Zombies. Apocalypse. Scary? Exciting?
No, I don’t have a bunker in the backyard and a shotgun under my bed; I don’t have a gas mask and I have not taught myself how to hotwire a car. I certainly wouldn’t be caught dead joining the Facebook Post-Apocalypse Survival Group (how does that even work!?). However, I do abide by the Boy Scouts’ motto, and so if you are anything like me, you’ll want to know The 5 Scientific Reasons a Zombie Apocalypse Could Actually Happen.
I’ll admit that I brave the corniness of many a zombie movie in exchange for the edge-of-the-seat intensity. Honestly, although I don’t mind gore, I’m really watching because of the post-apocalyptic aesthetic. The Fake Hipster (another blogger) agrees that fashion is key when facing the end of the world. There is something about torn clothes with lots of studs and buckles, re-purposed protective sports equipment, and stompy boots that just catches my eye. The angry cars, rusty motorcycles, badass tattoos, and creative weaponry add to the fun, but really, really what I love is the survival bit.
There is something in my hunter-gatherer core that is starving for a challenge to survival. It doesn’t have to be zombies, but they’ll do. Could be petrol-hording goons à la Mad Max or gooey mutants from Resident Evil. Wouldn’t mind battling it out against my rivals, just like the kids who survived the death of all adults, in the Kiwi TV series, The Tribe. There are many different dangers in a world torn apart by nuclear war, natural disaster, plague, or other catastrophe. Fortunately, wikipedia has a list of all the fiction pertaining to each category of doom!
Did I mention that I play videogames? Among those I’ve most enjoyed are Fallout (post-nuclear survival/adventure), Bioshock (surviving in the ruins of a failed genetic utopia), and Borderlands (living from quest to quest in the bleak desert). What? Doesn’t your doctor have an Xbox 360? Everyone knows that those who play video games are more accurate and faster at performing surgery. I don’t know how shooting aliens in the head with a console game translates to any real survival skill, but it sure does help the stress of regular life!
There is so much pop-culture devoted to this subject. I tried very hard to love the show Survivor when it came out. Unfortunately it was more about petty games rather than food, shelter, and transport in a desolate world. Lost had a bit of that, but it got a little too metaphysical. Shows like the classic Prisoner and the new Persons Unknown focus on psychological survival in closed worlds that are too close to reality. These have a frustrating appeal – I’d rather be up against something I can face. It’s much more disturbing not to know your enemy. It might be even worse if you didn’t know it was an Apocalypse. But! There’s an app for that. (Just in case you didn’t see it, I smacked myself in the forehead when I found that).
Apparently, I’m not alone in fantasizing about a post-apocalyptic era, as one might guess from the plethora of pertinent movies, TV shows, and games. Granted, some might be broadcasting a warning (The Day After Tomorrow) but others fetischize the idea (Doomsday).
I, like anyone else, strive to find a purpose for my life. There is no great conflict in my life, no major adversity to overcome. It sounds odd, but I crave something to rally against. Maybe “fantasize’” is the wrong word. I know with certainty that I romanticize the idea and that if I found myself in a truly apocalyptic world, I’d probably be dead. Or everyone I loved would be dead. Or many people in general would be. All pretty disturbing. It’d probably be less like Children of Men and more like Threads. (Threads is a UK production, predating Children of Men, offering essentially the same story but with a very unhappy ending).
As a (well-behaved) teenager I read dystopian science fiction and one of my favourite authors, William Gibson, wrote about the ‘cyperpunks’ in the future who lived to survive. That constant struggle had great appeal and my life is dull in comparison [though not bad for the average North American human in 2010].
Blogger Ethan Smith says
The question of ‘what is real after everything is a commodity’ comes up quite a bit in cyberpunk, but the characters in a Gibson novel had something we don’t have. They had a conflict—the battle of the megacorps and the hackers, the terrorists and the police. We have no Great War. No Great Depression. Our Great War’s a spiritual war… our Great Depression is our lives.
Chuck Palahniuk – another favourite author of mine – pokes fun at this in Fight Club. No, it’s not about an underground MMA ring. It’s about the banality of our lives and the commodification of our existence. In his grisly novel, American Psycho, Bret Easton Ellis reminds us of the path from narcissism, materialism, conformity, and social posturing to self-loathing and discontentment. To avoid the lack of fulfilment promised by eternal yuppidum, perhaps apocalpyse is the answer?
It makes no sense to want something like that – I don’t want other people to die, I don’t want to have to fear for my life at every turn, I don’t anticipate anything so terrible happening in my lifetime, and I don’t hold misanthropic views. Even though I know that, I can’t help but think that some part of me would be at home in a world of dust and chaos.
