Judgment

This week I noticed a lot of judgment. A few days ago, this article was published in an online university newspaper. I came across the article by coincidence, as neither I nor anyone I know has tattoos. It is an opinion column harshly judging any woman who would choose to tattoo her body. The argumentation behind the writer's opinion is rather weak. Basically, there is no argumentation. According to Khoury, a woman is supposed to have class, by going to the mall and getting her nails done and wearing high heels, and according to her, tattooed woman are classless by definition. That's a lot of judgment.

Not surprisingly, a lot of people were offended by this opinion column. What did surprise me was the large amount of hate mail sent to Khoury, calling her "Stupid Cow" or "Fat and ugly". A day after the original article, Khoury wrote a response called The Day I Met the Internet. After reading the response, I understood her. I still do not agree with what she said, but that could have been me, enthousiasticly writing an opinion piece without thinking it through. Which is why I'm happy to stay anonymous while blogging. Still, it's a reminder. Medicine is a sensitive topic and I need to be very careful in not sharing any sensitive information.

The second article about judgment is a little more medicine-related. It is a blog post from the perspective of a sick girl's mother. She has written before about doctor experiences, which were often negative in terms of attention and respect - those are supposed to be bullet points at any doctor's priority list. After reading some doctor blogs, she comes to a few conclusions. Most of them have to do with judgment. It sounds all too familiar. I judge people too. I sometimes catch myself judging classmates and now that I think of it, I judge patients, too. I judge the patient who complains of bloating but always asks for a third portion during dinner. I judge the patient who pities herself and does nothing to make her life better. I guess it's human, and I try to hide any preconceptions. But still.

Do you recognize being judgmental? Do you think it harms anyone and if not, why not?

Medical Ethics

Ethics is a word commonly associated with medicine, especially the negative adjective form - unethical. A lot of things are unethical. Providing opportunity for abortion and not proving this opportunity. Not informing your patient about upcoming procedures. Most aspects related to medical ethics are regulated by law. Where I live (don't bother asking, trying to keep up the illusion of privacy;)), there is a specific law protecting the staff and patients of psychiatric hospitals. The dementia-care part of the nursing home I work at is also considered a psychiatric hospital, so we have to abide by those laws. I did not receive any information about the law yet (which is crazy, but that's another story), but I did learn a bit about it. When we install a motion sensor to increase the patient's safety (because of an increased risk of falling, for example), we have to fill out a form, signed by a physician. This is because it limits the patient's freedom. No problem so far.

Another rule is: never ever lock a door unless on doctor's orders. Again, because the limitation of freedom. Here's where it gets interesting, from an ethical perspective. One evening I was independently running my 'home', as we call it. About ten 'homes' have access to the same hallway, which is password-protected to prevent the patients from going outdoors (by the way, it's also where this happened). Conclusion: the hallway is safe. Still, it is inconvenient, because your patients are not together and can wander through that part of the nursing home. That's why some staff members elect to close the door so everyone is contained, which is easier as they know where everyone is. An illegal action, which is also unethical.

Up to that time, I learned to think about rules in a practical sense, because it was clear that I couldn't work there if I followed all rules. Not that it's a bad nursing home, but coworkers don't like when you say that you can't watch the patient drink their med solution because technically, it's not allowed. But overstepping both legal and ethical boundaries, no way. That day, a particular co-worker asked me to lock the door because "I couldn't work like that, right?". That's what is so scary about overstepping boundaries: when are you sacrificing your patient's well-being for your own comfort?

I think there should be stricter enforcement of rules and laws. I practically have no choice but break some rules, but it is much clearer if no one ever has to. Because sometimes unethical decisions are made based on work load or social pressure. But there is still responsibility. So, politely but without hesitation, I said no. No, I will not compomise my patient's freedom for my own good. Will I make the same decision in five years, or will I get tired of searching everywhere and just lock that door? I don't know. I hope not.

The First Month

I can't believe it's already a month since I started my blog. The month went by so soon, yet I can barely remember not having this place to type out my thoughts and experiences. I never kept or even considered a diary, but strangely enough, I love blogging. I love being involved in a community that has so much valuable information an experiences. I think I will like looking back at my first month of something that will hopefully last much longer. In my first month I: -Received 484 pageviews from 175 visitors -Posted 13 times -Welcomed my first 6 followers -Submitted my very first entry to Grand Rounds Why should this matter to you? It shouldn't, and probably doesn't. Just wanted to get it out ;)

Diagnosis: Unknown

I always used to wonder why it is so hard for some patients to get a proper diagnosis. I reasoned that when a patient is seriously ill, doctors will continue to look for an answer until they find the cause. Someone must know the disease, which means it is just a matter of referring to the right person, right? Gradually, I came to find out that medicine does not work this way. This is unfortunate because a lot of rare diseases are only diagnosed after many years, if they are ever diagnosed. So why is it so hard to effectively diagnose patients? After seven months of health care experience, I came across two main causes for this problem.

