Saturday, June 23, 2007

when procrastination becomes sloth.....

so the 3rd week of my extended Swot Vac has ended, but still I have yet to accomplish any of the goals I set upon before. Revision wise, I have only covered weeks 7-11 of the lectures, now that's only 2.5 weeks of work, as weeks 9 and 10 are irrelevant. Head and neck anatomy went pass quite quickly but i have yet to review the larynx. In place of this revision, what I have done instead, is finishing seasons 1-5 of my new addiction Scrubs, in 1.5 weeks, and I must add season 5 in 8 hours. Also, i have finshed reading 2 very very intersting books on surgery which I have mentioned in earlier posts. you will find that this blog is particularly because I have some mental notes on the book which I would like to put down to paper.

Firstly, "Complications - A Surgeon's Notes on an Imperfect Science" by Atul Gawande, now this man is a Harvard Medical School Graduate, koodos to that. One of the chapters that stood out was 'Whose Body is it Anyway?'. Now in this chapter comes the endless debate about paternalism vs. patient autonomy, very relevant to recent developmetns in medical school education, involving the indoctrination of the belief that 'What the PATIENT wants supercedes the DOCTOR's recommendations'. This debate goes far back, to the time where doctors were idolized and worshiped, and from that pedestal, whatever being said by the doctor was the absolute truth. No Questions Asked. Then came along, a doctor by the name of Jay Katz, author of the revolutionary book 'The Silent World of Doctor and Patient' which had strong critique for the whole idea paternalism, which obviously did not take too well with the current mindset of clinicians. some would say, ' if doctor's have difficulty choosing the best options, how can the patient then be capable of doing so?' Patient ideology vs. Treatment outcome. In my opinion there is no hard and fast rule about this. Some patients feel that to live a life with some fear of a returning cancer, by preserving a social image is more important to them, hence choosing a lumpectomy over a total mastectomy, some will be smarter. Of course there are many considerations here, patient's age, degree of metastesis, patients occupation and other emotional, psychosocial babble. Now having being socialized into the medicine paradigm, naturally I would raise my hand for the treatment that boasts the best MEDICAL outcome, and whether a patient decides to follow your lead is purely their business. Now you might say, ' where is the empathy that doctor's are suppose to have?' Like I said before, it depends on the situation at hand, while a doctor may recommend a radical mastectomy for a 65 year old post-menopausal woman, he may not do the same for Kylie Minogue.

Whilst inundating the patients with a mountain of information regarding their options and then leaving them to decide might be the 'cover-my-ass' way of having a malpractise free career (as much as possible), it most certainly is not fair to the patient. At the same time, patients who say," don't tell me all that stuff doctor, i won't understand it, do what you think is best." also is unfair to the doctor. Then comes the idea of a partnership, that is being proposed in my med school, where the lay person with his -5 years of MBBS education but lifelong learning from Wikipedia and Google actually has a more important decision making role. Certainly even when give this position of authority, one question comes to mind, who gets the blame when something goes wrong? Is it the doctor? or is the patient left to live a life carry the burden of his mistake? At this juncture, the idea of a partnership ceases to exist and the blame-game starts. Such decisions which can lead to life and death situations carry a huge burden, neither the patient nor the doctor would want this. childish regression from the patient partnership vs. Aggressive Paternalism. The debate continues.

i quote from the book," whilst there is an art to becoming a doctor, there is an art to being patient." this is absolutely essential to YOUR/MY overall treatment outcome. just because you choose to absolve yourself of all responsibility in decision making, or decided to disregard the expert opinion of your doctor, a good and CLEVER patient must always question the doctor about the treatment. Ask questions that pertain to your lifestyle, how is the treatment goign to affect your work? can you play sports as aggressively as before? what ultimately is important to you in your time of sickness? These are all important questions, as they help the doctor in determining the best treatment for you. If patient's don't tell, doctor's dont ask (well good doctors like the one im going to be) will ask, and when you sign the form acknowledging the potential risks involved, i hope patient's don't start behaving like morons when things don't turn out their way. doctors make countless decisions everyday, some of them in emergencies some not. so the hard and fast rule of the ethicist about being partners cannot always be applied. These people, especially those without MBBS should realize that their idea of ULTIMATE patient AUTONOMY cannot exist in a blemished society. Whilst doctors must always act to serve in the patient's best interest, patients must remember that doctors are only always HELPING them, and the thing to do is to voice concerns and TRY to work towards an agreement, rather then play the blame game later on. This debate will continue for as long as existence goes and will only get more complexed as patient are enlightened by the resources of google and Wikipedia.

One quote i would always remember is " the real task is not to banish paternalism; but to preserve kindness."

What i really like about this book, is how it gives a really good insight from both perspectives of the patient and the doctor. As it the pages open to exciting surgical stories, it also brings with it important lessons that have strengthen the foundations my current MBBS education is giving me, allowing me to see the bigger picture of medicine and also understand that whilst some classes in med school might seem irrelevant now, they are absolutely important in any doctor's career.

1 comment:

Jeffrey said...

hey hey hey.

finally discovered ur blog!!! didn't know you do!!

dun fuss too much abt the exam prep dude! its 5%!! i think what's more impt we learn what is important. and do well in them

anyway, change to wordpress.com and forget this darn blogspot.

its like a piece of crap=pc