Johnathon Barrickman thinks we want to face zombies in order to strengthen our social connectedness
[The reason] the Zombie Apocalypse must seem so appealing; the great, rotting “reset button.” Everybody else f*cks off and dies while you and your Bros (and that hottie from the California Pizza Kitchen down the road) kick back, take whatever you want, answer to no one, and shoot any other bastard in the face (because that’s the only way to be sure). Your bonds with the people you actually care about strengthen, and anyone who might conceivably get in the way is no longer even a factor. Sounds kinda nice, doesn’t it? Oh, and you don’t ever have to go to work again too, so that’s extra cool.
I’m not sure if I buy that particular argument, but I still think there must be something hard-wired in some of us that NEEDS this. I’ll save criticizing the juvenile aspects of his analysis because I’m sure some of those resonate with a lot of people. Regardless of motivation, Ethan Smith thinks it’s a bad idea to fantasize about a dark future:
The fantasizing and fetishizing of the end of the world is a way to excuse not doing anything right now, in the same way that waiting for the future in most science fiction is a way of not doing anything now. But it’s different—hoping for the end is different then hoping for the beginning.
There is an entire forum thread dedicated to people who wish for it, fantasize about it, wonder about it, fear it, think other people are terrible for thinking about it, etc. Do you seek it?
I blame biology. Darwin. My primal instincts do not apply behind a computer screen. 
Some people can’t even survive the real world, so at least I feel a little better.
I’m going lazy-camping this weekend and I will simply enjoy the fact that I’m alive, looking at some beautiful natural stuff, and maybe I’ll hone some of those essential survival skills (like, bonding within my social circle?). And I might have a dream about zombies.
Tagged: movies, post-apocalyptic, survival, zombies
Comments
To add a comment to the original post, click here.
You must be signed in to post a comment.
Sign in nowmersyndol works great for my migraines. Don’t even need an RX , not that that is ever a problem in a hospital.
oh….could you please try these 2 remedies I read about ( I question both, but if you have a migraine, you try anything!):
1. Lidocaine squirted into the nostrils and let it drain upward (in other words, stand on your head I guess)
2. Get a slurpee and get a brain freeze while having a migraine.
If they work, get back to me!
Just sitting here “post call” feeling sorry for myself and decided to surf… Thank you for this. Emily was truly a gem to all that knew her or knew of her.
i have tried the brain freeze – doesn’t work though! just causes another kind of pain
I never prescribe narcotics for headaches because of the commonness of rebound headache but they do work for some people. A few of the triptans have worked for me, fortunately.
Good choice: If you’re interest in medicine is to be as much of as total a physician as possible, then hospitalist is as close as you can get, unless you never forget anything and master everything the first time around (then you can be a family practitioner). I’m an FP and hospitalist was not an option years ago. I liked FP to be able to practice all of medicine but dilution of diagnoses and patient steeling leads to less and less exposure to the complex and interesting cases. Ever lower compensation causes specialists often to refer the patients they get from FP’s to their own PA’s or NP’s to keep them busy. And patients often go to the specialists as first line so the FP sees too much of the simple stuff and less and less the more complex that makes it easy for those skills to fade, unless the fp is in the boondocks and all on his own.
The con’s you listed are not all that significant, from my perspective. Good Luck.
I am so saddened by this. Like you I watched that show over and over and it was Emily as well as others that inspired me to leave my Corporate job and go after my true dream of medicine, albeit veterinary medicine. Periodically I look on the internet to see where their lives had taken them and it was this search that led me to your site and this terrible news.
There was also one other MedStudent, Alyson Brodeur, that passed away in October 2009.
Such vibrant, young, incredible individuals that had their whole lives ahead of them. I’m so sad to read this and hope that she has found some peace.
Thanks for sharing. Odd how that little TV show meant so much.
I know that this post was placed over a year ago however I just found this site and am enjoying reading through all your posts.
With respect to NDs, I’ll be honest, I absolutely LOVE my naturopath. My regular M.D ended up pumping me full of pills based on one symptom after another in hopes of getting rid of my chronic pain. Of course I was put through all the tests imaginable and when everything came back ‘normal’ the only other option was ‘pain management’.
I was frustrated to believe that this was going to be my life, a young person with many years ahead of her popping pills that only barely touched the pain and foggy mind. I visited the Naturopath and was put on a strict diet. After a lot of foods being omitted and then reintroduced I found out that my body just doesn’t agree with gluten and dairy. When I eat them all my symptoms come back.
As much as I really respect my M.D seeing my Naturopath was just another avenue that I needed to take. Once my M.D and I exhausted all the testing we could it was time for me to look in another direction. My M.D could not do what my Naturopath did and my Naturopath could not do what my M.D did. They compliment each other.
As much as I love my Naturopath I do not believe that she has any credibility or the knowledge to effectively and safely prescribe medication. This is not her ‘field’ and not her area of expertise.
So I’m definitely with you. I want the person prescribing me medication to have ALL the information and schooling required to do so. Going to a Naturopath for prescription drugs is like going to the hardware store for milk, it just doesn’t fit.
