Self-inflicted health problems

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QuinnTheEskimo

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I worry I won't have the patience to deal with self-inflicted health problems ( especially obesity, type II diabetes, drug/alcohol addiction, etc). I haven't even started yet, but I see these types of patients as a recipe for burnout. Anyone else feel this way? Truth be told, this is one of the reasons I'm considering pediatrics (you can't really blame babies and kids for being willfully noncompliant).
 
QuinnTheEskimo said:
I worry I won't have the patience to deal with self-inflicted health problems ( especially obesity, type II diabetes, drug/alcohol addiction, etc). I haven't even started yet, but I see these types of patients as a recipe for burnout. Anyone else feel this way? Truth be told, this is one of the reasons I'm considering pediatrics (you can't really blame babies and kids for being willfully noncompliant).
Click to expand...

Yes, but wait until you have to deal with parents and their enabling of, and non-compliance in dealing with their kids' health problems. Especially with younger and younger cases of obesity, Type II DM, behavior and psych issues, etc.
 
While I understand your logic, and understand the frustration with treating these kinds of patients (I work in the ER alongside the physicians and we see plenty of "frequent fliers" with complications of these largely preventable ailments), I think WillburCobb hits the nail on the head. You may not "blame" the children as a physician, but while the individual you're treating is young, the people you'll have to deal with the most is parents, and that's a whole different bag. I've found that I actually really LOVE working with kids, but it's the parents that make it not so enjoyable much of the time! Good luck with that one....
 
My Grandma-in-law has lung cancer, breathes through a respirator 24/7... and still smokes. "My mother smoked until she died when she was 90. I'll die with a cigarette between my fingers, and I'll die happy."

Sometimes, no matter what you say, no matter what scientific/medical info you have... people will always make their own choices.
 
Aaand this is why I often (with my uninformed perspective, admittedly) think that the ideal specialties for patient population are peds surgery (parents, but the kids are actually sick, not just being helicoptered to death) or trauma surgery (nobody deserves traumatic injury, sorry).
 
Go into surgery. Or radiology. Or anesthesiology. Or pathology. There are lots of fields of medicine that will minimize this sort of frustration for you. Don't get too worried about little things like this - they'll work themselves out when you choose what field you want to go into.
 
ommnomm said:
What's the difference between a smoker and a motorcycylist? Both choose dangerous activities which will eventually necessitate medical treatment.
Click to expand...
Which is why, as a motorcyclist, I take issue with lifestyle controls/penalties such as large soda bans. 😀

But in all seriousness, EVERYONE, except for kids, picks their own medical risks. And then you pick the specialty where the risks the patients chose which led them to be in the hospital doesn't make you want to tear your hair out.

For me personally, there's a difference between "I'm going to try an activity and if it goes wrong I will be acutely injured" and "I am going to do something for years, which, even if everything goes as I plan, will result in chronic health problems". If you were never willing to try an activity which could result in physical harm, you shouldn't drive a car, ride a bike, walk near traffic, go hiking, play a sport, etc. Trauma is a risk of being alive, and yes, some activities are more prone to it than others, but the downsides of being entirely risk-averse (sitting indoors at all times working from home) are worse than getting out and DOING things...plus, what are people living for if not activity? Their cigs?
That's just me.

On an entirely separate note (and I loved your question, don't get me wrong, this is me joining that practice rather than getting worked up over it. It's exactly the sort of question this discussion needs)
Now I have a question: motorcyclists have a bad rep on the risk front...do you judge bicyclists as harshly? At least motorcyclists wear protective gear (9/10x), have maneuverability, and have some protection if they slide out (you can actually perch on the motorcycle pretty well...try that on a road bike) or get bumped by a car. Bicyclists are at the cars' mercy, are insanely unstable (taken down by a pebble) and wear spandex. Hands down, the most severe traumas I have seen in the ED are from people riding those insane little road bikes with their spandex and crushing their bones when they hit pavement. We had a bike race one weekend and saw 1 hemo/pneumo (flown out after stabilization), one death by spine injury, and 2 EMS fly-outs. The motorcyclists have had, collectively in all the time I've worked in the ED, 1 broken limb. I'm not saying motorcycling is safe...heck no, when it goes wrong, it goes really wrong. I'm just wondering if your equality of risk principle applies beyond the 'love-to-hate' classics like motorcycling.
 
