How alternative medicine makes fools of us all

Here's a book I just found, that I definitely plan to read this summer.

Those of you who aren't new to my blog will remember that I consider myself open to learning about how alternative therapies can legitimately help patients, and I'm always open to discussions with my friends in naturopathy school.

However, I'm sure I'll have plenty to discuss after I finish reading this.

Find out more about the book...

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The day the ER nurses ganged up on me

I swear I was being good. Really, I was! Honest!

But still, they hunted me down and cornered me, like an angry, bloodthirsty pack of shewolves avenging the death of their young. Or something like that.

Tonight, during a ER shadowing shift, I was sitting unsuspectingly at a computer (I don't know how else to sit), looking up the difference between ringworm lesions and lyme disease target lesions. You know, minding my own business. I thought I heard some nurses off in the distance saying something like "student" or "medical student"... but I brushed it off and ignored it. I went back to my googling.

And then it happened.

I felt a massive shadow coming up behind me.

I turned around... in time to see half the ER nursing staff approaching me in a pack akin (great word) to a pack of shewolves (yes that word is worth the repeated reference).

I hadn't done anything wrong (other than written a certain blog post several weeks ago which shall remain unnamed here) but I figured I was screwed.

I felt like those folks must feel when the infamous Sumdude - a.k.a. 'some dude' - jumps them without warning, rhyme, or reason. By the way, for those who don't know, Sumdud is an emergency medicine phenom (another great word) documented by paramedics, respiratory therapists, nurses, and doctors alike.

Anyways, they surrounded me, towering over me - only because I was sitting down - and shone a light in my face. And thus they began their brainwashing session.

"Be nice to nurses!" they said. "Nurses know best." The skinny one in the back of the herd adjusted the giant, whirling spiral which I can only assume was meant to hypnotize me into oblivion. "And nurses love coffee - bring your nurses coffee."

I shifted uncomfortably. Their tactics were working. I was feeling their efforts to convince me were working. I nodded my agreement in an attempt to signal to them that the giant stainless steel probe they were holding just inches from my face wouldn't be necessary.

Okay, I was wrong about the light, the whirling spiral, and the probe. But a group of nurses did corral me today, and did tell me to be kind to nurses. They were mostly joking, but obviously there is a certain level of seriousness to their comments - I'd be dumb to assume that these nurses haven't been cruelly treated by a doctor at one time or another - though the doctors I was working with today were outstanding.

Fortunately I was able to explain to them the same thing I said in that other, previously mentioned but unnamed post, that I've been told all this already by my nursing friends and my nurse mother.

I wish this story had a more dramatic ending, but that was it, really; my comments seemed to appease them. The rabid pack broke apart, most of the nurses wandering off into the meds room, still laughing about their indoctrination method, and sharing stories of nursing back in the days when nurses used to stand up when doctors entered the room and mustard poultices and turpentine were common treatment methods, and I went back to my Tinea corporis and Borrelia burgdorferi.

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Geez, what a dumb nurse.

Make sure you read this post to the end before you make any quick judgments!

I was in the emergency department this week shadowing a doctor, and I was surprised when an older nurse came up to the doctor and said,

"I don't usually have trouble putting in catheters, but I have no idea why putting one in this guy is so difficult. Could you help us out?"

When I looked over at the patient she was pointing at, I gasped. How the heck could the nurse be that stupid?

I had to interrupt. Looking her right in those dim-witted beady little eyes, I said, "Excuse me, but are you trying to be funny?"

The patient was a 67-year-old male who had come in with a chief complaint of "I can't pee because my prostate is flaring up again."

No kidding you're going to have a hard time putting a catheter in, and what do you mean you don't know why?! The guy's got BPH (Benign Prostatic Hyperplasia). When the prostate has swelled up to the size of an softball, seeing as how the urethra runs right through it, of course it's going to pinch that urethra right shut. Especially when the internal zone of the prostate is the part that increases in size due to BPH.

I mean, come on - how could the nurse be that stupid?! I'm a flippin' first-year medical student and I know this basic stuff; she's been on the wards for decades and you're telling me you're clueless? Haven't you seen how big an enlarged prostate can get on gross pathology?

Okay, I'll stop this little anecdote right here and tell the truth - this didn't actually happen. I've never called anyone "dumb" and meant it, and don't intend to start now.

