sanguinemare

October 8, 2015

Antibacterial Soap is not Better than Regular Soap… and learning from death

So, fun fact of the day: according to our MSTP seminar speaker tonight, apparently the FDA agrees that “antibacterial” soap is not any more effective at preventing disease transmission than regular soap, assuming both are used to wash hands properly!  Did not know that.  And to back that up, here’s an article straight off the FDA site that speaks about that, from 2013.

He also described a painful experience he had had as a clinician, where he did a procedure on a patient, and that patient ended up dying, even though he had done everything technically right.  This, in itself, was one of his lessons – that you can be technically right, but mess up intellectually.  Because, as it turns out, after that, they did a retrospective study, and apparently that patient was at high risk for bleeding out after that procedure, as they’d had a bone marrow transplant before that.  That wasn’t known at the time, but it cost that patient their life.  There are two lessons I learned from this:

The first, which is rather scary and sobering, is that as a doctor, we’re all going to make mistakes at some point.  Mistakes that may even cost people their lives.  And some of them, like the case here, won’t really be our “fault”, in the sense that it wasn’t anything that could be prevented at the time due to lack of knowledge, but in hindsight, for whatever reason – new research coming out, a new technique our clinic/hospital was not aware of, etc… we’ll realize that our decision at that point in time was what directly or indirectly, caused harm to the patient.  To be quite honest, that scares me quite a lot.  I don’t know if I can handle that. I think that would tear me apart from the inside.  And yet… if no one makes those decisions… even more people may come to harm.  It’s a tough job.  I guess time will tell.  I just pray that over the course of my career, I will be fortunate enough not to do anything so bad that it costs a life or cripples someone the rest of their time on earth.

The 2nd is that even in one’s darkest moments/worst mistakes, something good can come of it.  In this case, research that probably has saved at least a few lives since.  He recognized that maybe there was something about this patient that made them susceptible to the procedure, even though he did nothing wrong, and they went back and looked at records and realized this predisposition, and published a paper on it.  So now, anyone encountering this type of patient before this procedure will know that it is a high risk thing to do in these people, so they may be much more cautious about ordering that test to be done.  So even when making mistakes, analyzing it and building off of it may lead to research that helps others in the future.  And I guess that’s how we have to look at it, in order to keep moving forward, lest we crumble from the guilt and sadness of those we were unable to help.

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June 4, 2012

Food for thought

Throughout my classes in med school, no matter what organ system we are covering, we are always given statistics and risk factors for diseases.  Included in those lists are invariably obesity, diabetes, and smoking.  A few professors even explicitly say that the top two things people could do to present illness and disease is to quit smoking and lose weight.  Given that, do you think it’s ok for doctors to refuse non-emergency treatment for patients who don’t stop smoking or lose weight?  Well, according to this article, 54% of doctors in the UK apparently do.

Personally, I have to say I agree with them.  Maybe it’s my Asian upbringing, which teaches holistic lifestyle practices, but I do believe that a doctor should not be expected to be a miracle worker.  If a patient refuses to cooperate with their own health, a doctor should not be obligated to treat that person when it may do them no/much less benefit, and also uses up resources that someone else might have benefitted a lot more from.

It’s like the issue of compliance – whether patients follow what doctors tell them or not (things like taking medications on time, getting refills on time, coming to scheduled appointments and follow-ups, etc).  Doctors often decide on treatment regimes based not only on the medical condition, but on patient compliance.    Which makes sense.  You don’t want to send someone home with medications if you know they might forget to take it at the right times, for example, especially if it’s critical that they take it to prevent something bad from happening.  Instead, you might want to keep them in the hospital for a few days and have them on an IV drip to ensure the medication will be given at the right times and dosage.

So  why isn’t the same true for patients who don’t agree to take initiative in their own health and well-being?  Of course, it can be argued that people of lower education may not grasp the severity of the situation, which may be true, although it can also be argued that part of a physician’s job is to be an educator in healthcare.

Along those lines, perhaps part of what doctors need to learn is how to communicate effectively and connect with patients so that they will listen to their medical advice.  This article gave a few good tips on how to get people to listen to you better, which I thought could be useful both in and out of the clinic.

I guess that’s enough rambling for now.  Thoughts?

April 8, 2012

Happy Easter! More interesting reads

Happy Easter everyone!

