Is there anything you plan to do BETTER than some or all of today's doctor's when you become a dr?

[DermViser]

No I did not.
"Notice that the thread refers to some or all." And I chose to elaborate on the "some."

Yes you only elaborated "the some". How convenient.

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[Cyberdyne 101]

You know that surgeons want to protect their morbidity/mortality numbers right?

I would hope so. But then again, why would an obstetrician recommend an open surgery to remove an ovarian cyst when someone (literally up the block) can do it laparoscopically? And why would a spine surgeon recommend surgery when the patient can receive the same outcome (pain reduction) with conservative treatment such as exercise and weight loss?

 

[DermViser]

I would hope so. But then again, why would an obstetrician recommend an open surgery to remove an ovarian cyst when someone (literally up the block) do it laparoscopically? And why would a spine surgeon recommend surgery when the patient can receive the same outcome (pain reduction) with conservative treatment such as exercise and weight loss?

 

[Cyberdyne 101]

Yes you only elaborated "the some". How convenient.

Yeah. Because it's "Or" lol. In some cases it can't be both.

 

[Cyberdyne 101]

So these scenarios never happen?!

 

[circulus vitios]

I plan on paying my student loans off faster than most physicians. I also plan on saving and investing my money better than most physicians. No way in hell will I be the poor bastard who has to work 60 hours a week at 60 years old.

 

[circulus vitios]

I would hope so. But then again, why would an obstetrician recommend an open surgery to remove an ovarian cyst when someone (literally up the block) can do it laparoscopically? And why would a spine surgeon recommend surgery when the patient can receive the same outcome (pain reduction) with conservative treatment such as exercise and weight loss?

Uhh, probably because minimally invasive surgery isn't always the best option and because some patients, because they lack the willpower to follow through to diet and exercise, will get surgery whether you do it or the guy down the block does it?

 

[Cyberdyne 101]

Uhh, probably because minimally invasive surgery isn't always the best option and because some patients, because they lack the willpower to follow through to diet and exercise, will get surgery whether you do it or the guy down the block does it?

Yeah of course. But the MIS example I gave was based on a case (my friend's) in which not taking the open route was way more beneficial. And in terms of the person that lacks the will power to exercise, I guess it's just a difference in opinion and/or case. For example, someone may need a "quicker fix" due to job responsibilities while it may be different for someone else. But you also have cases in which surgery will likely exacerbate the condition, yet it is still recommended. My physiatrist told me that this happens a lot with spine cases.

 

[jm192]

Yeah of course. But the MIS example I gave was based on a case (my friend's) in which not taking the open route was way more beneficial. And in terms of the person that lacks the will power to exercise, I guess it's just a difference in opinion and/or case. For example, someone may need a "quicker fix" due to job responsibilities while it may be different for someone else. But you also have cases in which surgery will likely exacerbate the condition, yet it is still recommended. My physiatrist told me that this happens a lot with spine cases.

But you're changing the argument.

You asked WHY these things happen. You were then told WHY these things happen. And now you're saying, "Yeah, but exceptions exist." Of course there exist.

But surgeons DO try to protect their M&M numbers.

Diet and Exercise and stopping smoking is first line for virtually everything. To act like physicians aren't trying that before going the surgical route is simply incorrect.

 

[NickNaylor]

Yeah of course. But the MIS example I gave was based on a case (my friend's) in which not taking the open route was way more beneficial. And in terms of the person that lacks the will power to exercise, I guess it's just a difference in opinion and/or case. For example, someone may need a "quicker fix" due to job responsibilities while it may be different for someone else. But you also have cases in which surgery will likely exacerbate the condition, yet it is still recommended. My physiatrist told me that this happens a lot with spine cases.

How do you know? Often the decision between open vs. laparoscopic approaches are based on a variety of factors with the final decision ultimately left up to the surgeon and in no small part based on his/her experience and level of comfort with a particular approach. No offense, but I'm skeptical that you have the knowledge or experience necessary to know when one approach is more appropriate than the other.

I have also never heard of an OB/GYN doing MIS nor have I heard of a general surgeon taking out ovarian cysts, but I have very limited exposure in this regard.

 

[Cyberdyne 101]

I hate semantics. I paused District 9 to argue about the usage of the word "or."