It comes down to a matter of definitions. A text without a context is a pretext, and pretext can be used to rational anything. So for me, I would expect “related procedures” in a consent form to be consenting to procedures that are conducted in the same context/method as the main procedure is. Therefore, if the main procedure is conducted through an incision in the abdomen, when I signed the form I would expect that all other “related procedures” would also be conducted through that incision in the abdomen. I would not be expecting fingers (or any other object for that matter) to be shoved up my vagina, unless I was specifically told, and I would expect to have to give specific consent.
I think everyone, in their own way, is looking for the end of the world because everyone dies. The Apocalypse is real, and it happens to all of us, right?
Do you believe in Zombies? A post-apocalypse fantasy, movies & video-games, and why I care….
I found your entry interesting do I’ve added a Trackback to it on my weblog
…
I …. don’t know!
Everyone dies, yes.
[...] Pelvic Exams Done Without Consent « Dr. Ottematic [...]
Try wearing a fur coat all the time. I am one hot dog.
Jump in the lake! or the ocean! or just jump!
I’ll be here waiting for new posts.
~R
Sandra’s comment is not only infuriating, but horribly biased and opinionated. Sorry that her childhood was “sacrificed” to the military, but I know many families that have appreciated their military background.
My husband is a Doctor in the CF. I was in the military, bit now practice Nutrition privately. We have three wickedly bright, charismatic daughters, the oldest of which is heading to University this fall.
There is no culture of drink and debauchery. Like all neighborhoods, one has the choice of whom they socialize with. It sounds as if your father, perhaps, didn’t make the best choices in that arena. Unfortunate, but that is not unique to the military experience.
I am definitely not “pro war”, nor is my husband. We have many military friends of like mind who openly discuss their positions. It is not a requirement of the service that one forfeits their intellect, contrary to the implications of your comment.
We make a concerted effort to socialize outside of any base we ate posted to just as we would if we lived in a small community. A feeling that a base is insular demonstrates a lack of extension into outside activities and interests.
I certainly don’t think that living in a military community offers benefits over civilian life, but characterizing it with such generalities and sweeping prejudice does a disservice to the many happy, functional families that live within it.
Hello Jessica,
Your article is very interesting and I think it is great that it is great that you are trying to look at all the angles. Kudos to you for that!
I just finished my contract with the military (through the MOTP program) and also grew up in a military family so I have a lot of perspective about what it means to be a doctor in the Canadian Forces.
To cut to the chase I need to tell you what I think is your best option… DO NOT join the Canadian Forces as a physician. I know that may seem blunt but I have much basis for such a blunt and straightforward statement.
Firstly, you must keep in mind that the Canadian Forces is nothing but an American pawn at the current time. It is clear that Al-Qaeda was clearly crushed in Afghanistan in 2002, but yet the war kept on going despite no justification to do so. At the same time the US declared war on Iraq and diverted all their resources to that war instead. Now Afghanistan is even worse than before, and there is no way that keeping the war going there will help to make anything better. Anyone currently in the CF has to be prepared to turn a blind eye to this madness otherwise how else could they sleep at night. This is by far the biggest deterrent to being a CF physician (at least for me).
Secondly, as a physician in the CF, you can expect to do very little medicine, and plenty of administration. From my experience, at least two thirds of your job is admin.
Thirdly, expect very little respect for you as a professional once you are in the CF. Medicine and good patient care are always placed far secondary to the mission in the CF. Just look at what has happened at Guantanamo and how they have ordered physicians to force feed prisoners with the consequences of being charged if they do not do so (check out the article called `Physician First, Last, Always by George Annas for some more details on that). I know that you would expect that it would be different in Canada, but that is nothing but a false hope. Ultimately, the CF will try to crush anyone who expresses doubts about the mission, and that includes a physician. In the end, professional autonomy is thrown out the window in the CF.
Fourthly, from a financial perspective, is is clearly hugely disadvantageous to be in the CF once you are outside of residency. Now that I am out of the CF, I make about twice as much as what I did when I was in the military. Definitely, if you are thinking of joining the CF for financial reasons, that would be a huge mistake.
I know I may seem hugely one sided in my argument, but that is because I have been there and I know how bad being a physician in the CF truly.
I would be more than willing to answer any questions you have. Please email me if you have any questions.
All the best,
Jason
wow, thanks for the considered response
i’m pretty sure I won’t join
do wonder about doing the reserves/contract thing still though. is that something you would ever consider doing? lots of our Intensivists go overseas to be trauma junkies. I imagine I’d work better in a German hospital treating the recovering as opposed to a field trauma enviro, but I’d certainly learn more in the latter.
Hello Jessica,
I do know a few people who have joined as reservists and I must admit their is a lot more flexibility as a reservist. That is definitely true. I’m pretty sure you get to pick and choose your deployments, but you will want to ensure that is truly the case before you sign anything.
