Cardiac Arrest! Very scary.
Saturday, October 31, 2009
Friday, October 30, 2009
Preventative Medicine
I just got told off by a guitar repairman who was not so pleased that I didn't use a guitar stand and hadn't brought in my mom's guitar to the store in a case. It's true...if the guitar had been on a stand Catastrophe wouldn't have been able to knock it over, breaking the head. Sure he can fix it, but the repair will be expensive, it won't be good as new and the whole incident could have been prevented if we had taken better care of the guitar from the beginning. He sure made me feel like an idiot...it's just a guitar!!!!! I know a mechanic would probably have similarly harsh words about the condition of my car.
Oh preventative medicine...it makes such intuitive sense. Why not prevent a problem instead of finding elaborate, expensive, painful ways to fix it. Sure habits are hard to change, but why not have a healthy diet and exercise a little instead of getting type II diabetes. And once you have diabetes why not take your medication and avoid eating tons of donuts instead of requiring expensive hospital admissions for foot ulcers, kidney damage, amputations, etc. that eventually lead to an early death. Seriously. Health care just needs a change of focus as described in the article "Making Health Care About Health". We'd be a lot healthier as a nation. While I fully believe in preventative medicine, maybe I don't believe enough in people. One of the reasons I'm drawn to pediatrics is that kids are kids, they shouldn't yet know better and they are totally dependent on others so they need all the understanding help they can get. I do not want to deal with adults who won't follow medical advice, won't stop smoking or eating triple cheeseburgers even when it's obviously killing them (of course I've gained 5 pounds in the past month due to being sick, never exercising and eating all my mom home cooked meals). Issues such as access to healthy foods and safe places to exercise are understandble and most definitely need to be addressed, nothing is ever as simple as it sounds. That's why public health initiatives are incredibly important. It would be the general unwillingness of a patient to take on an active role in their health that I know would drive me crazy pretty quickly.
I've discovered that while I think patients need to be told about the importance of preventative medicine, I don't necessarily want to be the person doing it. All of the well child exams I've seen in general pediatrics have been fun due to the kids, but at the end of the day most don't serve much of a purpose beyond reassurance and occasionally some education. If we didn't do well child exams, 95% of the kids we see would be just fine regardless. Still it's that remaining 5% that it's important to catch...just like in prenatal care. However, as I'm encouraging kids to eat more fruits and vegetables, exercise more and wear their bicycle helmet I wonder if I really need 7 plus years of education to dispense this common sense. Of course, maybe it means more coming from a doctor, and if it actually inspires people to follow the advice that's great. Long term I think I'd rather deal with the kids with more serious problems, but we'll see how this all plays out.
Vaccines are an important part of preventative medicine too. Just look at polio. The number of vaccines given to kids has skyrocketed even since I was little and it's done a lot of good. And inspired some unfounded fear. Pediatricians (or their nurses) are at the frontlines of most vaccination campaigns. The flu clinics have been crazy with everyone scrambling for the H1N1 or seasonal flu vaccine (though some parents are afraid, there is still way more demand than supply). I'm fortunate the varicella vaccination came a long right when it did so hopefully I'll never get chicken pox. And it looks like an HIV vaccine is slowly becoming more than just a dream. Still vaccines can't fix everything...as the director of trauma surgery said, "Unfortunately there's no vaccine for bullets".
Oh preventative medicine...it makes such intuitive sense. Why not prevent a problem instead of finding elaborate, expensive, painful ways to fix it. Sure habits are hard to change, but why not have a healthy diet and exercise a little instead of getting type II diabetes. And once you have diabetes why not take your medication and avoid eating tons of donuts instead of requiring expensive hospital admissions for foot ulcers, kidney damage, amputations, etc. that eventually lead to an early death. Seriously. Health care just needs a change of focus as described in the article "Making Health Care About Health". We'd be a lot healthier as a nation. While I fully believe in preventative medicine, maybe I don't believe enough in people. One of the reasons I'm drawn to pediatrics is that kids are kids, they shouldn't yet know better and they are totally dependent on others so they need all the understanding help they can get. I do not want to deal with adults who won't follow medical advice, won't stop smoking or eating triple cheeseburgers even when it's obviously killing them (of course I've gained 5 pounds in the past month due to being sick, never exercising and eating all my mom home cooked meals). Issues such as access to healthy foods and safe places to exercise are understandble and most definitely need to be addressed, nothing is ever as simple as it sounds. That's why public health initiatives are incredibly important. It would be the general unwillingness of a patient to take on an active role in their health that I know would drive me crazy pretty quickly.
