I want to use this post, first to understand what I would expect from a doctor as patient and second to gain insight in how I could be a better doctor.
I'll start off with my second dermatologist in high school. As people who remembered me in high school knew, I had quite a bit of acne...unfortunately it runs pretty strongly on my dad's side. It got relatively bad, as my face would be covered in pimples (whiteheads, deep sebaceous swellings, and blackheads); I was afraid of scarring so I decided to explore some derms. My first dermatologist was a pretty good guy, he basically just prescribed doxycyclin and asked his PA to drain my pimples with a white-head removal tool. For some reason I still wasn't extremely satisfied with my care because for one my check-ups lasted only 10-15 minutes, and the doctor really had no other feedback except you have a classic case of acne. I personally wanted to hear about new treatments or drugs that he might be able to give me, but he didn't seem to have a solution. He wasn't a bad doctor..he just seemed average. He treated his practice like a day-job; punch-in and punch-out. That was his attitude. So I decided to go to another dermatologist.
The second dermatologist may have been the worst doctor I have come across. As soon as I arrived at his office, I waited in the examining room for 20 minutes. I couldn't imagine what type of dermatological case would take 20 minutes of my appointment, especially considering that there aren't many emergencies in dermatology. When he walked into my room, he was half awake. Right then and there I realized, "Omg this guy was taking a nap." Ok, so he took a nap, I was willing to overlook that...maybe he had a hard day blah blah w/e fine, as long as he does a good job in this consult I'll let it go. He looked at me for a total of 5 minutes, without touching my face or even looking closely, he gave me a topical cream and left. At this point, I was pissed off. Why? Because as a patient I felt disrespected. This was a doctor who saw me as some sort of annoying obligation he needed to get out of the way so that he could back to his nap. What could be more important than his patient? Medicine is ALL about the well-fare of the patient. He didn't care that I had questions about what was going on. For example, I was worried about permanent scarring, how long I could expect acne, and what treatments are available to remove scarring in the future. I didn't have any of those concerns addressed. I was completely neglected. On top of that, I payed him in full as it was a fully cosmetic consult. The lingering question in my head after this consult was, why is he treating people he doesn't care about? Doesn't he realize that they want understanding and clarity about their condition? I wanted to him to give me a sense of contentment. "O.k. Mr. Baig it's a normal phase of puberty, I think this is the most beneficial treatment, and scarring is removable... etc etc."
As a consequence I has some anxiety about the future of my skin. I didn't want the same scarring my dad has, and I was really worried because appearance means a lot in this society. Whether it's interviewing for a job, or interacting with future patients. This doctor had a duty to me, which I felt he failed. He failed to be what all doctors are, which is an advocate for their patient's health. With his knowledge and training I went to him to look our for my best interests, which why I put myself in his hands with a part of my body. If he doesn't take that seriously, I'm the one who suffers. On top of that I don't like feeling neglected by someone who I trusted to receive care from. I returned to my old dermatologist due to the large disparity in care
As bad as this experience may have been, good things came out of it. I now have a concrete example of how medicine should not be practiced. Note, I'm not making claims to how it should be practiced; but, if one hopes to be a caregiver, then they have a duty to provide superior care to their patients because patients are trusting them with their well being; it's only fair. A doctor is an authority because they make decisions in an arena where others pay the consequences, thus they have a responsibility to make decisions for the best possible outcome. As a doctor, I hope to embody this philosophy.
In my next post, I'll talk about doctors who in my opinion are great, and it's reflected in the success of their practice and their reputation in the medical community.
Wednesday, July 28, 2010
Oliver Sack's unique perspectives
I've been reading Oliver Sack's book "The Man Who Mistook His Wife for a Hat" and it's a pretty deep book. Dr. Sack attempts to show his audience that patients aren't merely a collection of debilitating symptoms, rather they have an identity with perceptions, emotions, consciousness that needs to be considered both inside and outside the context of their disease. I think it's fascinating, as he has the ability to look through people's problems to try to find out who they are deep within. I really admire Dr. Sacks because his approach seems to represent how doctors should look at their patients, and how this approach can be easily lost resulting in negative consequences for their patient specifically in their quality of life.
