medical education

Care Factor

I would like to take this opportunity to address some ideas I’ve found floating around about doctors that are not only incorrect but also downright offensive.

Myth 1: Doctors are all being paid by Big Pharma to cover up the truth about drugs/vaccines.

Fact: I’m still waiting on my incentive payment… and I haven’t met a group more sceptical and hard to convince about new medications than doctors- well, aside from conspiracy theorists and people who are anti-conventional medicine. As any drug rep could tell you, doctors ask the hard questions, because, shock-gasp, we actually CARE about our patients. That’s if we actually will speak to a rep. Many doctors refuse to (or are just really obstructive and rude to them as discouragement- not saying this is the right approach!).

Myth 2: Doctors don’t want people to get well because we’d be out of a job, so we have a vested interest in keeping everyone sick.

Fact: Most doctors genuinely care about their patients!! If everyone suddenly recovered from their health issues and never needed a doctor again, we’d be delirious with joy. We’d retire early and spend our days golfing, or make an exciting career change, or finally take up sudoku.
I would like to take this opportunity to address some ideas I’ve found floating around about doctors that are not only incorrect but also downright offensive.

Myth 3: Doctors don’t want to use ‘natural’ remedies because we can’t make money out of them and/or they work too well and we want our patients to stay sick (see above).

Fact: We don’t make any money from the treatments we use. If we write you a script and you go and buy a medication- we don’t get a cent from that sale. You know who DO make money on the remedies they concoct without any quality assurance and regulation and sell directly to you to fix a condition that they’ve just ‘diagnosed’ you with- naturopaths. If your doctor advises you to not use a ‘natural’ remedy it’s either because we think you’re wasting your money or that it could actually be doing you harm (directly, or by delaying the appropriate treatment). If there’s a ‘natural’ remedy that is safe and effective- we’ll tell you to go ahead and take it!

Myth 4: Doctors don’t know anything about nutrition or healthy lifestyle in general.

Fact: That’s false and really, quite insulting. We do know quite a bit. We are generally a humble bunch though, who don’t claim to know it all and we won’t make up our own ‘facts’ to fill the gaps. If we are saying something with limited evidence, we will tell you, instead of just coating it in random scientific sounding terms to impress you. What’s more, we acknowledge the limits of our knowledge and refer you to someone with specialised knowledge when needed, eg. a dietitian. We care about you getting the best care possible.

Myth 5: Doctors’ knowledge is limited because the whole of medical education has been infiltrated by Big Pharma.

Fact: Most of medical education is about clinical sciences and the art (and ETHICS, hello) of good patient care. Any drugs we learned about in med school went by their generic names. Along with the actions of drugs we learn all about their side effects and risks. Again, I’ve never met a tougher audience then doctors at a so called ‘drug dinner’. We really put the reps through their paces. We tear through their data and expose any shoddy results. We decry unacceptable side effects and query the actual benefit of any new treatments. These are not the actions of a group that has been ‘brainwashed’ or duped by evil corporations. Repeat: Doctors care about their patients!!

Myth 6: Doctors can’t be trusted because they are paid for what they do. It is better to trust someone who isn’t getting paid, for example, a celebrity chef on the internet or a random stranger on an online forum. These people don’t make a living from health therefore you can trust them to tell the truth.

Fact: This makes no sense to me. Your health is kind of important. Someone who makes a living providing health care is forever continuing their education and updating their knowledge. They care about your health because they care about you, AND because it’s their job. Their livelihood depends on giving you the best care they can, so why wouldn’t they want to do a good job? They aren’t after fame or fortune. Unless it’s Dr Oz- that’s a whole other blog post.
You should think of the pilot analogy here. Who do you want piloting your healthcare? A trained professional who does it all the time, or someone who just dabbles in it and makes it up as they go? Here’s a fun article about that.

Thanks for reading. I don’t hold out any hope that anyone who believes in these myths would even read this post let alone change their mind. I just wanted to get it off my chest. It hurts to be misjudged, to be called corrupt or untrustworthy when you are doing your damnedest to give good care.

Image: Crepes with icecream: a timeless natural remedy against hurtful rumours.