To celebrate, here are more interesting articles that have been sitting in my browser tabs for ages:

1. The 8-hour Sleep Myth

Ah sleep.  We all need more of it.  This article however, has an interesting take on exactly how we should get our daily dose of sleep, arguing that we were meant to actually have 2 sleep periods rather than a single one through the entire night.  Not sure how convinced I am about the article, but it is interesting to think about, especially in light of the new Hunger Games series, which brings the question of survival to the forefront.  (I still wish that people who talk about how novel an idea the Hunger Games are knew about Battle Royale, the Japanese movie that had a very similar premise, but came out almost a decade earlier, in 2001.  I have yet to see it, but hope to soon.  And I think even before that movie, it was a short story.  Anyways, moving on).

2. Speaking of sleeping and beds, women (who like having intercourse without procreative consequences) around the world, rejoice!  Male Birth Control

So, I don’t know how true this is, but apparently, a form of male birth control has been found through clinical trials in India that is “100% effective,” and reversible!  Don’t believe me?  Read the article for yourself.  Basically in requires injection of the vas deferens (the tube the sperm go down to come out of) with a polymer gel that breaks apart sperm, and if you want to reverse it, you just inject something else (I guess to break down the gel), and you can make babies again in 2-3 months.  Supposedly these trials have been going on for 25 years, and it has been shown to be safe.  I do wonder whether there’s any data on the children that are born after the reversing of the gel… It’s certainly an intriguing concept though.

On another note, I wonder if people would get up in arms about this from an ethical/religious standpoint.  Because unlike female contraception, which can be seen as abortion (such as the morning after pill) if one believes life begins at conception, male contraception would prevent the conception in the first place.  However, it could perhaps be argued that this would destroy potential life, which is what procreation was meant for in the first place.  Or maybe people won’t care at all.  We shall see I guess.

3. Clothing and perception: the White Coat

And now, for a psych experiment!  It seems that when people (undergraduates in this case) are given a white coat to wear, it will help them have heightened awareness and attention… but only if they are told it is a doctor’s coat, as vs. a painter’s coat (even though it is the same coat).

I do agree with the ending paragraph though.  I think that the effect does wear off over time, although some remnant is still there, especially for symbolic clothing – like a military/police uniform… and I guess the white coat, too (but it depends on the situation).  White coats in labs no longer mean much to an actual scientist, because in most labs, (sadly for safety officers and possibly the scientists’ own personal health), people don’t actually wear the coats most of the time.  But for the medical doctor, it may mean more, because you wear it right before seeing patients.  At least for us, at my school, the only time we are required to wear our white coats is if we’re going to see patients, so for us med students, I guess it’s symbolic.  But even I, as a first year, am starting to treat it as just another (somewhat bothersome) article of clothing I need to put on. So maybe the social phenomena in this study is something that happens only for people who perceive the symbolism of something that is not of their own profession/religion/culture/etc.

Random thought(s):  I wonder why the URL link says r=2 on it, even though the article is one page long.  Wonder what r=1 is?  *checks*  Oh… same article. lawls.  I also enjoyed the correction at the end because I actually was wondering at the ambiguity of the sentence talking about the hot drinks, thinking it didn’t really make sense for people to rate people with hot drinks in their hands as personally warmer, but it would make sense perhaps for people who held hot drinks to think others were personally warmer.  Yeah, yeah, I know, I’m a dork.

4.  And now, fatty/fried food lovers rejoice!

For a study in Spain now shows that fried foods do not in fact increase your risk for heart disease and  death!  Of course, this is a GREAT example of why you should never read articles at face value and should instead always read them in context, because, as you can even see in the limitations and conclusions of the study, “Our results are directly applicable only to Mediterranean countries with frying methods similar to those in Spain. Firstly, oil (mainly olive and sunflower) rather than solid fat is used for frying in Spain…Secondly, consumption of fried foods in Spain is not a proxy for fast food intake. Fast foods are generally prepared by deep frying with oils used several times, and are consumed mostly away from home…Moreover, we can assume that oil is not reused many times for foods consumed at home; however, the cardiovascular effects of food fried with overly reused oils merit further research,” amongst other things.

And on a more somber note: Doctors Cheated on Exams

This one is an interesting read that I’ve had as a tab since almost the beginning of the school year since I never got around to reading it (until now).  It talks about cheating in the Board certification exam for radiology – basically how for years, radiology residents would memorize certain questions on the exam, and get together with other radiology residents to compile a list (called the “recall”) and send it to the next year’s residents.  That of course, is blatantly cheating – in med school, we all have to sign an Honor Code before each test stating we will not cheat or engage in that kind of behavior… in fact, one student got kicked out this year for violating the Honor Code.  And yet, this is happening all the way at the residents’ level?  Quite surreal.

Of course, you have to wonder a bit at the guy (Webb) who complained about this practice to superiors and started this big investigation because he was trying to take the high moral road… but 1. he failed the first round (would he have brought it up if he had done well/passed?) and 2. his unprofessionalism, which resulted in his firing – “He was reprimanded last year for making “sexual comments” to another doctor and for “other conduct unbecoming an officer.” That led to his firing from the radiology program.”  That doesn’t seem to moral to me.

