Island Med Student

I just read this article about fecal implants. This is the coolest idea, ever! Putting other people’s poop in your butt! It reminded me of one of my most fave scenes in any movie, ever. Here is the clip from the movie Me and You and Everyone We Know…a must watch!

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As I alluded to in my recent post, I have a health insurance plan provided by my medical school, but have been unable to find a primary care physician. It seems that whenever I make calls to find one, they are either not accepting new patients, or the first available appointment is so far into the future that I can’t even guarantee that I’ll be able to make it. I live in New York City, so can you imagine what it would be like if I lived in a small town somewhere in rural America?

The unfortunate consequence of this situation became even more real to me a few weeks ago when I became sick and needed to see a doctor. Since I was unable to locate one, I ended up going to the Emergency Department of the hospital where I’m currently rotating. You can imagine how silly I felt sitting in the waiting room for many hours, clogging up the system, wasting the doctor’s time, when all I really needed was for someone to take a quick listen to my lungs, check out my throat, and write me a prescription for some antibiotics.

At least I was lucky enough to have access to a doctor at all. Not everyone is always this lucky. So many people out there don’t even have health insurance at all. What is going on?!

I’m sure most of the readers of this blog already have a good idea of how broken the U.S. healthcare system is. I could rant for many hours on this topic. However, I’m just going to focus on one specific part of the problem right now.

A survey of physicians recently published by the Physicians’ Foundation found that:

- 78% believe there is a shortage of primary care doctors in the U.S.
- 49% said that over the next three years they plan to reduce the number of patients they see or stop practicing entirely
- 94% said the time they devote to non-clinical paperwork in the last three years has increased, and 63% said that paperwork has caused them to spend less time per patient
- 82% said their practices would be “unsustainable” if proposed cuts to Medicare reimbursements were made
- 60% would not recommend medicine as a career to young people

Now, the results of this study must be taken with a grain of salt, as there was only a 4% response rate, and there is obviously some self-selection bias at play. However, I don’t think anyone would disagree that “the proof is in the pudding.” I was unable to find a primary care physician in New York City, one of the largest cities in America, in a reasonable amount of time. There is something seriously wrong with the system, and with the future of primary care in this country.

I encourage you to read some of the actual responses from physicians at the end of the report. It was pretty eye opening for me, and it might just make you want to get out of your chair, go to the window, and scream, “I’m mad as hell and I’m not gonna take this anymore!”

I found this response to be particularly saddening:

“I put everything I have into treating my patients. I’m about to lose my family for nothing. Just because I try to take good care of my patients ““ but it’s just too much work and nothing in return. My children have suffered because of time without their dad.”

What are we to do?

Click Here To View the Original Post on Medscape

A few weeks ago, I had an experience that has really stuck in my head. The resident and I were performing a painful procedure on a patient, and I could tell that he was really enduring a lot of pain by the grimace on his face. As I’ve done in the past, I instinctively reached out my hand and held his hand in mine. I allowed him to grip my fingers, and told him to squeeze my hand as hard as he needed to.

He started squeezing my fingers, and suddenly his face turned from a grimace to a smile. The change was rather startling, and so I jokingly told him that I’d never seen a patient with such a huge grin on their face while undergoing such a painful procedure. He smiled even more and said that it was because he was so happy to hold such a “pretty girl’s” hand. I smiled back, and soon the procedure was over.

I think it probably makes common sense that hand holding might bring some relief from pain. We all reflexively hold a child’s hand when they’re in pain. And I believe that even the most callous people might agree that there is something powerful about the human touch. Hugs are an even better example. I don’t know when the hug was invented, but I’m sure that it’s been around for quite some time. People of all races, ethnicities, and cultures seem to use the hug as a means of displaying affection. And while certain cultures might value human touch to varying degrees, I think we all agree on its significance.

One of the most well known studies on the power of touch and the importance of physical and social interaction is that of Harry Harlow. In his famous experiments, he allowed rhesus monkeys to choose either a cloth or wire “surrogate mother,” both with and without a bottle of milk attached. Regardless of which mother had the bottle, the monkeys continued to choose the softer, cloth mothers. He also performed other controversial experiments, including ones where he deprived the monkeys of all physical or social interaction. The lack of physical touch produced monkeys with severe psychological pathologies, and in a few cases led to their deaths from self-induced starvation.

