Episode 18: Can work be its own reward?

The rewards of medicine are sort of obvious: taking care of other people is one of the great privileges of life, and the fact that we get paid at all to do it sometimes seems like an unexpected, unnecessary pleasure. But the fact is that medicine asks more from us than simple patient care, and making that worthwhile is another question all together. As it is, there's no incentive to do anything more than just get by in medical residency, for instance...no matter how hard you work, you spend the same amount of time training, and get the same pay. The impact of this - a complete deviation, after all, from the American Dream - is underappreciated. I try to appreciate it a little bit this week.

The article I mention in the podcast, about how one hospital is trying incentive programs for surgeons, is here.

Haven't subscribed yet? No time like the present:

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!!

Episode 15: Three Patients, Three Families

As I finish a three-week rotation in the Intensive Care Unit, three patients with three families stick in my memory. Not so much for their individual cases, though each was memorable and heartbreaking in its way, but for how their needs and ours worked together - or failed to. Also, a trip to the mailbag for more questions from Nancy! Enjoy!

Episode 13: From Our Own Correspondents

You wrote, I read, and now here we are: an entire episode devoted to answering the questions of loyal listeners Cody (aka ZeroRocker) and Nancy, who wrote in with some great questions that I had a lot of fun answering. Want to know about why we need scrub techs? What's the relationship between surgeons and internal medicine doctors? Do you need calculus to be a doctor? And, of course, what are the romantic prospects for the modern single surgeon?? This is what I dream this podcast will become...an interactive place where we can have a real conversation about what it means to become a doctor in Modern Medicine. This is a great beginning!

One interesting tidbit given the recent podcasts on resources in medicine: in Episode 11 I talked about how we treat kids to the maximum of our abilities under all circumstances except for some very specific cases, such as babies born before 24 weeks gestation, who have no chance of survival. Well, that should teach me to speak in definitives (again): here's a story about a baby born even earlier that that...something of a one-off miracle, I think, but a good reminder that there's more to heaven and earth than is dreamt of in our philosophies.

Be Well!