Medical Mistakes

This post is the second in a series of blog posts for my class on the Profession of Medicine.

For me, mistakes in medicine have always been one of those awkward things to think about.  For lack of a better analogy, it’s like thinking about your parents having sex.  Nobody wants to think about that, but it obviously happens, or else you wouldn’t be sitting here struggling with the concept of your parents as sexual beings.  Likewise, we’re all aware that medical mistakes happen; we’re confronted with the statistics every day – 90-something thousand deaths due to preventable errors, 1 error per patient per day in the hospital.  And yet, very few med students (myself included) believe that competent physicians, much less great doctors, commit these so-called “sins” on a regular basis.

The Profession of Medicine – Resource Allocation

This post is the first in a new series of entries written for my Patient, Physician, and Society class on the Profession of Medicine.  The syllabus says “The Profession of Medicine (POM) is about the identity of the profession itself: what it is, what it should be, and how you might work to close any gaps you see between the two.  The key questions of POM remain constant: ‘What should the profession do?’ and ‘How will you practice medicine?’

Resource Allocation

When I read these articles criticizing the culture of modern medicine for spending way too much on (in these articles, it’s usually excessive) care for one patient when the same money could be spent to cure a multitude of patients, I wonder if these are the discussions of medical ethics boards around the world.  As far as I know, America is the only country (or maybe one of a select few) that puts so much emphasis on individualism.  Here in the States, it’s all about me, what I can do to better my situation, and the size of the crowd I can gather to promote my agenda.  It’s not too difficult, then, to understand why medical ethics boards in the United States focus so much of their efforts on discussions of brain death, organ transplantation, end of life care, and other issues that center mainly on the individual patient at hand.

But what kinds of questions would an ethics board in, say, Europe, ask? 

Compassion

There are some people whom you will remember better than they remember you, and there are some people who will remember you better than you remember them.

I’ve started to get some of the latter going on in my own life – mostly from M1s who met me on their interview day.  I’ve introduced myself to people who then say “I remember you…you were my tour guide when I interviewed here.”  And I’ll inevitably try to remember back to the day when I saw them, but it’s usually in vain.

The general trend is for the ratio to shift toward the latter as you get older.  We’ve met more people, and as status (usually) increases with age it’s inevitable that more and more people will remember you better than you remember them.

Fight the trend. Strive to be impressed by just as many people as you impress.

This thought was inspired by a random hit on my facebook feed.  I randomly ran across the profile of someone who was a beginner snowboard student of mine 2 years ago.  I decided to glance at her interests just for fun, and whaddaya know, she still snowboards.  After a day of pretty rough lows, it was uplifting to realize I had made a difference in someone’s life.

Thank you, Diandra, for helping me regain my faith in people.  Even if I’d only lost it for a brief while.

State of the Med School – Education not included

After having listened to our Dean talk about the current state of the med school and where we’re headed, I’ve realized how far down on the list of priorities undegraduate medical education really is to an academic medical center (AMC).  It must be weird to hear that medical education is not the main goal of a medical school; it’s much weirder living it.

The bottom line is, medical education is a resource sink.  First of all, medical education doesn’t bring in the big bucks like research grants do; in fact, most, if not all med schools lose money on education.  Most of us don’t pay 100% of our tuition, and even then, tuition does not cover all of the costs of providing an undergraduate medical education.  Secondly, medical education has a very very long timeline for return – it takes 8 or more years for us to become licensed physicians ready to give back to the community.  Last, undergraduate medical education affects a tiny fraction of the people involed in an academic medical center – the vast majority of an AMC’s employees work in research or solely in patient care.

Without much pull on the administration, undergraduate medical education can fall pretty far down on the list of issues to worry about for an academic medical institution.  But that’s the reality of our current situation.  My only hope is that the letter I’m about to write to the Dean imploring him to focus on improving the quality and standing of undergraduate medical education won’t fall on deaf ears.  But I’m not holding out much hope.

It’s sad

…when your cousin – who’s a senior in high school – has been with his girlfriend for over 2 and a half years.  Makes you feel like something is wrong with you.  I wonder what my uncle and aunt think.

But I’m happy for him.  His may very well be the first wedding I’m invited to. (no pressure)

but I’d better be a groomsman.

Long weekend…

…means I’ve felt bored for the first time in a long time.  Not counting winter break, of course…there’s never much to do at home.  Although this time I actually made the most of my vacation.  I don’t know why I didn’t do it in years past, but I decided to make living in Florida work for me…by driving out to the east coast and spending a weekend surfing.  Maybe Boston was never cold enough in December to make me want to enjoy the warm weather back home, but 2 months of consistently below-freezing weather in Chicago made coming back to 80 degree highs feel so revitalizing.