mehc012 said:
On an entirely separate note (and I loved your question, don't get me wrong, this is me joining that practice rather than getting worked up over it. It's exactly the sort of question this discussion needs)
Now I have a question: motorcyclists have a bad rep on the risk front...do you judge bicyclists as harshly? At least motorcyclists wear protective gear (9/10x), have maneuverability, and have some protection if they slide out (you can actually perch on the motorcycle pretty well...try that on a road bike) or get bumped by a car. Bicyclists are at the cars' mercy, are insanely unstable (taken down by a pebble) and wear spandex. Hands down, the most severe traumas I have seen in the ED are from people riding those insane little road bikes with their spandex and crushing their bones when they hit pavement. We had a bike race one weekend and saw 1 hemo/pneumo (flown out after stabilization), one death by spine injury, and 2 EMS fly-outs. The motorcyclists have had, collectively in all the time I've worked in the ED, 1 broken limb. I'm not saying motorcycling is safe...heck no, when it goes wrong, it goes really wrong. I'm just wondering if your equality of risk principle applies beyond the 'love-to-hate' classics like motorcycling.
Click to expand...
According to the NHTSA, bicycles accounted for 677 traffic fatalities plus 48,000 non-fatal injuries in 2011, vs 4,612 fatalities and 81,000 injuries for motorcycles. That's a rate of 24.93 per hundred million vehicle miles traveled for motorcycles. The data for bicycle miles travelled per year isn't available, but if you use the Sierra Club's claim of about 9 billion, you get a rate of 7.56 fatalities per hundred million miles traveled. Non-fatal injury rates using the same data are 440 for motorcycles vs. 536 for bicyclists.

So if you want to go by the data, then yes, bicycles should have a more dangerous reputation than they currently do. But motorcycles probably deserve the "hate." Apologies for the derail.
 
ommnomm said:
What's the difference between a smoker and a motorcycylist? Both choose dangerous activities which will eventually necessitate medical treatment.
Click to expand...

Smoking is directly detrimental to your health. A large part of what makes riding a motorcycle dangerous is OTHER people. Sure, they know this going into it, but so do people who drive cars. Do you judge car drivers the same way when they get in a wreck?
 
Reckoner said:
According to the NHTSA, bicycles accounted for 677 traffic fatalities plus 48,000 non-fatal injuries in 2011, vs 4,612 fatalities and 81,000 injuries for motorcycles. That's a rate of 24.93 per hundred million vehicle miles traveled for motorcycles. The data for bicycle miles travelled per year isn't available, but if you use the Sierra Club's claim of about 9 billion, you get a rate of 7.56 fatalities per hundred million miles traveled. Non-fatal injury rates using the same data are 440 for motorcycles vs. 536 for bicyclists.

So if you want to go by the data, then yes, bicycles should have a more dangerous reputation than they currently do. But motorcycles probably deserve the "hate." Apologies for the derail.
Click to expand...
Haha, it's all good, as I was the initial derailer (couldn't make that a bicycle pun, sorry).

I wasn't trying to necessarily claim that motorcycles aren't dangerous or that bicycles are more so, exactly, though my phrasing certainly implied it, sorry. It's more the principle of the thing - that people are very quick to judge some populations as having 'brought their trauma on themselves' by doing high-risk things, and yet no one considers more socially mainstream things such as cars or bicycles. (Side note: I am super skeptical of that 9 billion claim.)

The real thread-specific point is that in the end, everyone brings their own medical problems on themselves by their lifestyle, and you have to choose what jives with you.
 
mehc012 said:
The real thread-specific point is that in the end, everyone brings their own medical problems on themselves by their lifestyle, and you have to choose what jives with you.
Click to expand...

I'm not opposed to motorcycles, they're lots of fun. Just trying to point out that certain activities make you morel likely to suffer traumatic injury. Thus if you "deserve" to have health problems from other choices, you could logically say that some people "deserve" traumatic surgery.
 
ommnomm said:
I'm not opposed to motorcycles, they're lots of fun. Just trying to point out that certain activities make you morel likely to suffer traumatic injury. Thus if you "deserve" to have health problems from other choices, you could logically say that some people "deserve" traumatic surgery.
Click to expand...

Because everyone knows the most important part of medicine is assigning blame.

I kid I kid.
 
WillburCobb said:
Yes, but wait until you have to deal with parents and their enabling of, and non-compliance in dealing with their kids' health problems. Especially with younger and younger cases of obesity, Type II DM, behavior and psych issues, etc.
Click to expand...

True. Considering the widespread thought process of "Playing outside is too tiring and boring! Exercise is for those nasty health nuts who have no life!". In addition, to the bundles of kids on ADHD meds, 3-5 bipolar meds, etc.

And surgery deals with LOTS of non-compliant people 😛
 
Consider vet med.

Then you don't have to deal with patients that cause their own health problems! (But the owners are another story altogether.)
 
