Sunday, March 29, 2020

Do Doctors Wash Their Hands Properly?

There is no person unaffected by the coronavirus pandemic.  It does seem that the public and the government are responding belatedly in a manner commensurate with the threat.  I write this knowing that less than a week ago from the time I am composing this, Florida beaches were teeming with vacationers.  A memorable quote from one of these selfless and enlightened partiers was:

“If I get corona, I get corona. At the end of the day, I’m not gonna let it stop me from partying.”

This individual, from my own state of Ohio, did apologize for his remarks.  I would suggest that his mouth be mandated to take a 14 day quarantine from all speech. 

Look, we’ve all said dumb stuff.  I know I have.  My advice?  If you sense some dumb words about to erupt, and there are cameras rolling, sprint in the opposite direction as if the coronavirus is on your tail and gaining ground.

Right now, Ohio and many other states are in a ‘shelter-in-place’ status, in an effort to enforce social distancing.   I’m trying to do my part.  I’ve learned about curbside grocery pick up.  I haven’t shaken hands in weeks.  I try to keep my distance from others as best as I can. And, I am practicing telemedecine.  I watched a video that demonstrated ideal hand washing technique.  I’m in a profession that should be model hand scrubbers.  I’ve washed my hands probably hundreds of thousands of times and I’ve seen many colleagues lather up.  But I’ve never seen hand washing as depicted in the training video. This was no mere soap & water exercise.  It was a performance, a veritable choreography of cleanliness.   In other words, I think my own profession could use a hand hygiene refresher course, as could the rest of us.

Scrub Vigorously
(You Don't Have to Get This Deep.)

Interestingly, when the president and his medical minions are giving their frequent news conferences, they all seem huddled together, much closer than 6 feet apart. 

But, at most I’ve been inconvenienced during the pandemic.  For so many, this pandemic has been devastating medically and economically.  The job losses and company closures are horrifying.  I am more sanguine about prevailing over the virus than I am over recovering our economy.   And, there is tension between public health experts and many in the business world about when to permit economic activity to resume.  

As I write this, the U.S. Senate has still not agreed on the zillion dollar recovery package, which I anticipate will occur shortly.   If there was a legislative bill that was against cancer, would it be able to pass the House and Senate easily? I wonder.

We will get to the other side.  And, we will recover eventually.  But we will not be the same. We and the world will have learned about the ferocity and tenacity of an invading microbe and the strategy and tactics necessary to defeat a wily and stealth enemy.   And, we will surely need these battle skills again and again. 

Sunday, March 22, 2020

Coronavirus or Coronoverse?

A worker was told of corona.
Who's boss said, "You're on your own-a."
"Leave the arena"
"Begone! Quarantina!"
"You mean I'm gonna be all alone-a?"

Coronavirus - An Invisible Foe

We will get to the other side.   Clearly, the path to a safe and secure future has not been a straight shot.  Both the government and the public have fallen short. The initial coronavirus testing launched here was a debacle, in contrast to other countries that knew how to aim straight.  We have seen price gouging for hand sanitizer and face masks.  As recently as this past Thursday, Florida beaches were teaming with folks who brazenly and selfishly risked contracting the virus and transmitting it to others.

But, most of us have fallen into line.  And, so have our leaders.

I feel more sanguine that we will prevail in the medical arena than we will on the economic front.

Epidemics and pandemics will join the array of natural disasters that have become commonplace events in our lives.  And, we will learn to combat them more skillfully.

It's scary.  It's surreal.  A microscopic entity with no brain and no motive can bring the world to its knees.  The world will surely stand up again, but we may need to hold on to each other.

Sunday, March 15, 2020

Doctor-Patient Relationship Needs John Adams

In 1770, in Boston, British soldiers fired into a crowd of colonists who were taunting the soldiers.  Several colonists died and several soldiers were arrested and charged with murder.  This event known as the Boston Massacre was a seminal historical episode that contributed to the colonists’ growing desire to separate from the British Crown.

Boston was a cauldron of the independence movement.   Hatred against the British was prevalent.  Who would be willing to defend the accused soldiers at trial risking opprobrium or worse?  John Adams, our future second president, defended the soldiers believing that every accused deserves adequate representation.  To this day, America distinguishes itself with our belief and practice that an accused man is presumed innocent and is entitled to a competent legal defense.  As we all know, lawyers are often assigned or volunteer to defend unsavory individuals to protect their clients’ constitutional rights, ensure that the legal process is being respected and to prevent a rush to judgement from taking hold.  Understandably, many lawyers would not rush to defend accused child molesters, terrorists, white supremacists, kidnappers or abusers of the elderly or other vulnerable people, and yet these accused people fully deserve and are entitled to representation. 

John Adams Sets Example for Doctors

But, John Adams accepted defendants who were reviled and thereby burnished his own reputation as a principled statesman performing the noble mission of the legal profession.  Six of the soldiers were acquitted and two were convicted of manslaughter.

Both lawyers and physicians don’t choose their customers.  They come to us.  While many who come to physicians for assistance are pleasant and cooperative, others have less sanguine traits.  I have seen patients who are argumentative, demanding, rude, dishonest, hostile and overtly racist.  A few days before writing this, one of our secretaries became rattled when a patient cursed her. Of course, patients who are worried or sick are entitled to great latitude, which doctors and our staffs extend to them.  But, aside from this, there are disagreeable patients whom I just don’t like.  But, these folks are entitled to the best medical advice I can provide, and I do my best to meet this obligation.  Everyone has a right to competent medical care.  But, as doctors and nurses would testify, it is easier to do our jobs when patients and their families are pleasant and cooperative.

