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.

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"She was dying, and he didn't even look at her."

"I was watching my wife die over the course of those nine months. Our family doctor sent us to see a specialist. Without even doing a physical to see the her ribs jutting out of her back, he told me that 'women typically lose weight during their menstural period.' I was shocked. She was dying, she was as skinny as a corpse, her brain wasn't functioning properly, and he tried to tell me it was her menstrual period. He didn't even look at her."

That happened almost thirty years ago, and still, my patient's husband talks as if this happened last week. Today I had to go to the home of a patient who had volunteered to discuss their chronic condition, part of a rather interesting assignment meant to get me thinking about the impact of a chronic condition on a patient's life and family.

Unfortunately, the husband is still convinced that the only reason his wife was eventually diagnosed or received treatment is because he reamed out the doctor.

Not every story like that has a happy ending. But this one did. Once they diagnosed the disease, although that was a nine-month process, they gave her one injection and other than the low body weight, she was completely normal the next day. Today, one pill per day is all she needs to live a completely normal life, and if she didn't tell you about her disorder, you wouldn't even know it existed.

If only all diseases had outcomes like that...

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"The way the doctor talked to me made me want to kill myself."

Part of what I love about med school - even only a few days in - is that they're already teaching us how to be doctors.

It's a nice change from undergrad. When I studied science in my undergrad, we only really learned the science. Now, we have classes that teach us the scientific background, obviously, but they're much more applicable to the clinical setting - we learn about the pathology, the pharmacology, and so forth.

Better still, there are also a number of classes that could be summarized as belonging in the 'how to be a doctor' category. We have a course in clinical skills where we get the chance to learn how to take blood pressure, start IVs, stitch wounds (our school just started a new policy that the first time students practice suturing we are not allowed to do it on a patient), and practice injections on oranges. We'll be going into doctor's offices in just a couple of weeks to start interviewing patients and giving them injections. And we're taking classes on how to talk to patients, which will involve us not only learning the principles in lectures and small groups, but also being evaluated as we interview real and simulated patients (actors).

We had an excellent speaker today to open up our class on bedside manner / talking to patients. Even though he has five degrees, the one thing that is always highlighted when he is introduced to speak is that he has been on Oprah. He has interviewed thousands of patients for studies, and through that gained insight on iatrogenic suffering, meaning any sort of illness or suffering caused by the medical profession. "The way a doctor talks to a patient can cause more pain than the disease itself," he told us.

We were told a few examples of 'horror stories' of doctor/patient interaction, which most people hear about every once in a while. Here are a few of the ones he mentioned:

• "They decided to remove the lump anyways, even though they told me months ago it wasn't cancerous. As I was just starting to wake up after the surgery, the doctor came to my room and told me from the doorway, 'We made a mistake, it's cancer.' I was horrified that he would tell me in that way."
• "The doctor was talking outside the room and joking with someone else about a movie they'd just seen. Then, she came in and told us that our baby was dead. That's it. No intro or anything. Even though we were only 20 weeks along in the pregnancy, we had been trying for so long and were so excited. We knew it was a boy. We'll never go to this doctor again."
• "The way the doctor talked to me made me want to kill myself." Or, "After the doctor talked to me that way, I left his office and tried to kill myself."

Scenarios like that are the justifications they use for teaching us how to talk to patients, and clearly a course of this nature can serve some very important functions and is well-warranted. I'm not sure how long such courses have been around, but according to some articles I've read they're pretty new. Obviously they'll teach us important things about bedside manner, which we'll begin to use right away.

The thing is, pretty much anyone reading the above scenarios - even medical students and practicing physicians - would be shocked at the blatant disregard for patient dignity that the doctors allegedly displayed in these instances. I'm sure that even the doctors who committed those actions would be shocked when it was put in a statement like that. As a result, the above can only be explained by some sort of a desensitization that occurs in physicians after they have seen hundreds of thousands of patients, a desensitization that causes doctors to do the above things without even being aware of it.

There are obviously clear benefits to holding these classes. However, I don't think we'll know the extent of how effective they are for a long time, becuase I guess the real test of these classes is to see if they are still influencing the way us future doctors practice medicine 20, 30, or 40 years from now. If, decades down the road, they have been and continue to be successful in preventing such scenarios, then they will have turned out to be a good idea. Until then, I suppose we won't know if doctors should be taught bedside manner in some other way.

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"If you don't go out with me, I'll just report that you touched me during my clinic appointment."

She was absolutely gorgeous, and she dressed in a way that complimented her body incredibly well. She put her hand on my knee and looked me right in the eyes.

"I can't stop thinking about you," she said to me. "I have never really done this before, but I need to tell you that I think you and I are right for each other. I can't sleep at night thinking about you, and I know deep inside that we are meant to be together."

"Uh, okay, but actually, Esther, I don't...." I stammered.

She apparently only heard one word in my attemped objection.

"Okay? Wonderful! I'm so excited. We can go for coffee -"

I tried to interrupt. "Coffee? No, that won't work, I can't..."

"That's fine, you can come over tonight - I make a mean chicken pie!" She was unstoppable. I should never have agreed to meet with her - even in a public place like this.

"Chicken? I don't...I mean, I can't..."

"Then I'll make something else! I'm so excited to see you tonight!" I couldn't get a word in edgewise. I took a deep breath, tried to collect my thoughts, and said, "Well, no, I can't actually, I mean - okay, hold on for a second. Look, you and I, it's not going to happen. I can't date patients."

I couldn't believe I was saying this to someone during the first week of med school.

She did not take well to this statement. "Oh. Well. Okay then, I think you are completely wrong, and we just need to spend some time together before you can see," she told me. "If you don't agree to, I'll just report that you touched me during my clinic appointment."

She got up and left.

"Okay, let's recap," said the faculty member in charge of our group. "What are some things Vitum could've done better, or possibly done to avoid such an outcome?"

That was one of three simulated scenarios that we came across in our anti-harassment workshop, a part of my med school orientation week. Esther was an actor, one of several hired by my med school to involve us in such situations in order to train us how to react. We had actors sketch out two other situations - one who played a racist, sexist preceptor who felt it necessary to make frequent and insensitive comments about immigrants and women - and one who played a student in our group who thought that one of our classmates with a non-science background was so dumb that anytime now she was going to start killing patients left and right. It was a memorable way to learn, interacting with these actors and situations and discussing our responses. What I went through in that workshop was an outstanding way to structure our 90 minutes of anti-harrassment training, much better than just lecturing at us for the whole time.

I promised that I'd tell you about my first day of med school. It was pretty much the same as this whole week, filled with workshops, lectures, social events, and not much time for anything else. Right now is pretty much my first break. We didn't see patients the first day and probably won't for a week or two, but our first anatomy class is tomorrow, where we'll be dissecting cadavers. I'm not sure if there's any significance of us working on dead people before living ones.

Throughout the week, we've had a number of lectures, with titles ranging from "Library and Computer Orientation" to "Life as a Med Student" to Intro to Office Visits," some of which have been excellent and some of which have been somewhat dull. We heard a doctor and a dentist speak about the cocaine and steroid addictions they were recovering from, and learned about the crisis resources designed especially for physicians and med students. Our social activities thus far have included a scavenger hunt, BBQ, wine & cheese reception, and we've got some more parties lined up in the days to come.

It's slowly sinking in that I'm really here in this place which has been on a pedestal so high in my mind for so long. It's still exciting, but we'll see how long that lasts once the homework hits.

Six weeks till our first exam.

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