But it might have, had I not read what Kim at Emergiblog wrote after seeing BodyWorlds 3. (yeah I'm bringing up Kim again! can you tell I've found a new blog I love?) Don't forget, this is being written by a nurse of 28 years:

"I’m sure my mouth was open through the entire exhibit. There was so much I did not know or had forgotten over the years. I knew what was there, it was the proportions that astounded me.

• The only thing standing between us and paralysis is a thin cord of nerves about 1/2 inch wide - the spinal cord. It seemed very fragile when viewed in a display of the nervous system, from brain to periphery.
  
  
• The kidneys are so tiny - and now I understand in three dimensions where they lie in the body. I know why a 3 mm kidney stone causes so much agony as it travels down a ureter with a diameter of 1 mm. The spleen was smaller than I thought it was!
  
  
• The uterus, which looms so large in my imagination, is extremely small. All those period cramps come from that tiny sac? Holy cow! The ovaries? Smaller than walnuts - my daughter’s dermoid cysts were larger than the ovaries they inhabited!
  
  
• Sciatica? Well, that explains it!
  
  
• I not only know about COPD, I saw COPD!
  
  
• Cardiac tamponade? I see how it compresses the heart!
  
  
• Smoking? Take a look at the two lungs that look solid black. You’ll never smoke again.
  
  
• I saw why I can’t pass a catheter through an enlarged prostate."

End quote.

I'll be honest with you, and you'll see where that fable I told might have come from. After reading that list, my first thoughts were:

"Are you kidding me? You didn't know the spinal cord was 1/2" thick? You didn't know that smoking turns your lungs black?? I wouldn't have been surprised by ANYTHING on that list, and I'm just finished my first year! She's been a nurse for 28 years and STILL doesn't know all that stuff?!"

I suddenly looked up from my computer screen and felt a rush of shame come over me. I realized that if I had said that out loud, it would have no doubt come across as a jackass thing to say. The next thing in a rant like that could reasonably have been something like, "Geez, she is SUCH an idiot!"

How could I have thought something so rude? Me, of all people! After all my posts on interdisciplinarity and treating nurses with respect, after saying that I love and will always respect nurses because some of my good friends and my mom are nurses, and after pumping that same nurse who wrote that just this week, after having the purest and most idealistic of intentions, here I am pretty much bashing nurses already!

Then, I remembered something.

"That's right! I always knew that the nurses I went to undergrad with never really got the chance to work on cadavers and take pathology like I did."

And that's what I had been missing. Until now, I had never made the connection that unless you have taken pathology, or held a human kidney in your hand, it's actually pretty hard to visualize what an enlarged prostate looks like, or how thin the spinal cord is, or how small the kidneys actually are.

If I hadn't made that realization here, today, perhaps the little scenario I made up at the start of this post actually could have happened in a couple years when I'm on the wards.

I'm no better or smarter than Kim is. In fact, put me in a hospital or in front of a board exam right now and I bet you anything that Kim would answer more questions correctly and save more patient's lives than I would, after all those years of clinical experience under her belt. But already, after one year of classes, I was thinking thoughts that if spoken, could easily be interpereted as superiority, or simply being a jackass.

Yes, some doctors are assholes to nurses just because they think they can get away with it, because they have their own issues to deal with, because they're just assholes, or maybe because since orders have always been called "orders" they think it's okay to actually "order" other health professionals around. And after being through a year of medical school, I can almost sympathize with a doctor who stands up for him or herself and comes across as being a jerk, because after being through those first-year finals -- the most intense, trying time of my life -- I have a lot more confidence in myself, and quite frankly, after four years of this, I won't take crap from anybody.

But perhaps some of the barriers between professions aren't for any of those reasons. Perhaps some doctors come across as being jerks even if they try hard not to. Perhaps sometimes it's just because of simple misunderstandings.

Not because of a superiority complex, not because somebody thinks they're better than someone else, but because they just never took the time to stop and think about how differently we have been trained, and how our professions are designed to look at the same problem from different directions. And that's where the strength, the untapped gold mine of interdisciplinarity, comes from.

Yeah, I'm still fresh and new and idealistic, perhaps, but hopefully I can keep stopping myself whenever I think ignorant thoughts like that, and hopefully I'll continue to challenge myself to treat everyone with the respect they deserve. After all my good intentions of being kind to nurses, and then seeing my initial reaction to Kim's comments, clearly good intentions aren't all that it takes.

