Sunday, September 25, 2011

Not on my watch

In my ethics class, we talk a lot about medical interventions and dying. It's pretty well-known that many medical intervention are overused. The patient's underlying condition won't improve, the treatment will decrease the quality of life in the time the patient has left, or the treatment won't relieve pain. Patient and families often feel that medical staff push interventionso on them that they don't actually want.

I generally believe that we should try to change this culture of excess intervention, respect the patient's wishes, known when to "let go". I think many students also agree to this principle.

But I can also understand doctors and medical staff who end up intervenening more than is necessary. I think it's because we all want to avoid death even though the hospital is full of death and dying. In a recent post in "A Cartoon Guide to Becoming a Doctor" talked about how doctors want to personally avoid patient death,  "Every time I cross covered the hospital as an intern, I would pray to get through the night without harming anyone." (Cross cover is when interns receives the patients from the day team and takes care of them through the night. It's problematic because the new doc doesn't know the patients well.)

I haven't experienced the death of a patient I had responsibility for but I know that it'll be a milestone experience. It'll be something I'll remember for a long time even if my medical decisions did not cause premature death. I'm not really looking forward to it either.

Docs don't want patients to die "on their watch" so they end up prolonging dying until the next shift takes responsibility for the patient, and the next after that...

Wednesday, September 7, 2011

The hardest two months

I saw on the facebook of a third year student something like this:

So relieved I finished the two hardest months ever!

This was in response to finishing her first two-month rotation.

I was surprised by this because the two months before that, she studied for and took Step 1. I guess there are things more difficult than Step 1. It seems that each month in med school gets more difficult than one before.