There are ppl in every field that overreach. Medicine, law, finance, sales etc. And it's more than just exceptions. That's all I was saying.

 

[LilEngineThatCould]

Wow this whole thread is just US vs THEM. All the over-idealistic people will learn over time (I was one and I'm not even in med school yet), but I also don't think there's anything wrong with being a little altruistic (a healthy dose lol). Are some of the posters making exaggerations and gross generalizations? Yes. Are you helping them realize why certain things are the way they are by laughing at them and poking fun at their lack of knowledge? No.

Sheesh.

 

[Cyberdyne 101]

How do you know? Often the decision between open vs. laparoscopic approaches are based on a variety of factors with the final decision ultimately left up to the surgeon and in no small part based on his/her experience and level of comfort with a particular approach. No offense, but I'm skeptical that you have the knowledge or experience necessary to know when one approach is more appropriate than the other.

I have also never heard of an OB/GYN doing MIS nor have I heard of a general surgeon taking out ovarian cysts, but I have very limited exposure in this regard.

Of course I don't have that knowledge. My friend was given that information by a surgeon and she told me the story. The doctor told her the open procedure posed more risks (information the 1st doctor didn't give her). And the obstetrician she saw for MIS did a fellowship in Gynecologic oncology. It wasn't a general surgeon in either case.

 

[NickNaylor]

Of course I don't have that knowledge. My friend was given that information by a surgeon and she told me the story. The doctor told her the open procedure posed more risks (information the 1st doctor didn't give her). And the obstetrician she saw for MIS did a fellowship in Gynecologic oncology. It wasn't a general surgeon in either case.

I have never seen a gyn surgeon do minimally-invasive surgery other than robotic surgery, but hey, what do I know. Might be a center-specific thing.

 

[Cyberdyne 101]

I have never seen a gyn surgeon do minimally-invasive surgery other than robotic surgery, but hey, what do I know. Might be a center-specific thing.

It may have been the Da Vinci robot.

 

[Frostbite22]

I'd like to put more emphasis on educating my patients, not just treating them. Doctor-patient interactions can be tremendous learning opportunities. Every appointment doesn't have to turn into a biology lesson, but health literacy is a huge problem in this country, and physicians are in a great position to help address that issue. For example, when a kid comes in with a broken arm, rather than just resetting it, putting a cast on, and saying "have a nice day," take a couple minutes to talk about the "machines" (osteoclasts/osteoblasts) that are going to clean up the break and lay down new bone. Ultimately, I'd like to teach my patients about what is happening in their bodies and hopefully use those experiences to get them more invested in properly caring for themselves.

If you knew my parents or the majority of under educated Americans you would realize this would go straight in one ear and out the other. My mom had two heart attacks and still smokes like a champ, heck my dad had cancer and still is a 2 pack a day smoker. To them there is no point in taking care of the body because they want to live life the way they do.

To get back to the original question I'm doing what I would want to do but would probably have more influence over as a doctor. I live on the reservation and the majority of kids I know that are my age (25) never graduated high school and all they do is hang out in the neighborhood and cause trouble. Most don't know the scholarships available for Native Americans in college or pelgrants available to people with no income. So I am doing my best to education people here. It just usually falls on deaf ears. I hope that maybe I'll have more of an influence later on, but realistically I know that is probably just a a young kids dream.

 

[Fisherman1]

If you knew my parents or the majority of under educated Americans you would realize this would go straight in one ear and out the other. My mom had two heart attacks and still smokes like a champ, heck my dad had cancer and still is a 2 pack a day smoker. To them there is no point in taking care of the body because they want to live life the way they do.

To get back to the original question I'm doing what I would want to do but would probably have more influence over as a doctor. I live on the reservation and the majority of kids I know that are my age (25) never graduated high school and all they do is hang out in the neighborhood and cause trouble. Most don't know the scholarships available for Native Americans in college or pelgrants available to people with no income. So I am doing my best to education people here. It just usually falls on deaf ears. I hope that maybe I'll have more of an influence later on, but realistically I know that is probably just a a young kids dream.

