I have started doing the research for a project I will be doing on reasons that parents give for not vaccinating their children. It is a very good example of medical technology that has to be translated. Who cares how great the technology is, if everyone is afraid to use it?
First I will disclaim that my training teaches me that vaccines are one of the most important public health innovations in modern history… up there with water and sanitation. I am both saddened are angered by vaccine access issues in the developing world, where lack of access to vaccines results in vaccine PREVENTABLE infections that cause sickness and death. I am an avid proponent of vaccines.Other disclaimer: I’m not a doctor I am a fourth year medical student who has read some stuff and seen some people.
That said vaccines are a medical therapy. I would feel like I was committing malpractice if I did not recommend them. They are equivalent to antibiotics, or blood pressure medicine, or clot breaking medicine for someone who has stroke due to a blood clot. The difference is they are prophylactic. Like antibiotics, or blood pressure meds, or clot busters there are benefits and risks to the therapy. Most people do great with antibiotics (minus some diarrhea), but sometimes people have really bad very serious allergic reactions. Are we going to stop using life saving antibiotics because this is a possibility? I would say that if we did that would be criminal, and given the choice most people do their own risk benefit analysis and choose the therapy. In a country where people often choose very dangerous chemotherapy drugs, given very low probabilities of success I am a bit surprised by the reactions of some to the anecdotes about vaccines.
One thing that upsets me about the vaccine conversation is when people refuse them for uninformed reasons. If you weigh the true risks, and true benefits and decide against it, that’s fine with me. The problem is when anecdotes fuel a person’s decision. I understand the fear that a news story, or a friends experience can place in the minds of parents and individuals. But the millions of people who get the flu shot and are fine the next day (minus an achy arm), will never make the news. When making your decision remember that serious side effects are very rare. Some of the factors that lead to serious side effects include, the person’s previous health status, the person’s genetics, and the person’s unknown allergy. No one can tell you for sure that you will not be one of those 1 in a million that have a bad reaction, but the odds are you won’t. The other thing is, not every reaction is due to the vaccine. If a person gets the flu after the vaccine maybe they are one of the people who the vaccine does not cause a sufficient immune response. Vaccines are tested in such a way that they have to result in a protective response in most but not all people that it is tested on. That said some people do not have the right combo of immune genetics to respond to the vaccine. With regard to the flu, the vaccine does not include all of the strains of flu just the mostly likely and/or dangerous. The other thing is sometimes, things were going to happen anyway, and the timing of the vaccine was an unfortunate interlude. Association does not automatically mean causation. Sometimes it does. Sometimes it doesn’t. I think we should be even in our interpretation of these sorts of things.
With regard to H1N1 it is important to know that if you are fine with getting a regular flu shot you should be fine with getting the H1N1 shot. They are made in the exact same way. (see CDC website)
I would like to say that I don’t think health professionals do the greatest job of allaying the fears of those who come to them with anecdotes or other fears about vaccines. Much like other realms of medicine, they often make the decision for the patient saying “you much get this… it is safe don’t worry… see you later…” You are injecting medicine in a healthy patient to prevent a disease. If after given accurate information about the dangers of the disease, and most importantly after understand the real risks vs. benefits, the patient should be able to decide. I think that if we have an outbreak of H1N1 and people are very sick and/or dying around them, then people will run each other over to get the vaccine. We in the US have the luxury of not having witnessed an epidemic from any of the vaccine preventable diseases.
So weigh the pros and cons for yourself. If you are ambivalent about the flu vaccine consider: If you are a health care worker, you will be exposed to flu, if you get the flu, you will expose it to sick people who are more likely to die from it. If you are a hermit that never leaves the house without a gas mask on, your odd or different from our health care worker example. If your kids in day care, her or she will probably be exposed. If your kid never leaves the house, if you can keep sick family members away your kids’ odds of not getting the flu are lower than say the day care kid. If you’re a healthy adult that lives a normal life, you may get the flu. Weigh whether you want to deal with it or not, but odds are you won’t die. If you go home to a older person or child, the odds are you will pass it to them and they could have a long critical sickness or die. There are hundreds of scenarios.
Lastly, if you believe in a government conspiracy to kill the masses by injecting people with deadly diseases through vaccines I have nothing for you. Apologies, but I don’t really have any evidence to support that, especially in light of the large number of people living fine after vaccines. I do know that people die and or suffer serious sickness from some of these vaccine preventable diseases.
