Tuesday, August 17, 2010

Treating patients as parents…. Should we???

We all have heard remarks that doctors should treat patients as their parents. Some of us accepted this view as it’s provided a firm practices of medicine.

I personally think this notion should be alter.

When my parent was admitted, I was able to stay up more than 36 hours, running from department to department, stand-sit-kneel and all of others. I managed to do this for one patient. We managed numerous patients per day and it is impossible if we would have to do the same.

Plus, when we managed our parents, we tend not to be objectified. First, we would think the worst possible diagnosis and doing unnecessary investigations. Second, some of us would even go to the other extreme as thinking there is nothing terribly wrong with our parent and asking them to sit tight in the house.

Belief me when I say I’ve seen doctors that wrongly treated their parents. Most of them regretted what they have done.

The best way is to get a second opinion. This not only shows the doctor’s maturity, it would directly give the best treatment to our parents.

So when you ask
“Should you treat your patients as you are treating your parents?”.. I’ll answer NO and alter to..
“We should treat our patients as we would like other doctors to treat our parents”

Does it sound fair???

Friday, August 13, 2010

Inbreeding is a dangerous thing….

Genetic inbreeding has been going on up until now since the first it has been created. With regards to human inbreeding, I personally think that all of us agree that it does more harm. Well, if it’s not, I bet our parents will keep on asking us to marry our cousins without knowing about the consequences. It has not only scientifically proven that it carries genetics diseases, but it also slows human development.

If you accidentally made a silly mistake, people would even sometimes joke around and ask you if your parents are related. In a way, it implies that inbreeding produces a weaker (or slower) generation.

There is a concept of “Faculty Inbreeding” and this is the one that I would like to discuss more. Faculty inbreeding implies that the same student graduated and rejoins the same institution. It reduces the possibility of new ideas that are coming in from external sources, just as genetic inbreeding in which it reduces the possibility of new genes entering in to a population.

Let me simplify this concept for better understanding. A medical student graduated from university X became an intern in University X. He then later joined a specialist training in University X and became a specialist in University X and calling himself a world standard physician.

Try to imagine, a person that only drives a Proton Saga throughout his life, could not possibly commented much regarding Mercedes, BMW, Porsche and etc. This person can brag all he wants regarding proton fuel consumption, price on the road but until he has driven others, he might not know the smoothness, safety and reliability of other cars. If Proton is so good, people would not have bought other cars. There must be reasons behind it and until you have driven it, you might not see the whole picture of what I am saying.

Dr Ogren from University of Minnesota wrote “A high quality graduate training cannot be achieved if such inbreeding of ideas takes place”.

This statement did not surprise me. First, a student from the same institution was obviously has the same experiences and therefore ideas as others. Secondly, this student will always obey their “Master” no matter how old, ancients and disruptive the idea really is. Otherwise we will not have seen patients with unstable intra-abdominal injuries getting a CT Abdomen, patients with moderate to severe head injury getting X-ray cervical (AP, lateral, shoulder pull, swimmer’s view and etc) prior to CT cervical. All these happened and things are still happening because the “Master” is considered right even though he is clearly wrong.

These new inbreeding faculty members would have a narrow horizon. For them, the horizon is set and all that they have to do is just to continue to work as before. No new destination, no new technique, no new management and continue to breed a new generation that follows a very old captain. The worst thing is that they don’t even know what is new and the right thing to do. They act as in they are so smart and rejecting unheard ideas.

Inbreeding faculty members would want someone to stay with them and eventually those who have the same ideas like them (or the one that would not object). In turn, they will try not to hire people who try to introduce and invent new things. These new things might save more lives; transform the department to become more efficient and in turn it makes life worth living. But because it is not understand by these so called “Master”, it could not have been done.

This “Faculty inbreeding” product is very contagious. It can affect hospitals which are nearby and for those who depend on them as a tertiary hospital. Their management will have to alter according to this old, ancients rule prior to sending these patients.

I have always asked my students to compare their lecturers. Which one gives best, compact and informative lecture? Is it the one that inspires them most? Almost all gave me a lecturer who has been to a lot of places with lots of experiences.
Don’t get me wrong, I’m not trying to say that we should not buy proton cars. I’m driving a Proton car myself. After I have owned a Honda, Mercedes (a second hand car of course) and drives many others, I have decided to buy a Proton Saga because of its fuel consumption, cheaper taxes and maintenances. I know I have given-up some aspects in terms of comforts and safety but I try to compensate it by driving it carefully. All I’m saying is that I know what I’m driving rather than bragging that this is the best car ever.

Even Prophet Muhammad (pbuh) himself preaches us to travel to China if necessary. Yet, some of us are feeling so comfortable in their “comfort zone” and rejecting this precious statement.

Once we “The Doctors” have seen other systems, departments, protocols, personnel and etc, then only we would appreciate how much lives that we have truly saved and how much that have died in vain.