Category: Personal Account of Medical Worker or Student or Patient

[Please note: The word “Featured” on the left side above was NOT inserted by this blogger, but apparently was inserted by WordPress, and it cannot be removed. NO post in this blog is sponsored.]

The Book of the Week is “Gynecologist Reflections” by Robert A. Siegel, published in 2017. As is well known, until about the 1970’s, an American medical doctor was a trusted family friend, a generalist. The author started medical school at the dawn of that decade, and ultimately chose obstetrics and gynecology as his specialty. In this poorly edited volume, the author detailed his memorable patient-cases inside America’s changing medical industry amid changing cultural and economic times.

During his training, the author was required to perform abortions; if he didn’t, he’d be fired. Another medical institution wouldn’t accept him and he wouldn’t become a physician. He acknowledged the very emotionally charged, controversial nature of the procedure, and controversial nature of not only when life begins, but when it ends.

The author’s generation of medical interns was still male-dominated. According to the book (which appeared to be credible although it lacked a detailed list of Notes, Sources, References, Bibliography and an index), most of the interns were brainwashed into thinking that working around the clock, saving lives on eight hours of sleep a week, was a macho thing to do. Of course, in the next few decades, American medicine became an increasingly litigious line of work and its trainees rebelled against the abusive hierarchy.

After about a decade, the author was able to make a living as a solo practitioner treating private patients. But his dedication to his work (which often involved emergencies) still left him severely sleep-deprived and very stressed. He admitted to coming quite close to making a medical mistake that would have resulted in a patient’s kidney failure. Fortunately, his assistant asked him a simple question about the task at hand.

In another instance, the doctor bragged about saving the lives of a woman and her later prematurely-delivered baby who were in a serious car accident. He got all the kudos, but explained that the surgical team, the technology and the hospital were just as responsible for the positive outcome.

The doctor also recounted a legal case of an acquaintance of his (who was also a doctor). The acquaintance gave verbal instructions, which the mother of the patient (a young child who apparently died through no fault of the doctor’s) failed to follow. He wrote, “You should have seen this lady. She was reeking of alcohol but we weren’t allowed to say that in court…” The initial jury-award unexpectedly, outrageously exceeded his malpractice insurance coverage.

Read the book to learn about: hemorrhages, caesarean sections, hysterectomies, OB-GYN screening tools, etc., plus the sociological aspects of the doctor’s practice, and biographical info on him– including how he almost died at a young age (hint: he led an unhealthy lifestyle to say the least– “Two days before my double by-pass was scheduled, I signed myself out [of the hospital] against medical advice.” Exhibiting arrogance and a feeling of invincibility, no doubt.).

The First Bonus Book of the Week is “Morphine, Ice Cream and Tears. (sic) Tales of a City Hospital” by Joseph Sacco, M.D., published in 1989.

The cynical author did his medical internship and residency in New York City in the early 1980’s. He discussed emotional, financial and ethical issues that doctors-in-training encountered in his generation, illustrating his points with real-life cases.

Healthcare workers, not just medical doctors, must of course not only physically, but emotionally contend with the unpleasant sights and smells of a patient’s body fluids. Such fluids frequently end up on their person, unless they choose a specialty that is not so messy. The author remarked that, therefore, a huge number of medical-school students in their third year realize that they would feel most comfortable specializing in radiology. That partly accounts for why nuclear medicine has become so wildly popular in recent decades.

One medical-industry financial issue that has remained largely the same for the last forty years, has been the profit motive. Thus, emergency rooms are still overstaffed with specialists who overtreat patients to maximize profits for themselves and/or their employers, while drug-addicted patients are also selfish: “This patient was too stupid for conscious manipulation but had succeeded to (sic) engage the attention of doctors, nurses, the EMS, the police, his family, and probably a number of others, as well as to spend a good six figures of public money in his care.”