I just warn you to keep in mind though that once you decide to deploy with a unit, even as a reservist, you will fall underneath that unit’s chain of command. This means that you will be subject to the Code of Service Discipline, and when it comes to many units, particularly within the army, they can be very liberal in their application of this code. Something that you do would be viewed as good patient care by any rationale physician could be misconstrued as interfering with the mission by the Commanding Officer, who is often not a physician. I have a physician friend who was almost charged with insubordination in such a situation. This is a serious charge in the military. Even if your chain of command is purely medical, it happens quite often that you end up getting some physician-turned-administrator who hasn’t really seen a patient in several years “supervising” your medical care. This can become quite problematic, particularly if that individual starts interfering with your medical care, which they are more than entitled to do if they are a more senior medical officer to you (in terms of rank or seniority in the medical chain). Seniority in civilian medicine is determined usually by things like level of training and experience, and passing exams, but in the CF seniority is really determined by rank, which has nothing to do with your actual skill, level of training, or amount of experience as a doctor. This whole odd dilemma can become very problematic when you have a supervising physician of a higher rank who doesn’t realize how out of touch they are with clinical medicine. I know this happens in civilian medicine too, but it is taken to a whole new level in the CF. Following the chain of command and the “mission first” mentality always take precedence over everything else. This is definitely something to keep in mind and that you have to be comfortable with before joining the CF.
This does not even touch on the whole issue of whether supporting our current Canadian Forces (which is really just a US puppet at this point) as a physician is really morally correct or not from a more global perspective. I know that by the Geneva Convention you are obliged to treat everyone, but really your primary focus overseas is the Canadian troops. It all comes down once again to the “mission first” mentality. My belief is that being a physician in the CF currently is providing direct support to the US “War on Terror”, and you have to be comfortable with supporting that cause. I don’t know if you believe whether the current wars in Iraq and Afghanistan are truly helping to reduce the world burden of “terror”, and helping to establish true democracy in the war-torn nations in which these wars are being conducted, but I think you have to believe in that cause in order to sleep well at night wearing the CF uniform. I personally think that the current War in Afghanistan is actually making things far worse in terms of global terror and as well as in terms of peace and democracy for the Afghan people. Even if the American government had no hidden agenda with the War in Afghanistan (which is highly doubtful to me, but I am trying to be hypothetical here), the aim of “creating democracy” in a short time frame that a war takes place in (usually anywhere from 2-8 years say) in a country like Afghanistan that is populated in the large part by Pashtuns, who have followed for hundreds of years their own cultural form of government that is quite unique, but quite different from the Western idea of democracy, as well as highly influenced by the Islamic faith, is just not possible. Changing a culture takes decades. If the Americans expect to evoke such quick change in Afghanistan, they either have a hidden agenda, or they are foolishly optimistic, or just plain foolish.
As for other more “humanitarian” parts of the CF, even the DART, which everyone thinks is this great humanitarian aid vehicle, is nothing but a “huge political tool” (this is a direct quote from my ex-CO); aid could be delivered much “more quickly, effectively, and cheaply through NGO’s than through DART” (once again a direct quote from my ex-CO, paraphrased but the same essence of what he said).
I personally think if you look at being in the CF from a more global political and ethical perspective, it evokes a lot of soul searching, especially for a physician. In the Hippocratic oath it says,”In every house where I come I will enter only for the good of my patients”; however, that is often not the reality in the life of a CF doctor, especially during deployed operations. Yes you may learn a lot about trauma care doing field trauma (as you would also if you did a trauma fellowship or emerg rotation in any southern US city), but I just want to encourage you to look at the bigger picture. I didn’t do that when I joined, and I truly regret no doing so. Just something to keep in mind.
Once again, if you have any questions, please do not hesitate to ask.
Sincerely,
Jason
Hi, I just found your blog and I am enjoying your style of writing.
In reply to the “apocalypse” post, I think it’s simple really. Your drive or need or even desire puts you into the spotlight, keeps you in control, and makes you a hero or savior (whichever you prefer). Not to mention the constant verge of emergent action. I think almost everyone who chooses medicine for their career possesses some version of this fantasy at our very core.
What about ‘doctors’ who don’t really own a doctoral degree? I am nor referring to MD (which is not an actual doctoral degree, anyway — amazingly lawyers are more honest about this with their JD degrees) but to chiropractors, dentists, vets, etc. Even worse all those above plus physicians in countries like the UK and Australia where you received a Bachelor degree.
I always find hilarious when I go to the GP and she insists on calling me Mr even though I am a Professor with a PhD in engineering, which is well ahead of her education of a Bachelor.
I would hope that the student doing my pelvic exam would treat my vagina as they would want their own sexual organs treated.
If they would be offended to have someone probing in their most private areas while unconscious, perhaps they should think twice about doing a pelvic exam on a patient without explicit prior consent.
And as I mentioned in my blog a few months back, I would happily give consent. Please just ask me.
Finally, a break from the heat. Hope you feel inspired to keep writing now that fall is on its way here…
[...] This post was mentioned on Twitter by MedStudentRx, McGrawRyerson Health. McGrawRyerson Health said: Check out Dr. Ottematic: A Canadian Family Practice Resident trying to stay afloat http://ow.ly/2BGYY [...]
