Are Modern Patients to Blame? (Friday Link)

Doctor D has made his triumphal return from his vacation and is back to working himself to death and blogging.

Today is Friday which means D delivers some exciting links for your weekend reading. Doctor D has an interesting radio piece for you:

National Public Radio did a piece about how educated patients who read about medical care on the internet are costing too much. Doctor D is so relieved! He had been told all along it was doctors who are bankrupting the country. Turns out it's you patients, who all have "medical student syndrome" and think you have every disease you read about. You even made that nice overworked doctor in Virginia cry!

It actually is an interesting use of 8 minutes:

So medical pages like this one are ruining the healthcare system! Too much information and you start demanding tests and treatments you don't need.

Doctor D's theory is that doctor blogs might actually be helpful with this problem. Instead of just giving info on diseases and treatments, medblogs actually give the perspective of healthcare providers. Hopefully patients who read heathcare provider blogs learn not just about diseases and treatments but the mindset of physicians, which includes understanding why over-testing and over-treating is not a wise choice.

Doctor Blogs could save the healthcare system billions! Hopefully the AskAnMD will get a generous government grant to underwrite Doctor D's important work!

So what do you think? Does being an educated, web-savvy patient make you cost the system more? Do you think reading Medblogs make your healthcare cost more or less?

How To Speak Doctor

Question from a reader:

My heart sinks when I realize the vast difference between a detailed medical appreciation of my disease and the incredibly simplified version my doctors tell me. Do doctors feel like they are speaking baby talk to patients? Do patients ever really understand our illnesses, tests, and treatments?

First of all, any doctor who implies they have a full understanding of your body is bullshitting you! Some specialists may know a little more about a particular organ or disease, but in the end your body is a mystery and doctors are all just making educated guesses. Doctors know some useful things, but things we don't understand far outnumber the things we do.

Patients are nervous about doctors working with limited knowledge, so MDs learn to sound more knowledgeable than we really are. One of the easiest ways to sound really knowledgeable is to use a lot of technical jargon. We can really impress non-medical people by throwing out some dense multi-syllabic pseudo-Latin with a lot of acronyms mixed in. It just sounds so darn smart!

Doctors are also used to talking with each other in medical jargon and sometimes forget that patients have no idea what the heck these words mean. It's not that "MI" or "Raynaud's phenomenon" are too difficult to for you comprehend; it's just that they sound really complicated if you don't speak Physician.

If a doctor says something that makes no sense the best strategy is to frankly ask, "What does that mean?" When it comes to understanding your prognosis or making a decision it is important that you understand what is being discussed.

A wise teacher once told Doctor D, "If you think you understand something, but you can't explain it in a simple way you probably don't really understand it." This is true for medical knowledge. Your doctor should be able to explain these things in plain English when you ask for it.

Listening to a simple explanation in plain words it may become obvious that your physician doesn't fully understand everything either. Don't panic! We don't have to understand everything about a body or a disease to treat it well. We may not be good talkers, but we are great guessers!

Have you ever had a doctor that just couldn't speak simple English to explain your condition? Doctor D would love to hear your stories in the comments.

The Instinct To Link (Friday Links)

Since he is on vacation this week, Doctor D hasn't been keeping up with the world of Medblogging, but he does have some links for you:

You can still get your Doctor D fix because he did a Psyche Consult, so you can read his guest-posts over at the Reality of Anxiety Blog!

The first post Stress and The Survival Instinct explains the nature of stress instincts, and the second post on Anxiety Management explains how to take control of the stress instinct.

"For your hunter-gather ancestors violence and danger may have been around every corner, but you do your hunting and gathering at the local grocery with laws in place and police nearby to stop most violence. So why are the safest human beings in history always so stressed?"

Readers of this blog know D loves discussing how instincts that worked well in in the past cause a lot of poof health today from obesity to avoiding exercise. Doctor D hopes that understanding our instincts will lead to healthier living.

What do you think? Do you live better when you understand your body better? Or does understanding that certain instincts like stress instinct and eating instincts are hard wired make them harder to resist?

Doctor D will be returning home late next week after his stress-free vacation and he'll be posting some answers to your questions again soon after.

Doctor D's Disappearing Act

Just to let you know, I am out of town on vacation and I probably won't be answering posting any answers to reader questions for the next week. Doctor D still loves you, but he is really enjoying his family and his rest right now.

But you can still email Doctor D because he loves getting questions from readers and he'll be back to answering questions a soon as he returns. If you want to get the word about Doctor D's return when it happens you can sign on to the Ask An MD Feed or you can follow Doctor D on Twitter. (I will probably Twitter daily even when on vacation.)

I'll still be able to give you some Friday Links tomorrow.

Nurses VS. Residents

Question from a reader:

What is the relationship supposed to be between nurses and residents in a large teaching hospital? During a lengthy stay for a surgery, I noticed a tension between these two groups, especially between junior residents and highly experienced nurses. Perhaps it is inevitable?

It wasn't that long ago that Doctor D was a resident in a teaching hospital and he can still recollect old days of being a young doc fresh out of med school and working beside experienced nurses...