Medicine is a field of fast, ongoing progress. This is positive as survival rates for diseases go up and the number of undiagnosed patients goes down. But ongoing progress also means that medical professionals no not have all the answers. Diseases are complex and often have many manifestations. It is unreasonable to expect to make a diagnosis every time because currently, we can’t distinguish between certain ailments yet. It will take decades to be able to pinpoint some diseases, especially mental disorders, which can mimic physical disease.

Another aspect of diagnosis that can be overlooked by patients and family is the difference between theory and practice. In theory it is possible to monitor a patient closely and be on top of any changes until there is nothing new to discover. In practice this approach is undesirable (a lot of time investment on the patient’s part) and unmanageable (far too expensive). In practice, nurses and doctors have a large workload which limits their diagnostic abilities. They are human and hence can be sleep-deprived or having a bad day (or both). 

These factors add up to a frustrating situation for the patient with a rare disease. They ‘win’ the lottery twice: not only do they get sick, but the process of getting diagnosed is often long and complicated. One thing to speed up this process would be research. Research is crucial to gain knowledge and develop diagnostic tests. Money is necessary to conduct research. That’s why attention for rare diseases is good. Not only will attention and explanation help with much-needed empathy towards patients, but it also raises money. 

29 February. Rare Disease Day 2012. Spread the word. Get involved.

Vulnerable

Today I found an email in my inbox. It seemed normal, guessing by the title and sender, but I did not know the sender. I opened the email and found a very offensive photo with a text that's just... creepy. Even if I would desire to share its contents, I'm pretty sure that's illegal.

But that's not the worst part. It was adressed to all students of my school, and there was a discussion going on on Facebook. At least five teachers were jokingly mentioned as potential senders of the email. I was (and still am) shocked. How could someone do that? It also made me realize once more how vulnerable everyone is since the invention of internet. There's no way to reach over 200 people by letter in one night. Still, as opposed to with conversations, information is saved much too easily. These are teachers who did not ask to be online and certainly did not ask to be accused of sending these horrible emails. I sincerly hope that the sender of the email and the people rudely accusing teachers will be punished.

So why am I sharing this here? I'm not sure. I guess in a way (being completely egocentric, I know) I realize how vulnerable I am, purposely writing about myself on a blog, for everyone who wants to read about it. I did make a very conscious decision to remain anonymous and still blog as if everyone knew who I am, but still. Only one person has to find out your real identity and do the wrong thing and a lot of people know who you are. Your co-workers. Your future boss. What I am writing now might be totally inappropriate in ten years so I do wish to remain anonymous. Or am I overly concerned? I do of course keep in mind patient confidentiality and I only write about what I don't mind telling virtually anyone.

I would like to ask my current 3,5 readers (I love your support!) a question. How do you think about blogging and anonimity? Do you worry about your blog affecting your life in negative ways? What do you think about privacy and social media in general? Please leave a comment below!

Contentment

Right now I am watching Mystery ER. I watch a lot of medical shows (both fiction and non-fiction) and I absolutely love them. Figuring out what's wrong, absorbing as much information as possible, but also dreaming about the future. Medical professions are known for their popularity. Ever seen a TV series about garbage men? For some part I consider the general enthusiasm naive. Medicine, for reasons I mentioned before, is not equal to dreams, and not everyone realizes this.

That said, I look forward to med school so much. Because of course, the general dream of being a doctor is not completely unjustified. I look forward to learning how to use a stethoscope. I look forward to assisting in the emergency room. I look forward to growing personally and professionally. I look forward to learning everything related to the human body, and even wearing a white coat to symbolize it all.

Another thing I love is preparing to get into med school together with others. It is just motivating to talk about how you want to achieve the same goal. It fuels the desire to try just a little harder, work just a little more. Med schools are very selective, and however frustrating it can be at times, it is also a game. A very important one, which makes winning the game even more crucial. A very long game, as the preparation can last for over a year.

That's why it is so important to have a community to remind you of your goals when needed. I love my blog for this: it allows me to structure my thoughts and get useful responses. I also love forums: they allow me to interact with people in different stages of the 'doctor process'. But most of all the friends who critically listen to what you say and support you. Even in the pre-medical school part, I learn so much. I feel very content knowing there is so much more to come.

Happy Birthday Sweet Nella

Two years. And many more to come.

I fell in love with Nella two years ago, and it's just amazing to see her grow up. Happy birthday sweet girl! P.S. Nella's family started a great fundraiser, and by now they have raised over $180.000. One hundred and eighty thousand dollars to support individuals with Down syndrome. How great is that? Click here for more information.