The first two clinical cases he discusses are about two men who have neurological disorders that have caused "deficits" in recognition and short-term memory. He hates the work "deficit" as he says doctors tend to use this label to de-humanify their patient. It's easier to think a patient lacks a function that can or cannot be corrected. The label in essence, allows the doctor to view his patients solely as a symptom or condition. From what I understood, he thinks deficit should not be used because a patient's quality of life doesn't revolve around the lack of one or two functions, and rather if things aren't looked at as "deficits" but instead as quirks or challenges, doctors can then proceed to help the patient cope with their disease and help patients develop an alternative lifestyle. Of course this only relates to patients whose particular disorders are incurable.
The first man is a music teacher who suffers from lack of facial recognition. He can never recognize people by their faces, only by familiar sounds or characteristic features. In fact, he mistook his wife's head for a hat! This man's condition at least in 1985 did not have a cure, as it was prosopagnosia. Interestingly enough, the man was unaware that he couldn't recognize faces in the first place, which seemed to be a problem rooted in his consciousness or awareness, which is what makes this condition so fascinating. The quality of life issue comes into question because if he himself doesn't realize it, does he really feel any sense of suffering. Rather from a doctor's perspective the issue becomes about what he's missing out on in life. The ability to connect with people by associating expressions, beauty etc. any all of these types of visual communications that occur through the face. I suppose then a doctor's role isn't just fixing what's broken but opening up a world of potential satisfaction for their patient. Isn't it worth restoring sight to a blind person, even if they have never seen before?
Also, in the case of Dr. Sack's patient, he did have some trouble navigating streets and interacting with people as he mistook them for various objects. It didn't seem like something intensely debilitating, but it may be annoying to live with year after year. So how was this patient treated for this condition? Dr. Sacks told this patient to immerse himself in music because it was something he could recognize and coherently apply his mind to. In a sense, the patient albiet confused in a faceless world was able to find himself through music and auditory identification. He used his musical rhythm to work his way through the day. To find his way to his work, to put on his clothes etc. even if he couldn't rely on his vision. In essence, his doctor successfully treated this patient by making him functional in the context of his disease. It was quite profound.
Similarly, Dr. Sack's second patient suffered permanent retrograde amnesia. If you have seen "Momento" it's the exact same thing. The patient was stuck with memories from 1945, but could not remember anything after, even construct any new memories. It was interesting as this patient also was not aware of his disease, as he would forget about it even if you told him. But, what was most profound was that after observing him, Dr. Sacks saw that he had some sort of awareness deep down within his soul of the lack of progression in his life. He did suffer from not being able to progress in time, being constantly stuck in more of the same, these fixed memories which imprisoned him in a constant, unchanging past. Signs of this were that the patient was restless, could not feel happiness, had this underlying sadness even though consciously he didn't know why nor could ever confront it as he would constantly forget. Thus, it was an issue of quality of life. However, amazingly the patient was able to achieve progression and continuity through one thing...prayer. As a Muslim and a person of faith in the unseen world of souls, this was quite profound.
Even though the patient was at a loss in every intellectual and mental endeavor, he was able to find continuity, a sense of progression and existence in prayer. It seems that he was able to exist through a spiritual reality. Dr. Sack's recognized this spiritual dimension and facilitated this patient to garden and do things which would get him more in touch with his soul. Over time, this patient was coherent in tasks of gardening, praying, became familiar with areas of the building and where to eat etc. Even though he could never recognize or remember people or perform complex intellectual tasks that last over a few seconds, he still had an odd familiarity with spiritual tasks. What this meant to me was that a doctor must help his/her patient in all dimensions, and that medicine isn't about quantitative pathology alone. It's a holistic approach, which attempts to restore balance and function to a patient's life. Again, the patient may regain their identity and in tern quality of life.
I'm really benefiting from this book. It deals precisely with an issue I've always wondered about. How doctor's should view their patients? Not as specimens, but as people, as individuals, as souls. I think you can only help someone else if you understand who they are, and the context of what they are experiencing. If you can't understand your patient, then how are you going to help them? Why would they listen to you? Why would they trust you? More importantly why would I as a patient put my life in your hands if I'm not convinced you know what I'm going through both physically and spiritually? I wouldn't because my health is a collection of the physical, mental, and spiritual.