Thanks, Kim, for letting me pick on you without so much as asking, and I hope that this hasn't discouraged you from writing out your true feelings in the future, even though it it might make you vulnerable to ignorance people like me. I really do admire your writing.

---

Ever since Kim was kind enough to post this at Change of Shift (Grand Rounds of the Nursing blogworld, from my interpretation) I've noticed a lot of readers who have come from there. Those who want to read more about the difference between how doctors and nurses approach patients might want to take a look at the evil resident's take on this issue.

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Step Towards Interdisciplinarity: Blogging?

"[Until I read blogs written by physicians], I had no idea what it was like to be a physician."

Who would probably NOT say something like this:

a) A blogger who is a pre-med student 2 years away from medical school
b) A blogger who has been a nurse for 28 years
c) A blogger who is a patient that has suffered from a chronic condition for 3 years
d) A blogger who is an average, healthy 32-year-old female.

.
.
.
.
.
.

Did you choose B? I sure would have.

So you can imagine my shock when I read that quote on the high-quality Emergiblog, authored by a nurse of 28 years. Of all the people in this world beside doctors themselves, wouldn't you assume that nurses would the ones who understand doctors the best??

Sure, everyone knows that there is a varying level of disconnect between the two professions, but for being someone who has worked alongside doctors for nearly three decades you'd think she would understand what doctors are like.

It's great to see, then, that maybe blogging could be a tool for breaking down the walls between health care professions.

Unlike perhaps many medical students and doctors, I've got a soft spot for respiratory therapists, nurses, hospital security guards, and naturopaths, all because I've gotten to know some personally both before and after they entered their professions. Once you realize they're people too, people that you respect, you're much more inclined to respect their profession and look more closely for what they have to offer. Reading what they have to say, on blogs for instance, can help you towards that realization.

If reading blogs written by people in different health care professions helps us understand them more, then why couldn't that be one more step towards truly working together as a team.

PS - I think it's impressive that she would write that reading doctor's blogs has helped her "appreciate" physicians more than ever, especially considering how much crap nurses generally take from some doctors. Nice to see someone who has been in the profession that long who can still write things that are not bitter & jaded, when it's almost certain that over the years she has had to deal with more than a few doctors who haven't appreciated her as much as they should.

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Interdisciplinary health care: a gold mine being ignored?

...Continued from Preliminary Thoughts on Interdisciplinary Health

For interdisciplinarity being the newfangled wave in health care, throughout my time in hospitals and med school, I sure haven't gotten the sentiment that it's put into action very much.

After reading my previous post, my naturopath-student buddy asked if I'm for or against interdisciplinarity. I want to be clear: I'm not against it at all; I think that there's a lot to gain from it, if implemented properly ... i.e. not in the forced way described by the "Anonymous Therapist" commenter on my previous post.

My point is simply, I haven't seen much interdisciplinarity in action or even in theory at this point in my medical training, despite its lauded usefulness.

In fact, even though I'm only less than a quarter of the way in, to date I've felt the sentiment actually leans toward the opposite, almost against interdisciplinarity. I haven't felt much like we're being told to consider all those other professions as peers, equally-valuable limbs and body parts of the conglomerate, undoubtedly creepy-lookin' monster that is the health care industry. Can't function without the others, you can't live without one body part, so the interdisciplinarists might say (I'm abusing that word, aren't I?).

So how might the average medical student who has gone through the same training I have respond to this equal-value-body-part-organism metaphor? They'd probably say, "hey, you can actually live without some body parts. Naturopaths - they'd be the tail! Better off without 'em. You don't need a tail. You can function just fine without one. Humans, the smartest beings on earth: no tail. And we're better off for it...even the dumbest of us can't run in circles chasing it, which makes them look smart, because some people I know probably would chase their tails, if they had one."

Note that I said the average medical student - again let me point out this is not my opinion. In all honesty, I do feel myself and my profession could stand to learn some things from her and her profession. What I am talking about is the sentiment that I've felt to this point in medical school. Given the lack of interdisciplinary discussion at this point in our training, I wouldn't be surprised if a good number of my classmates thought like this.