Saturday, October 17, 2009
Sunday, August 16, 2009
Really Changing My Life... Part !!
I read a book called Confessions of an Economic Hitman and it really affected me. If you have an hour you can watch a free Democracy Now episode that is an interview with Mr. Perkins. http://uk.video.yahoo.com/watch/2375443/7418940 Basically, the book is about the way that he worked as an international consultant that manipulated lower income countries into taking so much debt that they can't pay back. They have 'professionals' like him intentionally 'forecast' economic possibilities that are overestimates so that people will agree to take the money... thus the inability to repay. The debt then allows the loaning country to have political clout and manipulate the country by pulling back on the debt. The thing that struck me most was when Mr. Perkins said basically, that it's not a conspiracy its a way of life. It is run by corporations who heavily influence government who want access to fuel and markets and resources etc. For example, whenever the government does something in a new country private companies get the money. Halliburton is a prime example in that it profits off of a politically established situation. When people say Iraq is about oil they are right but it is not just about oil its about money in general: see documentary Iraq for Sale. The worst part is that there are other situations that have happened and are happening just like this on a smaller scale where companies are capitalizing from development contracts, smaller wars and insurrections, privatization of things like water and other utilities, and in many cases the countries gain little in comparison to what the 'donating county' gains. So if corporations are behind it all, then we as consumers are behind it all. If governments are behind it all, then we as active or inactive members of our society are behind it. Every dollar we donate to organizations is almost like retribution, blood money to replace our unfair extractions.
But we are the non malicious piece. The system around us may also be non-malicious as everyone just tried to do their job. We want to be able to live our lives as we know it, but the problem is the life as we know it. If the recession and the issues with banks has taught us anything it's that we consume too much, we spend too much money we don't have. We are fueling the corporatocary paying those folks salaries all for lower prices for things that we mostly don't need! We fuel the malicious piece so if we know we should try to take a step back and be conscious shoppers. I don't think that people should completely ditch buying things, I think people should try to think about what they buy. Where does that outfit come from? What are the practices of that company? How much oil was used to bring that thing here. The point is understanding whats behind what we're doing so we can not blidly contribute to companies that are heavily polluting our enviroment , expoiting impoveristed nations, etc.
And if all of this is just too much to think about consider this (thanks Christine): If Chiquita Banana used poor children down the street from you to pick their banana's, would you support/patronize Chiquita? If oil was mined by your house that caused massive destruction of the surrounding environment such that you have changes in your farm lands because of it, AND you lived in poverty due to that destruction of the land you live off of, would you support that oil company? These scenarios play out everyday somewhere in the world. Please try to see the impact of some of these companies and realize that you will be fine without as much stuff and that you can afford to pay 5 dollars (instead of paying 2 dollars at ****mart) for fair trade or locally produced something if you don't buy as much stuff. People have a right to make a living, but I don't believe making a living is simply to be accepted no matter what the cost to people or environment.
I still do a lot of shopping and wasting, but I'm trying to do better. I know that all any person can do when bombarded by very convincing adverts and a culture of buying of disposables, is try his or her best to resist. And Lord willing one day I will be in a place where I feel good about all the money i earn and spend.
But we are the non malicious piece. The system around us may also be non-malicious as everyone just tried to do their job. We want to be able to live our lives as we know it, but the problem is the life as we know it. If the recession and the issues with banks has taught us anything it's that we consume too much, we spend too much money we don't have. We are fueling the corporatocary paying those folks salaries all for lower prices for things that we mostly don't need! We fuel the malicious piece so if we know we should try to take a step back and be conscious shoppers. I don't think that people should completely ditch buying things, I think people should try to think about what they buy. Where does that outfit come from? What are the practices of that company? How much oil was used to bring that thing here. The point is understanding whats behind what we're doing so we can not blidly contribute to companies that are heavily polluting our enviroment , expoiting impoveristed nations, etc.
And if all of this is just too much to think about consider this (thanks Christine): If Chiquita Banana used poor children down the street from you to pick their banana's, would you support/patronize Chiquita? If oil was mined by your house that caused massive destruction of the surrounding environment such that you have changes in your farm lands because of it, AND you lived in poverty due to that destruction of the land you live off of, would you support that oil company? These scenarios play out everyday somewhere in the world. Please try to see the impact of some of these companies and realize that you will be fine without as much stuff and that you can afford to pay 5 dollars (instead of paying 2 dollars at ****mart) for fair trade or locally produced something if you don't buy as much stuff. People have a right to make a living, but I don't believe making a living is simply to be accepted no matter what the cost to people or environment.
