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(04/23/13 8:13am)
Doctors save lives. One needs to look no further than the recent tragedy in Boston to see that. First responders cleaned wounds and stopped the bleeding, ER docs prepared patients for surgery and teams of surgeons, anesthesiologists and nurses worked tirelessly in operating rooms around the city to repair as much damage as they could. Three victims of the bombing died within seconds, but of the more than 170 patients who came pouring into Boston hospitals with bombing-related injuries, not one patient died. Boston’s hospitals were ready. They did an admirable job.
(04/16/13 8:20am)
Two weeks ago, I had the opportunity to attend a cardiothoracic workshop hosted at the Duke School of Medicine. Along with a host of other undergraduates, I crowded around the sterile examination table and listened attentively as medical students and a resident in cardiothoracic surgery explained the basics of the cardiopulmonary physical exam. First, look at the patient. Do you see any abnormalities at first glance? Is she breathing normally? Next, check her vital signs—temperature, blood pressure, heart rate, respiratory rate. I watched as the resident swiftly moved his stethoscope across different points on the student’s chest, seamlessly checking to see if all portions of her heart sounded normal, and then her back, listening to the rhythmic flow of air through her lungs. The entire exam took about three minutes.
(04/09/13 4:33am)
I could never understand how, immediately following Election Day, politicos were eager to speculate about the 2016 presidential race. All this talk of Hillary and Rubio was overwhelming—couldn’t we take some time to appreciate the conclusion of campaign season, a competitive period that had dominated our thoughts and passions for months? Then, we lost to Louisville, and I found myself counting down the days until Jabari Parker and Rodney Hood inaugurate Durham as the real “Dunk City” next season.
(04/02/13 6:56am)
The United States spent $2.6 trillion on healthcare in 2010—an amount larger than each of the GDPs of Brazil, India, Russia and the United Kingdom. More than half of that spending went toward covering hospital (31 percent) and physician (20 percent) services, and a non-trivial amount went toward paying for prescription drugs (10 percent) and nursing home (5 percent) costs. As I am sure you have heard, all of those costs will continue to go up over the next decade.
(03/26/13 9:49am)
It is a cool, midsummer’s night, and a middle-aged woman sits at a DATA bus stop clutching an empty pill bottle. She surreptitiously pockets it as the ambulance turns the corner, and begins to clutch at her chest with the fake pain of the prescription drug addict seeking her next hit.
(03/19/13 8:22am)
In medicine, there is a perennial conflict between the physician’s overarching goal of preserving the personal well-being of his or her patients, and the patient’s right to make independent decisions. Just a few decades ago, it was standard policy that physicians did not obtain the informed consent of their patients. This paternalistic policy stemmed largely from the belief that physicians, with their years of training and expertise, knew what was “best” for the patient. In the 1990s, these views began to change when people began to realize that sometimes the physician may not know which option is best for a patient. Moreover, even if he or she is confident in the outcome, the patient may not necessarily choose this option. In some cases, patients may refuse certain procedures out of principle (e.g., Jehovah’s Witnesses refusing blood transfusions); in other cases, patients may decide that they don’t want to live anymore and refuse life-sustaining treatments. In his article “What Makes Someone’s Life Go Best?” Derek Parfit suggests that the best decisions (i.e., medical decisions) must allow the person to fulfill goals and values to the extent that the person is capable at the time and that this decision must outweigh the benefits of other alternatives. In terms of patient well-being, I think happiness can be defined as the fulfillment that individuals experience from achieving their life goals and values, and personal good as the degree to which they succeed in this endeavor. To better illustrate these ideas, I will introduce the case of Mr. Williams in an article written by author John D. Arras.
(03/05/13 6:35am)
Despite being bundled up in scrubs, a surgical gown, gloves and a pair of odd, shoe-covering slippers, I still felt cold. ORs are always kept cool to limit the spread of bacteria, and the sterile cold that surrounded me didn’t seem much warmer than the Wisconsin winter outside the hospital walls. I had decided to spend my Spring break shadowing physicians and surgeons and was about to see my first surgery: a left mastectomy. The patient lay on the table anesthetized and draped in a sterile blue blanket, with just her left breast exposed. The surgeon drew a black circle along the target site and then, with me looking over his shoulder, took up his scalpel and Bovie pen to make the first incision.