A study recently published in the journal Science also found some interesting results with regard to “warm hands and a warm heart.” The researchers found that if people were given something warm to hold, they subsequently described other people as having “warmer” personality traits, such as being more generous, more social, happier, and better natured. They also discovered that people who held something warm were more likely to behave in a friendly and generous way.

I’ve only begun to scratch the surface of the importance of the human touch, but you can see that the subject is much more than simply skin deep (pun intended). I tried to find some research that supports my anecdotal notion that holding someone’s hand who is in pain can serve to decrease their perception of the pain, but I was unable to find much research on this topic. Perhaps it’s a topic that will be further explored in the future.

But for the time being, I will continue to hold my patients’ hands. Whether they are in pain, or just very sad, or just very lonely, or even just very happy, I will continue to offer my hands to them. And hopefully when I need a hand to hold, someone will do the same for me.

Click Here To View the Original Post on Medscape

This morning, an article in the Baltimore Sun really caught my eye. The article described a new pharmacy opening up in Virginia that has decided not to offer any form of birth control for sale. I was shocked to find out that this pharmacy is actually located very close to a town that I lived in during my undergrad years, and hence the article really hit close to home for me (literally).

The debate over pharmacists’ right to refuse to sell birth control pills based on religious views has been going on for years now. Some states have passed laws defending this right, while others require pharmacists to offer birth control, regardless of their religious beliefs. For years, the American Medical Association (AMA) has been battling the American Pharmacists Association’s policy, which states that pharmacists should not have to “engage in activity to which they object.” The AMA has voted to support legislation requiring pharmacists to either fill prescriptions or refer the patient to a pharmacy that will.

I support the AMA’s actions to protect patients’ access to pharmaceuticals, but the issue is much broader than just drugs. What about a patient’s right to have access to medical treatments? What about a doctor’s responsibility to provide care to all patients? This is, of course, a very heated debate, and is a sensitive subject for many.

The Differential’s Thomas Robey wrote an article that touched on the subject of a physician’s responsibility to provide therapies to patients. The debate is very old, and I can only offer a small amount of insight in this short article. But, it’s something that I feel strongly about, and I wanted to give an opportunity to others to air their opinions on this important subject.

In the AMA’s Code of Ethics, it states that a physician must “refrain from denying treatment to your patient because of a judgement based on discrimination.” But, the Code of Ethics also states that, “when a personal moral judgement or religious belief alone prevents you from recommending some form of therapy, inform your patient so that they may seek care elsewhere.”

Here comes my very provocative question. Where is the line between denying a patient care, such as prescribing birth control or even offering an abortion, and denying a patient care because a personal moral judgement or religious belief prevents you from doing so? If I deny a patient care because they are black, is that discrimination? Most people would say yes. If I deny a patient an abortion because it violates my religious beliefs, is that within my right? Perhaps many people would say yes. But what about denying a homosexual couple access to in vitro fertilization therapy because your religion doesn’t condone homosexuality? Would this be considered denying care because of discrimination, or is the physician’s right to deny treatment protected, because of their religious beliefs?

The waters are clearly murky. What do you think?

Click Here To View the Original Post on Medscape

A recent study reported that 51% of insured Americans were taking prescription drugs for at least one chronic health condition. The study found that over one in five people were on antihypertensive medications, and almost one in seven were taking cholesterol lowering drugs. For insured American men ages 20-44, cholesterol-lowering drugs were among the top four meds, and their use of these drugs has increased over 80% in seven years. In addition, almost 30% of children under age 19 were taking a medication for a chronic condition, the most popular ones being asthma, ADHD and depression.

What does all this mean? Not surprisingly, Americans young and old are taking more and more drugs. There are, of course, plenty of reasons for this trend, but I’m going to focus on just two of them.

I haven’t had access to television for a while, but the last time I sat down and watched it at a friend’s house I was astonished to see the number of drug advertisements in just a one hour period of time. The use of direct-to-consumer advertising (the promotion of prescription drugs through newspaper, magazine, television, and internet marketing) is currently banned in all developed countries except the U.S. and New Zealand. But some drug companies won’t stop campaigning to have it legalized in Europe and Canada.

