Tag: doctor

Posted in Psychology & Medicine

Holistic Medicine

Posted on by Jinavie

At face value, medicine appears to work on a relatively simple model. You gather information through history taking, clinical examination and investigations such as lab tests and imaging. Then, you narrow down the differential diagnosis to the single most likely diagnosis. Lastly, you treat the diagnosis as per the recommended treatment guidelines.

But if you ask anyone who works in healthcare, they will all know that is not the whole truth. There are so many other factors and variables that play in to the management of a patient that the model above does not address.

For example, you may diagnose a skin infection and prescribe antibiotics, but the person may not have enough disposable income to pay for the medications. You may come up with a plan for the patient to come in to clinic in a week’s time for a review, but they may not have transport or someone to look after their children so that they can come in. You may diagnose that there is nothing medically wrong with the patient, but they may still be worried that they have a serious condition that killed their father.

In medicine, you do not treat the disease; you treat the patient. It is easy to get so focussed on the clinical picture that the overall context is lost. This leads to incomplete care, which causes a variety of issues ranging from patient dissatisfaction to recurrent presentations.

Although it may seem difficult and time-consuming to pay attention to these extra details, it almost always pays off in one way or another. Addressing a patient’s troubled social situation may reduce the number of times they present to hospital, saving significant costs. The doctor taking the time to reassure the patient that their symptom is not concerning for a significant illness may let the patient sleep comfortably at night. Talking through the patient or their family’s concerns and questions might make the worst day of their lives slightly more tolerable.

This approach is useful outside of the hospital too. When you face a problem, regardless of the type, instead of trying to come up with a quick fix to patch it up, try to consider the context of the problem. You may discover that there is a deeper, more fundamental cause of the problem that needs fixing.

Posted in History & Literature

Surgeon

Posted on by Jinavie

In many cultures (especially in Asian countries), the public conception of doctors has changed where surgeons are considered the “real doctors”. This is particularly evident in Asian dramas where main characters tend to be surgeons, saving the patient’s life with dramatic operations and charisma. The idea that surgeons are superior to physicians may go as far as some adults advising medical students to become surgeons for a higher status (again, more evident in Asia). However, as the root of surgery is completely different from that of medicine, technically it is a misnomer to call a surgeon a “doctor”.

This is reflected in the relatively unknown fact that a fully-trained surgeon is referred to as “mister”, not “doctor”. To understand why surgeons call themselves Mr., we must look into the origin of the surgical discipline.

In ancient times, surgery was limited to treating flesh wounds and setting bones (with some exceptions such as trepanation), such as those sustained during battles. Other than the odd few cases of specialised surgeons such as Galen of ancient Greece and Hua Tuo of ancient China, it is hard to find records of doctors employing surgery as a form of treatment. This was mainly due to two reasons: that surgery was considered a “dirty, unrefined” form of treatment, and that surgery was too risky.

For a long time, especially in the Western world, surgery was considered to be of a lower status compared to medicine. It was considered more of a craft tradition – something which physicians believed was beneath them. Because of this, surgeries were mainly performed by barbers in medieval Europe. One can still find evidence of a barber’s alternative historical role on the barber’s pole, which has white, red and blue stripes. The white stripe symbolises bandages, the red symbolises arterial blood and the blue symbolises venous blood. This originates from the practice of bloodletting, where white bandages wrapped around a pole would get dyed red from the blood, giving the appearance of the barber’s pole. The profession of “surgeon” did not formally appear until around the 18th century when a Guild of Surgeons was formed in England. However, physicians refused to accept surgeons as equals for a further century. When they did come to accept that surgery was a legitimate form of medical treatment, the surgeons decided that they did not want to be assimilated as doctors, so they chose to keep their title of “mister” to distinguish themselves from physicians.

The reason why surgery was considered an unrefined art in the past mainly focuses on three issues: bleeding, pain and infections. Before modern surgical developments, uncontrolled bleeding was a real issue in surgery. This not only made surgeries extremely messy, but it was also dangerous for the patient as patients would often die from shock (dangerously low blood pressure). On top of this, anaesthetics was only introduced in the late 19th century, meaning before that, patients had to suffer the pain of their flesh being cut and stitched with no relief. Of course, this meant that surgeries were almost always a brutal scene, with the agonising screams of the patients filling the room, while they sprayed blood everywhere. Lastly, even if the patient somehow survived the surgery without bleeding out or dying from the stress and pain, there still remained a high risk of post-operative infection. Thus, surgeries were most often unsuccessful and were considered a barbaric form of treatment with no promise.

