Wednesday, November 14, 2007

Picking Cherries

It is alwasy gratifying to know that somebody is reading your blog. Somebody actually posted a response to my posting,

They asked me whether I went into medicine to look after healthy people. Actually I went into medicine because my parents thought I should be a professional and engineering, law, education, nursing and pharmacy didn't appeal to me. I really had no idea that I would ever be asked to look after healthy people and I sure had no idea how sick people could actually get and how totally soul destroying looking after them could be. Having said that, at least sick people you can actually do something and occasionally despite everything you do, they actually get better. Unlike healthy people who can only get worse.

It was in fact healthy people that lead me to flee general practice. Give me somebody with crushing chest pain and I knew what to do; asthma/COPD ditto. "Weak and dizzy" however I had no idea to treat except for admitting them to hospital and ordering every test in the book which bought you at best a week's peace.

Likewise in anaesthesiology sick patients are in many ways easier to treat. When I used to work at the CoE about every night I was on call we would do some poor soul from the ICU, often a liver transplant gone bad,usually for a laparotomy and washout. One night, surveying the individual on the table, connected up to about 20 infusion pumps, tubes sticking out of everywhere, I commented to the resident, "The one good thing about these cases, is that nothing you can do can make them worse". We also had a large dialyis unit at the CoE which was a steady source of business for our OR. I used to say,"If the nephrologist hasn't killed them yet, nothing I can do can". This didn't stop me from reading the obits for about two weeks after I did the vascular access list.

Some people actually enjoy doing big cases on sick (or soon to be sick) patients. I used to enjoy this too until I thought of all the hassle of doing these cases versus what the innevitable result was. During my residency I remember an eccentric vascular surgeon coming into ICU and surveying the ruptured aneurysm whose "life" he had saved and stating, "I give you a miracle, you give me a vegetable". On recollection, too many of the people on whose behalf I busted my butt ended up maybe not a vegetables but sometimes I wondered if I hadn't been such a skilled anaesthesiologist and had let them die, things might have been better for everyone.

I have however always regarded myself as a professional and team player and am prepared to accept what the surgeons, nephrologists and ICU throw at me. Do I enjoy it? Well there have been certain aspects of parenthood I haven't really enjoyed (0700 hockey practices, Christmas concerts) but overall you can't really have the good without the bad.

As I mentioned above, I was really naive about what I would be getting into by going into medicine. I seem to have had this vision of a culture where we all helped and supported each other, shared the difficult cases, as well as the easy cases. Every job, I had, I just thought okay, that isn't the way in just community or this department but the next one will be different. As I said I was very naive.

One of many things that disgusts me about medicine in this century is the tendency for certain doctors to cherry-pick the good cases, which means more difficult cases for the rest of us. In Canada, the president of our national medical society, is a surgeon who owns a private surgical suite. This suite does elective cases on healthy patients, it has no inpatient beds, it doesn't do sick patients, it doesn't do emergencies. This and other individuals then take this clinic and rub the rest of our noses in it stating if only we allowed patients to pay for their surgery, everything would be okay. The fact is that by outsourcing the easy cases to the private sector, the public system now deprived of those cases and with the responsibility to deal with however else comes in the door (including the complications from the private suites) is even more innefficient.

I'm not sure whether this post satisfies the commenter on my other post.

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