The United States may not have “socialized medicine”, but several federal agencies and many laws regulate health care for us. Let’s look at some of them.
“to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness. ” the Declaration of Independence
The United States may not have “socialized medicine”, but several federal agencies and many laws regulate health care for us. Let’s look at some of them.
“Despite its idyllic facade, the beach can be a dangerous place—and swimmer’s ear, sunburn and jellyfish stings may be the least of your worries. Beaches can get pretty dirty, and this pollution can come with some nasty pathogens.”
“What would you say to your doctor on your deathbed?”
What would you say to your doctor on your deathbed?
Would you remind them of the times you waited weeks for an appointment or sat in the waiting room long past your scheduled appointment time?
Would you ask them why they didn’t try harder to cure you? Would you ask why all the tests and medicines they ordered didn’t work to save your life?
Or would you ask, “How was your vacation?”
A patient named Rosemary
One woman did. In a JAMA essay (Journal of the AMA), Dr. Wendy Stead , an internal medicine physician, described her patient, Rosemary, who “never had a bad interaction with any of her health professionals. After a clinic visit, or hospital stay, she will rave about the excellent care she received from the many teams involved.”
“This is not because we are all such exceptional caregivers.” she admitted. “It is because of the kind of patient she is..the kind who probes for the person behind the doctor.”
When Rosemary was terminally ill, Dr. Stead left on a family vacation, fearing that her patient would die while she was gone. As soon as she returned, she went to Rosemary’s home to visit one last time.
Now so weak, Rosemary was confined to bed, and could barely speak. As Dr. Stead leaned over the bed straining to hear her, Rosemary asked, “How was your vacation?”
Probe for the person behind the doctor
Do you know if your doctor has children or grandchildren?
What hobbies they pursue?
Who is their favorite sports team?
My husband and his eye doctor share an interest in the Oklahoma City Thunder basketball team. At each visit, he and Dr. Nanda spend a few minutes discussing the team’s progress, good or bad. It makes what otherwise would be a dry, routine visit into a special occasion. I think Dr. Nanda enjoys it as much as Raymond does.
When I was expecting my second son, William and Audrey became my patients. William had multiple serious health conditions but he was always positive and never complained.
During his frequent office visits, they never failed to inquire about the progress of my pregnancy. After I delivered they always asked about my new baby boy.
When I walked into the exam room, William’s first words were always, “How are you Doc?” And the next words were, “How’s the baby?”- even though by the time William passed away, my “baby” was in kindergarten.
Seeing doctors and patients as people
For physicians, our patients’ “social histories” help us understand factors in your life that impact your health -where you live, your job, your family, your hobbies . Besides that, we enjoy getting to know you, especially the things that make you and your life unique and interesting. Dr. Stead points out that when our patients learn our social history we “build an even stronger bridge that goes both ways.”
Now you probably won’t have the time or interest to “probe” every doctor you see, maybe just those you see regularly . Exchanging a few social words can make the encounter more satisfying for both of you. Some of us will be more open about sharing our personal lives, and some subjects may be off limits. But I don’t think any of us will object to honest, caring interest in our lives outside of medicine.
“As healthcare professionals we like to think of compassion as a limitless resource, but some days even the deepest well can feel like it’s running dry. Patients like Rosemary refill the well. They make us better doctors for all our patients.” Dr. Stead
Burnout- bad for doctors and patients
Leaders in the medical community recognize the high and increasing rate of burnout in physicians. In burnout, physicians feel exhausted, lack enthusiasm about work, lose motivation, and feel cynical about the value of the medical profession. Some estimate as many as 50% of physicians in the United States experience burnout.
Perhaps even more common among physicians is compassion fatigue, which can affect anyone involved intensely in helping others. Compassion fatigue occurs when a helper begins to feel overwhelmed and stressed from their efforts to relieve the pain and suffering of those they help. As they give more of themselves and neglect self care, they in turn become traumatized by their own efforts.
(Photo credit-American Academy of Family Physicians)
Doctors on the “front lines” of medicine -family physicians, emergency physicians, internists, pediatricians, psychiatrists- are especially vulnerable to burnout and compassion fatigue as are other health care workers, police, social workers, teachers and disaster workers.
Why should you care about physician burnout and compassion fatigue?
Factors causing physician burnout include the technological and bureaucratic hassles in medical practice that hinder doctors from spending adequate and quality time with patients and interfere with our ability to care for patients in the way we believe is best.
Studies suggest that burnout causes physicians to spend less time providing direct care to patients, and that care may be less efficient and effective.
According to observational studies of physicians at work, we spend 50% of our time doing paper/computer work about the care we provide the other 50% of the time. (photo credit- American Academy of Family Physicians)
One way you can honor your doctor is by trying to connect personally next time you visit. By doing so, you may get a glimpse of the “person behind the doctor” ; empathy can go both ways. If you see your doctor as a person with a life not that different from yours, you may see your interaction as a partnership and find it easier to communicate .
