sanguinemare

July 28, 2011

Day 3 – Aging, Ethics, Professionalism, and musings

Filed under: Med School and the MSTP — sanguinemare @ 1:42 am
Tags: , , , ,

Today was the first day of actual classes (!) for the first course module of the medical school.  It is, in essence, an intro course designed to help us understand the role of the doctor in society/ things we should be aware of on our road to being physicians.  It is also functionally a way to ease us into medical school before the REAL work begins, and presumably a way to get us more acquainted with our classmates.  That’s how most of us view it anyway, haha.

The course is a smorgasbord of topics, ranging from professionalism to ethics, to a preliminary understanding of healthcare policies/reform to brief glimpses at the history of medicine.  Just today, for example, we went through the history of health care finance, how to differentiate between sick vs. dying patients, introduction to medical ethics, aging, and what medical professionalism means and entails.

I’m not going to go into details for all the classes, but here are some interesting things/food for thought (Note: I don’t necessarily agree with all stated here – these are just things I found interesting to think about):

—————–

History of Medical Economics:

In the early 1920’s, there were government-based programs/hospitals to take care of the sick, but there was no organization from the top-down like in other countries.  Mostly, it was a private practice market, where the ratio of doctors to patients was much higher than now, and clinics were run like small businesses.  One thing that I think was actually pretty neat was that though there was no insurance, patients were charged on a sliding scale, meaning people who couldn’t afford as much were charged less, and the rich were charged more.  That’s actually a concept an elderly Chinese math teacher I met last year told me after I told him I was going to med school. Having never thought about that before, I was pretty surprised and felt it quite an interesting idea at that time, as well.

Rising costs of healthcare were due mainly to 3 things:
1. 1890’s – antiseptic surgery became possible, so more (delicate) procedures could be performed.
2. 1895 – invention of x-ray, with rapid, widespread use within 10 years.
3. Lab tests (rudimentary) began to be ordered on a semi-regular basis
In addition, the Great Depression severely limited people’s ability to pay for health care.  All these contributed to the people’s feeling of a rising need for medical insurance.

Differentiating between the sick and dying:

Before, death was such a part of daily life that it couldn’t be ignored – 1:12 mothers died in childbirth around the civil war, siblings/grandparents died at home, country-wide plagues killed masses.  Now, with modern medicine and grandparents sent to nursing homes, death is seen much less.

“Medicine is a balance between science [/power] and humanitarian service.”  Recognize that you are serving people, not the disease.

The difference between the sick and dying in terms of what responsibilities the patient has, is apparently that the sick patient is expected to want to get well ASAP, so will undergo any type of treatment (even very terrible ones) to do so, whereas the dying patient is no longer expected to get well or seek help/accept therapies.  And apparently, as a physician, one does all they can to help sick people get well, but when you know someone is dying, understand that you can’t do much to help them, so you “withhold your power.”  I don’t know if I can agree with that… I think I subscribe more to what the other physician said in the panel discussion the other day.  He said “Never say ‘There’s nothing we can do.’  There is always something.”

“A physician is the only profession that fails 100% of the time to do what we profess to do” [which is to do the best we can to restore people to full health]

“In the attempt to defeat death, man has been inevitably obliged to defeat life, for the two are inextricably related.  Life moves on to death, and to deny one is to deny the other” – H. Miller, Wisdom of the Heart, in Creative Death, 1960

Principles of medical ethics:
1. Autonomy (of the patient)
2. Beneficience – do good
3. Non-malificence – do no harm
4. Justice
Thought question: what should be the order of importance?

Alternative: 4 Box Model
1. Medical Facts
2. Autonomy (of both patient and physician)
3. Benefits vs. burdens (of the technology, so it is no longer a sticky question about “is the patient worth it?”, but rather “is the technology worth it?”)
4. Contextual/other (family, spiritual, social, economical, etc).

“Even if people agree on the action [ie X is not ethical], they may not agree on why.”  Though I don’t know if you necessarily have to agree on why to be able to go ahead with the decision if both of you “know” something is “right”/”wrong.”

Aging (this professor was pretty awesome)
How do you define old?
1. Chronological – how old you are. (65+ is “old” in the government’s eyes)
2. Functional – how well does your body function?
Aging = “the loss of ability of an organism to adapt to change.”

The idea of pension first came about with Otto von Bismarck, when he was trying to unify Germany.  One of the ways was the idea that if citizens give to the country, and the country gives something back.  Eventually, this idea trickled to America through things like Social Security in 1934 and Medicare in 1965.

Side note: the life expectancy of people in 1900 was 47, and currently it is 78.  This is likely not because people actually died much younger, but because infant mortality was much higher, skewing the numbers.  A much more accurate assessment is seeing the avg. life expectancy of people who live to be over 65 years old. That makes a lot more sense (and the current numbers are 83 for males and 89 for females, in case you’re wondering).

