Friday, November 5, 2010

Topics In Medicine

Man there is a lot that I want to talk about, from topics from class, to filling out my applications, (which feels more and more like I'm playing to my audience in a vaguely guilty fashion) to medical ethics.  I'm not 100% sure if I'm going to get to all of them, really (I want to finish complement, talk about heart physiology, do a quick and dirty overview of eicosanoids, and whine about filling out rather tiresome applications) but I'm going to try and get to the more time-sensitive ones first, like the ones that affect my grades and my application deadlines.

White Coat Underground is a wonderful blog about topics in science-based medicine and medical ethics. I particularly enjoy his posts on the latter, because I think that in our litigation-happy culture, we need to think about these things. We also don't want to repeat mistakes of the past.

I worked in veterinary clinics for years. I saw a lot of disease and suffering and death. When one is exposed to such things on a regular basis, you have to figure out how to justify it somehow. How do you get through a day when you have to euthanize parvo puppies because the owner can't afford the treatment? It is difficult and can be heartbreaking.

Euthanasia isn't part of the medical dialogue (yet) like it is with veterinary medicine. In emergency cases people just work the best way they can, as fast as they can. A patient's life must be saved. Period.

In situations where the person is sick and lingering, the decision must be made about how to spend those last few months. Doctors approach the situation from the perspective that every bit of extra time is worth it in order to allow the patient to spend it with loved ones, doing the things they enjoy, and the illness is managed rather than treated.

I think that it is very important to have and maintain an open dialogue with your patients. Telling someone that they are going to die soon cannot be easy, but it is important to make certain that the patient understands all of the options, even at the risk of overwhelming them with information. They need literature to take home, something to discuss with their loved ones, and your phone number. Tell them that you can talk to them and make sure that their questions are answered. This is the only way that they can make an informed decision.

The ability of patients to have that kind of informed decision-making, to be able to enjoy those last few months with their families and friends, is, in my opinion, what makes it a little easier. All doctors have to be around and see suffering on a daily basis. Death isn't easy for anyone, but it is comforting to know that the patient knew the options and was able to go for the one that best suited them. That situation is impossible without informed consent.

And PalMD did an excellent job of framing the question. Go have a look-see.

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