Today I visited my blog for the first time in what seems like ages. I half expected my browser window to crack and crumble like stale bread as I scrolled through old entries. If I didn't know better, I would almost believe that much of this stuff was written by somebody else. It wasn't, I assure you. I don't claim any of what you read here to be factually true. But, it is all by a single author and all opinions represented here do represent those of said author.
On a vaguely related note, my brain's limited capacity to keep large amounts of information readily accessible has begun to bother me. It's not so much a matter of total memory storage. I have clear memories of what I ate for breakfast in third grade and the first long road trip our family took during the summer before first grade. Rather, it's a problem of accessing relevant information when I need it. I need more RAM. Take this blog, for example. I created this all myself. I didn't write the actual code or create the HTML doc's. Moveable type, sandbox and various other services were kind enough to do some free legwork for me. But I did put it all together and modify it to my liking. There was a time when I was quite proficient in HTML and web design. Today, I was lucky to remember how to get past the login screen let alone how I set the whole thing up. If something ever breaks, I'll be in trouble because I'm the only one (in theory) who knows how it all works.
Aside these frustrations, the reason this blog has languished is not because I've run out of things to say. Quite the contrary. Nor is it because I haven't had time to devote to writing; residency is actually treating me quite well in that respect. It's mainly just a matter of laziness. And I plan to stop being lazy very soon. Maybe even as soon as tomorrow. Or maybe next month :)
For clearance to participate in sports, The American Academy of Family Physicians recommends the following:
Athletes with a murmur that becomes softer with squatting or louder or longer with standing or during a Valsalva maneuver should be evaluated for hypertrophic cardiomyopathy and mitral valve prolapse.
For clearance to participate in sports, The American Academy of Family Physicians recommends against following:
Routine screening with noninvasive tests, such as echocardiography, exercise stress testing, and electrocardiography is not recommended
If this blog has one mission in life - besides to amuse and entertain - it is to prevent those in the medical profession from doing excess harm. Lord knows, there are plenty of people out there who would have been much better off had they never come in contact with the medical profession. As doctors, we can't always help people. But, at the very least, I think it is incumbent upon us to become proficient at not harming our patients. And, one of the best and easiest ways to prevent harm to our patients is to decline to screen them for things that they don't need to be screened for!
Whether or not we should screen for hypertrophic cardiomyopathy in order to prevent sudden death in young athletes is controversial. Currently, there is no evidence to support it, but more studies need to be done. HOWEVER, if there is no evidence to support routine screening with ECG or echo, then you can be damn well positive that there isn't any evidence to support routine screening with cardiac ascultation!
This happens rather frequently in medicine. I'm thinking particularly about the recent controversy over the new age recommendations for routine mammography. Whenever the evidence points us in a direction contrary to what health care professionals believe to be their beneficent duty, we end up with recommendations that simply don't make sense.
I've got to go to the local high school and do some sports physicals this afternoon.
NBC will be airing a new reality show set in Cook County prison in which investigators probe innmates for information. A brief glimpse of prison life reminded of my former job as in OBGYN resident. There's a very real sense in which OBGYN, and most other surgical, residents are actually less free than prisoners. I think Cook County innmates have at least as much control over their day to day activities as I used to. Of course, they can't quit prison the way I quit my former residency program. Let's put it to a vote: assuming you would be finnancially set by the end without having to work another day in your life, would you rather spend 5 years in prison or 5 years in a surgical residency?
Just writing a few lines as I wait for Windows 7 to download. I do have a new post planned. In the spirit of the holidays, the topic will be empathy and what the concept is completely irrelevant to medicine. I'll have it up by Christmas Eve.
Thomas Nasca, CEO of the accreditation council for GME published, on October 28, 2009, an open letter to the medical community. It details the findings of a 16 member ACGME task force regarding the effect that limiting resident work hours has had on medical professionalism. Thanks to DB for bringing it to my attention.
My problems with this letter are severalfold, but can mainly be distilled down to the following. Dr. Nasca would seem to suggest that it is ACGME's belief that medical professionals, bound as we are by the oath of Hippocrates and motivated as we are by altruism, should not be held to the same standard as other industries when it comes to safety and work hour regulations.
Thus, while residents must not be forced to remain on duty for excessive periods, they must not be precluded from demonstrating the caring and commitment required of them as altruistic professionals. ACGME's standards, and the expectations of the public of the nature of enforcement of those standards, must match this important principle. It is here, as in other places, that the analogy with the airline industry fails. A pilot, running out of hours, can refuse to fly the plane, and the passengers are no worse off for the decision, other than the delay. The Neurosurgeon, faced with a patient requiring an emergency craniotomy, does not see an option to, nor does he or she want to say no. The patient struck by a car, with multiple trauma, acute rhabdomyolysis with hyperkalemia and acute renal failure, needs dialysis now, not after the Nephrologist has slept for five hours. The patient needs and demands no less, as does our vow of Hippocrates.
I vehemently, though respectfully, disagree, Dr. Nasca. It is here that the analogy to the airline industry is more appropriate than ever. No more is it ok for a pilot - who is responsible for over a hundered lives - to violate his work hour restrictions than it is for a neurosurgeon who has been awake for 14 hours to perform an emergency craniotomy despite the fact that it is only one life that is at stake. Taking care of patient needs in violation of duty hour restrictions is not the hallmark of professionalism. Quite the contrary. Lack of adherence to standards that are put into place for the explicit purpose of protecting patient safety is irresponsible and clearly unprofessional
Within the boundaries of reasonableness, and with a goal of patient safety, residents must demonstrate willingness to sacrifice for their patients' needs, being taught and given the opportunity to demonstrate the practical manifestations of altruism, the core virtue undergirding professionalism.
In this case, Dr. Nasca, I will vehemently and disrespectfully disagree by referring the above quoted text as 'BULLSHIT!' As professionals, it is not our job to "sacrifice" for our patients - unless you're referring to the whole enterprise of being a doctor as "sacrifice." On the contrary, it our mandate as professionals to remove ourselves from situations in which our own well being has the potential to come into conflict with that of our patients - just as any professional in any other industry should recognize when his or her interests come into conflict with the interests of those whom he or she is purported to serve. I don't know about you, but I don't want my doctor to be in any situation in which he may have to choose between my well being and his own.
I think the medical profession is going to continue to struggle with this issue until there is some kind of cultural shift toward a more rational conception of the doctor-patient relationship.