The current problem with medicare is that it is designed for acute care, and is not well equipped to deal with chronic diseases, which is what many people at that age have.  For example, “[medicare] will pay for COPD patients for repeat hospitalizations for respiratory failure, but won’t pay for the air conditioner to keep them out of the hospital in the first place!  Because it is not counted as a medical cost.”

Europeans are more interested in morbidity, rather than mortality, like us.  This is also a reason for the great disparities in cost (we pour at least 2x as many resources into healthcare, with not much significant difference in outcome).  This is because we tend to spend all our resources into preventing one type of disease, and then another becomes prevalent and we spend everything in that.  “Don’t those silly Americans realized that in the end, it all adds up to 100%?”

There is no death education in the American health system.  Look at CPR.  It saves only ~2% of people who are 80 years and older, but 75% of 80 year olds think it would save them in an emergency.  Why? Because of TV, education, etc. (Scary thought – so those Traditional Chinese Medicine doctors telling me about the ineffectiveness of CPR actually did know what they were talking about…)

——————

I had the second part of my basic life support (BLS) training/test today.  Pretty quick and chill.  I really do wonder though, why we still have this kind of training for CPR (and have to pay ~$50 for the certificate every 2 years) when statistics show that the rate of survival after using it is generally <5% (just like we talked about in class.  Yay, application!)  Plus it’s all done online, so you don’t even have the benefit of someone demonstrating the techniques in front of you/getting to practice the technique yourself.

On a completely separate note, during lunch at one of the Subways on campus, we saw the googlemap truck pass by.  That was pretty awesome.  Too bad I couldn’t get my camera out in time.

And finally, some musings of the day:

The next few years are certainly going to be interesting.  All of us are going to be taking the exact same classes every day, for at least the next two years.  I’m willing to bet most of us have never been placed in this kind of learning environment before, and probably never will again.  Potentially a sticky situation in the event of any drama, of course – one (very) senior upperclassman in my program did warn me before we started that it’ll be “just like high school all over again!” – but hopefully nothing too untoward will befall our class.  I think it might be kind of fun actually – at the very least, it should foster the whole “making friends for life” thing.  And it’ll be just like boarding school – or at least, as close to it as I can figure.

To be honest, the last couple of days have been really strange for me.  I’m used to being quiet and alone the first few days at a new school, not really talking to anyone and just listening in class to get a feel of group dynamics and soak in information.  And the general trend is that it takes me about 4-6 weeks to begin opening up to my classmates, to begin voicing my opinions in class and slowly getting to know people.  The last couple days though, I have been quite the opposite.  I am not used to being so outgoing and sociable, actively introducing myself to others and swapping stories or making wisecracks/jokes.  I feel like I’m not really being me.  I don’t know if it’s some kind of defense mechanism for adjusting to such a different environment/group of people, or if my experiences last year have forged me into a different person, or if I subconsciously want to change my image, or what… but it’s kind of weirding me out.

Upon reflection, though probably at least one of the above is true, it is also likely due in large part to the fact that I’ve already been here 6 weeks (the magic number, hah) and slowly gotten to know my MSTP class.  Thus, I’ve already gone through the gradual process of getting to know people this year, and am more confident in meeting more new people because I have people I sort of know around me as a kind of security blanket – people I can hang around and talk with when I am feeling too awkward with my newer acquaintances.  It’s kind of pathetic really, but hey, what else is a dorky, awkward, self-conscious girl supposed to do?

Also wanted to say a few words about different modes of operation (pure listening like a sponge vs. active thinking during a lecture) and their effects on learning, at least for me, but it’s kind of late and my brain is no longer functioning, so will save that for some other day… (if I remember…)

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4 Comments »

  1. Googlemap truck?! Haha. Medical ethics seems like a really interesting class. After all, it’s in the hands of doctors to decide what’s right for patients and being equipped with definitions, morals, and different modes of thinking definitely can’t hurt.

    Comment by foreverastudentoflife — July 30, 2011 @ 4:18 pm | Reply

    • Yeah I know, right?! That was so random haha. Yeah – though sometimes it seems medical ethics should be “common sense” and therefore sadly some people don’t take classes like this seriously, these are questions that we will eventually have to face as doctors, and it’s good to think about these things early in our career so we won’t be forced to make hasty on-the-spot decisions once confronted with a confusing situation in the clinic.

      Btw, thanks for reading! 🙂

      Comment by sanguinemare — July 30, 2011 @ 5:50 pm | Reply

  2. Exactly. And hey, I wouldn’t be reading if your posts weren’t so interesting 🙂 I’m shooting for med school too (maybe a MD/PhD program). I’m taking my MCATs in a month and I just wanted to see where my hard work is going to get me, haha. Then, I found your page. Seems pretty interesting so far!

    Comment by foreverastudentoflife — July 30, 2011 @ 9:12 pm | Reply

    • Haha well, thank you. You give me motivation to continue writing, even when I’m tired 🙂 And I’m glad it’s helpful – that was the original purpose in writing after all.

      Best wishes on your MCAT’s!!

      Comment by sanguinemare — July 31, 2011 @ 11:33 pm | Reply


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