Pneumonochrome

I recently started handling the podcasting of lectures for my Medical School class, and it’s been a really cool learning experience. It also got me wanting to do my own podcast. I don’t usually have much to talk about, so I’ve put off actually doing this, but I thought today would be as good a time to do this as any. I’ve created a new category on my blog: Podcast. Subscribing to the feed for that category in iTunes will subscribe you to my podcast. (Go to Advanced->Subscribe to feed and enter the link http://blog.theburrowfamily.net/category/podcast/feed/)

For today, I’ve just recorded myself reading Edgar Allen Poe’s The Raven. I had fun, and that’s really all I care about at this point. But, if you enjoy it too, cool.

“There’s a right that’s given to us as physicians to do things to patients that would be criminal for anyone else to do.”

That was part of the closing remark in one of my classes today, and I can’t think of many things that would be more important for a doctor to realize. Physicians are given permission to have contact with patients that would be considered criminal contact coming from almost anyone else. The amount of trust that must exist between physician and patient for the patient to be comfortable with this arrangement is unimaginable to me, and I think it helps me understand why “medical professionalism” is so very important.

While many patients may give that trust to a physician because of his credentials and white coat, and others may give that trust to a physician because they trust the person who referred them to the physician, no patient should ever be expected to give that trust to someone, including a physician, who has not earned it through profession, respectful behavior toward the patient.

Really think about that. Surgeons cut into their patients. They inflict wounds that could very well be fatal, and in any other circumstance probably would be fatal. How could I, if I pursue a career in surgery expect a patient just to trust me, without any effort at building a trusting relationship from me, to bring them well within the reach of death, and to bring them back again?

How can a physician expect a patient to whom he has not shown compassion and respect to be comfortable revealing what may be the most intimate details of his life? And yet, in many cases, exactly those most intimate details are the ones necessary to determine the correct diagnosis, and effectively administer the right treatment?

It was very sobering to me to hear that said today, and I think it helped impress upon me the responsibility that I am taking on along with the privilege of having the opportunity to see people in the humble, vulnerable, and fearful moments of their lives, the privilege of being able to help them find some relief from their fears and their pains. That is why I’m going into medicine, but I think it is a very serious thing the remember that those privileges come with some heavy responsibilities as well.

Woke up this morning with a pounding headache, head so full of snot it feels like my eyes are swimming in it, and a voice that sounds like the scary old guy from a b-grade swords-and-sorcerers flick. The cold I’ve been fighting off for the last couple of days has apparently finally decided to get serious and give me a beat-down. Being sick is no fun. On the other hand, I’m considering recording myself reading some corny, scary book out loud just because I think my voice sounds so funny right now.

Now if my head would stop threatening to turn itself inside out through my ears I might be able to enjoy this a little bit. Might.

Oh, and I’m not running any more. This last time I started running, after the first two weeks of doing so, the meniscus pain in my left knee got too bad. It hurt just to get in and out of cars, or to go up stairs. Looks like its time for me to find another aerobic exercise that I can feel productive doing, because the impact on my knees is just too much.

So, I really love my iPod.  It’s nice to have my whole music library with me, ready to be listened to whenever I want.  I sync my iPod with my desktop machine at home, because that seems to be the most convenient place to leave my music, and because I don’t want to have to haul my laptop out every time I want to sync.  But sometimes I’d like to be able to connect my iPod to my laptop via the dock cable and play the music from the iPod (not transfer it back to the laptop) through the laptop’s built-in speakers, be able to control it via a software remote, etc.

The hardware is not prohibitive in this, as far as I can tell, because you can connect your iPod to a small set of speakers, alarm clock, or any other number of gadgets and control it from the docking unit there, I just can’t seem to find any Windows software that will do what I want.  iTunes can show me what music is on my iPod, but it won’t play that music from the iPod as far as I can tell, and if I open up iTunes on my laptop while the iPod is connected, it wants to delete my music from the iPod because that isn’t the machine I sync the iPod with (another irritation of mine, actually).

