Slept in today. I've been tired recently. Took a nap 3 of the last 3 days. And I never take naps. Think I needed a little relaxation.
Still on my string of night.... 2 more to go. Miss the wife and the friends so I'll be glad to be back on a more normal schedule soon.
Sometimes being a doctor is more about salesmanship than scientific knowledge. About half the people I see in the ED aren't really sick. Granted, some if them are super sick and need critical care. But there is a large percentage that I have to convince that they aren't sick. That seems different in Utah. I don't remember that many false-sickers in South Carolina. Seems like everyone in SC ignored their health for so long that by the time they got ill enough to go to the ED- they were on death's door. I think a lot of it is cultural. Utah is full of super healthy, active young people. these people are more in-tune with their bodies and get nervous when something seems wrong. I'm probably one of them. The hard part is when I walk in to room, talk to them for 3 minutes.... and instantly know they're not sick. Granted sometimes I'm wrong, and that why we do tests and look.
In any case, a large part of my job ends up as the "selling of health." Talking people into believing that we can't figure out whats wrong, we believe they don't feel well, but it will probably get better.
Expectations in health care in this country are out of control. People expect doctors to know everything and be able to figure out the most insignificant of complaints. I don't blame them. They, err their insurance, is paying us a lot. But the expectations along with a legal enviroment where risk is not tolerated cause people to get too many tests. The most recent literature puts the risk of cancer death due to radiation recieved from a whole body CT (often performed after severe trauma) at 1/200 over 20 years. I.E. you get in a bad car wreck and are taken to the hospital where a whole body CT is performed- bam, you now have a 1/200 risk of dying from cancer in the next 20 years from that CT scan.
Medicine is all about weighing risk. As our diagnostic tools become better we run the risk of over-calling disease..... leading to interventions that can have adverse outcomes. For example- if you have a 1/100 risk of having some disease that has a 10% adverse outcome rate, does it make sense to perform a test with a 2/00 risk of a false positive and a subsequent intervention with a 20% complication rate. No. That would increase your risk of harm for the sole purpose of coming to a diagnosis. But Americans don't like not knowing.
I guess I've blabbered on for a while now. Thats some of my thoughts regarding the difficulty of my job.
3 comments:
I saw a show on spiders once and they interviewed an Australian that had been bitten on the arm. She didn't go to the doctor for several days until the wound evolved into a 3" wide hole in her now semi necrotic arm. This resulted in amputation. Maybe SC is more like Australia than we previously thought?
I like your comments about the CT scan risk. There has been lots of discussion regarding this topic on NPR recently. I was shocked to learn that the amount of radiation used is un-standardized. This sub standardization leads to wide variance in cancer risk (don't remember the rates, but the high side was scary!).
-that statement is supposed to provide a transition to the following question:
Do you know anything about the cancer risk associated with full-body airport scans? This seems to have gone unaddressed and it's something that definitely bothers me.
"All of the concerns that we have about the medical use of X-rays really don't apply to these devices," Thrall said in a telephone interview.
"The exposure is extremely low and the energy of the X-rays is also very, very low," he said.
"When X-rays are used for medical imaging purposes, they have to be energetic enough to get through the human body. The X-rays used in the backscatter machines in airports have such low energy that they literally bounce off the skin. That is what backscatter implies," Thrall said.
- Dr. James Thrall of the American College of Radiology and chief of radiology at Massachusetts General Hospital in Boston.
The false positive rate is one of the more counterintuitive things you learn about in security calculations as well.
I think I read about it first over here: http://www.schneier.com/blog/archives/2006/03/data_mining_for.html
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