Where do I get this impression? Experiences like, say, the time when one of my professors actually mentioned naturopaths directly in one lecture: "Sprinkle some herbs over a bunch of white beads and give that to a patient to eat? How will that help the patient?!" Yep, interdisciplinarity in action. That's what we've learned about naturopaths to date in medical school. And you wonder why some doctors look down on naturopaths.

Chiropractors? There's a whole other topic. Based on how some of my colleagues view chiropractors, in this organism of equally-valuable parts they'd rank chiropractors as, say, the appendix (ie. another organ of no known usefulness). One med student asked me, "How come chiropractors get to call themselves doctors?" Clearly subtle hints of superiority are more than evident in that statement. Another med student told me about her experience volunteering in a rehabilitation ward, and told me, "I was shocked at how many of the patients there were rendered paraplegics because of a chiropractic adjustment." Not a shining commendation by any means.

Moving away from hearsay: my limited experience with chiropractors, when I accompanied a friend on an chiropractic visit, was that the adjustments were very much aggressive, near-violent; and the doctor was very much like a salesman, near-slimy. My honest opinion of them, however, is I have yet to see first-hand any harm they have done, and I have read testimonials saying that they have made a huge positive difference in some patient's lives (but so have miracle healers...hmm).

And what about the ol' D.O., or Doctor of Osteopathy? Thanks to ads at test-prep courses and in pre-med literature aimed at pre-professional students and mostly worded along the lines of "Have you considered D.O.?" (which actually come across as "Hey eager pre-med student, have you considered D.O. as a backup plan should you be too dumb to get into med school and yet still crave the feeling of being called 'doctor?'") an impression of this profession among medical students as being a profession for pre-meds not smart enough to get into med school might be understandable. Fortunately, in a random encounter starting a conversation with a stranger on a park bench in London last year, I have met a D.O. student and know that to not be true.

D.O.s claim that they are another type of doctor, "equal to M.D.s in the eyes of the law." So why aren't D.O.s mentioned in medical school then? Maybe it's just because I'm in a Canadian medical school, but I think there's more to it than that...

So would I go see a chiropractor or a naturopath or a DO? Right now, probably not.

Would I recommend patients see one? At this point, I don't think so.

Based on my impression of them (admittedly based on anecdotal comments and impressions from friends) I haven't been convinced they do more good than harm. But would I recommend against a patient seeing one, or try to stop a friend from going to see one? Nope. I might pass on the paraplegic story, but I'm not against people finding what works for them, and I haven't been entirely convinced that these other practitioners do more harm than good. And if my smart friend is convinced enough about naturopathy to pursue a career in it, there's gotta be some merit to it.

Would my preferences change if I were taught the merits and capabilities of these professionals and believed that evidence showed they are medically indicated and make a significant positive difference in certain conditions? Definitely.

Like I said, while the conceptions I hold now may be misinformed or even grossly incorrect, I do believe there's value to be gained from interdisciplinarity, and I consider myself open-minded and willing to change should I be proven wrong.

The thing is, at this point, I haven't had the chance to go look up this evidence on my own. Not because I'm lazy, but because I've been too busy learning the things my medical has deemed important... and this isn't one of those things. But supposing I take the initiative to look this up on my own; what about the other students in my class? How will they know what to think about chiropractors and naturopaths and DOs other than what they've heard from their friends or seen on YouTube? Hopefully you can see why I think that training future doctors should involve discussions about these other healthcare professionals, because I do think that medical professionals have a lot to gain from an interdisciplinary mindset and from each other.

So far by discussing 'interdisciplinarity' I've mentioned practitioners seen as more alternative (the DOs and chiros will hate me for using that term, the naturos have to live with it), but this extends to all sorts of therapists and healthcare workers that don't call themselves 'doctor.' And yet, despite the fact that interdisciplinarity can be a huge benefit, if you were to ask ten people in my med school class what an occupational therapist does all day, I'd be shocked if more than one of them could tell you. Same goes for a respiratory therapist, or a licensed professional nurse, or a naturopath, even. I happen to know in great detail what each one of those does, with no thanks to my med curriculum (up to the end of first year) - I simply happen to have had three friends going to school for OT and have talked to them at length about what they do; I've volunteered for a couple years under a respiratory therapist; my mom is a LPN; and I have another good friend in naturopathy school. But if I relied on what I've learned in med school, well, I'd know nothing about these professions, nothing about how to help a patient access the valuable services these therapists have to offer.