Thanks to medical advancements, surgery has become an important aspect of medicine, where one cannot live without the other. However, the tension still remains between physicians and surgeons, with each profession jokingly mocking the other whenever a chance arises.

Posted in Psychology & Medicine

Lazarus

Posted on by Jinavie

In the New Testament of the Bible, there is a scene where Jesus resurrects a man by the name of Lazarus back four days after his death. This “miracle” is of course a fictitious event, but nonetheless, the name Lazarus has come to symbolise resurrection after death. For example, there are two actual medical conditions named after Lazarus, both related to death.

The first is called Lazarus phenomenon, where a person who is declared to be clinically dead spontaneously returns to life. This is an extremely rare event that has only been recorded in about 30 cases. In most of these cases, the patients had suffered a cardiac arrest, with all attempts at resuscitation (e.g. CPR, adrenaline) had failed. Sometime after the person was declared clinically dead (usually around 5~10 minutes), the person’s circulatory system would suddenly start on its own and the person would be “resurrected” (quite literally). In one case, a 61 year-old woman was declared officially dead after her heart stopped and her vitals did not return after continuous resuscitation. At the morgue, however, she was found to have a pulse and breathing on her own. She later sued the hospital for the neurological and physical injury caused by oxygen deprivation during her death. There is even a case report of a patient who returned to life two and a half hours after dying (although he died again 3 weeks later).

Of course, the Lazarus phenomenon is not a miracle. In most cases, it is hypothesised that when resuscitation is attempted then stopped, there is a rare chance of the relieving of pressure causing blood to fill the heart, causing a sudden expansion and kickstarting the electrical circuit. Other factors that may influence this is hyperkalaemia resulting from ischaemia and high doses of adrenaline given to the patient during resuscitation having a delayed effect.
Because of this rare “complication” of death, doctors are advised to observe the patient for about 10 minutes after declaring them dead. Just in case.

The second is called Lazarus sign and it occurs not in dead patients, but brain-dead patients. Brain-dead patients are immobile as their higher functions such as cognition and motor functions are destroyed. However, there are rare cases where the brainstem is somehow stimulated, triggering a reflex arc from the spinal cord. This reflex is seen as the patient suddenly raising their arms and dropping them on their chest in a crossed position, much like Egyptian mummies. As the spinal cord is not usually damaged in brain-dead patients, this reflex arc is possible, similar to a knee jerk reflex. The Lazarus sign should not be misinterpreted as a sign that a brain-dead patient is conscious, as it is an involuntary movement. However, it has been mistaken for the resuscitation of a patient, or in some cases, as a miracle.

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Posted in Psychology & Medicine

Scrubs

Posted on by Jinavie

Scrubs is the uniform that surgeons, anaesthetists, emergency department doctors and nurses wear for the freedom and mobility required in activities such as surgery and CPR. Also, since it is owned and washed by the hospital instead of being privately owned, it is more hygienic and helps prevents infections. A noticeable trait of scrubs (and also surgical gowns) is that almost every hospital uses a shade of blue or green instead of white. Why is this?

The reason being, looking at a surgical scene for a long period of time can cause eye fatigue and afterimages due to the redness of blood and organs. Afterimage is a phenomenon that occurs when the retina becomes insensitive to a strong colour and instead making the complementary colour stand out more. Ergo, a surgeon looking at blood and organs for too long will see afterimages of a blue shade, which may cause accidents to happen as it overlaps on white surfaces or the surgical field. Clothing of blue or green colour neutralises the afterimage and is much easier on the eyes, reducing the fatigue. Lastly, blue-green colours have a calming psychological effect, which helps in a high-tension, stressful environment such as in an operating theatre.

Posted in Psychology & Medicine

Pulse

Posted on by Jinavie

Blood, which supplies all the cells in the human body with nutrients and oxygen, flows through the vessels due to the pumping of the heart. Thus, blood flow directly transmits the force generated by every heartbeat. As the blood ejected by the heart causes the arteries to “pulse” by stretching and relaxing. As some pulses can be felt over the skin, they are very useful in patient examinations, especially a clinical exam of the cardiovascular system. Although people commonly know how to take a pulse from the wrist or neck, there are many more places a pulse can be taken from.

  • Radial pulse: Taken from the inside of the wrist on the side of the thumb.
  • Brachial pulse: Taken from the inside of the elbow.
  • Carotid pulse: Taken from where the neck meets the jawline, or 2~3cm either side of the Adam’s apple to be precise.
  • Apex beat: This measures the heartbeats directly, taken on the left chest between the 4th and 6th ribs (around the left nipple).
  • Abdominal pulse: Taken from above the belly button of a lying patient, may be able to see the pulse.
  • Femoral pulse: Taken from the middle of the groin. 
  • Popliteal pulse: Taken from the inside of the knee.
  • Posterior tibial pulse: Taken from the inside of the ankle behind the bone.
  • Dorsalis pedis pulse: Taken from the back (upper side) of the foot along the middle.

