Well done- you all earned full credit!

You guys all have 10 posts... good work.  Please add feedback... did you get used to the blogger format or prefer facebook or moodle interface better?  And also- online discussion versus live versus one formal refection paper.. I am open for feedback for next semester and classes that follow you.

nk

Shira

The story of Shira, this little adopted girl from Vietnam and her mother Rachel was hard to read. It is unbelievable that a whole team of doctors could be responsible for doing a bone marrow transplant on a little baby when it is not even required. It was only at the insistence of Rachel, the adoptive mother that Shira’s immune testing was repeated. The medical team was all prepared to do the bone marrow transplant and the donor had been identified. Thank goodness, that the bone marrow transplant was not done and Shira managed to get better in the end. I know that we cannot question everything the doctors do and ask for tests to be repeated constantly but we do have to be our own advocates and if anything, Dr. Groopman’s book make this point abundantly clear. We cannot just assume that the doctors are doing everything right. We have to educate ourselves and ask questions. Doctors may have the best intentions but are fallible after all.
What do you guys think?

Practice makes perfect!

I wanted to share another story that I thought some of you may find interesting. A few months ago, my husband went to India to visit hospitals for the first time in his life. He did not really know what to expect but he came away with a new respect for Indian surgeons especially cardio-thoracic surgeons. My husband’s company makes operating room medical devices so he was there to observe operating room procedures etc. He met some of the best cardiac surgeons in the country. Apparently, Indian surgeons operate on the heart while it is still beating which requires a unique skill because the sutures are done in between the beats. It is more prevalent in India because while it requires more skill, it is much less expensive because you don’t need the heart lung machines. The specialist in this type of surgery usually have 5-6 operating rooms going and have a team of surgeons prepping and opening up the patient. The specialist come in and just do the beating heart surgery part and go on to the next cardiac patient. They can do as many as ten cardiac surgeries in a day. The key thing here is that because these surgeons get a lot of practice, they become very good at what they do. In America, beating heart surgery is quite rare I believe and very few doctors are trained to perform this type of surgery.

Dr Abraham Varghese

In an earlier post I had mentioned that I was reading book by Dr. Abraham Varghese titles “cutting for Stones” that was very interesting. In it, Dr. Varghese decries the vanishing “physical exam” and the overt dependence on numerous lab tests for dianoses. It’s as if doctors are reluctant to physically touch patients anymore. It should be noted that Dr. Varghese got his medical tarining in Ethiopia and India before he came to do his residency in the US. He was trained in an environment where there was no fear of lawsuits and it’s easy to imagine that in such an environment, one can really hone their skills in diagnosing patients using mostly physical exams. Dr. Varghese is now the chairman of a dept in the medical school at Stanford and according to his book, he has some interesting grand rounds with his medical students on rotations. He really puts them through the ringer in front of patients but also guides them to think critically. If any of you are interested, try his book. I really liked it.
Here is the link to this book on Amazon:
http://www.amazon.com/Cutting-Stone-novel-Abraham-Verghese/dp/0375414495

Huge responsibility!

I enjoy reading Dr. Groopman’s ancedotes about his experiences with his patients over his long career. They provide a glimpse into the world of doctors which many of us are generally unaware of when we see them as patients. If a doctor see 20-30 patients a day, it means that there are 20-30 cases that you have to get right and as many opportunities for you to miss something important. My son is in medical school now and occasionally as I was reading this book, it crossed my mind that he will have so much responsibility on his shoulders. Can he handle it? For example, Dr Groopman, as careful and compassionate as he was, he slipped up and did not examine Brad miller when he should have and missed an abcess in his left buttock that landed him in the ICU. It is inevitable that all doctors will make mistakes as they begin their medical training. The key is to not make any fatal one (no pun intended) and learn from your mistakes. I feel the same as a student pharmacist. Next summer when we have to do our hospital rotations, we will get a taste of some of this responsibility and hopefully we can all handle it well.

How do doctors view drug interactions?

I thought I’d share an interesting experience I had recently. Recently my dad was ill and so I went to visit him in California. Now that I am in pharmacy school, I was curious about all his medications and decided to check them out. He was also a little amused because I had not ever asked him about his medications before. Anyway, I got out my lexi-comp and started looking up doses, interactions etc. Then I came across a pretty major interaction between digoxin and verapamil. The dose of digoxin was not on the low end either. I started asking him about it and he said he takes them both together in the morning. I explained that verapamil could increase the exposure to digoxin and we all know by now about its narrow therapeutic index. Well, he had a doctor’s appointment that afternoon so I told him to make sure to ask the doctor about these two drugs and whether he should be spreading them apart. I sort of made a big deal about it so that he would actually ask. Turns out that the doctor completely waived off any concerns about the two drugs taken together and said there is nothing to worry about. He didn’t even acknowledge my dad’s concern. I sure felt like a fool. As a student pharmacist, I am learning that clinical practice is not quite the way we learn in class.

The Emotional Demands of a Physician

In Chapter 5 the author writes, "I did not have the emotional reserve to witness and absorb the suffering of these children or to comfort their anguished parents. I had found my limits as a doctor." This really made me think of what a difficult position physicians are placed in. They went to medical school and began practicing to heal and save lives, but the very nature of their job demands that they take an emotional step back so that they are able to witness so much suffering and deal with death. We expect them to be caring and wholly invested in each patient, but in order for them to keep functioning day after day, they need to be at least slightly detached. I think most of us find some comfort in the dichotomy of life and death, but doctors don't get that luxury. As angry as I am to hear about cold or short physicians with poor bedside manner, this book has successfully elicited sympathy for their predicament, and I feel like I now understand that they make a lot of emotional sacrifices in order to witness such suffering every single day.