I absolutely love this post. You are the kind of doctor I would like to have on my team. I have an enormous amount of respect for professionals who approach their patients/clients in a spirit of partnership.
Do you think that your medical education fostered your perspective? Or is it something that you bring from your life experience?
Loved your post. I can only surmise that doctors see a lot of disrespectful, self-centered, egotistic and obnoxious patients. Please keep in mind that not all patients are maniacs. Doctors need to be discerning and not paint each patient with a broad brush. Apparently, the many doctors I saw over a lifetime thought I was making symptoms up. Turns out I was telling the truth. I became disabled unnecessarily at age 50 because doctors failed to diagnose an intestinal blockage that led to a plethora of disease states including a degenerating and compressed spine.
It was only after becoming too ill to work that I realized how responsible patients need to be about their health. In order for me to get proper medical care in the U.S., I had to gather my medical records, read everything I could get my hands on about the practice of medical care, research the significance of all the positive test results that were never mentioned to me, self-diagnose, research which relevant physicians were competent, qualify for Social Security Disability and Medicare in the U.S. then travel to the Cleveland Clinic, where I got the necessary surgery seven years after I embarked on this journey for what was a congenital defect no one believed I had because they couldn’t “see” it.. I blog about my experiences at http://doctorblue.wordpress.com.
Understanding the system, my disease states and knowing what therapies I need to get better enabled me to establish an excellent report with some competent physicians. The #1 trait these doctors share is their ability to listen to their patients. And they take time to listen.
I found that I am not an anomaly after becoming active in patient medical mistake support groups. In fact, medical mistakes occur much more frequently than reported because few patients can afford the cost of litigation, particularly after having spent their last dime (in the U.S.) seeking competent medical care.
I don’t understand why doctors don’t have little pamphlets they can hand out with Patient Rules of Behavior that clearly states that the patient is responsible for the patient’s well being and explains what that means and cites books the patient should read to get a realistic perspective on medical care.
that’s very kind
I should say I _try_ to approach patients in this way. It doesn’t always happen.
On of my favourite questions is: “does that sound reasonable?” after I lay out a plan. I’m not sure it’s the exact question yet but it is a start.
Yah, I think the culture is changing. We steer away from paternalism and more toward “patient centred care” as a profession now. Much of this does come from my med school teaching. Also a bit from my personal thoughts – I’m not smart enough to make the decisions for other people. I try to sometimes, but it (selfishly) feels good to unload responsibility that probably never should have been yours to begin with.
Thanks for your comment.
It sounds like you have faced a lot of frustration with the system. We are very fortunate in Canada to not have HMOs/insurance/etc. dictating treatment. No one imposes a rule about which doctor you can go to, and I think that’s a great thing. People need to find the right match and I think that a good therapeutic relationship can even sometimes overcome bad medicine.
I don’t know about your medical case but from your writing I can see it was a long journey to figuring things out. There remain many diseases that we can’t identify or classify/label, which makes appropriate treatment difficult. Another important part about transparency in medicine is, as a patient, making a safe environment for your physician to say “I don’t know” at some point. We don’t want to say this, but we have to more often than one might think. “Comfort with uncertainty” is an essential characteristic in a person applying to Family Medicine residency, especially.
We never figure everything out – the usual course is to rule out all the big and scary things, all the common or easily correctable things, and then to follow along from there. Unfortunately, some patients get dealt a terrible hand and we do not recognize their disease or perhaps we don’t have the means to treat it. Sometimes acknowledging that we “just don’t know” can make it easier to accept and live with the disease. I can’t find the reference but I read a doctor’s blog post recently that talked about how satisfying it was for both he and the patient that they labelled her unknown disease as some goofy name. [I thought it was Dr. D at Ask an MD but i can't find it!]
Mistakes do happen and misdiagnoses persist. Doctors and other HCPs should be advocates when they can, in this regard. But sometimes, like in your case, the patient has to take on that advocacy themselves.
I agree with you about patient empowerment. I actually wrote something about that for this post, but cut it out (to be placed in a post of its own at a later date). I think doctors and patients should have a kind of contract that encourages the patient to take responsibility for their health. I’m gonna have a look and see if there is any literature about such contracts.
As a patient who has experienced a misdiagnosis and an inappropriate surgery, I found your article of particular interest. In my case, the misdiagnosis and surgical misadventure were not disclosed by my treating physicians. I experienced blame shifting in the form of berating and withdrawal of services from the PCP and the specialists. It took quite some time to find another doctor willing to tell me what actually went wrong and to embark on a corrective surgery to fix it. In the interim, I was trying to understand how I could walk the fine line between being assertive without being too aggressive in my pursuit of good medical care.
