Odysseys of George

A moving talk – something for patients and doctors alike…..something we doctors have forgotten .. the human touch.

As written on the TED, “Modern medicine is in danger of losing a powerful, old-fashioned tool: human touch. Physician and writer Abraham Verghese describes our strange new world where patients are merely data points, and calls for a return to the traditional one-on-one physical exam.”

I read this beautiful article by Dudley Clendinen who is a former national correspondent and editorial writer for The Times, and author of “A Place Called Canterbury” and suffers from Lou Gehrig’s disease.

The Good Short Life
By DUDLEY CLENDINEN

I have wonderful friends. In this last year, one took me to Istanbul. One gave me a box of hand-crafted chocolates. Fifteen of them held two rousing, pre-posthumous wakes for me. Several wrote large checks. Two sent me a boxed set of all the Bach sacred cantatas. And one, from Texas, put a hand on my thinning shoulder, and appeared to study the ground where we were standing. He had flown in to see me. continue reading…

This article was written by RONALD MCCOY who was the former president of Malaysian Medical Association (MMA) and International Physicians for the Prevention of the Nuclear War (IPPNW)

My right to wear clean yellow T-shirt

Human rights and fundamental freedoms have become dominant issues of the day, since the United Nations General Assembly adopted the Universal Declaration of Human Rights in 1948.

The Preamble states that recognition of the inherent dignity and equal and inalienable rights of all individuals is the foundation of freedom, justice and peace in the world.

1966, the General Assembly adopted two binding Covenants, the International Covenant on Economic, Social and Cultural Rights and the International Covenant on Civil and Political Rights, which together with the Declaration form the International Bill of Human Rights.

However, the Malaysian government has not signed or ratified both Covenants. continue reading…

There was an editorial written in Surgery News by the esteemed lead editor, Lazar J. Greenfield, M.D. who is a Professor Emeritus of Surgery, University Michigan and also the president-elect of the American College of Surgeons. The editorial brought about complaints and eventually, the inventor of the Greenfield filter — a device placed in the IVC (inferior vena cava), used to prevent blood clots migrating to the lung, resigned as the editor -in-chief and the editorial was retracted. However, the editorial was printed on a blog.

As I read the editorial, I personally find no fault with it. However, many women found it demeaning and offensive especially the last sentence. I would like to know what readers feel of this editorial thus I will paste the editorial here. For the comments and what was the issues leading to the resignation of a surgeon of such caliber and a retraction of the editorial seem to me just a little bit over-kill and very political in nature! I guess it is one of those instances where people were just waiting to kick his butt probably for some other reasons which have been accumulating over time – being a surgeon, I foresee a possible character issue with being blunt, sarcastic and occasionally rude.

** taken from Retraction Watch
Now back to the offending editorial, which we’ll bring you in its entirety since 1) we think given the events that you should read the whole thing, and 2) because the ACS has taken the entire February issue off its website we can’t link to it even if we wanted to (more on that later). Under the heading “Gut Feelings,” Greenfield wrote (we added links):

One of the legends of St. Valentine says that he was a priest arrested by Roman Emperor Claudius II for secretly performing marriages. Claudius wanted to enlarge his army and believed that married men did not make good soldiers, rather like Halsted’s feelings about surgical residents. But Valentine’s Day is about love, and if you remember a romantic gut feeling when you met your significant other, it might have a physiological basis.

It has long been known that Drosophila raised on starch media are more likely to mate with other starch-raised flies, whereas those fed maltose have similar preferences. In a study published online in the November issue of the Proceedings of the National Academy of Sciences, investigators explored the mechanism for this preference by treating flies with antibiotics to sterilize the gut and saw the preferences disappear (Proc. Nad. Acad. Sci. U.S.A. 2010 Nov. 1).

In cultures of untreated flies, the bacterium L. plantarum was more common in those on starch, and sure enough, when L. plantarum was returned to the sterile groups, the mating preference returned. The best explanation for this is revealed in the significant differences in their sex pheromones. These experiments also support the hologenome theory of evolution wherein the unit of natural selection is the “holobiont,” or combination of organism and its microorganisms, that determines mating preferences.

Mating gets more interesting when you have an organism that can choose between sexual and asexual reproduction, like the rotifer. Biologists say that it’s more advantageous for a rotifer to remain asexual and pass 100% of its genetic information to the next generation. But if the environment changes, rotifers must adapt quickly in order to survive and reproduce with new gene combinations that have an advantage over existing genotypes. So in this new situation, the stressed rotifers, all of which are female, begin sending messages to each other to produce males for the switch to sexual reproduction (Nature 2010 Oct. 13). You can draw your own inference about males not being needed until there’s trouble in the environment.

As far as humans are concerned, you may think you know all about sexual signals, but you’d be surprised by new findings. It’s been known since the 1990s that heterosexual women living together synchronize their menstrual cycles because of pheromones, but when a study of lesbians showed that they do not synchronize, the researchers suspected that semen played a role. In fact, they found ingredients in semen that include mood enhancers like estrone, cortisol, prolactin, oxytocin, and serotonin; a sleep enhancer, melatonin; and of course, sperm, which makes up only 1%-5%. Delivering these compounds into the richly vascularized vagina also turns out to have major salutary effects for the recipient. Female college students having unprotected sex were significantly less depressed than were those whose partners used condoms (Arch. Sex. Behav. 2002;31:289-93). Their better moods were not just a feature of promiscuity, because women using condoms were just as depressed as those practicing total abstinence. The benefits of semen contact also were seen in fewer suicide attempts and better performance on cognition tests.