I know that most people don't give a f***, and I've got no illusions that a two-minute lecture on why smoking is bad will magically convince somebody to quit cold turkey. All I'm really trying to say is that medicine and the human body are really interesting, and where it is possible I would like to be able to teach people something cool about what's going on inside of them. If I can say something interesting about how an arm heals or how nerves work, maybe I can get my patients interested in learning more about themselves, and hopefully they leave felling a little more comfortable about their condition. If not, then at the very least I got to spend two minutes talking about something that I think is awesome. Win/win situation.
I've seen very few situations where a two-minute conversation would have had life or death consequences. In those situations, I'd obviously skip the discussion. Maybe it's idealistic, but I'd rather go in with high expectations and adjust down accordingly than plan on shafting patients. Every day won't go like I want it to, but when I have the chance, I want my patients to leave feeling better and knowing more than when they sat down in the waiting room.

 

[JMEDM]

I wouldn't presume to think that I will be able to do anything better clinically than current physicians, but I will say that I don't want to fall into many of the financial traps that some current doctors find themselves in. You can do quite well financially on a physician's income if you know how to manage your money and not live beyond your means.

I agree with you on this.

 

[SouthernSurgeon]

I have also never heard of an OB/GYN doing MIS nor have I heard of a general surgeon taking out ovarian cysts, but I have very limited exposure in this regard.

OB/Gyn, despite frequently getting ragged on by other surgical fields for their technical skills, have actually historically been a leader in minimally invasive techniques.

Gynecologists routinely do laparoscopic and (even, despite its lack of proven benefit and some push back that it is an expensive timesuck) robotic cases.

Now as to the particulars of who offers what...it's so hard to know. Could be an older surgeon not as comfortable in laparoscopic techniques - which is exceptionally common in all types of surgical fields. Could be it was a borderline indication and one surgeon was more willing to push it than another. Could be that one surgeon was actually doing something stupid by offering laparoscopy, even if it's what the patient wants. Who can tell from the minimal detail offered.

 

[Cyberdyne 101]

OB/Gyn, despite frequently getting ragged on by other surgical fields for their technical skills, have actually historically been a leader in minimally invasive techniques.

Gynecologists routinely do laparoscopic and (even, despite its lack of proven benefit and some push back that it is an expensive timesuck) robotic cases.

Now as to the particulars of who offers what...it's so hard to know. Could be an older surgeon not as comfortable in laparoscopic techniques - which is exceptionally common in all types of surgical fields. Could be it was a borderline indication and one surgeon was more willing to push it than another. Could be that one surgeon was actually doing something stupid by offering laparoscopy, even if it's what the patient wants. Who can tell from the minimal detail offered.

A GI surgical oncologist at NYU told me that in some cases, the robot is "overkill." And that its setup can actually take longer than some procedures.

 

[Gauss44]

I plan to network and get a sense who other doctors are, what they're like, and what their main medical interests are. This way I can deliberately refer patients to specialists who I believe will be a good match for them and their situations.

Along these lines, I might even start a DATABASE that includes a doctors medical interests within their specialty. Of course, a specialist is trained to handle just about anything within their specialty, but many specialists also have "pet issues" or specific problems/illnesses they do RESEARCH on as well. For example, if I were a PCP and had a patient with MS, I would much rather send him/her to a neurologist who did research on MS than one who spent most of his/her days researching seizures.

 

[jm192]

I know that most people don't give a f***, and I've got no illusions that a two-minute lecture on why smoking is bad will magically convince somebody to quit cold turkey. All I'm really trying to say is that medicine and the human body are really interesting, and where it is possible I would like to be able to teach people something cool about what's going on inside of them. If I can say something interesting about how an arm heals or how nerves work, maybe I can get my patients interested in learning more about themselves, and hopefully they leave felling a little more comfortable about their condition. If not, then at the very least I got to spend two minutes talking about something that I think is awesome. Win/win situation.
I've seen very few situations where a two-minute conversation would have had life or death consequences. In those situations, I'd obviously skip the discussion. Maybe it's idealistic, but I'd rather go in with high expectations and adjust down accordingly than plan on shafting patients. Every day won't go like I want it to, but when I have the chance, I want my patients to leave feeling better and knowing more than when they sat down in the waiting room.

I mean, I think most people do this to an extent.

You're taught to explain what's going on with someone, why they have it, and what they can do to not have it again.