When taking a pulse, you use your second and third fingers (and the fourth if you want) and press lightly on the pulse point. If you press too hard, you may stop the blood flow and obliterate the pulse. As a pulse is measured per-minute, it is often taken for 10 or 15 seconds and multiplied by 6 or 4 respectively. Also, it should be noted whether the pulse has a regular rhythm, and if it is irregular, whether it is regularly irregular or irregularly irregular. If the pulse is over 100 beats per minute, it is called tachycardia, while less than 60 beats per minute is referred to as bradycardia. If it is irregular, it is called an arrhythmia.

An experienced doctor can diagnose different conditions such as an aortic stenosis or atrial fibrillation just from taking the pulse of the patient. Taking a pulse is also a crucial diagnostic tool in traditional Korean and Chinese medicine.

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Posted in Life & Happiness

Specialist

Posted on by Jinavie

In modern ant cities, there can be found many genetic mutations as a result of millennia of division of labour. Thus, ants born with large mandibles that can cut down enemies become soldier ants, while ants born with mandibles that can grind grains become milling ants. Some ants have highly advanced salivary glands and these ants wash and disinfect young larvae.

Here are some examples of the amazing adaptability of ants through the use of mutations:

  • Doorkeeper ants have large, flat heads that can block strategically important entry points to guard the hive. If a worker ant wishes to enter the hive, it must knock on the broad head. If it gives the wrong password, the living door attacks and devours the worker ant.
  • Honeypot ants are found in some tropical ant species. These worker ants are hung upside down on the ceiling and are filled with honey until their abdomens swell up to 20 times the normal size. When another ant comes and strokes the honeypot ant, it releases a few drops of honey it is storing.

However, out of all of these mutations that produce “specialists”, the most noticeable is the mutation that produced specialists of love.
Worker ants are born without the ability to reproduce. This is to prevent these busy worker ants from being distracted from sexual impulses. Reproduction is left to certain ants that do nothing other than reproduce. These ants are the male and female ants – essentially the princes and princesses of the ant kingdom. These ants are born only to make love and have special anatomical features that make the mating process easier. Wings that allow them to fly, antennae that allow the communication of abstract emotions and eyes that can sense infrared light are all examples of this.

How about human beings? We too have “specialists”, but they are not based on features we are born with. Instead, they are a result of the education and upbringing we receive as we grow up – an acquired specialisation rather than a natural one. Then again, it is not as if we are all born equal. Some people are born with a more muscular body that is helpful for labour-intensive work, while others are born with more intelligent brains that are better for jobs that require much thinking. However, our societies have a strange style of oppressing these natural talents and only push study on them. No matter how good a child is at the arts, music or sports, their abilities are ignored and the children are forced to conform into a pre-set path. If a child is introverted and prefer working quietly indoors, they are told off and told to become more extroverted. Ultimately, human societies prefer producing all-round individuals rather than specialists in a certain trade.

But what if we did what ants did and recognise a child’s natural talents and nurture it? The Jewish people have followed a system of education that focusses on helping a child develop their own skill instead of forcing something on them. Considering that 18 of the 40 richest people in USA are Jewish, it could be suggested that this is a very effective form of educating children.

Then why do so many parents want their children to become doctors, lawyers and CEOs? The reason is capitalism. Given the characteristics of the jobs, they are comparatively better paid and more stable than workers and artists. Ergo, parents push children towards such professions “for the sake of their future”. Even though many other professions are required for the smooth functioning of society. If so, could we not equalise the pay of all jobs? Unfortunately, this was tried in communist states but tragically failed as the incentive to study and go into such professions disappeared as the pay was “not worth it”. In fact, the major reason for the downfall of communism was human greed. As ants work for the good of the society rather than the individual, they have the luxury of doing the job they were literally born for and still be well-nourished.

Then what if we paid salaries not equally, but fairly? For example, instead of giving everyone the same pay, we pay people according to the amount of work they do, regardless of the profession. If we distributed the unnecessarily high amounts of wealth of politicians and upper class have to fund the wages of technicians and artists, the income gap between jobs would disappear and children would receive the same reward for whatever profession they chose (given it helps society). If this was implemented, then everyone would be able to bring out their strongest trade and significantly boost productivity. Furthermore, the tragedy of having to give up something you want to do for the sake of money would disappear. If we can find a way to overcome human greed and make equitable distribution of wealth possible, human societies would be able to kill two birds with one stone – progress and happiness.