First, let me admit that not every physician is a clone of Marcus Welby, MD, and patients may legitimately complain that some of their doctors are wanting in their bedside manners and attitude.  If readers wish to speak on this issue, leave a comment.

There is no application process to become a doctor’s patient.  Universities and employers can reject applicants, but physicians, for the most part, see everyone.   While I like and enjoy the majority of my patients, there are some whom I serve despite harboring some negative feelings.  And, of course, even those whom I enjoy being with may have a variety of private views and opinions that differ from mine.  Part of my job is to make sure that any personal feelings I have do not interfere with my ability to serve the patient well. 

I’d like to think that I could serve any patient, but I recognize that this idealistic statement is not realistic.  Humans cannot be expected to exhibit superhuman behavior.  If the doctor-patient relationship is strained beyond the point where the doctor can give sound and sober medical advice, then the physician may need to step aside. 

John Adams has set a stratospheric example for lawyers, physicians and, indeed, for all of us.

Sunday, March 8, 2020

Has Coronavirus Infected our Politics?

Have you heard enough about Coronavirus yet?   If not, feel free to tune in to the Coronavirus News Network, also known as CNN.

I have zero medical experience in virology and public health, so read no further if you are looking for a Whistleblower travel advisory or if it’s safe to pet Scruffy if he develops a fever.

I’m also not here to gripe about our nation’s response to this incipient pandemic.   Although we have a first class team in place now, even they admit that they stumbled initially.  I'm more interested in making progress than in racking up debate points.

My observation is that there is no issue or event that is immune to politicization, a reality that depresses me.  We all agree that prior to the virus’s emergence from China, we were already rabidly hyper-polarized and hyper-partisan in the zero sum game that now defines our political landscape.  I won’t add to this sentence so as not to waste readers’ time in reading what we all know and agree on. 

On many issues we should expect differing views from our two main political parties that are philosophically distinct.  For example, changing income tax rates, border issues, health care policy, funding our defense department, trade policy are examples that will give rise to spirited policy debates. This is as it should be.  During normal times, meaning decades ago, these differences would be debated and a solution forged by resorting to the diabolical technique called compromise. 
But, or so I had thought, some issues should hover above this chaos in the rarefied region of the stratosphere where reasonableness prevails.   

Illustration of Coronovirus
Is it Democrat or Republican?

To offer an absurd hypothetical, if a lawmaker offers a bill declaring cancer to be evil, would this pass unanimously?  It seems non-controversial, but who knows?  Perhaps, the opposing party might be suspicious of the motive, or fear that this is the entry point to the slippery slope that will lead to Medicare for All.   Or, the opposition will agree to vote for the bill only in exchange for votes on some unrelated issue.  We all know how this works.

I have hear many pundits and partisans in recent days who can’t resist taking political shots at their adversaries when they are questioned about Coronavirus issues.  These crass responses give this gastroenterologist heartburn.   Let them save their partisan venom for an appropriate issue.  Coronavirus is a potential global health crisis and, as a medical professional, I assure you that it is non-partisan.  It will infect anyone.  So, when a salivating political hack is asked about it, he should be telling us how he intends to help rather than angling for a cheap political dividend.

I wonder how my patients might react if I queried them about their political leanings as they were about to be sedated before undergoing a procedure.  

Sunday, March 1, 2020

Can Sherlock Holmes Teach Today's Doctors?

To Sherlock Holmes, she is always the woman.   Thus begins Conan Doyle’s, A Scandal in Bohemia published in 1891.   In this gripping tale, Holmes is bested by a woman who proves to be the detective’s equal in intelligence and deception.  

For reasons I cannot explain, I restrict my exposure to Holmes and Dr. Watson to podcast listening when I am airborne.  Years ago, I did love watching the classic movies starring Basil Rathbone and Nigel Bruce who defined the roles for me. 

Conan Doyle, a physician, was a superb story teller, who wove his tales with texture, plot and humanity.  I think he wields words with surgical precision.   I admire his skill.

I wonder to what extent Conan Doyle’s medical training influenced his writing?  Certainly, the stories often discuss arcane medical conditions that provide the detective with important clues.  In The Adventure of the Blanched Soldier, Holmes suspects that the protagonist is suffering from leprosy, a diagnosis that is revised after Holmes arranges for a consulting dermatologist to examine the soldier. 

Holmes would have been master diagnostician.

Beyond these medical intricacies that the author includes, I suggest that Conan Doyle has a more direct connection to the world’s most famous sleuth.  Physicians operate as detectives.  We gather facts and evidence in real time.  We have suspicions which may be strengthened or refuted as additional data emerges.  There may be competing theories that torture us.   At times, we are forced to make judgments and recommendations when our knowledge base in incomplete.   And some of our patients’ dilemmas remain unsolved, similar to crime solvers’ cold cases. 

In The Sign of the Four, Holmes remarks to Watson, How often have I said to you that when you have eliminated the impossible, whatever remains, however improbable, must be the truth.  Holmes would have been a superb physician.