And better communication can lead to better care for you. See my previous post
( This is an update of a previous post. This post contains an affiliate,commission paying link)
Dr. Paul Kalanithi was a 36-year-old resident physician who had, as he wrote, “reached the mountaintop” of anticipating a promising career as a neurosurgeon and neuroscientist. He had a loving wife, a supportive family and professors who respected his knowledge and skill. He seemed destined to be sought after, well paid, productive, successful, and famous.
(note: a neurosurgeon treats brain, spinal cord and nerve diseases such as brain tumors that can be cured or improved with surgery,)
Unfortunately, “the culmination of decades of striving evaporated” when he was diagnosed with an aggressive form of lung cancer for which the prognosis was bleak, even with treatment. He was admitted to the very hospital where he trained as a neurosurgery resident, now to learn what it is like to be a patient with a potentially terminal illness.
Dr. Kalanithi faced his diagnosis with the same resolve, fortitude, and determination that served him well through medical school and a grueling neurosurgery residency. After his first round of treatment he was able to return to the operating room as a doctor, not a patient.
Prior to entering medicine, Dr. Kalanithi had studied literature, earning degrees in English literature as well as human biology. He also completed a doctorate in history and philosophy of science and medicine at Cambridge. Thus, when he realized he was facing his own death, he turned to his first love of writing to chronicle his experience and to explore “what makes human life meaningful?” And as he explored the meaning of what life is all about, he also explored the inevitability of death.
“I began to realize that coming in such close contact with my own mortality had changed both nothing and everything. Before my cancer was diagnosed, I knew that someday I would die, but I didn’t know when. After the diagnosis, I knew that someday I would die, but I didn’t know when. But now I knew acutely. The problem wasn’t really a scientific one. The fact of death is unsettling. But there is no other way to live.”
Dr. Kalanithi passed away without completing his book, although his wife writes in the epilogue, “When Breath Becomes Air is complete, just as it is.” She and his parents kept their promise to have his book published after his death. She writes, “Paul was proud of this book, which was a culmination of his love for literature.”
Even before I finished reading this book, I felt as if I knew Paul and his wife Lucy. As someone who also enjoys writing, I can understand and appreciate his desire to preserve and share this experience.
This memoir is not so much a diary of what happened to Dr. Kalanithi as what happened within him as he confronted his own mortality and chose not to let it define the remainder of his life.
On the copyright page, “Death and Dying” is included in the list of categories for this book. However, you will not find “how to die” instructions here. Instead, you will learn how one man and his family chose to live despite knowing that he would soon die.
His wife, Dr.Lucy Kalanithi, has recently spoken publicly about her husband, his illness, his death, and the memories he left her and us through his book. Listen as she reflects on his legacy in this interview .
“In the end, it cannot be doubted that each of us can see only a part of the picture….Human knowledge is never contained in one person. It grows from the relationships we create between each other and the world, and still it is never complete. And Truth comes somewhere above all of them, where, as at the end of that Sunday’s (scripture) reading,
“The sowers and reapers can rejoice together. For here the saying is verified that ‘One sows and another reaps.’ I sent you to reap what you have not worked for; others have done the work, and you are sharing the fruits of their work.”
Watercress Words is on Facebook where I post additional content to explore the heart of health just like I do here- posts to inform, instruct and inspire you . If you haven’t visited me there, please do.
Here are a few of my recent Facebook posts.
Do you qualify to donate blood?
This article from the New York Times health blog explains who can and can’t donate blood. If you meet the qualifications, consider donating in your community. You may help save a life.
Wednesday Word is where I define and discuss a medical term , like this one.
endemic- natural to or characteristic of a particular people or place
Medically speaking, an endemic disease occurs in a particular place or a particular population; for example, malaria is endemic to tropical areas; malnutrition is endemic to people suffering from famine.
Related words are
epidemic– a sudden severe outbreak of a disease in a particular location or group , such as influenza epidemics.
pandemic– an epidemic becomes wide spread, across countries and continents
Are you looking for a new doctor?
This article offers sound advice on finding and choosing a physician, and how to prepare for your first visit.
At one time, I worked at a hospital whose motto was “we’re changing lives” in healthcare.In their promotions, they would share stories about patients whose lives have been improved through their medical care.
Sometimes the people who work in healthcare have had their lives changed, also.
I have recently shared these examples on the blog Facebook page .
Kevin Morton entered a hospital the first time with a bullet in his chest. Years later, he has returned- this time with a stethoscope around his neck.
