A recent analysis by John Flynn of Zenit.org presents the disturbing reality of the growing number of children without fathers, on purpose. Children conceived by IVF using "donor sperm" are denied the right to grow up with a father and a mother. As Flynn points out, even more disturbing is the notion currently being entertained by policy-makers that perhaps it is not necessary (or at least highly beneficial) for the physical and mental wellbeing of a human person to be conceived and nurtured by a father as well as a mother.
Flynn makes the point that our sympathy is usually focused on the parent struggling with infertility rather than with the child conceived in the sterile petri dish with donor sperm. Careful consideration of both helps to understand why those who condemn IVF and sperm banks are not unsympathetic to infertile persons, but are prioritizing the wellbeing of the human beings who in the end will be called the "products" of a patented process.
Monday, December 25, 2006
Tuesday, September 26, 2006
One paper at a time
My handwriting is deteriorating rapidly. In fact, it's become almost impossible to read my own writing. I can make exceptions for small things, like prescriptions, that must be semi-legible to avoid them coming back to bite me. But for the rest, notes upon pages of notes, forms upon pages of forms, writing all day long, it doesn't matter. What matters is that there is a scrawl (legible or not) on the line for physician or medical doctor. No one reads any of it, yet piles of papers have to be filled out every day for every patient seen. Is it worth the arthritis I already am starting to feel in my 1st metacarpal joint?
And that's how the days go, saving lives, one paper at a time.
Patient charts grow fast than bacterial colonies in hospital. In a matter of days, a half-inch folder can grow several inches, all to say "Mrs.-M-had-pneumonia-and-it-got-better-and-we-sent-her-home." But think of all the people employed in making those notes and filling those forms. Doctors, nurses, physiotherapists, occupational therapist, social workers, case managers, unit clerks, personal care assistants, etc. They have good job security, they feed their families, all by writing notes.
And patients seem to get better if you just let them be. So I'll just stick to writing notes.
And that's how the days go, saving lives, one paper at a time.
Patient charts grow fast than bacterial colonies in hospital. In a matter of days, a half-inch folder can grow several inches, all to say "Mrs.-M-had-pneumonia-and-it-got-better-and-we-sent-her-home." But think of all the people employed in making those notes and filling those forms. Doctors, nurses, physiotherapists, occupational therapist, social workers, case managers, unit clerks, personal care assistants, etc. They have good job security, they feed their families, all by writing notes.
And patients seem to get better if you just let them be. So I'll just stick to writing notes.
Wednesday, July 26, 2006
The DNR order
My experiences lately on the "medicine wards" have made me think more about the DNR order ("Do Not Resuscitate"). It's beginning to become quite apparent that the medical order for DNR is neither understood nor utilized properly by both patients and family members, as well as by physicians, who ought to be the ones to understand it and explain it. In the next couple of blogs I want to try to explore this issue and get some feedback.
The DNR order (also called DNAR in some hospitals for "Do Not Attempt Resuscitation") is a medical directive for a patient in a hospital or chronic care facility which instructs the care providers NOT to attempt to resuscitate a patient in the event that the patient's heart stops beating or the patient stops breathing.
A resuscitation commonly involves the following:
-CPR (chest compressions and mouth-to-mouth),
-Defibrillation or Pacing (electric shocks to try to get the heart going again), and
-Intubation (putting a tube down the throat and hooking it up to a ventilator to breathe for the patient).
The majority of patients in a hospital do not have a DNR order on their charts, which means that if they "code" (cardiac or respiratory arrest) the doctors and nurses will use the resuscitation protocol to try to "bring them back." Naturally, this is the default for anyone coming into a hospital, at least in North America today, as far as I know. No one is a default DNR because of age or medical condition, as far as I know. That being said, there are certainly some medical conditions in which resuscitation attempts will be futile, and we should consider them at some point. But first,
How does someone get a DNR order?
1. First thing to remember is that the vast majority of patients in normal hospitals (excepting children's hospitals) are elderly people. Most of them are sick with more than one, often four or five, illnesses and on multiple medications. Many of them are "frequent flyers" who come into hospital anytime their heart failure gets out of control or they get a pneumonia. For these patients you can bet they have at best one or two years left to live, but no one can predict that they this admission will be their last. (On that note, studies show quite conclusively that doctors are notoriously bad at judging prognosis for heart disease and the like -cancer is easier. Judgement gets worse the better a doctor knows the patient. And errors are made equally on both sides - patients die a lot faster when we expect them to pull through just fine, and they pull through when we were sure they were breathing their last breaths.)
2. There are some people who openly say - I don't want anything done: if I die, let me die in peace. Few and far between.
3. For most patients, it is the responsibility of the admitting doctor to ascertain with the patient what direction will be taken in the event, even if highly unlikely, that a patient will code. It is the nature of this discussion which determines what "order" the doctor will write on the chart.
The DNR order (also called DNAR in some hospitals for "Do Not Attempt Resuscitation") is a medical directive for a patient in a hospital or chronic care facility which instructs the care providers NOT to attempt to resuscitate a patient in the event that the patient's heart stops beating or the patient stops breathing.