So there’s a deeper bond between men and women than St. Valentine would have suspected, and now we know there’s a better gift for that day than chocolates.

Sad to say that such an editorial can bring down an eminent man to his knees. Any hopes to go further in the surgical fraternity is next to impossible. The question is where does this lead too – are we all going to have to write political correct articles and that being sarcastic or blunt is totally disallowed? I read that editorial over and over again and am still not able to find it offending or demeaning rather find it a little amusing. Are we getting too uptight?

Posted by a blog friend Vijay!

Enjoy!

Today in the newspaper, the Director General of Health spoke on a few issues namely:
1. The exorbitant fees in private practice
2. The failure of medical curriculum
3. The loss of human touch
4. Mushrooming of medical schools
5. Quality of Housemans

Lets look at the issues which actually has been around for ages and yet the typical Malaysian attitude prevails that is to make noise and then forget about it as fast as it was brought up.

The issue of exorbitant private fees have been brought many times but what most of us fail to understand is that while the doctors charges are regulated by the MMA, the private hospital charges aren’t. Well, then again there are many aspects that this matter can be looked at. The doctors who do their job and charges according to the MMA schedule, well I guess that should not be an issue. However, there will always be the ugly ducking, where charges are made unethically, though bounding to the schedule – that is to say there are abusers of the schedule — people who will make multiple charges for a 10 minute procedure for instance. From the hospitals standpoint, medications, technology and utility charges are rising and therefore the need to increase the charges gradually but saying this some hospital managements are equal to that of hotels. I suppose that it is difficult to regulate the hospitals as many sitting on the top of these hospital managements are linked politically or another and thus are indispensable. So the best way – squeeze the doctors!

The failure of the medical curriculum and the mushrooming of medical faculties are issues that have been voiced for many years. The problem is that those who now enter universities are not mentally prepared to undertake the real university education which for the failure of our secondary education, the tertiary education has been modified. Many lectures and professors have been heard saying that students that enter universities nowadays are not mentally matured as what it was before. The students are less resilient and the need to “hold hand and guide” is so high that if the past system maintains there would be many more failures and mental breakdowns. This I believe is the failure of the primary and secondary education. Then we have the major migration of brains to overseas especially to our neighboring Singapore. Then we have so many medical schools that blooms faster than mushrooms that dilutes the brains further. This has caused many major medical faculties to fall to the support of younger inexperienced staff to teach. Many of these new medical faculties do not have enough staff to teach their medical students and are dependent on the support of government specialist to assist the teaching of their students. The remunerations in pay and the acknowledgment of the work of those who did this country proud has been forgotten and left unattended to the extent frustration would be the natural response. Now, in government service everybody is sitting on the same scale as long as you are a specialist regardless of seniority and experience which is paramount in medical fraternity. I regress. The curriculum has been modified over time to make medical education more fun and attractive at the price of the quality of education. The so called US-based system is adopted without taking into consideration the local health system. There are more assignments and projects which has overtaken the need of medical students to spend time with patients. So, one wonders why the loss of human touch? Medical students nowadays hardly spend anytime with patients unlike my time. I have seen this happening in UMMC,UITM and also USIM. I am sure it is across the board.

Then we have the new houseman. As it is with students entering universities, we now have fresh doctors who are not ready to work and fail to realize that they are in a job that deals with life. Our government has spent billions to send some “brains” to many ambiguous medical universities overseas where the curriculum is worse than that of our very own — where they hardly have exams and that these fresh doctors hardly know what the thyroid gland is or what hernia is all about. It irritates me that the DG says that the onus are on the specialist to train these fresh graduates when at the same moment protects these bunch of fresh doctors with various rules and regulations. These new doctors are so not ready for the job that in recent years, as the DG says, “There have been many instances where housemen experienced mental anguish, depression, anxiety, stress and suicidal tendencies while undergoing training and this is no laughing matter.” But the truth to the matter is not to then blame the specialist but to then go back to the crux of the issue – stop sending these students to such places. As a patient, would you be happy to be treated by somebody who know not where the thyroid gland is or know not how to ascertain your diagnosis because he has no clue what your complaint is about? Is it fair for the public to be treated by these generation of fresh doctors even though there are specialist supposedly overlooking their work? There are people you can train and teach and there are the ones you just can’t! To make things worse, the DG decides to enforce a promotion exercise where part of the assessment is from the housemen– “As such, he advocated a two-way assessment system where not only the specialist and doctors provide feedback, but the houseman would also be given an opportunity to provide feedback on their trainers. On the criteria for promotion of public service doctors, Ismail said it was based on five main aspects, namely service, training, research, one’s standing in the eyes of peers and the 360 degree perception” — ridiculous — it only encourages the system to get worse then any better as now those specialist who really care and are strict would be judged badly and those who have no regards for the future of the medical system would be promoted quickly – Bullocks!

This is just part of the matter but I have said enough for now!