Spina bifida is a neural tube defect – a type of birth defect of the brain, spine, or spinal cord. It happens if the spinal column of the fetus doesn’t close completely during the first month of pregnancy. This can damage the nerves and spinal cord. Screening tests during pregnancy can check for spina bifida. Sometimes it is discovered only after the baby is born.
The symptoms of spina bifida vary from person to person. Most people with spina bifida are of normal intelligence. Some people need assistive devices such as braces, crutches, or wheelchairs. They may have learning difficulties, urinary and bowel problems, or hydrocephalus, a buildup of fluid in the brain.
The exact cause of spina bifida is unknown. It seems to run in families. Taking folic acid can reduce the risk of having a baby with spina bifida. It’s in most multivitamins. Women who could become pregnant should take it daily.
NIH: National Institute of Neurological Disorders and Stroke
Nanette Monroe didn’t listen when people told her she was “too old” to pursue her dream. She did anyway, and now she helps others do the same.
Svetlana Kleyman‘s life was changed, first by an unexpected illness which left her with a physical disability, and then by other people’s response to it. She’s still fighting to get her life back.
Dr. Carson’s mother, Sonya, one of 24 children, married at age 13 ;her husband abandoned her when Dr. Carson and his brother were young boys. An uneducated illiterate woman, she taught herself to read, and required her sons to read books weekly.
While he was growing up, his family depended on food stamps to have enough to eat.
At age 8, after hearing a missionary doctor speak at his church, he decided to become a physician.
He had such poor vision, he was almost legally blind. His grades improved when he started wearing glasses.
As a teenager, he had such a quick and fiery temper, her feared he might kill someone.
Both he and his brother were in JROTC while in high school; his brother served in the Navy during the Vietnam War.
In high school he played clarinet and developed a love of classical music, something he would share with his future wife Candy.
During college he worked at the Ford Auto plant and at Chrysler.
He and Candy lived in Australia for one year so he could train in neurosurgery there- and his first child was born in Australia that year.
His third child was born at home- and he did the unplanned, quick delivery while his mother dialed 911 for help.
Neurosurgery is the surgical specialty that deals with the nervous system, including the brain and spinal cord. Long before Dr. Carson became involved in politics, he was known for his pioneering work in brain surgery. He discusses this work in his autobiography, which was also made into a movie of the same name. In the movie, one of my favorite actors, Cuba Gooding Jr., played Dr. Carson.
Dr. Carson specialized in two difficult and dangerous types of surgeries.
In hemispherectomy half of the brain is surgically removed as a treatment for severe, intractable seizures. It is only used as a last resort, is not always successful and can cause paralysis on one side of the body. Dr.Carson was known as an expert in this surgery.
Conjoined or Siamese twins joined at the head are rare, occurring in 1 in 2 million births.
“In 1987, Carson attracted international attention by performing a surgery to separate 7-month-old occipital craniopagus twins in Germany.
Patrick and Benjamin Binder were born joined at the head. Their parents contacted Carson, who went to Germany to consult with the family and the boys’ doctors. Because the boys were joined at the back of the head, and because they had separate brains, he felt the operation could be performed successfully.
On September 4, 1987, after months of rehearsals, Carson and a huge team of doctors, nurses and support staff joined forces for what would be a 22-hour procedure. Part of the challenge in radical neurosurgery is to prevent severe bleeding and trauma to the patients.
In the highly complex operation, Carson had applied both hypothermic and circulatory arrest. Although the twins did suffer some brain damage and post-operation bleeding, both survived the separation, allowing Carson’s surgery to be considered by the medical establishment the first successful procedure of its kind.”(from Ben Carson bio)
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Anyone who is following the United States Presidential campaign knows it has become one of the most unexpected, unpredictable and contentious races in history. And so far the candidates are only vying for their parties’ nominations.
Have been a resident of the United States for 14 years
The election process is anything but simple. The candidates campaign to secure delegates to their party’s convention through caucuses or primaries in each state. Then at the convention they must win the nomination to be on the ballot to win the electors in each state.
Finally, the Electoral College votes on which candidate will be President. Even that might not be final since in one recent election the final decision ended up in the Supreme Court (Bush vs Gore).
Holding the office of the President is our country’s highest honor but the job of president has become so thankless I wonder why anyone wants to do it. But I am grateful that people volunteer for and seek the position, and this year three of the candidates are physicians. (three that I discovered; if you know of others, please tell me.)
Since March 30 is National Doctor’s Day this blog is recognizing and thanking the three physician presidential candidates in this and my next post.
These posts are meant to inform, not influence you; they do not indicate an endorsement of the candidates. I will not promote or endorse any candidate on this blog.
In medical usage, progress notes are “Records kept by health care workers to indicate the course of the patient during care”
I have written some “progress notes” about each candidate that will give you a glimpse into their professional, personal and political lives.