A resuscitation commonly involves the following:
-CPR (chest compressions and mouth-to-mouth),
-Defibrillation or Pacing (electric shocks to try to get the heart going again), and
-Intubation (putting a tube down the throat and hooking it up to a ventilator to breathe for the patient).
The majority of patients in a hospital do not have a DNR order on their charts, which means that if they "code" (cardiac or respiratory arrest) the doctors and nurses will use the resuscitation protocol to try to "bring them back." Naturally, this is the default for anyone coming into a hospital, at least in North America today, as far as I know. No one is a default DNR because of age or medical condition, as far as I know. That being said, there are certainly some medical conditions in which resuscitation attempts will be futile, and we should consider them at some point. But first,
How does someone get a DNR order?
1. First thing to remember is that the vast majority of patients in normal hospitals (excepting children's hospitals) are elderly people. Most of them are sick with more than one, often four or five, illnesses and on multiple medications. Many of them are "frequent flyers" who come into hospital anytime their heart failure gets out of control or they get a pneumonia. For these patients you can bet they have at best one or two years left to live, but no one can predict that they this admission will be their last. (On that note, studies show quite conclusively that doctors are notoriously bad at judging prognosis for heart disease and the like -cancer is easier. Judgement gets worse the better a doctor knows the patient. And errors are made equally on both sides - patients die a lot faster when we expect them to pull through just fine, and they pull through when we were sure they were breathing their last breaths.)
2. There are some people who openly say - I don't want anything done: if I die, let me die in peace. Few and far between.
3. For most patients, it is the responsibility of the admitting doctor to ascertain with the patient what direction will be taken in the event, even if highly unlikely, that a patient will code. It is the nature of this discussion which determines what "order" the doctor will write on the chart.
Friday, July 07, 2006
Dr. Sicut
That about summarizes it. I was introduced as Doctor for the first time this week, and wrote my first prescription.
Going to have to change the name of the blog. And start writing again.
Going to have to change the name of the blog. And start writing again.
Thursday, February 02, 2006
More Thinking Doctors
The world needs thinking doctors. There are very few, I think.
Thinking doctors aren't technicians. They try to see the big picture. They know that, as doctors, they are no more qualified to make ethical conclusions than a software programmer or a fine-dining waiter.
Non-thinking doctors think (?) they are experts in almost any area, especially the ethics of their own profession (end-of-life issues, beginning-of-life issues). In one of my classes in first year medical school, the question was put out there, "should doctors be able to make their own ethical codes?"
Obviously government legislative bodies make laws on the basics dos and don'ts. But physicians are left to establish their own "standard of care" that often goes beyond the law. A case in point is protection of conscience laws and the "duty to refer" for abortion that has become the standard of care in many places.
Read any medical association's Code of Ethics and see what you find - should we be letting doctors, as doctors, impose their majority opinions on the members of their professions?
Thinking doctors aren't technicians. They try to see the big picture. They know that, as doctors, they are no more qualified to make ethical conclusions than a software programmer or a fine-dining waiter.
Non-thinking doctors think (?) they are experts in almost any area, especially the ethics of their own profession (end-of-life issues, beginning-of-life issues). In one of my classes in first year medical school, the question was put out there, "should doctors be able to make their own ethical codes?"
Obviously government legislative bodies make laws on the basics dos and don'ts. But physicians are left to establish their own "standard of care" that often goes beyond the law. A case in point is protection of conscience laws and the "duty to refer" for abortion that has become the standard of care in many places.
Read any medical association's Code of Ethics and see what you find - should we be letting doctors, as doctors, impose their majority opinions on the members of their professions?
HIbernation in the North
I have been enjoying a break from medicine, before the final stretch. This spring I'll be called a doctor, employed as an intern in the hospital. I'll rotate through many of the same specialties again, this time with real responsibility for patients' lives.
Many people look at internship as a kind of slavery - long hours, long nights, almost continually paged for little things by patients, nurses, staff doctors - the one who does all the grunt work, all the miles of paperwork (in my hospital we say, "saving lives, one paper at a time.") Like most things in this "career" of medical education, it shouldn't be as bad as they make it out to be.
In fact, medical education must be a cake walk compared to what it used to be. I am eternally grateful to activist feminists who have made medical school and residency a humane occupation. I won't go into details - it would be too embarassing to recount how many hours medical students used to be instructed in anatomy, for instance, and how many hours were spent in the labs, etc. compared to how much is required now... But I certainly have no complaints.
Many people look at internship as a kind of slavery - long hours, long nights, almost continually paged for little things by patients, nurses, staff doctors - the one who does all the grunt work, all the miles of paperwork (in my hospital we say, "saving lives, one paper at a time.") Like most things in this "career" of medical education, it shouldn't be as bad as they make it out to be.
In fact, medical education must be a cake walk compared to what it used to be. I am eternally grateful to activist feminists who have made medical school and residency a humane occupation. I won't go into details - it would be too embarassing to recount how many hours medical students used to be instructed in anatomy, for instance, and how many hours were spent in the labs, etc. compared to how much is required now... But I certainly have no complaints.