The first two clinical cases he discusses are about two men who have neurological disorders that have caused "deficits" in recognition and short-term memory. He hates the work "deficit" as he says doctors tend to use this label to de-humanify their patient. It's easier to think a patient lacks a function that can or cannot be corrected. The label in essence, allows the doctor to view his patients solely as a symptom or condition. From what I understood, he thinks deficit should not be used because a patient's quality of life doesn't revolve around the lack of one or two functions, and rather if things aren't looked at as "deficits" but instead as quirks or challenges, doctors can then proceed to help the patient cope with their disease and help patients develop an alternative lifestyle. Of course this only relates to patients whose particular disorders are incurable.
The first man is a music teacher who suffers from lack of facial recognition. He can never recognize people by their faces, only by familiar sounds or characteristic features. In fact, he mistook his wife's head for a hat! This man's condition at least in 1985 did not have a cure, as it was prosopagnosia. Interestingly enough, the man was unaware that he couldn't recognize faces in the first place, which seemed to be a problem rooted in his consciousness or awareness, which is what makes this condition so fascinating. The quality of life issue comes into question because if he himself doesn't realize it, does he really feel any sense of suffering. Rather from a doctor's perspective the issue becomes about what he's missing out on in life. The ability to connect with people by associating expressions, beauty etc. any all of these types of visual communications that occur through the face. I suppose then a doctor's role isn't just fixing what's broken but opening up a world of potential satisfaction for their patient. Isn't it worth restoring sight to a blind person, even if they have never seen before?
Also, in the case of Dr. Sack's patient, he did have some trouble navigating streets and interacting with people as he mistook them for various objects. It didn't seem like something intensely debilitating, but it may be annoying to live with year after year. So how was this patient treated for this condition? Dr. Sacks told this patient to immerse himself in music because it was something he could recognize and coherently apply his mind to. In a sense, the patient albiet confused in a faceless world was able to find himself through music and auditory identification. He used his musical rhythm to work his way through the day. To find his way to his work, to put on his clothes etc. even if he couldn't rely on his vision. In essence, his doctor successfully treated this patient by making him functional in the context of his disease. It was quite profound.
Similarly, Dr. Sack's second patient suffered permanent retrograde amnesia. If you have seen "Momento" it's the exact same thing. The patient was stuck with memories from 1945, but could not remember anything after, even construct any new memories. It was interesting as this patient also was not aware of his disease, as he would forget about it even if you told him. But, what was most profound was that after observing him, Dr. Sacks saw that he had some sort of awareness deep down within his soul of the lack of progression in his life. He did suffer from not being able to progress in time, being constantly stuck in more of the same, these fixed memories which imprisoned him in a constant, unchanging past. Signs of this were that the patient was restless, could not feel happiness, had this underlying sadness even though consciously he didn't know why nor could ever confront it as he would constantly forget. Thus, it was an issue of quality of life. However, amazingly the patient was able to achieve progression and continuity through one thing...prayer. As a Muslim and a person of faith in the unseen world of souls, this was quite profound.
Even though the patient was at a loss in every intellectual and mental endeavor, he was able to find continuity, a sense of progression and existence in prayer. It seems that he was able to exist through a spiritual reality. Dr. Sack's recognized this spiritual dimension and facilitated this patient to garden and do things which would get him more in touch with his soul. Over time, this patient was coherent in tasks of gardening, praying, became familiar with areas of the building and where to eat etc. Even though he could never recognize or remember people or perform complex intellectual tasks that last over a few seconds, he still had an odd familiarity with spiritual tasks. What this meant to me was that a doctor must help his/her patient in all dimensions, and that medicine isn't about quantitative pathology alone. It's a holistic approach, which attempts to restore balance and function to a patient's life. Again, the patient may regain their identity and in tern quality of life.
