Machu Picchu And A Journey In Medicine

I recently finished a three day trek to Machu Picchu. The “Lost City of the Incas” is perched atop an incredible ridge, overlooking the surrounding mountain ranges and a beautiful valley below. It is the definition of impressive.

The trek to Machu Picchu was difficult but exciting. We combined mountain biking, river rafting and a decent amount of hiking (including the final ascent to Machu Picchu at 4AM!). We started on top a 4,300 meter mountain, passed through jungle, hiked old Inca trails, tasted freshly picked coffee beans and swam in an ice cold stream among other adventures. The whole trek, from start to destination was amazing.

I have been thinking about the journey to becoming a physician and what it has to do with my recent trek. I like the concept of a “journey”. It is the reason behind the name of this blog.

Journeys are fun. They take you places you´ve never been before. You see new and wonderful things. And if you make it to the end you are rewarded with the  joy of reaching your destination.

Journeys are also challenging. You may have hardships and setbacks. They may be painful at times. You may have the heartbreak of not reaching your destination.

I wonder if pre med students are enjoying the journey to med school. Is your pre med journey fun? Are you having great experiences and learning? Are you perservering through the hard times and using them as an opportunity for growth?

Or are you just jumping through hoops longing for the destination?

Summer is a great time to explore these questions. There are no right answers. But consider this: if pre med life is constantly miserable for you, what makes you think that will change once you get into medical school?

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Mountains Beyond Mountains: What Paul Farmer Teaches Us About Passion

“I’m going to build my own f—ing hospital. And there will be none of that there, thank you.” 51cTq8IIW L._SL160_

Dr Paul Farmer can get testy at times. He helped raise money to get blood bank equipment at a rural hospital in Haiti. He was pissed when he found out the hospital was going to charge patients in advance to access it, so he takes matters into his own hands. He states earlier in the book, “I”m an action kind of guy.”

And yes, he does build his own f—ing hospital. And he does not charge patients for it’s services. The story is told in Mountains Beyond Mountains by Tracy Kidder.

The book illuminates the many journeys of Dr Farmer and his work to serve the poorest in the world. We see him go from Alabama, to Harvard Medical School, to rural Haiti, south to Peru and across the Atlantic to Russia to name just a few destinations. But the book, like it’s primary subject, is anchored in Haiti, the western hemisphere’s poorest country.

Dr Farmer’s quest is an inspiring story for anyone, but it has special resonance for those interested in medicine. Reading the book for a second time recently has re-oriented my reasons for going into medicine. I remembered why I wanted to be a physician and travel.

Everyone goes into medicine for different reasons. I am in no place to judge whether certain motivations are superior to others. I only know what makes sense to me. And to me using my knowledge and influence as a physician to serve the poor, well it fits with who I am.

I want to serve those in need. I want to increase access to vaccines, antibiotics and prevention programs. I want to study global public health and make a contribution. I am under no illusion that I want to do this because I am some selfless human being. I want to do it because I think it will be fulfilling and it fits with my faith background.

While Paul Farmer is an inspiration to me, I do not wish to model my life after him. His life really serves best as an example of someone who cares deeply about people and translates that intense passion into meaningful work. And that is something I will always support.

Read more about the organization Farmer helped to start, Partners In Health. They are doing great work in Haiti.

Has anyone else read Mountains Beyond Mountains? What did you think?

Words I Want to Avoid as a Physician: Asymptomatic

I’m starting a new series of posts called “Words I Want to Avoid as a Physician.” 3593239363_a69f948bfe_o

A huge chunk of my day as an ER Scribe is spent observing patient-doctor interactions. Too often I’ve seen physicians use a medical word or phrase that 90% of the time the general population would not know. Unfortunately, some doctors completely miss the fact that their patients are utterly confused.  They feel they have adequately described what was necessary and leave the patient’s room even as the patient’s face clearly is asking, “WTF did he/she just say?”

In especially obvious cases I’m tempted to stay and offer a short explanation, but I’m basically tethered to the physician I’m working with so I risk being left behind and missing something important. Thus, I leave too.

This example of poor communication furthers the disconnect between patients and physicians. Patients nearly always are initially at a position lower than their physician, as they are coming in saying, “I don’t know what is going on, you’re the expert, please figure it out.”

Clearly there are times when certain terminology may communicate most accurately what a physician is trying to explain. But is it the most effective way to communicate? If you describe something accurately but the other party has no idea what you’re talking about, what is accomplished?

With this in mind, I’m keeping track of words and phrases that most often appear to trip up patients and their families. This is mostly for my benefit, so I can go back and read this list when I’m actually practicing medicine and see if I’m actually meeting my own ideals. My goal is to be able to use simple, clear language without coming across as patronizing. Some doctors I work with are great at it, and it’s their example I hope to follow.

My first word/phrase? Asymptomatic. It means without symptoms. Example that I hear often that throws people off: “How long have you been asymptomatic?”

This question is usually answered with a blank stare.

Alternative question: How long have you not had (such and such symptom, cough, fever etc)?

I hope you enjoy the series! I’m cooking up a post about a crazy story in the ER from the other day, stay tuned…

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The Dark Side: Malpractice and Burnout

Today, links to some great medical blog posts. A common theme ties them together: the darker side of medicine. I think it’s important for pre med students to try and understand the whole picture of practicing medicine.

The first post comes from Kim at Emergiblog. Burnout occurs across all careers but I think it is especially important to be wary of in health care. Kim says,

I had stopped looking patients in the eye. I was spitting out standard responses instead of listening to what my patients were saying. I was expending the bare minimum of energy required to complete tasks.

I was doing; I wasn’t caring.

And I was burnt.

Check out the rest of the post here.

Next, I want to highlight a series of posts by Whitecoat at Whitecoat’s Call Room. Starting a couple weeks back, Whitecoat started outlining the story of his own medical malpractice trial. What he delivers is a surprisingly gripping account of a crazy process. Read the disclaimer here, then check out the first four posts in the yet to be finished series.

Post 1. Post 2. Post 3. Post 4.

Here’s a quote from the first post,

After reading through the chart, I remembered the patient. Nice older fellow who was laughing and joking with the staff when he first came in. I also remembered the patient’s daughter. As soon as she arrived, she began questioning everything we did and everything I ordered. I remember asking her if she had any suggestions for her father’s care. She wanted him transferred to his regular doctor at a hospital across town. By the time she made that request, he was already in shock and we couldn’t transfer him. That made her even more upset. Fortunately, because of the daughter’s animosity, I documented that chart very well.

I’m looking forward to the rest of the series!