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Those who can, teach #2

Last week I spent a session sitting in with a GP who works in bariatric medicine- similar to me, but she has been doing it for seven years. I learned a lot during the session. She involved me in the consultations and spent a good amount of time answering my questions and discussing cases. Since then I have received emails from her with useful references and resources. She has also offered to talk with me over Skype about my own cases.

This was all pro bono.

I know. I am duly humbled and very appreciative of the valuable time I have been given.

One of the lovely aspects of the medical profession is our propensity to mentor each other; helping shape junior doctors into kind and expert clinicians who will give their patients the very best of care.

Often this guidance is unpaid, yet many doctors give so generously of their time and wisdom for the sole reason of improving the care of future patients. Part of being a doctor is looking after our colleagues and aiding each other’s learning. As we work for the benefit of our patients above all, their wellbeing is often the only incentive for our efforts.

I’m a member of the Facebook forum GPs Down Under. This is a cluster of GPs in Australia and New Zealand who offer each other advice and support online. It’s a fantastic group. One GP on the forum said she was talking to a lawyer friend about our forum, who was apparently stunned that we were ‘giving our time and expertise away for free’ (or similar).

I wrote recently about my dear friend in Virginia who passed away last month. She was a shining example of a clinician who was dedicated to fostering the learning of her colleagues and students. She would stay up in the evenings coaching residents for their vivas. She tirelessly taught me, fed me, nurtured me, all out of the goodness of her heart. I know she cared for others in this same way, friends and colleagues alike.

The time I spent with her and the rest of the team at Atlantic Anesthesia was so valuable. And they weren’t paid a cent. It’s not like I was a US med student and a potential future member of their team. I was an Aussie med student and future Aussie doc. What was in it for them?

Knowing that some patients somewhere, some day, will receive better quality care as a result of your careful instruction- this is one incentive. The other? Genuine care for our colleagues, wanting to support them in their development as clinicians and help them flourish.

I think that’s pretty damn amazing.

I would love to hear your stories about memorable mentors and caring coaches, who I know are not limited to the healthcare professions.

Image: Dr De Loony as an impressionable med student far from home, in Virginia USA.

Medical Mentors- thoughts on the passing of a friend

Stories are emerging from the woodwork about bullies in medicine. I’d like to say I’m shocked, but sadly I think most doctors have experienced, seen, or at least heard whispers in the corridor hinting of similar experiences.

I’ve been thinking about the opposite of bullying: where someone is not only pleasant and professional, but they go out of their way to teach you, help you or mentor you. I hope that most doctors have known someone like this, a clinician who they could respect and seek to emulate.

This week a mentor and dear friend of mine passed away and I feel bereft. Besides feelings of loss, regret at not visiting more and pangs of sorrow for her family, I am reminded of the lifelong impact she had on not only the way I practice medicine, but the way I live life.

It was by a happy accident that as a third year med student on an overseas elective in the US, I landed in theatre with Anne, a warm, strong and highly intelligent Scottish-born anesthesiologist. I will be forever grateful for this.

I was not only in need of teaching, I was in dire need of a mentor. Being far from home, in a pretty sticky situation, I felt lost. Life doesn’t stop for medical school and it was a sometimes painful and tumultuous time for me.

She saw I needed guidance and took me under her wing. ‘I’ve decided to adopt you,’ she said, with a pleasing Scottish lilt.

She taught me not only about anaesthetics, but plenty about patient care and rapport, medical ethics, and how to live life fully and generously. Who says anaesthetists are only good with the unconscious!

She took me in for Christmas, introduced me to her family and her beloved boxer dogs. I stayed a while and it felt like home. Looking out over the river from her back window I felt so peaceful.

I have since learnt that my friend has helped countless others. It was completely usual for her to give tirelessly of her time, knowledge, expertise, affection and energy. It was ordinary for her, but to me, extraordinary and so needed.

She would devote evenings to residents who were preparing for their vivas, spending hours going over the minutiae of anaesthetics.

She was wholeheartedly a patient advocate. She was a wonderful colleague, offering to take shifts when others were struggling. She was a support for friends, students, patients and her team. She was always ready with a kind word or a good strong hug.

