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dark side of medicine
8:51 pm
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medicine has always been about life and death. as people look at me, a medical student, sometimes they ask me how do i cope with seeing life and death so often. they are so emotionally affected by stories of how some cancer patients are on terminal care etc. i will give them a blank confused look, and tell them that i don't actually see dying patients everyday.

come to think about it, it's more like I tend to ignore the fact i see dying patients everyday sometimes.
for me, (it'll sound horribly unempathetic and unkind) I'll be so focus on the task at hand-
take a history
draw bloods
do this examination
examine this joint
examine the nerves

and because these task are no simple task and because i lack the clinical competence to do it on the fly, a million and one things will run through my brain
(example: taking a history. i tend to speak in monologue to myself. it'll be things like "remember to ask about her cough she just mentioned. remember to ask if it was productive. and if was bloody. oya, don't forget about appetite, sleep and weight. wait, she just mentioned chest pains. make sure to write that down. ask about radiation. make sure to do a systemic review. this patient seems complicated. she said morphine helps the pain. what dose was it?? check her drug chart later. remember family history sook cheng. i keep forgetting that. wait, what did she say?"
imagine this all condense into a 30 second banter in my brain.
a typical history would take about 5-10 minutes.
no wonder they say doctors don't listen. i have to admit i don't listen sometimes because i'm so busy thinking about the next question to ask! otherwise i'll get the dreaded awkward silence while i try and sift through the information and ask about the next relevant question)

with all these, (examinations are far worse) we really do lose sight of the patient as a person.
times where i feel really sad is when patient's own expectation doesn't match up with reality. worse if the patient's family has greater expectations than the patient or the doctor.
i met a patient who had COPD, and i was just meant to sit him through the whole clinic. his wife and him were really chatty and i found out he came to the clinic to have a "flight test" as he wanted to visit his relatives in Spain (flight test- patients with poor lung function have to do this to make sure they can cope with reduced oxygen pressure in the aeroplane). he was really keen on going to Spain and told me he has been trying to get more exercise done on his stationary bike to improve his lung function (since he had to stop a few months back due to "winter flu").
in the doctor's office, the doctor told him to keep up the good work and continue exercising. when it came to the flight test, the doctor just became really vague about it and told him it might not be a good idea to think about flying now since he just recovered from an infection.
when the patient left and i said my goodbyes, the doctor signalled me to come into the office. we discussed a bit about COPD then he asked me what I thought about my patient. I didn't really know what to say but I knew his COPD was pretty bad since he was on oxygen and was pretty breathless just chatting. The doctor told, "to be honest, he probably has months to live since his O2 sats are dropping and he is becoming cachetic (aka super thin... like cancer patients)"

i left the clinic feeling a bit empty and sad as i don't believe he or his wife knows this.

is ignorance bliss?