The rules of medicine say that the doctor should call the shots, but this can be problematic when a new doc with no experience is giving orders to nurses who have been taking care of patients for years. There will always be some tension. It's like a captain just out of military academy taking command of a group of battle-hardened veterans. The captain may have an officer's rank and a head full of military theory, but the foot soldiers are the only ones who know what it's like to get shot at.

Ideally, this tension will make the team better. The young doctor learns a lot from working with experienced nurses, and the fresh ideas from the newly-educated residents improves the care the nurses give.

Unfortunately people who should be working together sometimes go to fighting amongst themselves. When inflated egos of new doctors or experienced nurses cause trouble and it is patients who can get hurt. Any doctor who doesn't listen to experienced nurses is headed for disaster, and any nurses who abuse new doctors are harming both patient care and medical education. Once the battle gets going, however, it is hard for either side to back down.

The best strategy is to start out on friendly terms and work to stay there. When Doctor D started residency the first advice his attending gave him was, "Be good to the nurses and you'll do well."

Mutual respect and open-communication works best for everyone, including patients. I can tell you it is hard to be nice when an older nurse is giving you shit just for being young. I'm sure nurses can attest that it's equally difficult to refrain from kicking the ass of a cocky resident with a big god-complex and zero inexperience. I have found, however, that if I bite my tongue and act respectful the obnoxious behavior of insecure nurses and doctors usually subsides to a tolerable level.

If you are a patient in a hospital where the tension between residents and nurses has broken into open warfare this is a bad sign. I would advise you appeal to a higher power to intervene, such as an attending physician or head of nursing. Don't take sides--trust me you don't want a part of that battle. Just tell them that you as a patient are worried by the animosity. Usually the responsible authorities can sort out who needs to have "come to Jesus" talk so that both sides can calm down and start playing nice together.

Have you ever witnessed (or been a part of) an interesting Nurse VS. Resident conflict? How was it resolved? I would love to hear your stories in the comments.

The Curse of Doctor D (Friday Dead Links)

Be afraid! Doctor D is the kiss of death for really great medical blogs!

Just when Doctor D says to himself, "This is my favorite blog on the whole frickin' internet!" the blog suddenly disappears. Not just stops updating, but disappears completely into password protected oblivion!

First came Crass Pollination by Nurse K. Doctor D laughed so hard reading those wild tales from Nurse K's ER! It closed just a few weeks after Doctor D found it. Coincidence?

Then just this week Doctor D was reading Journey to MD and said to himself, "I really enjoy Ella's witty commentary and stories from medical school. I think this is my favorite medblog of all!" And suddenly it's gone... without even a "Hiatus" post!

This is some dangerous stuff! I am desperately trying not to love Dr. Grumpy lest I inadvertently destroy his blog as well. But in case I don't succeed, you should read the post about drunk doctors, the story of Mr. Jackass, and the time Happy Hospitalist got schooled by Grumpy right now!

Doctor D's new found blog-killing power really should be harnessed and used for good! Feel free to let Doctor D know in your comments which medblogs should be spared and which should be destroyed.

Ella and Nurse K if you are out there, please come back! I promise not to annihilate your blogs again.

*UPDATE: So just a few hours after I posted this Ella's Blog reappeared! WTF? Was she just messing with Doctor D to see if he missed her? Welcome back Ella! Now we just need to figure out how to do the same for Nurse K!

Putting Down Pets And People

I read a very poignant post by Neo-Conduit this morning about her terminally-ill friend who considered suicide. I was reminded of a question I have often been asked by patients:

We put down our dying pets humanely. Why can't we be so good to people in the same situation?

It is a good question that needs an answer. Doctor D used to just say, "Doctors shouldn't kill patients," but that really didn't respond to the suffering of people facing terminal illness.

I am glad that euthanasia is illegal where I work. Doctors have the ability to keep a dying person comfortable without putting them down like dogs. Human beings are not dogs. Doctor D was good to his elderly dog when he euthanized her, but there is a huge difference between killing a pet and a person.

The most important approach to suffering people is a deep respect for their value as human beings. That respect motivates me to care for their pain. It motivates me stop treatments when they no longer desire them. It also motives me to never give a deadly medicine—even if it is requested.

The approach of death can be disorienting and terrifying. There is a spiritual suffering that is often greater than any physical pain. In moments of hopelessness ending one's own life may seem like the only escape. A person asks him or herself, "What is the value of this dying thing that is me?"

Doctor D has had many patients nearing the end of life say to him, "I wish I could die now!" I have yet to have a single one be disappointed when I respond, "It is ethically wrong for me to end your life, but I will stay with you till the last breath and make sure you are comfortable and respected."

Suffering and dying people need to know they have some value that is more than the sum of days they have left. The deepest respect of all is reminding them they have the most valuable thing of all: a human soul.

Quality of Life is a subjective judgment. I honor my patients by letting them decide what is a quality life and what is not. Value of a Life is different. The value of every person's life is infinite. I honor that value by never killing a human being for any reason.

I already know Nurse K is going to give me a hard time for such a touchy-feely post. Doctor D promises to get back to some fun shit soon.

...But before we get back to fun questions what do you think of Euthanasia?