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Doctor, Please Explain…

Recently I have been thinking about communication.

In my short career so far, I have realized that there is often a huge chasm between what we (physicians) think we have explained and what patients understand.

As a general rule, I try to take the time needed to talk to patients and answer all their questions. Sometimes I think I do an adequate job. And patients have voice appreciation for it before. I have been thanked for actually taking the time to explain my thought process and my plan. But I’m sure there are other times when I my question-answering leaves something to be desired.

Unfortunately, time is a luxury. Sometimes things get rushed. Sometimes there are patients who need more attention because of their condition so we spend a shorter amount of time talking to the more stable patient.

I’ve also had nurses tell me that they care for patients who ask them all sorts of questions about their medical care but when the physician comes in to see them, the patient either forgets or chooses not to pose the question to the physician. Sometimes they get overwhelmed. Sometimes they are intimidated. Nurses tell me that sometimes after the doctor leaves the room, the patients will ask their questions to the nurses.
Most of my work caring for patients involves residents/interns and medical students. I try to emphasize the need for clear and accurate information each time I work with a new group. Nevertheless, miscommunication happens. We aren’t perfect. We operate in a flawed and broken system that expects perfection and efficiency from medical providers.

If you’re reading this post, I’d love to hear about your experience as a patient. Are there still things that confuse you about that experience? Are there things that you wish your doctor had taken more time to explain? Are their topics or diseases that they sped through while talking to you? Do you wish they’d have slowed down and spoken in plain English? I want to know what the confusing topics are! I want to know where we, as a profession, fall short!

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On Teaching

The following is something I wrote in 2009 while still a medical student:

Teaching is a hard thing. By teaching I don’t mean explaining or instructing. Take, for example, teaching basketball to someone. Telling someone the rules of the game is not, to me, teaching them how to play basketball. Explaining what the rules mean and how and when they apply is not teaching either. Teaching involves more. It is showing someone how to dribble the ball, demonstrating the correct form, and then helping the student develop these skills. Teaching is not merely conveying knowledge. It is imparting excellence — or, at the very least, competence in a particular area or field.

Teaching involves lifting a student up with compliments while simultaneously providing criticism that is at the same time constructive, painful, and humbling. Delivering these two — compliment and criticism — can be tricky. How does one find the right balance? It’s unfortunate that there is no formula. Each person is different. The combination of compliment and criticism that motivates and inspires one student could very well devastate and discourage another. Maybe the truly amazing teachers are able to read their students and expertly walk that fine line.

In the absence of truly amazing teachers, or truly amazing teachers with plenty of time to spend with us, a student must resort to other means of attaining competence. One alternative is learning from multiple teachers. Good teachers have different methods, techniques, and personalities. Each one can provide a different, yet helpful angle.

As this academic year inches closer and closer to an end, my mind seems to frequently wander to the future. One of the things I think about is my position as one of the chief residents next year. I hope that I will able to be a good teacher. I may even be willing to settle for an “ok” teacher too.

Maybe I am getting ahead of myself. Maybe I should just concentrate on learing as much as I can as a resident.

Teaching, I feel, is such a great responsibility. Especially when you are training people to take care of patients. The good thing is that I won’t bear this responsibility on my own. I will merely be a cog in a larger wheel; I will only be one part in a larger system. There will be plenty of seasoned attendings who will gladly teach the residents, and I am sure myself as well.

Teaching, I hope, is something that one can learn. And I hope that through the next year I will be able to develop my own teaching style. I’m sure I won’t be able to develop in a year — it’ll take time. But I do hope I am able to make a significant evolutionary leap in my development as an educator and teacher.

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The Event — It’s Time to Clean This House

Let’s ignore the details — for a moment — of what has happened in the city of Ferguson from the day Michael Brown was shot until the decision of the grand jury not to indict Darren Wilson was announced. Let’s compress it into a singular event.

Essentially, that event seems to have thrown open this nation’s closet door. It’s the closet into which we have thrown all our racially charged skeletons for the sake of appearing tidy, clean, and welcoming to guests who may come to visit — or the nosy neighbors who might peer through open windows. It’s a closet that has been stuffed full and whose contents burst out as soon as that door cracked open. But the Event didn’t crack the closet door open; it violently flung it open and exposed our darkest secrets to a watching international audience.

Whether or not you believe that the Event was motivated by racial undertones or not, it has pulled back the covers to reveal a deep pain, anger, and mistrust that was conveniently pushed aside or ignored for a very long time.

It’s time for this House to have an honest, deep, rip-the-carpet-out, fix-the-bannister, get-rid-of-all-the-termites type of spring cleaning. Or else watch as this House crumbles from the inside.

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Emails

I do my best to answer all emails I receive. Admittedly, sometimes there may be a few that slip through the cracks.

As I do have a smartphone, the emails come right to my pocket. But sometimes I read them when I have a moment of downtime while standing in a hospital. I can’t tap out a reply at that very moment. So I put it away with every intention of replying when I get the chance.

However, sometimes things get busy. You get other emails that push the email down the pile. And when things finally settle down I simply forget.

And I apologize for that.

If you have emailed me through the Contact Me page and have not received a reply, please do re-send it.

I will continue to do my best to respond as soon as I can.

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Breast Cancer Awareness Month

It’s been a while since I have posted here. It’s been stressful lately with application going out, asking for letters of recommendation, waiting for word from programs.

I’ll be happy when it’s over.

In the meantime, here’s a video I found and am sharing in honor of breast cancer awareness month — because early detection saves lives.

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The Almost-Kamikaze American Pilots

I can’t believe it’s been 10 years since the Twin Towers fell. In these last few days there have been numerous articles about that day and of memorials being held in NYC. For the most part I have stayed away from them. While I do think it is important for us to remember what happened, I think I just wanted to avoid it this week.

But one article caught my attention and I couldn’t help but click on it. It told of the two pilots who were ordered to intercept Flight 93. Back in 2001, there were no fighter jets that were armed and ready to take off to intercept planes. It was a different time.

When the order came to intercept Flight 93, the two pilots, Lt. Heather Penney and Col. Marc Sasseville, could not wait for their planes to be armed. They took off with only 105 lead-nosed bullets and the knowledge that those bullets wouldn’t do the job.

From the article:

“It was decided that Sass and I would take off first, even though we knew we would end up having to take off before our aircraft were armed,” Penney, among the first generation of American female fighter pilots, said to C-SPAN.

Penney said each jet had 105 lead-nosed bullets on board, but little more.

“As we were putting on our flight gear … Sass looked at me and said, ‘I’ll ram the cockpit.’ And I had made the decision that I would take the tail off the aircraft,” Penney recalled.

Both pilots thought about whether they would have enough time to eject before impact.

“I was hoping to do both at the same time,” Sasseville told the Washington Post. “It probably wasn’t going to work, but that’s what I was hoping.”

Penney, a rookie fight pilot, worried about missing her target.

“You only got one chance. You don’t want to eject and then miss. You’ve got to be able to stick with it the whole way,” she said.

The pilots chose their impact spots in order to minimize the debris field on the ground. A plane with no nose and no tail would likely fall straight out of the sky, its forward momentum halted, Penney said.

I read the article and was just amazed and reminded about what our men and women in uniform are willing to do for us each day.

Source: MSNBC.com

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LLU School of Medicine Student Blogs

Apparently Loma Linda University School of Medicine has started a group blog for students from LLU. This is the first I’ve heard of it. And it looks fairly new.

I’m guessing they asked/invited these students to write for them.

You can check the group blog at: http://llusm.wordpress.com/.

So if you’re at all interested in Loma Linda University School of Medicine, you can definitely find more student perspectives there.