I still do a lot of shopping and wasting, but I'm trying to do better. I know that all any person can do when bombarded by very convincing adverts and a culture of buying of disposables, is try his or her best to resist. And Lord willing one day I will be in a place where I feel good about all the money i earn and spend.
year 1 Medical School
I have finished my first year of medical school. It FLEW by and allegedlly it gets easier from here. I don't know about that but I'm happy to be done. Happy because I'm going to Ecuador to do something helpful (instead of just learning how to be helpful one day) and after Ecuador I'm going to Detroit to do a month long program in Urban health disparities. I'm excited about learning the different things that you can't read about when it comes to trying to make the world a more healthy and equitable place.
I feel bad that my life has been run over by medicine. Like can I still have a good conversation about constructionism, or about the way to tell the differnce between chinese and indian buddah statues? Can I still write a poem? I mean its only been a year but still, it's like medical knowledge is pushing everything else out. I can't remember things I never thought I'd forget, even though my brain has already decided that those details are minor. I guess everyone has to sacrafice in order to move to the next level. I can't be everything I want to be right now. Especially when the path I've chosen is a billion pages of infomation that I have to at least try my hardest to know as much as I can. But medicine in itself is intriguing and ther are many edges to it. Not just medicine, but dealing with human beings human emotions human illogic and logic. Learning health care systems and health care politics, learningin health economics and business. Learning how to work with others who are investing thier educations into health like therapists of all sorts and communitiy groups like AA, and education and the ways to translate education into health behavior.
I'm still trying to find my niche. I would like to learn development like how to build communities, but I also want to dabble is some aspects of public health though bioterrorism and preparedness, I could care less about; sorry people are dying in droves from economic terrorism and corruption not so much from anthrax.
Its been fun though. I remember when I was set on being a surgeon for like 5 months. I'm sure that that dream hasn't completly died but I think there is something closer to the roots for me. A little less clear cut but made for the poor people I want to work with. I still don't know how that's going to work considereing the fact that I allegedly have to make money in order to live. It'll all work out, though I probably won't be making real money. I just hope I make enough to vacation. I just hope that there is a person who can be there with me in life. My latest philosophical question is whether or not it's ok to sacrafice a social life for a occupation like medicine where your intentions are the purest. I used to think it was a little questionable that business man/woman X decided their work was more important than raising their kids blah blah. I've always wanted to provide my little seeds (well to have them first) with as much mom time as they needed to be good people. How am I supposed to know that?! Maybe I shouldn't want children... I mean I don't think I'm having any kids anytime in any kind of fathomable future but still. I can always adopt teenagers which is sort of a secret desire of mine. And what kind of man whould I need to be with in order to live the kind of life that I am setting myself up for. Which also throws in a wrench because it's more than a dream now, now it's steps its a matter of taking them and I will probably get to point B.
One year down means its really real. I'm gonna be a doctor! (God Willing)
I feel bad that my life has been run over by medicine. Like can I still have a good conversation about constructionism, or about the way to tell the differnce between chinese and indian buddah statues? Can I still write a poem? I mean its only been a year but still, it's like medical knowledge is pushing everything else out. I can't remember things I never thought I'd forget, even though my brain has already decided that those details are minor. I guess everyone has to sacrafice in order to move to the next level. I can't be everything I want to be right now. Especially when the path I've chosen is a billion pages of infomation that I have to at least try my hardest to know as much as I can. But medicine in itself is intriguing and ther are many edges to it. Not just medicine, but dealing with human beings human emotions human illogic and logic. Learning health care systems and health care politics, learningin health economics and business. Learning how to work with others who are investing thier educations into health like therapists of all sorts and communitiy groups like AA, and education and the ways to translate education into health behavior.
I'm still trying to find my niche. I would like to learn development like how to build communities, but I also want to dabble is some aspects of public health though bioterrorism and preparedness, I could care less about; sorry people are dying in droves from economic terrorism and corruption not so much from anthrax.