I'm really benefiting from this book. It deals precisely with an issue I've always wondered about. How doctor's should view their patients? Not as specimens, but as people, as individuals, as souls. I think you can only help someone else if you understand who they are, and the context of what they are experiencing. If you can't understand your patient, then how are you going to help them? Why would they listen to you? Why would they trust you? More importantly why would I as a patient put my life in your hands if I'm not convinced you know what I'm going through both physically and spiritually? I wouldn't because my health is a collection of the physical, mental, and spiritual.
Sunday, July 25, 2010
The Man Who Mistook his Wife for a Hat
Cheerio,
This is my mid-summer blog. I'll try to stay somewhat consistent in my posts and reflections :). I can't, however, promise that my thoughts won't be everywhere!
I just finished my MCATs Alhamdullilah, and I'm currently at a crossroads in deciding whether to apply late this year or prepare my application early next year. I'll leave this one up to God (I made istikhara so w/e happens will be good). There are few things to talk about for this upcoming year. For one, I have joined a new neuroradiology lab at UCSF, under the mentoriship and guidance of renowned UCSF interventional neuroradiologist ****** (gotta get his permission!). Also, I'm planning to head off to learn arabic in Egypt, tour Morocco, do Umrah, and visit Tarim...not sure if I can do all of those things but definitely Egypt and Umrah. Lastly, I'm reading this fantastic book by Oliver Sacks called The Man Who Mistook his Wife for a Hat; I'll be using this blog extensively to reflect on my readings of this book.
So to start off. I joined a neuro-ir lab at UCSF, moving from the neurosurgery lab I was at last year. The last lab was great, but unfortunately summer interns filled up space when I took time off for my MCATs so I decided to explore other fields of research. Early 2010, during lab I would head off to parnassus to attend a variety of neurosurgical conferences, and it's where I discovered the field of neuro-ir; specifically through the cerebrovascular conference headed by cerebrovascular surgeon M. Lawton. What really attracted me to this field was the use of MRI and endovascular techniques to treat various types of vascular pathologies. What I appreciated most about the conference was the amazing diagnostic insight of neurointerventionalists in classifying, determining treatment, and predicting outcomes based on the location and etiology of arterio-venous malformations, aneurysms, and fistulas. I was intrigued by how radiologists diagnose pathology by using visual acuity, knowledge, and experience. As a spatial learning and thinker I find cerebrovascular neurosurgery and neuro-ir (and probably other diagnostic/surgical fields) as a potential career path in medicine.
Last week, I interviewed with the head of the lab M. Saeed, whose a Ph.D interested in using IR-techniques in treating coronary vascular malfornations. It seems pretty interesting, and I have a few publications to read through before I decide on any project. I think I'm still more interested in vasculature of the brain...but we'll see after I read.
The first day, Dr. *** gave a lesson to me and a medical student on aneurysm classification and how neuro-irs generally treat them. Pretty interesting stuff. Fusiform aneurysms balloon out from all sides of the artery and can be treated with a stent surrounded by coils, or balloon occlusion which utilizes collateral blood flow. Saccular aneurysms which are more prone to rupture are filled with coils. The lesson was interesting, and it was a good introduction to what's going on the field. I have a choice of working with strokes, medical device development, particular embolization glues; I'll probably dabble in both clinical and translational studies. I think it will be a great experience because my Dr. **** loves to teach, which will make it easy for me to obtain a wealth of knowledge and insight.
While working on my research, I plan to concurrently shadow in order to obtain a human perspective to my case studies. I'm particularly curious on the morbidity and reduction in quality of life associated with vascular malformations. I think it varies depending on the region of the brain that's effected. But I would definitely like to interact with families and understand their pain in relation to that of patient. Something I really admire about Oliver Sacks, a neurologist in the east coast, is that he looks at each patient not as a collection of symptoms and deficits, rather he views each person as someone whose struggling to restore their identity and dignity amongst their difficult circumstances. I think viewing patients are people, who are struggling to restore their identity, dignity, and sense of control over lives, a doctor can truly practice the art of medicine. Because I truly believe that medicine is an artform. It isn't just a science because science can be cold facts applied to a textbook problem. Rather medicine is the intersection of science and humanity. It's where one uses both knowledge, empathy, and spirituality to achieve a positive outcome for an individual who has feelings, perceptions, and a sense of self.