Many patients with high risk cardiovascular problems fall into the care of vascular surgeons. Prior to the "endovascular revolution" vascular surgeons were among the busiest and possibly the most miserable doctors (various doctors have confirmed this to me).
This study of physician work hours is a few years old, but you can see the who came in first (or last lol).
image.jpg
 
Womb Raider said:
Smoking is directly detrimental to your health. A large part of what makes riding a motorcycle dangerous is OTHER people. Sure, they know this going into it, but so do people who drive cars. Do you judge car drivers the same way when they get in a wreck?
Click to expand...
Agree. There is no safe way to smoke a cigarette.
Every animal takes risks when it goes about its day. However, some behaviors are inherently more risky and intentionally carried out with disregard to future consequences. Smoking would fall under that kind of behavior. Other behaviors, such as driving are mandated by our society, and although inherently risky, are not the same as intentionally harming oneself. The two do not compare.
 
ommnomm said:
He said he didn't want to treat patients that had caused their own health problems :shrugs:
Click to expand...
SHE absolutely did not say that.
I said that I would prefer patient populations such as those in peds surg and trauma.
I thought we were going to get into an interesting discussion, but you skipped all of the fun bits in your reply 🙁

How about this for a difference: treat a motorcyclist who fractured his pelvis, and they're not going to spend all of recovery repeatedly crashing their bikes into the median.
Treat a COPDer for years and they may just keep on smoking the whole while.
Treat someone with HTN and DM which could be diet-controlled and scream in frustration as they actively work against you.

Neither one is 'better' - hell, the motorcyclist may get right back on the bike as soon as the pain clears, and end up in a coma the next year, and that's on him. But hey, once I fixed him back up to the point where he could make those further decisions, that was our part together. I may or may not be there for the next one - and I may or may not win it. But we're on the same side for the recovery process; hell, my GOAL is to fix them up to the point where they again have the capability of picking their activities.
 
mehc012 said:
Which is why, as a motorcyclist, I take issue with lifestyle controls/penalties such as large soda bans. 😀

But in all seriousness, EVERYONE, except for kids, picks their own medical risks. And then you pick the specialty where the risks the patients chose which led them to be in the hospital doesn't make you want to tear your hair out.

For me personally, there's a difference between "I'm going to try an activity and if it goes wrong I will be acutely injured" and "I am going to do something for years, which, even if everything goes as I plan, will result in chronic health problems". If you were never willing to try an activity which could result in physical harm, you shouldn't drive a car, ride a bike, walk near traffic, go hiking, play a sport, etc. Trauma is a risk of being alive, and yes, some activities are more prone to it than others, but the downsides of being entirely risk-averse (sitting indoors at all times working from home) are worse than getting out and DOING things...plus, what are people living for if not activity? Their cigs?
That's just me.

On an entirely separate note (and I loved your question, don't get me wrong, this is me joining that practice rather than getting worked up over it. It's exactly the sort of question this discussion needs)
Now I have a question: motorcyclists have a bad rep on the risk front...do you judge bicyclists as harshly? At least motorcyclists wear protective gear (9/10x), have maneuverability, and have some protection if they slide out (you can actually perch on the motorcycle pretty well...try that on a road bike) or get bumped by a car. Bicyclists are at the cars' mercy, are insanely unstable (taken down by a pebble) and wear spandex. Hands down, the most severe traumas I have seen in the ED are from people riding those insane little road bikes with their spandex and crushing their bones when they hit pavement. We had a bike race one weekend and saw 1 hemo/pneumo (flown out after stabilization), one death by spine injury, and 2 EMS fly-outs. The motorcyclists have had, collectively in all the time I've worked in the ED, 1 broken limb. I'm not saying motorcycling is safe...heck no, when it goes wrong, it goes really wrong. I'm just wondering if your equality of risk principle applies beyond the 'love-to-hate' classics like motorcycling.
Click to expand...
Probably 90% of traumatic TBIs we see at my hospital from April to November are motorcyclists. Nearly every patient that is a quad or paraplegic that doesn't have a gunshot wound or cancer is a motorcyclist. I've only seen one bad biking injury in 6 years, and that guy lost consciousness on the bike- a motorcycle wouldn't have saved him from that lol. Not a lot of people use bicycles in my state though, and especially not in metro areas. Regardless, your odds off getting wtfmangled are waaaaay worse on a motorcycle than in a car. I've seen so many sad cases, broken families, and people with severe and permanent brain damage from motorcycles that I pretty much hate the damn things. You can only see so many kids looking at their father and begging him to talk and come back to them (when everyone on the medical staff knows he's basically braindead and has been for months) before it starts to get to you. There's nothing I can think of, aside from cancer, that has led to so many profoundly depressing cases.
 
ommnomm said:
I'm not opposed to motorcycles, they're lots of fun. Just trying to point out that certain activities make you morel likely to suffer traumatic injury. Thus if you "deserve" to have health problems from other choices, you could logically say that some people "deserve" traumatic surgery.
Click to expand...
This is the one where you skipped the fun parts...where do you draw the line? People doing 'healthy' activities, or culturally acceptable ones?

