Saturday, April 14, 2007

Episode 16: Questions you should ask

Here's Episode 16. We start with some letters from the Listenership, then take a quick trip to the newswires, where we check on the medical accuracy and completeness of recent stories about Tony Snow's cancer diagnosis and Jon Corzine's car accident. Then, at long last, we arrive at the stated topic: questions you should ask your surgeon before having an operation, and things you can do in the hospital to be sure that you're getting all the treatment that you should.

Of course, I'm not your doctor, and you should take my medical advice the way you take any advice from a complete stranger who won't tell you his name...

For convenient reference, I'll put the main points here:

1. Be sure your attending is going to be in town while you're recovering, not heading to the airport from your operating room.

2. Is your attending surgeon going to see you every day while you're in the hospital? I used to take that for granted. No longer.

3. What's the patient to staff ratio going to be? If you're going to be in ICU, will you have 1:1 nursing, or at least 1:2 nursing? And what sort of physician coverage is going to be present at night and on the weekends? Will there always be a senior-level doctor in house, or are the interns sometimes left to their own devices?

4. How many cases like yours has your attending done - AS AN ATTENDING?

5. When you get to the hospital, ask about the following...and keep asking:
a. Prophylaxis against Deep Venous Thrombosis (DVT)
b. Peri-operative antibiotics
c. Beta-blockers (not everybody needs them, but be sure your team is thinking about it)

Hope this proves a useful reference. If you have things that you think should be added to this list, please, let us know!!

Letter from Denise

Here's the letter from "Denise", as read in Episode 16. What do you think?

-D, M.D.

Dear Dashing MD,
I haven't listened to many of your podasts yet, but I'm so glad I've found you. Thankyou so much for sharing your world and your point of view with us, for crossing that barrier. What you're doing is something seriously lacking in the medical profession, and very much needed.

I'll try to cross the barrier in the other direction.
I've recently had an experience that has radically changed the way I view doctors. It should have been for the worst, but there's no way I can see it that way.
In November, I went into hospital with a fracture. Things went wrong over a very busy weekend, I was not seen, complications developed and have been ongoing. Forgive me for not being more specific but it isn't important to the story anyway.
I should be blaming the doctors for not coming to see me post-op. I should be blaming those that did come for not diagnosing the complications and letting them develop. I should be blaming them for not prescribing antibiotics afterwards. But I can't. I should be furious at the injustice of it all. I should be saying "why me?" But I'm not.
Instead, I've learnt some really valuable lessons about what it means to be human.
Now I've seen that doctors are allowed to be humans, to have emotions, to make mistakes and be forgiven, I'm really inspired. I'm ready to be one. I was previously holding off going to medical school because I was afraid of the responsibility that comes with being a doctor, but now I see that only the most inexperienced registrars are afraid to ask for help. Surgeons consult each other all the time. And that's the way it should be. You're not supposed to shoulder that burden all by yourself.

Another reason I didn't want to be a doctor is that I was afraid of being too cold and impersonal. Now i've seen the alternative.
You said something along the lines of "doctors don't have the time to be there and hold hands". I'm not entirely certain about that.
I've had interactions with many doctors during this experience. My respect for them doesn't rank with who was and wasn't responsible for the lack of communication that allowed things to go wrong, nor does it rank with who was the most senior, who operated on me and solved the problems. It ranks with who took the time out to reassure me. I think the most important role of the doctor is to control fear. Without fear, things can heal. The doctor has the power of information. We patients thrive on information. Even if it's the same information over again. Also, just knowing that someone out there is keeping track on you so you don't get lost in the system, that means the world.

And metaphors aside, hand holding itself is so important. Just touch. In that big sterile impersonal place, a hand on the shoulder just means so much.

It seems to me that there are two types of doctors, the ones who give out their mobile phone numbers and those who don't.
I hope I'll be one who does. I have no idea how they cope with the emotional burden they take on from each patient they engage with, but I'm going to have to find out. The hospital system wouldn't function without them. If they let me become a doctor, I pledge to devote my life to the battle against Lack Of Communication.

Anyway, I can't wait to hear more of your podcasts. I know there will be some answers there.