Wednesday, September 15, 2010

Thoughts on medicine

First of all, take a look at this article about a Mayo Clinic study which links overwork and stress among young doctors to unprofessional behavior.  For the uninitiated, medical school can easily result in a quarter million dollars of debt, and typical course loads are in the 18-20 hours range--quite heavy when one considers that a great deal of memorization and thinking is needed.  Follow that with long workdays in residency, and you have a great recipe for burnout.   (if you don't respect your doctor for making it through this, you should!)

Now I'm torn on this.  On one level, when I come into the ER with searing pain in my abdomen, or a wound that needs to be closed in minutes, I certainly want my ER physician to respond almost reflexively--painkiller, stitches, whatever.   Long hours and repetition are certainly good for this.  A good ER doctor can almost do stitches in his sleep, and that's a good thing gained from, well, doing stitches and such while dead tired in residency.

On the other hand, when I come in for a routine physical--as I did yesterday--I'm not sure I want a reflexive response, but rather the mental agility to decipher the evidence proferred by a patient and come to a reasonable set of tests and/or therapies for my conditions.

Along those lines, my doctor mentioned that I would be (per standard practice) having my first colonoscopy at the standard time at age 50, and (watching out for myself) I posed the question of whether my mother's death of colon cancer would change this recommendation.  Well, it did, of course--he had reflexively responded to the ordinary charts, but when he considered my personal condition....well....all you guys are going to be so jealous that I'm getting one a little early.   (or not!)

So we have two lessons here; one, it might be wise to modify medical training somewhat to make sure the pressures of medical school don't push out creativity.  Second, if you want to be healthy, you've got to take a certain amount of responsibility for your own care, and even better, it helps to have someone else keeping an eye on your care when you're not able to.  It's not that doctors are incompetent or bad people, but they've got the same limitations that we all do.

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