(02/26/13 5:59am)
Whether you are in fact “pre-med,” are friends with a bunch of us nerds or are just a casual spectator of folks drawing organic chemistry reactions all over Link study rooms, there’s a pretty good chance you’ve asked somebody (or yourself) a question: “Why medicine?” In response, I’m betting you heard the standard answers: “to help people,” “to change the world,” etc. I know them, because I’ve recited these verbatim for the past three-and-a-half years. Yet, while the sentiment of selflessness may be genuine for some aspiring docs, I don’t buy it anymore—at least not from myself.
(02/19/13 10:13am)
I can’t help but chuckle whenever I hear people talking about a perceived lack of campus safety. A few incidents notwithstanding, Duke’s campuses (and their peripheral areas) tend to be some of the safest locales in the city—you’re probably not going to get shot walking down Campus Drive at 2 a.m.
(02/12/13 10:26am)
The first semester of my freshman year, a girl on my floor walked into our common room and started talking about this new research position that she was recently offered. All of us congratulated her and “ooo’d and ahh’d” over her shiny new lab keys and listened to her talk about her project. Afterward, I left thinking, “Well crap. Maybe I should start looking for a research position too.”
(02/05/13 11:54am)
It is perhaps the most fundamental premise of any intro biology course that, although tremendously useful to study, our inherited anatomy (and by extension our genetic code) cannot alone explain the mysteries of life. Far from being a template for development, our “nature” is not deterministic; it’s a factor that, only when combined with the environment in which we’ve been “nurtured,” can help explain who we are. It’s also a concept that’s not very novel, a strand of common sense that every pre-med student here has had drilled into their head ad nauseum. Yet, it’s the one truth we’ve failed to truly integrate in medicine for generations.
(01/29/13 7:16am)
I didn’t grow up wanting to be a physician. But some time during the Fall of my junior year, it occurred to me that medicine might be a good fit. The problem was that I knew next to nothing about medicine, had never interacted with physicians outside of regular check ups and had finished my economics major without ever taking a pre-med class. Was I too late? Do you really need to know what you want to do with your life by the time you are a junior? A senior? Over the past year, I have learned that the answer to these questions is a definitive “no.”
(01/22/13 7:25am)
Whenever I bring up my EMS involvement in casual conversation, the questions I get are usually influenced by a high-adrenaline public perception of the field: “What’s the worst thing you’ve seen?” “Have you ever seen somebody get shot?” “Have you ever done CPR?” While we’ve all had our fair share of harrowing experiences in the field, the call-to-call reality is considerably less dramatic -- though that’s not to say it doesn’t hold its own excitement. Truth be told, sometimes the most critical patients are the easiest to manage. After all, pre-hospital care boils down to some simple concepts – to quote an instructor of mine, “air goes in and out, blood goes round and round, any variation on this is a bad thing.” Sometimes, it actually is that easy. Patient not breathing? Breathe for the patient. Massive extremity arterial bleed? Tourniquet it and forget it. See? Emergency medicine’s not that hard.
(01/15/13 10:45am)
This is a column about medicine, but it doesn’t start in a hospital. Instead it starts in a classroom filled to the brim with eager medical students awaiting the words of a prominent physician. The physician is not of this world. He is, in fact, imaginary—the creation of a real-world physician Abraham Verghese, who practices and teaches at Stanford. Verghese is known to the American public as the author of the bestsellers “My Own Country: A Doctor’s Story” and “Cutting for Stone,” and to the medical community as an incredibly effective, albeit unorthodox, physician. You can watch one of his lectures on TED.com, where he argues that medicine is bound to discover a new and revolutionary tool—the human hand. His fictitious physician—the prominent Dr. Thomas Stone, namesake for his most recent best seller—tries to make a similar point to his packed class of medical students. He asks, “What treatment in an emergency is administered by ear?” No one seems to know; there aren’t many drugs administered by ear. And then, finally, someone speaks up with the sought-after answer: “words of comfort.”