In my next post, I'll talk more about what I've learned from Oliver Sacks, and include some observation from shadowing experiences that I've had. Maybe I'll be able to find some insight into a truly effective doctor-patient relationship.
This is my mid-summer blog. I'll try to stay somewhat consistent in my posts and reflections :). I can't, however, promise that my thoughts won't be everywhere!
I just finished my MCATs Alhamdullilah, and I'm currently at a crossroads in deciding whether to apply late this year or prepare my application early next year. I'll leave this one up to God (I made istikhara so w/e happens will be good). There are few things to talk about for this upcoming year. For one, I have joined a new neuroradiology lab at UCSF, under the mentoriship and guidance of renowned UCSF interventional neuroradiologist ****** (gotta get his permission!). Also, I'm planning to head off to learn arabic in Egypt, tour Morocco, do Umrah, and visit Tarim...not sure if I can do all of those things but definitely Egypt and Umrah. Lastly, I'm reading this fantastic book by Oliver Sacks called The Man Who Mistook his Wife for a Hat; I'll be using this blog extensively to reflect on my readings of this book.
So to start off. I joined a neuro-ir lab at UCSF, moving from the neurosurgery lab I was at last year. The last lab was great, but unfortunately summer interns filled up space when I took time off for my MCATs so I decided to explore other fields of research. Early 2010, during lab I would head off to parnassus to attend a variety of neurosurgical conferences, and it's where I discovered the field of neuro-ir; specifically through the cerebrovascular conference headed by cerebrovascular surgeon M. Lawton. What really attracted me to this field was the use of MRI and endovascular techniques to treat various types of vascular pathologies. What I appreciated most about the conference was the amazing diagnostic insight of neurointerventionalists in classifying, determining treatment, and predicting outcomes based on the location and etiology of arterio-venous malformations, aneurysms, and fistulas. I was intrigued by how radiologists diagnose pathology by using visual acuity, knowledge, and experience. As a spatial learning and thinker I find cerebrovascular neurosurgery and neuro-ir (and probably other diagnostic/surgical fields) as a potential career path in medicine.
Last week, I interviewed with the head of the lab M. Saeed, whose a Ph.D interested in using IR-techniques in treating coronary vascular malfornations. It seems pretty interesting, and I have a few publications to read through before I decide on any project. I think I'm still more interested in vasculature of the brain...but we'll see after I read.
The first day, Dr. *** gave a lesson to me and a medical student on aneurysm classification and how neuro-irs generally treat them. Pretty interesting stuff. Fusiform aneurysms balloon out from all sides of the artery and can be treated with a stent surrounded by coils, or balloon occlusion which utilizes collateral blood flow. Saccular aneurysms which are more prone to rupture are filled with coils. The lesson was interesting, and it was a good introduction to what's going on the field. I have a choice of working with strokes, medical device development, particular embolization glues; I'll probably dabble in both clinical and translational studies. I think it will be a great experience because my Dr. **** loves to teach, which will make it easy for me to obtain a wealth of knowledge and insight.
While working on my research, I plan to concurrently shadow in order to obtain a human perspective to my case studies. I'm particularly curious on the morbidity and reduction in quality of life associated with vascular malformations. I think it varies depending on the region of the brain that's effected. But I would definitely like to interact with families and understand their pain in relation to that of patient. Something I really admire about Oliver Sacks, a neurologist in the east coast, is that he looks at each patient not as a collection of symptoms and deficits, rather he views each person as someone whose struggling to restore their identity and dignity amongst their difficult circumstances. I think viewing patients are people, who are struggling to restore their identity, dignity, and sense of control over lives, a doctor can truly practice the art of medicine. Because I truly believe that medicine is an artform. It isn't just a science because science can be cold facts applied to a textbook problem. Rather medicine is the intersection of science and humanity. It's where one uses both knowledge, empathy, and spirituality to achieve a positive outcome for an individual who has feelings, perceptions, and a sense of self.
In my next post, I'll talk more about what I've learned from Oliver Sacks, and include some observation from shadowing experiences that I've had. Maybe I'll be able to find some insight into a truly effective doctor-patient relationship.
Subscribe to:
Posts (Atom)