I honestly hope that my school starts touching on these other important parts of the health-care profession as I proceed through the curriculum. But if med school keeps on going the way they've been going so far, and don't explain to future doctors what each of these other healthcare professionals do, "interdisciplinary health care" will just be another Utopian ideal with no manifestation in this world... another untapped gold mine.

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What doctors REALLY think... and preliminary thoughts on interdisciplinary health

"Research is a real problem. Doctors just make up the data. They don’t report negative side effects, no question about it."

Someone at New York magazine had a brilliant idea a few weeks ago.

"If I ask a bunch of doctors a bunch of questions," they pondered, "but promise them anonymity, just think all the great dirt I'll be able to print! They'll be so straightforward and honest, I'll be one of the few people on earth to know what doctors really think."

Someone at New York magazine seems to have forgotten about the medical blogosphere.

Every day, countless doctors rant anonymously about the dirt that goes on in hospitals. They just happen to do so in the form of blogging.

But someone at New York Magazine ended up doing the interview, writing the article, and hey, it got published. How Comrade found this article in the New York magazine online four full days ahead of print, I'll never know, but thank him, since you'll probably find it quite interesting.

Selected highights, my smartass comments in italics:

• Why you have to wait so long in a doctor's waiting room.
  It's because you are not the doctor's only patient.

• Doctors make up research data.
  Did you know that 86% of statistics you hear are made up on the spot?

• The way we train doctors now is worse than it used to be, because the residents who do surgery on patients are now allowed to do surgeries after they have had time to sleep.
  Yeah, you'll have trouble convincing me of that one. Say it with me: "Old-Boy's-Club."

• Patients have to wait for 45 minutes after they press the call button, not because nurses are standing around chatting, but because there's a nursing shortage.
  Hmm, so it's not just in Canada, eh?

• Doctors think that "By virtue of our training and knowledge, we can get away with... treating patients like shit."
  Strange, it took me only one year's worth of med school finals to get that feeling. At this point, I call it self-respect. Three more years of this and you'll probably call it me being an asshole.

• A doctor admitted to dropping a baby once.
  You think that's a big deal? Read the next one.

• Doctors feel powerful when they've killed somebody.
  I told you you need to read this article. Here's the link again.

After reading that article, I'm surprised that even at my early stage in the game, a lot of it I could have told you. A good chunk of it is, in fact, common sense. Think about it. Doctors like seeing patients that don't yell at them. Surprise. You have to wait in the waiting room for a long time because, well, doctors are seeing other patients. Surprise again.

But there's one thing that I'm surprised they didn't mention. It's...wait a minute, what? you want my opinion?

Sorry, but apparently in training for making a living by, well, mostly giving my professional opinion, it's been made abundantly clear that I am not to provide medical opinions of any sort. Not even to a friend who asks about their cold. Or growth. Or whatever.

Of course, I'll give you my opinion anyways. That's what this blog is all about. But here, I'm protected by my fancy disclaimer at the bottom of this page. Yeah, it probably provides little more protection than did those fancy flying-squirrel-like jumpsuits that early would-be aviators donned before jumping to their deaths, but at least it's something.

So here's what I think. I'm surprised the article didn't ask any of the doctors their take on the "interdisciplinary health team" that everybody is talking about.

I was talking about this interdisciplinary health thing with a nurse friend of mine the other day. I was going with that old joke that I find so funny (that no nurses see any humour in at all), telling her, "I can't wait until I've graduated med school so I can boss around nurses." (That is NOT how I will approach nurses on the wards...trust me, I know better.) But after we got back on speaking terms, we got into this talk about interdisciplinary health care - a concept that is very interesting, considering how little of it I've heard in my med school curriculum.

Medicine these days is supposed to involve all "health professionals" on an "equal playing field" - doctors, nurse practicioners, nurses, licenced professional nurses slash registered practical nurses (depending on your geographical location), respiratory therapists, physiotherapists, occupational therapists, chiropractors, naturopaths, quack cure-all syrup salesmen... (uh, in no, particular order...I swear...), all working together in perfect harmony like oompa-loompas churning out everlasting gobstoppers. If that's the case, though, and if it's the new wave, how come I haven't been taught that yet in medical school?

But that's another story for another day - I have a rant on that waiting in the wings...to be continued.

Click here to read the continuation of this post.

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