mind waged in an eternal battle?

Yes, I realise how cliché that sounds. I know you have just come back from speaking to a young gentleman who has been paralysed. I know you have spent your years dealing with the terminally ill, holding the hands of the dying as you speak to a family overwhelmed with grief.

How can a teenage girl compare? Yes, she may appear to have everything. But aren’t humans’ more than just molecules and proteins? Don’t we all have dreams and desires of our own? What is it that makes us human? Our relationships, our goals, our ability to connect with one another. How would you feel to have these vital components torn away from you? No, it is not the equivalent of the man next door whose wife has just died. But that does not mean that she does not deserve your attention and your respect. You may have lived through the battles of the emergency department, the grievances of the families, the diagnosis’s of tumours to children barely in their teens. But she has not.

Look at her, sitting on the bed, her head bent over her lightly covered shoulders. Look at her, fingers fidgeting with the bed sheets, unsure what to touch or who to speak to. She is scared. She is in a new place. There are bright lights glaring down upon her, strangers rushing past her, eerie machines beeping at her. And inside her mind, the battle is continuing to rage. Look at the scars glistening upon her skin as she cowers in a blanket, trying to hide her wounds from the world. Aren’t those battle scars as well?

Imagine how it feels to have a mass of doctors suddenly gathering around your bed, all looking upon you with pity. Do you realise how exposed it can feel to be probed with such personal questions? The intricacies of your mind held open for a stranger to dissect.

‘Do you have any plans to end your life?
What methods have you thought about?’

She needs a friend. She needs someone to take her hand and ask her how she is feeling. Forget the Fluoxetine, the charts filled with drug doses. It is not a prescription pad that she needs. She needs a human touch.

I know she cannot hear you as you make your curt remarks. I know you will walk towards her filled with smiles and concerning eyes. I have seen that gentle handshake that you have mastered over the years, the slight pitch in your voice as you gently prod your questions. There is no doubt that you have a bedside manner. And within one minute you are gone, the prescription chart left upon her bed for the nurse to dispatch the drugs. The girl still sits there, her posture unchanged, unsure if the conversation had taken place.

I know you are busy. I know you have a team of doctors to command, a list of patients to see, a hospital to run. Yes, I know you have sat through hours of exams, studied well into countless nights to get to where you are standing now. I have respect for the devotion you have put into your career.

But please do not forget that young girl. Please remember to hold your tongue the next time you see a teenage overdose. Yes, to you it is another statistic to keep record of, another prescription to fill out. But to that teen lying in the corner, throwing up the contents of her stomach? She wanted to die just two hours ago. Do you know how that feels? To feel hopelessness so deep, that the future is but one long tunnel, filled with uncertainties and fear. Do you know how it feels to hold a bottle of pills in your hand, staring longingly at the container, at the hope it contains inside?

Yes, she will be fine. She will be discharged within a few hours, another free bed to fill. But please, the next time you come across such despair in someone’s eyes, do just one thing; sit down on the bed beside them, and ask them how they are. Look into their eyes as they speak, and let your whole being be encapsulated by their story. Let them open up to you, with patience and empathy. If someone had done this to them before, do you think they would be in this position now?

Please, the next time you blurt out another cutting remark, a sneer at the cries for attention. Look across the room at your patient sitting there. Look at their posture, their body language, their eyes. Does this look like the sort of person who needs your judgement? Or does this look like someone who needs a listening ear?

 

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Writing with Ink by urbanworkbench