She passed on her wisdom generously. For example, she told me that it is poor form to tell clinical stories as tales of battle for personal glory, because by doing this you are capitalising on a human being’s suffering and misfortune. I think of this every time I go to tell a clinical anecdote, asking myself ‘Am I telling this story to debrief, to enlighten, for advice- or for glory?’ If it’s for the latter, I keep my mouth shut.

This was a cute thing: she startled easily- but recovered with hilarious immediacy. I came down one morning and she was in the kitchen making coffee. I said ‘Morning!’, and she shrieked and nearly hit the roof. Then she turned to me with a serene smile. ‘Morning,’ she replied. She came over and took my face in her hands and beamed at me, like I was the very thing she had wanted to see at six in the morning.

When I went back to visit her, during a break in my GP training, I was a brighter and slightly more self assured human being. I had no task but to enjoy Anne. To make her coffee, or a meal after her shift, walk her dogs and bask in her sweet company. It was one of the happiest weeks of my life. She welcomed me into her home and her life and I am a better human being as a result.

Though she’s gone, I am determined to carry on being the kind of doctor and human being who she’d be proud to know. She was just one person, but her presence in the world was large and she will be so missed by her family and many devoted friends.

I would love to hear stories from any of you about mentors, role models and friends who have inspired you and touched your lives.

Those Who Can- Teach

Some of the best teachers I’ve had got good results from me by seeming to expect them.

If I gave a subpar performance, they seemed confused. I worked harder if only to avoid that look on their face. I felt like they’d mistaken me for a high achiever, but I was determined they should not now be disillusioned.

The first teacher I remember using this technique- quite by accident I’m sure- was my year 9 history teacher. I had been skulking along through the early years of high school trying not to do too well or seem too smart; not doing my classwork or homework; reading novels under the desk. I made the mistake of participating in the first history lesson of the year, probably to be polite to the new teacher. She jumped on me as a ‘talent’ and so, not wanting to disappoint, I had to actually do history that year.

Later as a medical student, I remember presenting a case in the corridor to my tutorial group and our tutor, let’s call her Dr. Winner. I was about to run off and go to a job interview. I thought I was doing a reasonable presentation, but Dr. Winner kept shaking her head.

‘Come on De Loony, you can do better than this’, she said. Still I floundered. ‘You must be nervous about your interview,’ she offered, and I gladly dropped my eyes to the floor, nodding solemnly.

Under her hopeful gaze I swotted Talley and O’Connor, practiced my examination techniques at home and especially applied myself in neurology- a favourite of mine anyway, but it happened to be Dr. Winner’s speciality.

Another tutor would race up the hospital stairs ahead of us, despite her Cam-booted broken foot. Come to think of it, I think she had broken her foot running on those stairs. She taught us how to get our case presentations to be ‘really slick’. Her enthusiasm was admirable. She had enough energy for our entire group. We were swept along by her backdraft.

Dr. Staghorn taught us ‘the backhand technique’ for examining a prostate, which I still use today. When I must.

Now I’m trying to think of the less memorable teachers, or those who were memorable for their negative effects.

Dr. Claude taught using the always popular Socratic method, which I hated. Still hate, if it’s not done well. Firing questions at impressionable students who don’t yet have the knowledge to answer them is humiliating at best. On the other hand, he let us observe while he inserted a chest drain. That was pretty cool.

And I’ll never forget the tutor who had me perform a testicular exam with no gloves. ‘You don’t need gloves’, said he. I often fly back in time to supply this quick rejoinder to my former, mouselike self: ‘Oh yes I do…’

I’ve learnt a bit about teaching from my years of being a student. I think a good teacher has enthusiasm for their subject, confidence enough to remain patient and kind even in the face of belligerent pupils, and knows enough about their material to be able to explain it well to those who know nothing. As another excellent teacher told me: ‘losing your audience is not a mark of intelligence’. (Who else out there remembers a certain expat American who made neuroscience come alive?)

A good and memorable teacher is one who also brings a little personal colour to their work, whether through the use of stories and anecdotes, well placed jokes or just a little eccentricity.

I would love to hear your stories about memorable teachers, or what you think are the characteristics of a good teacher.

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