That’s not to say I didn’t get a good dose of the snow before coming back.  It snowed 2 feet in New Hampshire while I was there…that made for some brutal weather the first day there, but incredible conditions the couple days after that.  It feels really weird that I’m coming to terms with the notion that I’ll be riding for a maximum for 10, 12 days this season when last year I was on the mountain almost every single day of the winter.  I think I’ve made my peace with it, not so much because I’m okay with it but more out of necessity.  I’d be totally unproductive if I sat around all day wishing I could ride more this season.  It’s not without consequence, though…I feel like there’s something missing, especially on pow days.  As much as I hated missing out on parties and barhops on Friday nights, I think I hate not getting first tracks in on Saturday mornings more.  I tried throwing down like I used to at Loon over break…and realized I cut at least 360 off my spins since the end of last season.

We do it all pt. 1 – Music

Wood density holds key to Stradivarius sweet sound

By Ben Hirschler Tue Jul 1, 9:02 PM ET

LONDON (Reuters) – Researchers using a medical scanner have worked out why a Stradivarius violin sounds so good — it is because of the remarkably even density of the wood.

For the past 300 years, musicians and scientists have puzzled over the unparalleled quality of classical Cremonese violins made by Italian masters like Antonio Stradivari and Giuseppe Guarneri del Gesu.

Now a Dutch doctor and a violin maker from Arkansas think they have cracked the mystery after comparing five classical and eight modern violins in a computed tomography (CT) scanner normally used to examine patients.

Using an adaptation of a computer program developed to calculate lung densities in people with emphysema, they were able to analyze the physical properties of violins without risking damage to instruments worth millions of dollars.

“You’re more likely to be struck by lightning…”

Girl survives lightning strike, then wins lottery

Fri Jun 13, 7:33 PM ET

BLANCHARD, Mich. – No one quite understands the term “striking it lucky” better than 16-year-old BreAnna Helsel. The Michigan teen survived being struck by lightning and went on to win $20 in the lottery the next day.

Helsel was at her home in Blanchard, about 50 miles northeast of Grand Rapids, watching thunderstorms roll by on June 6 when she noticed rain entering an open kitchen window.

“She went to close the window and the lightning came through and hit her,” her mother, Linda Johnson, told The Daily News of Greenville. “We think it must have hit the house or something.”

Helsel struggled to describe the sensation she felt as the electricity passed through her body.

“It felt like when your foot falls asleep,” she said.

Helsel said she saw the electricity shoot out of her fingers and into the overhead lights, immediately knocking out the house’s power.

My new favorite fish

I’d like to think that I’m pretty well-versed when it comes to sushi, so I was intrigued when I found a new type of nigiri on a Japanese fusion restaurant’s menu.

It’s called ono – Premium Hawaiian Escolar.  I looked it up in wikipedia, and this is what I found:

“Like its relative the oilfish (Ruvettus pretiosus), it cannot metabolize the wax esters (Gempylotoxin) naturally found in its diet, which accumulates to give an oil content in the muscle meat of 18–21%. These wax esters may rapidly cause gastrointestinal symptoms following consumption….

“The gastrointestinal symptoms, called ‘keriorrhoea‘, caused by these wax esters may include oily orange diarrhea, discharge, or leakage from the rectum that may smell of mineral oil. The discharge can stain clothing and occur without warning 30 minutes to 36 hours after consuming the fish. The oil may pool in the rectum and cause frequent urges for bowel movements due to its lubricant qualities and may be accidentally discharged by the passing of gas. Symptoms may occur over a period of one or more days.”

“For these reasons, escolar has been banned from consumption in Japan since 1977, as the Japanese government considers it toxic.”

Can you really call it sushi if the Japanese don’t eat it? =)

Figuring out what’s wrong with you just got easier

I was on WebMD this morning looking up advice on sinus infections when I saw a curious little box on the page.  It was a little slider that you can move from left to right to change age ranges, and under it was a list of diseases pertaining to that particular age range, with the intended effect being to inform you of what problems to expect and hopefully take precaution against.

It was actually pretty interesting to read about what I might have now and what I can expect to have when I’m 70+: arthritis, colon cancer, grief & loss, memory loss, sleep disorders, and sex after 70…

If anything, it reminded me to enjoy my youth while it lasts.