I've been with surgeons with no bedside manor who hated clinic. Even they sat down and drew out a picture to explain how the biliary tree worked and why their gallbladder was causing them so much pain.

Now, as far as explaining how nerves work or osteoclasts vs osteoblasts--you realistically don't have the time to get into something like that. And most people don't care.

As far as smoking, you're taught to address it with every patient. Of course it goes in 1 ear and out the other.
The first time you see an end stage COPD patient, you'll vow to get everyone to stop smoking.
50 speeches later, you'll remember you can't.

 

[circulus vitios]

I plan to network and get a sense who other doctors are, what they're like, and what their main medical interests are. This way I can deliberately refer patients to specialists who I believe will be a good match for them and their situations.

Along these lines, I might even start a DATABASE that includes a doctors medical interests within their specialty. Of course, a specialist is trained to handle just about anything within their specialty, but many specialists also have "pet issues" or specific problems/illnesses they do RESEARCH on as well. For example, if I were a PCP and had a patient with MS, I would much rather send him/her to a neurologist who did research on MS than one who spent most of his/her days researching seizures.

More often than not you're going to be referring patients to doctors who are taking new patients, accept their insurance, are within a reasonable commuting distance. Probably not that big of a list.

 

[jm192]

I plan to network and get a sense who other doctors are, what they're like, and what their main medical interests are. This way I can deliberately refer patients to specialists who I believe will be a good match for them and their situations.

Along these lines, I might even start a DATABASE that includes a doctors medical interests within their specialty. Of course, a specialist is trained to handle just about anything within their specialty, but many specialists also have "pet issues" or specific problems/illnesses they do RESEARCH on as well. For example, if I were a PCP and had a patient with MS, I would much rather send him/her to a neurologist who did research on MS than one who spent most of his/her days researching seizures.

Typically speaking, a general neurologists is well-trained in most neurological problems. If I'm a neurologists that does seizure research--I still know how to handle MS. And if you ONLY send me seizure patients, I might just be offended.

Now, if someone is considered a seizure specialist, only sees seizure patients, or openly states they only want to treat seizures--that's another thing. Or if the MS Leader in the country is in your area--sure.

But, variety is the spice of life. And I'm sure the Neuro guys don't want the PCP's sending the interesting stuff to everyone else just because they happened to do seizure research.

 

[DrBowtie]

I plan to network and get a sense who other doctors are, what they're like, and what their main medical interests are. This way I can deliberately refer patients to specialists who I believe will be a good match for them and their situations.

Along these lines, I might even start a DATABASE that includes a doctors medical interests within their specialty. Of course, a specialist is trained to handle just about anything within their specialty, but many specialists also have "pet issues" or specific problems/illnesses they do RESEARCH on as well. For example, if I were a PCP and had a patient with MS, I would much rather send him/her to a neurologist who did research on MS than one who spent most of his/her days researching seizures.

That's a good way to lose patients. Ship them to the subspecialty academic center and they get sucked into the system and poached by other docs so that it's "easier to coordinate care".

Local referral patterns are very nebulous.

 

[Darth Doc]

To get back to the original question I'm doing what I would want to do but would probably have more influence over as a doctor. I live on the reservation and the majority of kids I know that are my age (25) never graduated high school and all they do is hang out in the neighborhood and cause trouble. Most don't know the scholarships available for Native Americans in college or pelgrants available to people with no income. So I am doing my best to education people here. It just usually falls on deaf ears. I hope that maybe I'll have more of an influence later on, but realistically I know that is probably just a a young kids dream.

I was just reading yesterday about the troubles one Native American pre-med was having getting into school. I read through a lot of the comments at the end and one responder had a list of scholarships and such for Native Americans trying to attend medical school. You may already know the information. I found the article heartbreaking, since the author found the struggle for financing impossible and gave up. But the comments were so encouraging it gives me hope.
http://www.idealmedicalcare.org/blo...ich-kids-this-native-american-woman-says-yes/

My contribution to the list: I plan to try to be as good as the best doctor I've ever worked with by being humble, continue learning no matter how long I've been a doc, and being a willing teacher of patients, co-workers, and students. I don't think there's any thing I can do to improve on that.