Its been fun though. I remember when I was set on being a surgeon for like 5 months. I'm sure that that dream hasn't completly died but I think there is something closer to the roots for me. A little less clear cut but made for the poor people I want to work with. I still don't know how that's going to work considereing the fact that I allegedly have to make money in order to live. It'll all work out, though I probably won't be making real money. I just hope I make enough to vacation. I just hope that there is a person who can be there with me in life. My latest philosophical question is whether or not it's ok to sacrafice a social life for a occupation like medicine where your intentions are the purest. I used to think it was a little questionable that business man/woman X decided their work was more important than raising their kids blah blah. I've always wanted to provide my little seeds (well to have them first) with as much mom time as they needed to be good people. How am I supposed to know that?! Maybe I shouldn't want children... I mean I don't think I'm having any kids anytime in any kind of fathomable future but still. I can always adopt teenagers which is sort of a secret desire of mine. And what kind of man whould I need to be with in order to live the kind of life that I am setting myself up for. Which also throws in a wrench because it's more than a dream now, now it's steps its a matter of taking them and I will probably get to point B.
One year down means its really real. I'm gonna be a doctor! (God Willing)
What direction to go?
I see where i want to be and i know now i can get there. I think there was a time when I wanted to be like Paul Farmer traveling all over doing all these things to build health systems in so many ways. But I don't want to be Paul Farmer. I want to be Merrian. I want to live and work in Africa. Be a doctor, teach at a medical school, help advocate for public health infrastructure improvements. Be a person that goes and lives because I care. I'm just one person but I can be one more person that goes in instead of going out. I have the privilege of having a blue passport. I have the privilege of knowing English. I have the privilege to have access to dollars, or pounds, or Euros. Because of that I can do anything anywhere. I have the privilege of being on that path to becoming a doctor! One day I will be wanted in all health systems in the world. I don't have to worry about not being ok, financially. I will always be ok. And with that my dream is to live and work in Africa. Using my privileges and advantages and blessings and hard work to be that doctor in Africa.
I am inspired by women like Dr. Nkosazana Dlamini-Zuma, who were physicians, who were brave in the face of injustice, who fought and struggled and made it through all the training, who have families, listen to their children, take stock in the future of the country. I look at women like her and smile knowing that she has paved a way for me to be a women, that doctor, in Africa.
I am inspired by women like Dr. Nkosazana Dlamini-Zuma, who were physicians, who were brave in the face of injustice, who fought and struggled and made it through all the training, who have families, listen to their children, take stock in the future of the country. I look at women like her and smile knowing that she has paved a way for me to be a women, that doctor, in Africa.
Global Health? The numbers
Lesotho has 89 doctors for 2 million people. If they divided up the country each doc would have 22,471 patients.
Ethiopia has only 2,000 doctors for 75 million people. If they divided up the country each doc would have to have 37 500 patients.
There are 800,000 doctors in the USA(not counting chiropractors or dentists or clinical psychologists) for a population of 300 million. Each doc needs something like 375 patients.
When I graduate with my other nationwide-colleagues there will be 17,000 graduates making their way into America's doctor pool.
If Lesotho had 90 instead of 89, each doctor would need 200 fewer patients (22,471).Even though it doesn't work this way, it's still pretty interesting.
Ethiopia has only 2,000 doctors for 75 million people. If they divided up the country each doc would have to have 37 500 patients.
There are 800,000 doctors in the USA(not counting chiropractors or dentists or clinical psychologists) for a population of 300 million. Each doc needs something like 375 patients.
When I graduate with my other nationwide-colleagues there will be 17,000 graduates making their way into America's doctor pool.
If Lesotho had 90 instead of 89, each doctor would need 200 fewer patients (22,471).Even though it doesn't work this way, it's still pretty interesting.
Being a Third Year Medical Student
I love medicine. It fits right in there with God, love. family, and friends as something that is so good for me and to me that I can't describe it. Maybe it's not medicine, but being brought in to peoples lives over and over again. The way they just open up and share and trust, and the way you can do something even if its just trying to help... even when it doesn't turn out so well.
But being a third year student sucks sometimes. You fumble around trying to figure things out and when you finally do the rotation is over. There are people 'pimping' you as we so affectionately call it, all the time and if they aren't you feel like they should be. Why should they be, cause these people are giving you a grade and you need them to know that you know something, so if they don't pimp you you're on your own trying to balance the fine line between being an a--hole and actually asking intelligent questions and making intelligent comments. The hardest thing is the hurt of knowing that some people are going to die.. or worse... not get better despite the fact that they will probably be alive for a long long time. It's seeing what people can do to each other.. gun shot wounds, blunt trauma assaults, physical and sexual abuse... All of that and realizing that you don't know that much and need to fit in reading and studying on your own... and learning how to cope with all that stuff... on your own. Because although this is medicine and these circumstances will always be a part of medicine, as a third year student its all new, sometimes overwhelming, and most times uncomfortable.