My personal thoughts are to wonder whether there are any test prep materials like Princeton Review or Kaplan for these kinds of tests like there are for so many other things (SAT’s to GRE’s to MCAT’s, to USMLE Step 1 test books).  If not, though I don’t condone the practice of copying the test questions and answer choices directly, I can see why the recalls could be helpful as a resource in terms of practicing test-style questions and seeing what areas one needs to study more (just like any other test prep book).  However, if there ARE test prep materials, then I wonder why residents don’t use those instead.

It is interesting to note that this issue only seems to pertain to the radiology specialty in partiular. “Dr. Kevin Weiss, president and CEO of the American Board of Medical Specialties, said he had not heard about anything similar to the radiology testing issue in other medical specialties. The ABMS is the umbrella group for 24 boards and 152 specialties and sub-specialties.”

And with that, I now conclude the second round of interesting medical reads on zee internetz.

Happy Easter everyone! 🙂

December 5, 2011

Interesting reads

Haven’t had much time to update lately, but here are some (semi-) medically relevant links that I’ve read fairly recently that I thought were interesting.

1.  Apparently, some people are working on growing meat from cells (called “invitro meat”) through bioreactors.  It’s an interesting concept, and would eliminate the need to kill animals for food.  I wonder if vegans are vegetarians who are currently on their respective diets because they are against cruelty to/killing of animals would be fine eating this kind of meat.  At any rate, it is much better than the Japanese poop burger solution to this problem (and this one is actually real, at least as far as I can tell :P)

2.   We’re currently studying microbiology in med school for these next couple of weeks, so this article on an antiviral therapy fits right up our alley.  As a general rule, there are lots of treatments for bacterial infections through antibiotics, but there aren’t very many that target viruses effectively, and those that do only target a specific virus, or have many bad side effects.  However, these scientists seem to have created something called a “Double-stranded RNA (dsRNA) Activated Caspase Oligomerizer” (DRACO), which basically only targets cells with viral dsRNA and causes them to undergo apoptosis (programmed cell death).  They’ve shown that it’s effective in 15 different viruses and that it does not harm normal, uninfected cells.  Pretty exciting.  I would like to see them apply this to more chronic, life-threatening viruses as well in the future though, such as HIV, hepatitis A-C, etc.  But it’s definitely a hopeful start.

3. Teaching Good Sex – This article was about a high school sex ed teacher that came up with innovative activities and ideas for his students, encouraging discussion and challenging his students to think deeper about the questions at stake.  While I’m not advocating for premartial sex by any means, I think the style of teaching is a great one – to give students a place where they feel comfortable asking hard questions and examine their own feelings, insecurities, and plain curiosities, in a safe environment.  Much better to be frank about it rather than to hide things under a corner and hope things don’t happen.  And I like how the class is a balance – it’s neither the idea of “abstinence is the only way,” nor is it the resigned attitude of “let’s talk about/pass out condoms so you guys can do it safely, since you’ll be doing it anyway.” Rather, it is a medium through which better understanding can be made.  Honestly, I think once questions and concepts are demystified and can be seen more analytically (and appreciated for its wonder), people are much more likely to make informed decisions, and less likely to do things out of (presumed) peer pressure or curiosity.  That’s my opinion on almost anything by the way, not just this topic.

4. Finally, here is a more somber article (but a great read!) one of my classmates posted on our class Facebook page (don’t get intimidated by the length of the sidebar – most of it is due to comments).  It’s an interesting commentary on how when doctors have to make life or death choices for themselves, they often choose the route with the least medical interference and go peacefully.  This is because they “know enough about modern medicine to know its limits…They want to be sure, when the time comes, that no heroic measures will happen—that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).”  The rest of the article also addresses this discrepancy between what patients think they want, versus what is reasonable and what the doctors would advise.  There is so much hidden pressure and confusion in the system we currently have ingrained in us that contribute to the tragedies in medical care happening all the time.  We are so caught up in the idea of prolonging life, doing “everything possible” to save someone, but how do we know it would not cause undue and prolonged suffering instead?  Because of this mentality, most people don’t even realize there’s another choice.  The author mentions how “[A]mazingly, studies have found that people placed in hospice care often live longer than people with the same disease who are seeking active cures.”  Death that is pain free and with dignity.  How lovely.  I am a first year medical student, and already, if I am ever confronted with a terminal condition, I am leaning towards the choice of letting go (medically) and enjoying my last days in peace.

Happy reading!

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