Healthcare is fraught with ethical issues. One is the completion of the death certificate. The author, as an intern, was tasked with such lowly paperwork. He got scolded for improperly filling in the correct words or phrases (there was a list of them) that constituted “acceptable” causes of death. Overworked and sleep-deprived, most interns sought peace more than accuracy, so the primary or secondary cause of death became “cardiopulmonary arrest” repeatedly. This systemic quirk probably put a wrench in death statistics in the United States. Perhaps it has even been manipulated for political purposes. Enough said about that.

During his residency, the author treated female teenage patients for minor ailments. Because he saw so many who were pregnant, of his own volition, he took the opportunity to counsel them about birth control. He felt that the pill was their best option. He “… sent her off with two free packets and a prescription for several months more. Most incredibly, some patients even decided to use them .”

Read the book to learn of the author’s trials and tribulations, and of other ways times have changed for aspiring medical doctors in America.

The second Bonus Book of the Week is “Chasing My Cure, A Doctor’s Race to Turn Hope into Action, A Memoir” by David Fajgenbaum, published in 2019.

The author’s ordeal began in 2010, when he was halfway through medical school. He suffered from a mysterious illness for weeks, with multiple-organ failure, and misguided, incorrect diagnoses of lymphoma, or an infectious or rheumatologic disease. It turned out he had a rare disease whose origins were auto-immune or cancerous.

Later on, through his own actions, he determined the correct categorization. He connected the dots on many fronts, mentioning two traits peculiar to him: when he was a student, his consumption of energy drinks was excessive, and he had inherited a tendency to have an excessive number of blood vessels in various body parts, compared to other people. The former environmental factor, and the latter genetic factor, when they came together, could have played a role in his responding poorly to treatment, and his having to be bombarded with an extremely powerful chemotherapy cocktail approximately every one to two years.

The above are the kinds of factors scientists take into account when attempting to explain why certain patients do better than others with different treatment options. When patients who have a fatal disease are out of options, they aren’t usually as lucky, insightful and resource-rich as Fajgenbaum was. But even he had to overcome numerous obstacles and nearly died on several occasions.

When he initially tried to do research on his fatal ailment, the author was frustrated by scant, old, inaccurate knowledge on it and scattered sources. He likened the medical community’s situation to that of law enforcement prior to 9/11: “..no one talked to one another, no prime database existed, there was no expectation of coordination or data sharing.” Competition for federal funding meant that resources dedicated to all different kinds of medical research varied widely– a matter of money and politics. Even so, this wasn’t due to malicious intent, but merely honest ineptitude– one would hope. Nevertheless, there was a lot of wasted talent, and a lot of misallocated resources (not to mention, unnecessary deaths!).

The above provided an argument for why the author decided to earn an MBA (he had already completed a medical master’s degree) right after graduating medical school, instead of beginning his residency. Acquiring money-oriented, management and leadership knowledge and experience would be more important than practicing medicine. It would allow him to create a medical-research group that he hoped would find a cure for his disease before he died.

Read the book to learn: how the author broke tradition in thinking about the cause of his illness; how that led to his helping to pioneer a medical-treatment trend that will endure in the future; how his actions have led to sooner diagnoses and saved lives (hint– he marshaled resources to consolidate knowledge, and his team found that “… it’s much more efficient to go directly to patients for [blood] samples, just like we do for patient data in the registry study.”); and to learn about other aspects of healthcare in the United States.

ENDNOTE: The above state of affairs provides yet another argument in favor of a national healthcare system for the United States. Free-market economics is fine for business, but healthcare is super-complicated because it also involves matters of life and death. For more information, see the posts: “full circle” (sic)–eleventh paragraph from the top, and “Here at the New Yorker“– fourth paragraph from the bottom, onward. The best healthcare delivery requires the right balance between cooperation and competition among specific parties. This is why training for both war and healthcare delivery utilizes divestiture socialization. Healthcare delivery works best when there is cooperation within a team and among teams, and disease is the enemy. A capitalistic approach to healthcare necessitates an unhealthy level of competition, as Fajgenbaum learned.