Also, I personally see a difference between taking risks and directly damaging yourself. If I were placed in a room with a 6-shot pistol with 1 bullet and a bottle of slowly debilitating poison and told to pick one, I would absolutely aim that gun at my foot, spin, click, spin, click, spin, click, before I would sit there sipping the poison.
 
QuinnTheEskimo said:
Yeah but somehow I don't blame them as harshly. They are kids, they are not mature yet.
Click to expand...

So your qualifier for this behavior is maturity? I hate to break it to you, but plenty of adults are objectively immature.
 
Cyberdyne 101 said:
Many patients with high risk cardiovascular problems fall into the care of vascular surgeons. Prior to the "endovascular revolution" vascular surgeons were among the busiest and possibly the most miserable doctors (various doctors have confirmed this to me).
This study of physician work hours is a few years old, but you can see the who came in first (or last lol).View attachment 180602
Click to expand...

I'm liking these numbers. My current interest is peds EM.
 
Mad Jack said:
Probably 90% of traumatic TBIs we see at my hospital from April to November are motorcyclists. Nearly every patient that is a quad or paraplegic that doesn't have a gunshot wound or cancer is a motorcyclist. I've only seen one bad biking injury in 6 years, and that guy lost consciousness on the bike- a motorcycle wouldn't have saved him from that lol. Not a lot of people use bicycles in my state though, and especially not in metro areas. Regardless, your odds off getting wtfmangled are waaaaay worse on a motorcycle than in a car. I've seen so many sad cases, broken families, and people with severe and permanent brain damage from motorcycles that I pretty much hate the damn things. You can only see so many kids looking at their father and begging him to talk and come back to them (when everyone on the medical staff knows he's basically braindead and has been for months) before it starts to get to you. There's nothing I can think of, aside from cancer, that has led to so many profoundly depressing cases.
Click to expand...

Found this on youtube a few months ago (NOTE, THIS IS A GRAPHIC VIDEO OF A MEDICAL TRAUMA CASE).


Btw, James Bond is the name of the doctor that is featured in this video.
 
Reckoner said:
According to the NHTSA, bicycles accounted for 677 traffic fatalities plus 48,000 non-fatal injuries in 2011, vs 4,612 fatalities and 81,000 injuries for motorcycles. That's a rate of 24.93 per hundred million vehicle miles traveled for motorcycles. The data for bicycle miles travelled per year isn't available, but if you use the Sierra Club's claim of about 9 billion, you get a rate of 7.56 fatalities per hundred million miles traveled. Non-fatal injury rates using the same data are 440 for motorcycles vs. 536 for bicyclists.

So if you want to go by the data, then yes, bicycles should have a more dangerous reputation than they currently do. But motorcycles probably deserve the "hate." Apologies for the derail.
Click to expand...

Both bicyclists and motorcyclists are hazardous to the health of DRIVERS. I've probably already had several mini heart-attacks as a result of cyclists weaving in front of my car. I say get in the bike lane or get off the road.
 
IF you don't learn to deal with it, you better find another career. Or go into Pathology.

QuinnTheEskimo said:
I worry I won't have the patience to deal with self-inflicted health problems ( especially obesity, type II diabetes, drug/alcohol addiction, etc). I haven't even started yet, but I see these types of patients as a recipe for burnout. Anyone else feel this way? Truth be told, this is one of the reasons I'm considering pediatrics (you can't really blame babies and kids for being willfully noncompliant).
Click to expand...
 
mehc012 said:
The real thread-specific point is that in the end, everyone brings their own medical problems on themselves by their lifestyle, and you have to choose what jives with you.
Click to expand...

Not to derail this further, but there are tons of medical problems that are not attributed to lifestyle choices (neurological illnesses, deformities, avm's etc) that are present in adults.
 
Cyberdyne 101 said:
Not to derail this further, but there are tons of medical problems that are not attributed to lifestyle choices (neurological illnesses, deformities, avm's etc) that are present in adults.
Click to expand...
You're not going to make it to Alzheimer's if you crash your motorcycle at 40!

That's a good point, though. I suppose I was more thinking of the common ones, who'll be the bulk of your practice.
 
mehc012 said:
You're not going to make it to Alzheimer's if you crash your motorcycle at 40!

That's a good point, though. I suppose I was more thinking of the common ones, who'll be the bulk of your practice.
Click to expand...

But you could develop serious neurodegeneration prior to age 40 if you play football and that is a very common lifestyle choice👽 (They should have a better alien icon)
image.jpg

(like this)
 
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