By and large, Doctors are still taught in a rapid fire and relatively mechanistic framework to find and fix a problem. Many have the expectation that not solving the problem is a moral failure. From a philosophical perspective, I believe that doctors are internally driven to succeed and that this personality characteristic is exactly what makes a good doctor. At times, this is also a double edged sword because the definition of success is directly tied to clinical results (independent of external issues like insurance company mandates or even litigation). A patient’s willingness to accept ambiguity (an external source of validation for the doctor) usually has a marginal impact in the doctor/patient relationship. If a doctor feels ineffective or at fault in diagnosis or treatment, then the patient suffers from the doctor’s negative feelings: either in the form of dismissive behavior or in negatively nuanced referrals (e.g. hypochondria or mental illness because “nothing can be found” to explain the symptoms). Often, these are the same patients that later manifest with a serious condition and then instill more guilt in the conscientious but frustrated doctor. It is a downward spiral. Sometimes doctors need more support.
While I do believe in the existence of difficult patients, I am now of the opinion that due to the power/knowledge imbalance between doctors and patients and the fact that most truly ill people are apprehensive (and dare I say moody) the physician really does have primary responsibility for managing difficult encounters. If appointments are too challenging, then the doctor has a responsibility to arrange a patient transfer to another doctor who is a better fit. Preferably with clear, positive communication and thoughtful coordination and not with a form letter abruptly terminating services. I do not view this as a paternalistic stance, but rather a necessary component of pragmatic professionalism. Most patients do try to please their doctors while simultaneously struggling to get their needs met. Because of the unique nature of this relationship and the inherent vulnerability of an ailing patient, having the insight and fortitude to confront or leave a doctor is a very difficult if not impossible thing for many patients to do.
[...] here to see the original: Ethics on Call: A Case Study on my Weekend in Hellllllooooo « Dr … Comments [...]
isn’t it nice to be a grown-up? everything’s so nice and black and white! it is indeed the art of medicine. go with your gut;know what you know. know what you don’t know.learn what you didn’t know; and get ready for more things you can’t know. bottom line: do the best you can; that’s the best you can do! maybe someone else can do better know who that is; ask for help.
This, I feel, is very generational, as well as regional. ie: I am much more comfortable calling my colleagues by their first name when they are close to my age (by which I mean within 20 years). However, my soon to be partner is 73, and although I call him by his first name in private conversation with my guy (always preceded by a pause and followed by a giggle), you can bet I call him Dr when speaking to him. I also have a neurologist friend who is about 3 years shy of being my parents’ age. When he asked me to call him by his first name, it took a while (and several slip ups) to get used to.
As for regional: I did my med school clinicals all over the states, followed by residency/ fellowship in the East. I can tell you that in the midwest, it is much more common for Drs to introduce themselves by their first name to other healthcare professionals. It is understood that they, in turn, will be introduced as “Dr” to patients. As soon as I came to the East Coast, it was Drs all around. This makes me often feel pretentious, so I will frequently introduce myself by my first and last name, followed by my specialty. I let them decide what to call me. And, for the most part, I will eventually correct them to call me by my first name in private.
As for patients, I am not too interested in being buddies, so I introduce myself as Dr. Older patients appreciate the formality, for the most part. Although, I have had elderly patients insisting on knowing my first name–and then calling me by that name–which made me feel a little like I was talking to my grandparents. Also, being young and attractive, I have been hit on by patients (of all ages), and I believe that introducing myself as “Dr” nips that possibility in the bud–sometimes. On the other hand, introducing myself as my first name kind of invites that kind of discussion.
Of course, things will be a little different very soon. I think that at my new place I may introduce myself to patients as first and last name. Cancer is a place where it’s nice to have a buddy.
Sorry for the ramble… I think I may post this to my blog. credit to you, of course!!
Yah it’s tough to get used to calling older colleagues – who have probably been mentors or even supervisors at some point – by first name. Since writing this post I have increasingly used “Hello, I’m Dr. Otte, I’m a resident physician with the [insert service] team.” It’s just easier. No one remembers my last name though. I get “ohh Hi, Dr. Lotto!” and other variations that are quite amusing. Totally agree with you in the context of special relationships, like palliative care, than being a ‘buddy’ might be the best way to go.
[...] you don’t know what that is, Dr. Ottematic wrote a great post about it here and you could sign up for hers, as well, because her blog is also [...]
Better/cheaply/more profitably is like the engineering triangle: you ain’t gonna get all three. In the states, “cheaply” gives. Here, we’re on a different triangle since we don’t have a “more profitably” corner.
I’ve read that the UK experimented with a public/private solution. I got the impression that those working within it starved the public solution in favor of the private one, mostly through selective availability.
good points!
I talked to a nurse today who had worked in England with the NHS. When her own kid needed a tonsillectomy, they could go with Surgeon X in the public system (6 month wait) or the SAME Surgeon X in the private system (2 weeks wait because he was on vacation), depending on whether they used her insurance or her husband’s.