The good thing is I'm learning a lot and learning what it truly means to balance my time. when its all up to me. I'm learning how to relate to people without being thoroughly overwhelmed by their circumstances (learning how...) and even though I'm totally lost 50% of the time, patients still let me in. The best thing I'm learning and becoming one with is the fact that I will probably make 100 mistakes or more... probably more like 365 mistakes in this year.. and probably be embarassed by at least a third of them.. and that its ok because the next day (or even a few minutes later), patients will still let me be a part of this thing that I love.
I was given this pamphlet entitled: Love is the remedy God is the healer. And whatever faith you have or don't have there is something about that concept that really describes medicine. You do your best everyday to throw these IV bags, tablets, scalpels of love at peoples bodies hoping that 'the healing factor' will do it's part. Some old or young people get pneumonia and die, some don't. If you take malpractice and population bias out of it, there is something magical about that. And perhaps this thought is what helps me get through the heartbreak of knowing Ms. IQ is not getting better, or that PM has major depression (horrible childhood) at age 12. And perhaps its the love that gets MB through her third year, and God that makes her a strong doctor.
All praise to the healer.
Changing my Lifestyle Part I
I just watch this movie called in debt we trust available online free:
http://video.google.com/videoplay?docid=-9016886482738598023 .
It illustrated the ways that credit cards and generally living beyond our means, have become a necessity in so many people's lives. Most people are not paying these debts back and part of the the current state of the economy is related to the revolving door aspects of credit cards and other similar types of debt. You spend money you don't have, you can't pay it back, people spend money trying to make you pay it back, you still can't so you borrow more, eventually you can't pay for necessities because you get sick, or have an accident or loose your job, you then get more credit and at this point you actually NEED it to survive. But you still can't pay it back, and so the bank takes your stuff that is not worth the money they loaned you and no one is going to buy it for the price they want for it because it's used anyway... and so banks get into trouble because they have loaned all this money that they are not getting back. We're broke, the banks get broker and we're all pointing fingers and waiting to be saved.
Yes, it is partially these bank's faults. They do prey on all members of society. They lead us to believe its just money, that borrowing is just the way things are. They give us money that we can't afford to pay back and then charge us extra when we miss the payments. But this bank industry spends millions lobbying congress to decrease regulations. It has only gotten easier for banks to give more high interest pay day loans etc.. If there is an activist group fighting for the rights of the consumer give them a thanks or join the squad. But really, what we can do to fight to power is to not fall for the excessively materialistic mentality that the banks are literally selling to us.
I looked at myself. I realized that I am a cheap person but I still overspend. I don't overspend on things that I need either. I go on trips that I can't afford to go on, I buy scarves, and books, and music that I really don't need. I buy gifts for people who can live without those things. Now, medical school loans notwithstanding, I have this credit card that I just whip out when i run out of funds. And with me it is just a matter of budgeting. I can live off of my loan money if I sacrifice a luxury or 5. Everyone always says, 'but you have to have a life'... who told you that, mastercard? Cause it is saturday night and i just watched a movie I got from the library for free. I talked to friends I haven't spoken to in a while. I cooked some food from scratch (cheaper). I mean I'm clearly more boring than the average 25 year old but there is cheap stuff to do even if you do like to go out. Do you need as many clothes as you have?? NEED nope. I see at least 5 things in my house that I could probably sell on craigs list right now... my tv that is collecting dust, a bag of clothes, this dvd player, numerous purse/backpacks, this printer that doesn't work with my computer but is still fully functional.... (if you want any of these items holler at me..)