If you’ve spent any time in the States, you’re probably all too familiar with the television advertisements for various drugs. The basic plot line is a person whose life is miserable until they discover drug X. Once they start taking the magic pill, their life is transformed and they run through fields of flowers and look more beautiful and happier than ever. The next thing you know, the person watching this commercial is in their doctor’s office, demanding that they, or maybe even their child, get a prescription for drug X. And how can the doctor say no to someone who is convinced that they will be beautiful and happy if they have drug X? Yes, I am taking this example a bit far, but I think you get the point.

The second reason I think that Americans are taking more prescription drugs is directly related to our increasing obesity, as I’ve written about before. It’s simply more work to eat healthy and exercise. Popping a pill is much easier than changing one’s entire lifestyle. While there are other factors (genetics, etc.) that contribute to hypertension and high cholesterol, a poor diet and sedentary lifestyle are certainly important risk factors. Obesity in children is also well documented to be on the rise. And no one seems to be arguing the fact that lack of exercise and poor diets are significantly impacting the health of Americans, both young and old.

There are, of course, many other factors that are contributing to the increase in prescription drug utilization in America and other countries, but I shall save those topics for another entry. The point is that Americans are using more and more prescription drugs, and it’s not just older people anymore. Our children are increasingly becoming the targets of pharmaceutical advertisements, and are being prescribed increasing numbers of medications for chronic conditions. While there are significant positive impacts because of the availability of new drugs, especially for chronic conditions, I don’t think the trend is necessarily a good thing.

In the 1980′s, the U.S. first lady Nancy Reagan coined the phrase “just say no” as a slogan to help decrease the use of recreational drugs, especially by children. Now our children and young adults are actually using more and more prescription drugs for chronic and preventable conditions. If our child seems a little too anxious, we seek out an antidepressant. If they’re a little too restless, we put them on Ritalin. When they start getting fat, we put them on statins.

I want to know when are we going to start taking responsibility for our own health and the health of our children? When will we realize that we can’t always take the easy way out and pop a pill whenever we have a problem? When are we going to start “just saying no?”

Click Here To View the Original Post on Medscape

I have admittedly not been keeping up with the news until recently. I barely knew who was even running in the upcoming presidential election. So, I’ve been trying to catch up in the past few days.

There’s one thing I know for sure: I hate Huckabee. I have to admit up front that I’ve barely skimmed the surface of his position on issues. It only took listening to these two answers about evolution and medical marijuana, however, for me to have a pretty good hunch that I don’t like this guy. Also, am I the only one who thinks he looks like Richard Nixon?

Here’s his first response on evolution:

Okay, I’ll admit that he did a great job answering the question. However, he represents what pisses me off about many people who don’t believe in evolution–he obviously does not even understand what it is. He said that we’re not “descended from primates.” Well, that’s absolutely correct. But no one is claiming that we descended from primates. We are, in fact, primates. Also, some anti-evolutionists will say “humans didn’t descend from monkeys.” Well, that’s correct as well. We did, however, share a common ancestor. I could rant on this for a while, but I shall not.

My second favorite Huckabee response of the day is this answer he gave to a woman who wanted to know if he was for legalizing marijuana.

There are a million reasons why this video upsets me, but I’ll stick to the main one. Bascially, Huckabee suggested that narcotics could be a viable alternative to marijuana for relieving chronic pain. I could write a book on why this is a terrible argument, and he never actually said “legal” narcotics, but let’s assume that’s what he meant. Okay, so he’s saying that morphine, for example, is an alternative to marijuana. Well, that’s great because morphine is legal, and marijuana is not. That works out so well! And everyone knows that legal drugs like alcohol and cigarettes are way better for you and less addictive than the scary illegal ones like marijuana. And everyone knows that morphine is way less addictive than marijuana. And that people rob banks all the time to get more marijuana. And that…..okay, I’ll stop now.

On another note, I’m sick as hell. I don’t know if it was the travelling, or change of climate, or stress of the season, but I have a pretty bad cold. I have gotten up only to go to the bathroom for the past 3 days. I hope I start feeling better soon. Googling Huckabee is certainly not making me want to stay for very long in this country.