She also worked at Johns Hopkins on a “profit sharing” floor. To maximize profits, they put underqualified nurses to work and gave them 12 heavy (neuro and ENT post-op) patients each. She had to get a job elsewhere because it was just too much!
There’s that triangle “better” side collapsing, I guess.
Interesting article, thanks for sharing. Despite my health promotion background, I see a lot of value to a private healthcare option.
Last year I joined a concierge medical practice as a ‘member’. I didn’t do it for shorter wait times (although that is a benefit), and I didn’t join because I want an expresso in the waiting room (although that is also an option), I joined because I wanted to have a say in my own care. In the public system my family physician did not seem to take my concerns seriously.
Being a ‘consumer’ instead of a “patient” made all the difference in finally getting the proper treatment.
; ) Revised Hippocratic Oath
This parodistic selection originally appeared in a publication called:
‘The Journal of Irreproducible Results’
I swear by Apollo the physician, by Aesculapius, by Melvin Belli, an by my DEA number, to keep according to the advice of my accountant and attorney the following oath:
To consider dear to me as my stock certificates him who enabled me to learn this art: the banker who approved my educational loans; to live in common with him and to acquire my mortgages through his bank and that of his sons; to consider equally dear my teachers, and if necessary to split fees with them and request from them unnecessary consultations. I will prescribe regimen for the good of my practice according to my patients’ third party coverage or remaining Medicaid stickers, taking care not to perform non-reimbursable procedures. To please no one, with the possible exception of favored detail men, will I prescribe a non-FDA approved drug unless it should be essential to one of my clinical research projects; nor will I give advice which may cause my patients’ death prior to obtaining a flat EEG for 24 hours. But I will preserve the purity of my reputation. In every clinical situation, I will cover my ass by ordering all conceivable lab work and by documenting my every move in the chart. I will faithfully accumulate 25 Category I CME credits per year, and none of these by attending Sports Medicine conferences on the slopes of Aspen. I will not cut for stone, even for patients in whom the disease is manifest, before documenting the diagnosis by I.V. or retrograde pyelogram and obtaining informed consent. In every house where I come I will enter only if a house-call is absolutely unavoidable, keeping myself far from all intentional ill-doing and all seduction, and especially free from the pleasures of love with women or with men. Or, for that matter, with both simultaneously. Such activities I will confine to my office or yacht. I will not be induced to testify against my colleagues in court, nor to disagree with them when asked for a second opinion. I will not charge less for any procedure than the prevailing rate in my community. All that may come to my knowledge in the exercise of my profession, such as diagnosis, prognoses, details of treatment, and fee schedules, I will keep secret and never reveal to patients; I will, however, cheerfully provide these to insurance companies. Finally, under no circumstances will I vote for Ted Kennedy or anyone of his ilk. If I keep this oath faithfully, may I enjoy my life, build my practice, incorporate, find some solid tax shelters, and ultimately make a killing in real estate; but if I swerve from it or violate it, may a profusion of malpractice claims be my lot.
Specialist Caveat:
When you have a hammer…Everything looks like a nail.
NEWS: National Post Editorial: ?Give family docs more freedom?…
I found your entry interesting do I’ve added a Trackback to it on my weblog
…
[...] This post was mentioned on Twitter by MedStudentRx and MedStudentRx, McGrawRyerson Health. McGrawRyerson Health said: National Post Editorial: “Give family docs more freedom” http://ow.ly/2SMyb ^JS [...]
Again, I don’t know your public system doc, but I do know that (at least) in Canada, there are many doctors who want to empower patients. Granted, a private system might mean more $$ and consequently they can spend more time with you, doing this critical bit. You’ve found that grey concierge-medicine area that is serving some Canadians well. It would probably be a privilege for the doc to be able to deliver a higher level of care, too.
Most GPs in Canada can bill $29 for a patient visit, no matter the duration. To make a good salary and pay for overhead (as well as to allow time for charting and copious other paperwork), the suggested appointment time is 10 minutes – not long enough to do much education, listening, etc. Doctors who want to take the time – and I’ve been fortunate to work with many – simply book 15 minute appointments. They have to work longer days and burn out sooner for it. It’s a lot easier not to care too intensely. Right now I’m in that honeymoon period of being a resident and not having my salary tied to volume. There’s still plenty of time for me to become that jaded, workin-for-the-money, caring-but-only-’til-the-timer’s up kinda person.
Things are getting better with Chronic Care incentives in BC. Physicians get extra time / money to look after more complicated patients. It just makes good sense. Hospitalist medicine appeals to me because each day I can spend how much time I spend with each patient. If I spent a lot with them one day, the next day will be quicker and I can focus on someone else.
I agree that where there is no choice, there is not necessarily “customer service.” The new generation of family docs in BC are being trained to listen, teach, and encourage people to take health into their own hands and the government is slowly learning to support this model. Hopefully it only improves from here!
buahaha! that’s great, even if Medicaid, FDA, talking to insurance companies, and setting-rates are not applicable north of your border.
Gee, we Canucks are lucky!