It would be really nice if a program existed that was a software “remote” of sorts for my iPod, though, that would let me turn my computer into a remote-control and host speaker system for the iPod.  That would be really, really nice.

“If I hide myself wherever I go, am I ever really there?”  Bare Naked Ladies, For You

So, I really like the above song by the Bare Naked Ladies.  I like to listen to it while I run, for some reason, it just fits my running.  Listening to it today, I realized how applicable it is to situations not specifically implied by the song.  Situations like practicing medicine.

We take a “Physical Diagnosis” class as Medical Students here, and the first topic they focused on was what they call the “Crisis in Medical Professionalism.”  Our small-group preceptor summed it up well by saying that the take-home message from this part of the course is, “Don’t be a jerk.”  We read a lot of things that talked about doctors and the common cynical and misanthropic views they have towards patients, the passing of those attitudes on to medical students, and the effect those attitudes have on the patient experience.  Generally it boils down to this:  Doctors have the job not just of conquering disease, but of healing their patients.  This difference is illustrated in the medical care of a patient with terminal disease.  The doctor isn’t going to conquer the disease, but he can provide healing for the patient by helping the patient manage his disease and maintain the best quality of life possible for his situation.

The papers we read indicated that this can only really be done when the doctor allows himself to connect with his patients, when he views his patients as people and not just medical problems to be addressed (the difference between thinking of a patient as “Mr. Smith with the ankle problem” and thinking of him as “The Ankle”).  The attitude of a physician, including this aspect of that attitude, is at least sometimes going to be evident to at least some of his patients, regardless of how good of an actor he is.  A patient who feels hostility, cynicism, or disinterest from his physician is not going to feel comfortable opening himself up to the doctor, and thus will not be able to receive any true healing (which has mental, emotional, and physical parts) from the physician, not to mention that cynical physician is less apt to try to provide that healing.

I agree with all of this, and feel that this disconnection between patients and physicians often stems from the physician building a wall between himself and his patients.  It may be a glass wall, or even a thin fabric wall, rather than a brick or steel wall, but it is a wall.  Physicians do this to protect themselves, and try to maintain emotional stability.  I believe (though I will admit that I’m inexperienced at this point) that the need to protect one’s self from a patient stems from a poor approach to medicine in general, one that places the patient in the position of being an adversary or threat to the doctor.  But why would a doctor need to defend himself against his patients emotionally (perhaps legally, sure, but emotionally?)  I don’t know anyone who goes to the doctor with the intent of assailing his emotional health.  People go to the doctor for help, sometimes they go to the doctor because of minor physical complaints because they are really seeking emotional care.  Why would a physician feel the need to, even partially, close himself to sensing this need and attempting to provide for it?

It’s a discouraging thing for me to see physicians in their practices feel so unfulfilled without seeing that they are closing the doors to fulfillment by distancing themselves from their patients.  We become physicians because we want to help people, at least, I hope that’s at least part of why we become physicians.  How effectively can we help someone we view as an enemy though?

Satisfaction, I think, comes from treating patients, not disease.  Treating disease is a losing battle, as new diseases appear, old remedies fail, and each line of understanding reveals multiple new avenues of questioning, we cannot hope to even keep up, let alone master or destroy disease.  We can, however, win the battle when we treat patients, because each patient we see presents us with a new opportunity to heal, a new chance to succeed.  I may never be able to cure HIV, but I can help a patient with HIV have a satisfying quality of life.  If that’s my aim, then I’ve won, and I’ve received satisfaction as my reward.  If I fail to help my patient, which I will sometimes do, then I do receive some pain, but I also learn, and it truly is the sum of our pain and our pleasure, our grief and our joy, that makes us who we are.

In the end, it begs the question:  Are we ever really treating them, or are we just treating disease? If we hide ourselves from our patients, if we build walls to protect us, if we approach our patients as threats to our emotional health, are we ever really there?