So yes, I am doomed to at least 10 years of debt because of medical school. But I do not have to live excessively because Visa makes the world look so awesome. Sure I may have to reevaluate when I apply for residency... but I'm sure I can be practical about my spending there too. So friends don't be offended if I say no 90% of the time you invite me to do something that involves spending money. I'm not just broke right now. I'm broke all the time, and will be broke living off of sallie mae until I get income. You're welcome to come over to my house and watch documentaries with me, or I'll bring them to you. I'll even make dinner.
http://video.google.com/vi
It illustrated the ways that credit cards and generally living beyond our means, have become a necessity in so many people's lives. Most people are not paying these debts back and part of the the current state of the economy is related to the revolving door aspects of credit cards and other similar types of debt. You spend money you don't have, you can't pay it back, people spend money trying to make you pay it back, you still can't so you borrow more, eventually you can't pay for necessities because you get sick, or have an accident or loose your job, you then get more credit and at this point you actually NEED it to survive. But you still can't pay it back, and so the bank takes your stuff that is not worth the money they loaned you and no one is going to buy it for the price they want for it because it's used anyway... and so banks get into trouble because they have loaned all this money that they are not getting back. We're broke, the banks get broker and we're all pointing fingers and waiting to be saved.
Yes, it is partially these bank's faults. They do prey on all members of society. They lead us to believe its just money, that borrowing is just the way things are. They give us money that we can't afford to pay back and then charge us extra when we miss the payments. But this bank industry spends millions lobbying congress to decrease regulations. It has only gotten easier for banks to give more high interest pay day loans etc.. If there is an activist group fighting for the rights of the consumer give them a thanks or join the squad. But really, what we can do to fight to power is to not fall for the excessively materialistic mentality that the banks are literally selling to us.
I looked at myself. I realized that I am a cheap person but I still overspend. I don't overspend on things that I need either. I go on trips that I can't afford to go on, I buy scarves, and books, and music that I really don't need. I buy gifts for people who can live without those things. Now, medical school loans notwithstanding, I have this credit card that I just whip out when i run out of funds. And with me it is just a matter of budgeting. I can live off of my loan money if I sacrifice a luxury or 5. Everyone always says, 'but you have to have a life'... who told you that, mastercard? Cause it is saturday night and i just watched a movie I got from the library for free. I talked to friends I haven't spoken to in a while. I cooked some food from scratch (cheaper). I mean I'm clearly more boring than the average 25 year old but there is cheap stuff to do even if you do like to go out. Do you need as many clothes as you have?? NEED nope. I see at least 5 things in my house that I could probably sell on craigs list right now... my tv that is collecting dust, a bag of clothes, this dvd player, numerous purse/backpacks, this printer that doesn't work with my computer but is still fully functional.... (if you want any of these items holler at me..)
So yes, I am doomed to at least 10 years of debt because of medical school. But I do not have to live excessively because Visa makes the world look so awesome. Sure I may have to reevaluate when I apply for residency... but I'm sure I can be practical about my spending there too. So friends don't be offended if I say no 90% of the time you invite me to do something that involves spending money. I'm not just broke right now. I'm broke all the time, and will be broke living off of sallie mae until I get income. You're welcome to come over to my house and watch documentaries with me, or I'll bring them to you. I'll even make dinner.
A Patient in Pain
So I need to vent this really quickly.
Today we saw a patient that is in the middle of a sickle cell crisis. She is having pain throughout her body, deep bone pain. She is normally on a decently high dose of pain medications and the pain is so bad that her normal pain medications aren't working. See where this is going?
Well, after listening to resident physicians and nurses talk about her being a 'frequent flyer', 'annoying', and saying don't give her anything more than her normal pain meds because she is 'drug seeking'... I listened as they planned to give her a very low dose of PRN hyrdomorphone (2 mg q 4) and stop all of her home meds including (!!!) her 90mg of oxycontin. Which ... fine if you are going to try to control pain with another narcotic convert it! 90 of Oxycontin is 8mg q 4-6 of hydromorphone. I'm a medical student I can figure that out with a simple table! 2mg of hydromorphone is not going to TOUCH this ladies pain without a baseline on top of it. I was sooo frustrated. So I asked... If you stop this ladies Oxycontin isn't she going to withdraw? The answer I got... uhhhh I don't really deal with pain medications... What?!?!? You have patients on 12-18 different medications and you consider them a welcomed challenge and you're telling me you don't deal with a whole class of meds? You don't understand simple equivalence conversions? You admit patients and you don't understand narcotic dependency and withdrawal? You don't understand that a person on a high dose of Oxycontin has tolerance to narcotics and HAS to take more for breakthrough pain? So unfortunately they left her on that BS dose of hydromorphone and she was probably never not it pain. I did ask them to at least consult people who aren't afraid of narcotics and they said they would if that lady still has pain tomorrow.
They then said.. Oh we've had this lady before she's going to be asking for more and more pain medications she will be such a headache watch. YOURE DAMN RIGHT SHES GOING TO BE ASKING FOR MORE... HELLLLLO. Now she will exhibit drug seeking behavior because everyone runs from proper treatment with narcotics.