I just read an article about a company making treadmill desktops. All I can say is IT’S ABOUT TIME!! Probably the WORST thing about my last job was that I had to sit at a desk the entire day. It was absolute torture! Ask anyone who knew me. I was constantly complaining about having restless legs (no, not the syndrome), and I had to go on frequent walks just to maintain my sanity. It’s NOT NATURAL! I’d go as far to say that the two largest influences causing obesity and sedentary lifestyles in the US are television and desk jobs. (Of course the Internet is up there as well.) I had talked about inventing little stand alone bicycle pedals that you cut put under your desk, but of course I never did. I’m so glad someone finally invented something that might work. I expect that they won’t sell all that well, but I’d like to think they will. If I were still at a desk job, you can bet I’d get one of them suckers. Obviously I don’t care how stupid they look, but other people might. But what looks more stupid? Walking on a treadmill and working at the same time? Or sitting on your big ass everyday until it ultimately kills you? (Pardon my hostility, but I really do loathe desk jobs.)

I finally made it back to the USA. I flew out of the “airport”in Dominica on Saturday morning and arrived in Baltimore around midnight. As I walked through the airport to the baggage claim, I noticed two things right away. The first was the overabundance of food options: fried chicken, pizza, cheeseburgers, and just about anything one could imagine. In Dominica, there are very few restaurants, and certainly no McDonald’s or Taco Bell. The second thing I noticed was the preponderance of overweight people. Everywhere I looked I saw heavy people, and even some who were morbidly obese. I couldn’t help but realize the connection. Of course, I had noticed this before when I lived in the States, but the stark contrast between Dominica and the U.S. really made it stand out in my mind. In Dominica, there are overweight people, but they are a much smaller percentage of the population.

Obesity is a popular topic in the news lately, and the medical system bears much of the financial burden of America’s expanding waistlines. Most major killers in the U.S., such as Type II diabetes, high blood pressure, and coronary heart disease, can be tied to obesity.

As a physician-in-training, I’m trying to get a grip on the problem. By the time I’m practicing, I will likely have a lot of patients who are overweight. It’s important that I understand the causes of obesity and know effective ways to treat it.

Of course, I haven’t lived a completely healthy life myself. I’ve abused my body just like most people, and I’ve paid the price. Over the past few years, though, I’ve really tried to maintain a healthier lifestyle. I try to eat plenty of fruits and vegetables, and I have worked out regularly for years. I’d say that I’m in fairly good health, and my appearance reflects that. But as a future physician, do I actually have a duty to maintain a healthy lifestyle? Do all doctors have an obligation to live healthy lives and stay at an appropriate weight in order to be effective healers?

This is a very hotly debated question (as seen in the discussion following this Medscape article). I don’t have the perfect answer, but I do believe that it’s important to maintain a healthy lifestyle, and I’m also a huge proponent of maintaining a balance in life. I will definitely eat a doughnut every once in a while, and I’m already guilty of eating at McDonald’s since I’ve been back in the States. I sometimes fall behind in my exercise, and I’ve gone without good sleep some nights. But, I always return to my healthy habits, even if I do splurge every once in a while.

The question is, what about doctors who don’t adopt this philosophy? Can a patient be expected to do as you say, but not as you do? Is it fair to counsel someone on healthy habits and insist that they change their lifestyle, when you don’t hold yourself to these same standards?

As for myself, I hope to continue to live a healthy lifestyle (with my admitted lapses at times), and I hope that this will reinforce my advice to patients. On the other hand, will a patient who is struggling with their weight look at me and believe that I know what it’s like to struggle with a weight issue? Would it be easier to accept instructions from a doctor who also is overweight?

Looking forward, I hope to be able to effectively communicate with my patients and let them know that living healthily is not always easy. I give in to my cravings for peanut butter pie, and sometimes I skip my daily run and veg out with a movie instead. I don’t think that makes me a bad role model, nor will it make me a bad physician someday. I think it just makes me human. Perhaps being able to see a doctor as a human, and not just a role model, is more important than the size of the doctor’s waist.

Click Here To View the Original Post on Medscape

NY Times just posted an article, about this year in health fads. Here is the summary:

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Merry Christmas everyone! I must admit that I am not terribly in the Christmas spirit today. In fact, the only proof that I have that it’s Christmas is the date on my wall calendar. It doesn’t feel like Christmas here. I don’t see any signs of Christmas. I don’t smell any Christmas food. If I was a synesthete, I might say that seeing a Christmas tree makes me smell eggnog, or that when I eat fruitcake, I hear the song Jingle Bells. An article that just appeared in Seed Magazine discussed this very phenomenon. It turns out that around one to four percent of people suffer from a form of synesthesia, which is a neurological mixing of various sensory inputs in their brain. The picture above was drawn by Marcia Smilack, an artist and synesthete who uses her synesthesia to create many forms of art.
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