I know it is assumed to be the correct thing to say, but should someone be paid more just because they have “more training”? In that case should not the GP who has been working for 20 years and has taken all their CME in that time not be paid infinitely more than the specialist who graduated three weeks ago. Sure he has three more years of formal training but…
I would take a more conservative approach. GPs should be remunerated based on the value society (read consumers) places upon the services they provide. If society values GP services as equal or greater than that of a specialist, they should be paid that way. Training be damned.
An academic with more letters after, than in, their name, who provides work of little value to society should not be paid more than someone with no credentials who provides work of immense value just because they have more training, to take the hyperbolic position.
What would you think about online charts, available for consultation by one doctor at a time at any place in the medical campus/district/practice or whatever? Surely it would be better ultimately and the nurses’ insights would be equally available with the others- so many docs I know are sooo against electronic stuff, although they have got as far as using it for prescribing. Also in Australia there are standard printed consent forms for each hospital, based on the blank one by the NHMRC (National Health & Medical Research Council) and specialties agree on written spiels for various procedures so patients can read them or have them read to them by a translator if their language is not in print at the time. I’m a researcher, not a practitioner, so I can’t know what constrains the use of new stuff by doctors- only by what you say! The ethics dilemmas I understand- although it seems like the general public, ie. patients’ relatives, expect mind-reading miracles from doctors. And those people who won’t consent to DNR for their 95 year-old grandma and sue the hospital when she dies from a futile procedure like draining the chest- I have plenty of middle-aged friends who expect their parents to come home from hospital even with the most horrible combinations of diagnoses! Keep on truckin’- researchers admire your guts and stick-at-it-ness!
and… why aren’t you a GP?!
I like these thoughts, but knowing that one of the (many) reasons I chose family practice was the shorter training period and less prolongation of debt, there are other factors. If our medical school tuition was better subsidized (+/- return of service contract), things might be different. A part of me sees value in a residency system in which everyone comes out as a GP, then can specialize in a field of interest after a few years of general practice. There are obvious problems with this and all the other solutions – I’m just glad that people are starting to challenge the specialist/GP divide.
great ideas; there are many things we could do to streamline healthcare. The biggest question for me is why don’t we?! I could name about 100 optimizations for patient care that would not be costly or require any training beyond a one-time demonstration of each change. It is actually easy to reduce error, improve patient satisfaction, and decrease harm & readmissions except that there’s a lot of red tape in the way.
Pathetically enough, I sometimes dream of opening my own nursing home or hospital ward to model these changes. That would be great to do but even better care could be had if, as you touch on, we could change peoples attitudes and expectations a little more rapidly!
The upside of down
“Emerging scientific research suggests coping with adverse life events improves our ability to adapt and handle future events,” Psychcentral.com reports. “… The new national multi-year longitudinal study of the effects of adverse life events on mental health discovered that the experiences appear to foster adaptability and resilience. As such, an individual is able to handle future mental-health issues and possess a strong sense of well-being.” The study will be published in the forthcoming issue of the Journal of Personality and Social Psychology.
. . . but [stress] will shorten your life!
trust me, I’m a doctor.
LOL…stress does seem to do some crazy things to the body. I like your classification system of “warm fuzzies and cold pricklies”, perhaps I can incorporate this into my daily routine.
On the plus side, the palliative patient who died at least had a caring physician by their side who was trying to honour their wishes.
As for your clinic closing – that’s lousy. We need all the XY Clinics we can get. Here’s hoping that another door opens for you.
BTW…can you send someone over to make me dinner and do my laundry? My thesis has taken over my house and life!
Thanks – that thought activity works well alone or in a group, if you don’t mind the sharing part. Don’t know if you have office-mates but I’m sure doctoral peeps have high-highs and low-lows just like MDs.
I’ll ask Lois if she does house calls to other parts of the country. She even folded my underwear and bought me some bubble bath cuz I guess I look a bit stressed, hah!
Well the clinic may not be closing, just exploding a bit; since I’m still training, it’s just a learning environment for me but unfortunately the administrative collapse has meant that it is hard to focus on learning while there. Things are changing, probably for the better.
Bertrand Russell~ Man needs for his happiness not only the enjoyment of this or that but hope and enterprise and change.
I think I’d rather have a doctor that stands a chance of crying than one who couldn’t.
If I forgot to pee for 10 hours, I would be crying too!
Seriously, it sounds like you have a great supervisor and good friends, those are some big positives that will help keep you sane.
I’m dying now to hear about the sleeping examiner…even more than pap tests.
I have a bladder like a camel has a, uh…
I don’t know how to make that analogy but lets just say I’m due for early renal failure thanks to the on the job “there-is-no-time-to-pee” training.
I will write something about that soon, first I wanted to write to the MCC people in case they had a witty response. Or one that I could make fun of, at least.
[...] Remembering in two parts: My Kriegsmarine and Canadian Forces grandfathers – not at war in me 4:45 pm [...]