I would absolutely argue we need to get as close as professionally possible to our patients. Yes, it’s extremely trying when things go bad (with or without fault), but nothing inspires me to pick apart a study or consider all treatment alternatives like putting a face (and a life) to a disease process.
I have some patients who are so poor, they pay me in vegetables and muscadine wine. And yet, I find myself as their last bastion of hope when their health is compromised. Those are the cases that remind me of the reason I got into this field.
BT was a pt admitted to the urology service for hematuria. He had Terminal / metastatic prostate cancer diagnosis, and he was a subject in a research protocol. On being called for internal medicine issues, I discovered that he and the family were more interested in qol and comfort and had never been properly instructed on palliative or hospice care options. We discussed the topic at length and to their satisfaction. He decided he wanted to be a DNR and go with comfort measures and be sent home on Hospice. This didn’t please the ones doing research and caused a problem for me, but to this day, I don’t regret it. The pt and family were very relieved and appreciative. We are the pts advocates first.
I had an EJ. He had taken an HIV test and had a CD4 count under 50 but refused ART. I met with him month after month, as he worked at a clinic on my schedule. Every month I tried a new approach but he was insistent. Finally he presented to hospital with cryptococcal meningitis and survived to start ART. As far as I know he is alive and well 15 years later.
Lesson Number Two is the one I would put in front of every new student, and it is also the hardest to teach without it sounding like an invitation to ignore your teachers. What I would add from the other end of the operating table is that being taught something wrong is not always new evidence overturning old evidence. Early in training I gave an anesthetic that was correct by every textbook standard, and the patient still moved. The textbook is written for a population and I was treating one body, and the distance between those two things is where most of the judgment in my job actually lives. The detail about insisting on paying EJ for the painting is the version of that lesson people will remember, because it shows the cost of following good advice past the point where it applied.
after witnessing the covid years , The Fauci diaries I would advice those going into medicine that they have to strive to rise above the structural limitations of the profession , the system of control and hierarchy that is worse than the military , a system that puts profits before people - a sick child is long term income - follow the money - the negative influence of Big Pharma and coopted doctors , agencies that control the hospitals , academia , research etc , respect those doctors who are willing to put their careers on line for the truth . If you rise above this , you may have a chance to follow the advice given in the article
As a new intern, this is a very timely and great read, thank you Dr. Cifu. Would love to see a picture of the drawing if you can post it
Excellent - forwarded to my daughter who started medical school this week!
Amazing. Please wish her all the best from me.
I would absolutely argue we need to get as close as professionally possible to our patients. Yes, it’s extremely trying when things go bad (with or without fault), but nothing inspires me to pick apart a study or consider all treatment alternatives like putting a face (and a life) to a disease process.
I have some patients who are so poor, they pay me in vegetables and muscadine wine. And yet, I find myself as their last bastion of hope when their health is compromised. Those are the cases that remind me of the reason I got into this field.
Another way of saying footnote #6- “What do you call the person who graduates last in the medical school class?” Answer- “Doctor”
BT was a pt admitted to the urology service for hematuria. He had Terminal / metastatic prostate cancer diagnosis, and he was a subject in a research protocol. On being called for internal medicine issues, I discovered that he and the family were more interested in qol and comfort and had never been properly instructed on palliative or hospice care options. We discussed the topic at length and to their satisfaction. He decided he wanted to be a DNR and go with comfort measures and be sent home on Hospice. This didn’t please the ones doing research and caused a problem for me, but to this day, I don’t regret it. The pt and family were very relieved and appreciative. We are the pts advocates first.
I had an EJ. He had taken an HIV test and had a CD4 count under 50 but refused ART. I met with him month after month, as he worked at a clinic on my schedule. Every month I tried a new approach but he was insistent. Finally he presented to hospital with cryptococcal meningitis and survived to start ART. As far as I know he is alive and well 15 years later.
Lesson Number Two is the one I would put in front of every new student, and it is also the hardest to teach without it sounding like an invitation to ignore your teachers. What I would add from the other end of the operating table is that being taught something wrong is not always new evidence overturning old evidence. Early in training I gave an anesthetic that was correct by every textbook standard, and the patient still moved. The textbook is written for a population and I was treating one body, and the distance between those two things is where most of the judgment in my job actually lives. The detail about insisting on paying EJ for the painting is the version of that lesson people will remember, because it shows the cost of following good advice past the point where it applied.
after witnessing the covid years , The Fauci diaries I would advice those going into medicine that they have to strive to rise above the structural limitations of the profession , the system of control and hierarchy that is worse than the military , a system that puts profits before people - a sick child is long term income - follow the money - the negative influence of Big Pharma and coopted doctors , agencies that control the hospitals , academia , research etc , respect those doctors who are willing to put their careers on line for the truth . If you rise above this , you may have a chance to follow the advice given in the article