I've discovered that while I think patients need to be told about the importance of preventative medicine, I don't necessarily want to be the person doing it. All of the well child exams I've seen in general pediatrics have been fun due to the kids, but at the end of the day most don't serve much of a purpose beyond reassurance and occasionally some education. If we didn't do well child exams, 95% of the kids we see would be just fine regardless. Still it's that remaining 5% that it's important to catch...just like in prenatal care. However, as I'm encouraging kids to eat more fruits and vegetables, exercise more and wear their bicycle helmet I wonder if I really need 7 plus years of education to dispense this common sense. Of course, maybe it means more coming from a doctor, and if it actually inspires people to follow the advice that's great. Long term I think I'd rather deal with the kids with more serious problems, but we'll see how this all plays out.
Vaccines are an important part of preventative medicine too. Just look at polio. The number of vaccines given to kids has skyrocketed even since I was little and it's done a lot of good. And inspired some unfounded fear. Pediatricians (or their nurses) are at the frontlines of most vaccination campaigns. The flu clinics have been crazy with everyone scrambling for the H1N1 or seasonal flu vaccine (though some parents are afraid, there is still way more demand than supply). I'm fortunate the varicella vaccination came a long right when it did so hopefully I'll never get chicken pox. And it looks like an HIV vaccine is slowly becoming more than just a dream. Still vaccines can't fix everything...as the director of trauma surgery said, "Unfortunately there's no vaccine for bullets".
Wednesday, October 28, 2009
Where the Wild Things Are
Two weeks into my pediatrics rotation and I've embraced my inner child. Saturday I went to see "Where the Wild Things Are" in all its dappled golden sunlight glory. It's a beautifully filmed movie, but I honestly think I preferred the trailer to the full length film...it captures all the sweeping emotion and magical creatures and the nonexistent plot isn't really an issue. I spent Sunday at the Children's Museum of Indianapolis visiting the King Tut exhibit on its last day...most recent theory is that he died of an infection after breaking his femur right above the knee...who knew? Also played with the dinosaurs, trains, water clock, glass fireworks, dollhouses, mirror maze, etc. So much fun!
Outpatient peds has been fun too. I'm down in Bloomington working with all the doctors at Southern Indiana Pediatrics including my own pediatrician! Of course, due to H1N1, my very first week here was apparently the craziest week they've seen in 10 years. Great. Plus I was sick even before I started so it was a little rough getting through the days without coughing on the kids (generally bad form). It feels like half the kids in town have fever, chills, cough and runny nose and I've seen most of them. At least I finally got my H1N1 vaccine (and I got to administer the nasal mist to myself). It's been a good experience working with a different doctor every day because you get to see different styles and figure out what works best for you. Love the bird sounds and handouts (and Dr. McDaniel referring to everyone as "little buddy" which is my nickname for Catastrophe), not so wild about the doctor who put all kids in a death grip in order to see their ears. I also get to see the newborns at Bloomington Hospital...right back where I was born! There have been some interesting patients along with all the flu and otitis media...a toddler recovering from neuroblastoma, a kid hospitalized with cystic fibrosis, and a sixth grader with albinism, a concussion, and sorta freaky congenital nystagmus.
With general pediatrics so much is about the interaction with the kids and their families. Our clerkship director told us today that in order to be a primary care pediatrician you need to get joy out of reassuring the family that their child will be just fine and it's just the flu, or contact dermatitis, or an ear infection. At the same time you need to be prepared in the rare case it is something more serious. I've enjoyed every one of the 200+ kids I've seen in the past two weeks, even the fussy ones. It's just more fun working with kids and it's nice to see reasonably healthy kids after all of the pediatric surgery patients I encountered at Riley. Next up I have my inpatient pediatrics rotation with Hematology/Oncology at Riley so it will be back to the seriously ill kiddos. I can definitely envision a pediatrics residency in my future...