Then, I almost went off on one of my seniors but then remembered my role. He said... Yeah, I've dealt with a fair number of 'sicklers' and they are really irritating to deal with. I almost got sick to my stomach. The attending said well they do have miserable lives (thank goodness she said that), and I quickly chimed, Can you imagine living a life where you get frequent attacks of intractable deep bone pain some that never goes away and also being susceptible to all types of infections and everything else and every time you go to the hospital you get a new set of doctors afraid to treat you. He didn't say anything else.
This situation really upset me. After doing pain managemnt I've seen a fair number of obviously criminal tendancies, but most people that end up there have not been therapeutically treated and thus are made to buy meds on the street or look desperate in the pain mgmt clinic because NO doctor has made them feel relief or explained to them that some pain is expected. If our patient is addicted then she deserves treatment for that too. She probably been on narcotics since childhood and she's almost 30 now. She. can't sell medications she gets in the hospital. Its hard for someone on 90mg of q 12 oxycontin to get snowed by a little bit of hydromorphone and that can EASILY be monitored since all of her medications are being given by a nurse who has to look at her.
This was crazy injustice to me and I felt so helpless. I do feel much more motivated to be really good at all major medication classes within my practice INCLUDING narcotics.
Today we saw a patient that is in the middle of a sickle cell crisis. She is having pain throughout her body, deep bone pain. She is normally on a decently high dose of pain medications and the pain is so bad that her normal pain medications aren't working. See where this is going?
Well, after listening to resident physicians and nurses talk about her being a 'frequent flyer', 'annoying', and saying don't give her anything more than her normal pain meds because she is 'drug seeking'... I listened as they planned to give her a very low dose of PRN hyrdomorphone (2 mg q 4) and stop all of her home meds including (!!!) her 90mg of oxycontin. Which ... fine if you are going to try to control pain with another narcotic convert it! 90 of Oxycontin is 8mg q 4-6 of hydromorphone. I'm a medical student I can figure that out with a simple table! 2mg of hydromorphone is not going to TOUCH this ladies pain without a baseline on top of it. I was sooo frustrated. So I asked... If you stop this ladies Oxycontin isn't she going to withdraw? The answer I got... uhhhh I don't really deal with pain medications... What?!?!? You have patients on 12-18 different medications and you consider them a welcomed challenge and you're telling me you don't deal with a whole class of meds? You don't understand simple equivalence conversions? You admit patients and you don't understand narcotic dependency and withdrawal? You don't understand that a person on a high dose of Oxycontin has tolerance to narcotics and HAS to take more for breakthrough pain? So unfortunately they left her on that BS dose of hydromorphone and she was probably never not it pain. I did ask them to at least consult people who aren't afraid of narcotics and they said they would if that lady still has pain tomorrow.
They then said.. Oh we've had this lady before she's going to be asking for more and more pain medications she will be such a headache watch. YOURE DAMN RIGHT SHES GOING TO BE ASKING FOR MORE... HELLLLLO. Now she will exhibit drug seeking behavior because everyone runs from proper treatment with narcotics.
Then, I almost went off on one of my seniors but then remembered my role. He said... Yeah, I've dealt with a fair number of 'sicklers' and they are really irritating to deal with. I almost got sick to my stomach. The attending said well they do have miserable lives (thank goodness she said that), and I quickly chimed, Can you imagine living a life where you get frequent attacks of intractable deep bone pain some that never goes away and also being susceptible to all types of infections and everything else and every time you go to the hospital you get a new set of doctors afraid to treat you. He didn't say anything else.
This situation really upset me. After doing pain managemnt I've seen a fair number of obviously criminal tendancies, but most people that end up there have not been therapeutically treated and thus are made to buy meds on the street or look desperate in the pain mgmt clinic because NO doctor has made them feel relief or explained to them that some pain is expected. If our patient is addicted then she deserves treatment for that too. She probably been on narcotics since childhood and she's almost 30 now. She. can't sell medications she gets in the hospital. Its hard for someone on 90mg of q 12 oxycontin to get snowed by a little bit of hydromorphone and that can EASILY be monitored since all of her medications are being given by a nurse who has to look at her.
This was crazy injustice to me and I felt so helpless. I do feel much more motivated to be really good at all major medication classes within my practice INCLUDING narcotics.
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