 

[Frostbite22]

I was just reading yesterday about the troubles one Native American pre-med was having getting into school. I read through a lot of the comments at the end and one responder had a list of scholarships and such for Native Americans trying to attend medical school. You may already know the information. I found the article heartbreaking, since the author found the struggle for financing impossible and gave up. But the comments were so encouraging it gives me hope.
http://www.idealmedicalcare.org/blo...ich-kids-this-native-american-woman-says-yes/
.

Thanks for the article, it definitely does hit home. Especially at the end talking about suicide and alcoholism. At the hospital here every weekend we see roughly 10-15 suicide attempts. At one portion of the rez it is a complete food desert, the nearest grocery store being 2.5 hours. Both of my parents struggle with alcoholism and will probably never see me graduate as a doctor. The worst part is I am often un-accepted by people my age in my actual tribe because I am different and am not doing the norm.

If it wasn't for my references I doubt that I would've gotten into certain jobs because of being labeled as an alocholic from the get go (especially where I live). It is reasons like this why kids in my neighborhood don't dare to dream of attending school for anything. Definitely why I want to return home and hopefully have a better influence on kids and help find them money wherever it is available.

Sorry about the long response. Them feels though.

 

[beto]

Yes: not be a condescending imbecile.

 

[NontradCA]

One thing that gets me is the traditional, masculine role that is the physician today. I want to put a change to this and be more progressive with my peers and colleagues.

So I want to be better at picking up women than other physicians. That way all the nurses who work with me wanna bang and won't be subjected to all the pigs.

 

[BestDoctorEver]

I wouldn't presume to think that I will be able to do anything better clinically than current physicians, but I will say that I don't want to fall into many of the financial traps that some current doctors find themselves in. You can do quite well financially on a physician's income if you know how to manage your money and not live beyond your means.

I was going to say that, but you beat me to it... However, sometimes their spouses 'make' them do stuff and I heard that a lot working around anesthesiologists/surgeons in the OR.

 

[ZezKaiEll]

I plan to have better handwriting than today's docs.

 

[Gauss44]

Double check on important information that sounds unlikely... and personally look into important unclear matters in my personal time...

I recently learned 2 new things:

1. If someone is accidentally exposed to HIV in any way, they might be helped by a post exposure prophylaxis..

(I learned that years ago in a healthcare setting where a patient who had unprotected sex, learned after the fact that her partner might have been HIV positive. The doctor proscribed post exposure prophylaxis. As a second go around, I mentored a homeless youth who had a similar experience, took the prophylaxis and tested negative... Sadly, I've encountered a few nurses since then who definitely didn't seem to know that was an option until I told them, and didn't seem compelled to look into it either. I would have looked into it because HIV is common, and IMO the experience of potentially being exposed, is probably common too, and especially in a city full of colleges, like where I live.)

2. Apparently, you CAN catch syphilis without having sex. All you have to do is touch a sore or the fluid from a sore.

(There's a tiny chance I'm wrong here, but I will ask around to confirm this. Basically, a friend of mine thought she had several ringworm rashes, which would be odd given that she hasn't handled any cats or dogs lately. She asked me if I knew what her round rashes where, since she knows I'm a premed. Of course, I told her to see the doctor. Meanwhile I wondered if it was really ringworm and looked up other rashes including syphilis, another circular rash. And I couldn't believe what I found: So many websites claim that you cannot possibly catch syphilis without having "unprotected sex." However, a few websites say all you have to do is touch a sore which can be anywhere on another person's body. The later makes more sense to me. And if it's correct, than the former is creating a stigma and spreading misinformation....)

Part of my purpose in starting this thread was so we can share ideas. I think that often times, the only reason people don't act on great ideas is because they never came to mind.

 

[2Pints]

@guass44 I have received a lot of education on what to do if exposed to HIV. In nursing school and every year through mandatory education. We have a policy in place if we are accidentally pricked by needles regardless of patient HIV status. I'm pretty sure our CNAs have to complete the same HIV module. Just to calm your fears a little.

As for me, I'd change end-of-life care. It's a very sad and frustrating process to watch when patients and caregivers aren't properly prepared. I get riled up when I see somebody get trached and PEGed and sent to a long term facility with limited quality of life.