Outpatient peds has been fun too. I'm down in Bloomington working with all the doctors at Southern Indiana Pediatrics including my own pediatrician! Of course, due to H1N1, my very first week here was apparently the craziest week they've seen in 10 years. Great. Plus I was sick even before I started so it was a little rough getting through the days without coughing on the kids (generally bad form). It feels like half the kids in town have fever, chills, cough and runny nose and I've seen most of them. At least I finally got my H1N1 vaccine (and I got to administer the nasal mist to myself). It's been a good experience working with a different doctor every day because you get to see different styles and figure out what works best for you. Love the bird sounds and handouts (and Dr. McDaniel referring to everyone as "little buddy" which is my nickname for Catastrophe), not so wild about the doctor who put all kids in a death grip in order to see their ears. I also get to see the newborns at Bloomington Hospital...right back where I was born! There have been some interesting patients along with all the flu and otitis media...a toddler recovering from neuroblastoma, a kid hospitalized with cystic fibrosis, and a sixth grader with albinism, a concussion, and sorta freaky congenital nystagmus.
With general pediatrics so much is about the interaction with the kids and their families. Our clerkship director told us today that in order to be a primary care pediatrician you need to get joy out of reassuring the family that their child will be just fine and it's just the flu, or contact dermatitis, or an ear infection. At the same time you need to be prepared in the rare case it is something more serious. I've enjoyed every one of the 200+ kids I've seen in the past two weeks, even the fussy ones. It's just more fun working with kids and it's nice to see reasonably healthy kids after all of the pediatric surgery patients I encountered at Riley. Next up I have my inpatient pediatrics rotation with Hematology/Oncology at Riley so it will be back to the seriously ill kiddos. I can definitely envision a pediatrics residency in my future...
Sunday, October 11, 2009
Suddenly I See...or not
Good grief...I'm already a third of the way done with third year! Normally I would be ecstatic, but for the first time in my life I'm feeling that just knowing enough to get through the days and get through the tests is not sufficient. Not all that long from now my knowledge (or lack thereof) could really make a difference in someone's life. Sure there should always be some doctor around I can ask for help throughout residency, but a good part of the responsibility lies with me...and I just don't know how I can learn all I need to know in the time I have left. Perhaps I'm prematurely freaking out (that's what I do), but it has inspired me to focus on the most practical skills that can make a huge difference in a crunch...you can always stop and look up a biochemical pathway, but if someone has a tension pneumothorax they need it fixed NOW.
It's a relief to be done with my surgical rotation (assuming I passed that damn test) and move on from ophthalmology. I learned quite a bit in that month...but I wasn't really inspired to pursue it further. Incredible things are being done in ophthalmology (Burst of Technology Helps Blind To See) but the only other surgery I saw on my rotation was a medial wall orbital fracture repair where the patient went in with fine vision and extraocular motion and post-op he couldn't move his eye properly. That's not cool. Sometimes doctors must inflict a little pain to solve a problem, but it's generally not great when we take an almost non-issue and make the problem much worse.
I'm super excited about my peds rotation! I'm down in Bloomington for the rest of the month and I'll even be working with my pediatrician part of the time (hope that's not too weird). Here's hoping I avoid this whole H1N1 mess.
It's a relief to be done with my surgical rotation (assuming I passed that damn test) and move on from ophthalmology. I learned quite a bit in that month...but I wasn't really inspired to pursue it further. Incredible things are being done in ophthalmology (Burst of Technology Helps Blind To See) but the only other surgery I saw on my rotation was a medial wall orbital fracture repair where the patient went in with fine vision and extraocular motion and post-op he couldn't move his eye properly. That's not cool. Sometimes doctors must inflict a little pain to solve a problem, but it's generally not great when we take an almost non-issue and make the problem much worse.
I'm super excited about my peds rotation! I'm down in Bloomington for the rest of the month and I'll even be working with my pediatrician part of the time (hope that's not too weird). Here's hoping I avoid this whole H1N1 mess.
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