(first half from the Encyclopaedia of Relative and Absolute Knowledge by Bernard Werber, second half from author’s original thoughts)
(Image Source: http://www.behance.net/gallery/Collages-ABC-of-professions/237797, see source for description of each letter (professions in French))

Posted in Philosophy

Clown

Posted on by Jinavie

Excerpt from Rorschach’s journal, October 16th, 1985

“…Heard a joke once: Man goes to doctor. Says he’s depressed. Says life seems harsh and cruel. Says he feels all alone in a threatening world where what lies ahead is vague and uncertain.

Doctor says “Treatment is simple. Great clown Pagliacci is in town tonight. Go and see him. That should pick you up.”

Man bursts into tears. Says “But, doctor…I am Pagliacci.”

Good joke. Everybody laugh. Roll on snare drum. Curtains. Fade to black.”

(from Watchmen by Alan Moore)

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Posted in Psychology & Medicine

Munchausen’s Syndrome

Posted on by Jinavie

Some people are known to overreact regarding their health, such as a hypochondriac thinking that she has kidney failure because her urine looks slightly frothier. However, some people far surpass the level of hypochondrias to the level of psychiatric disease.
Münchausen’s syndrome patients are known to exaggerate or create symptoms so that the doctor would pay attention to them. When the doctor investigates, treats and sympathises with the patient they gain satisfaction from all the attention they are receiving.
Although this may sound like hypochondrias, Münchausen’s is far more serious.

A Münchausen’s patients are known to cause symptoms just to get attention from others. For example, a common manoeuvre used is the injection of insulin to induce a hypoglycaemic seizure. When their symptoms are “treated”, the patient will most likely invent another factitious disease to be treated for a longer time. They will also seek out many different doctors when the attending doctor catches on to their act. In fact, a Münchausen’s patient will do almost anything to prolong medical care, even accepting unnecessary and risky procedures such as surgeries.

The key difference between Münchausen’s syndrome and hypochondriasis is that the patient is aware that they are not actually sick (hypochondriacs actually believe they are sick). The fundamental basis for Münchausen’s syndrome is the desire for attention. Thus, the main risk factor for developing Münchausen’s is childhood experience of seeing someone close (typically a family member) suffering a debilitating disease. For example, if a girl sees her sister suffering from leukaemia and receiving all the attention of everyone around her, she may develop feelings of jealousy and later try to duplicate the scenario. As a patient, the person feels safe and comfortable and this feeds their addiction to medical care.

As Münchausen’s patients are very proficient liars and act completely like an actual patient, doctors must rule out any diseases before suspecting that their patients have a psychiatric problem. However, some signs such as the patient being overly keen on receiving procedures such as biopsies or continuously developing random symptoms may indicate Münchausen’s.

Interestingly, a similar condition called Münchausen’s syndrome by proxy also exists, where a caregiver (e.g. mother) convinces a doctor that the person they are caring for (e.g. child) are sick. Unfortunately, as these patients actually cause illness in the child, it is considered a form of child abuse. Common “symptoms” include: growth problems, asthma, allergies, vomiting, diarrhoea, seizures and infections. This may lead to the child developing Münchausen’s syndrome in the future.

Posted in Psychology & Medicine

Hysteria

Posted on by Jinavie

Hysteria is a disease that was believed until the late 19th century to be a disease unique to women due to a pathology of the uterus (hystera is Greek for uterus). The most common symptom was mental disturbance (such as extreme moods) accompanied by shortness of breath, vaginal dryness, nervousness, insomnia, oedema, faintness and many more. The treatment back then was for a physician to massage or stimulate the patient’s vagina to induce an orgasm. By the 19th century, the treatment evolved and involved vibrators and water massage machines.

This disease was first noted by Hippocrates, the father of modern medicine. Galen, another famous physician in the 2nd century, believed it to be caused by sexual deprivation. Thus, sexual intercourse was prescribed as treatment in the Middle Ages.

Modern medicine no longer recognises hysteria as a medical condition and is now referred to as sexual dysfunction (the sexual treatments described above are no longer used either). However, there is a condition called mass hysteria that indeed exists.
This is a psychological phenomenon rather than a disease, commonly occurring in closed spaces such as planes or in crowds in a state of panic. When a high tension situation arises, people easily become delusional and believe that they are suffering from a disease. The body reacts to this with actual symptoms such as a psychosomatic rash. These symptoms can be as severe as fevers, vomiting and even paralysis.

If many people are all complaining of similar symptoms and infectious disease seems unlikely, there is an easy way of diagnosing mass hysteria. Tell the patients that they have a rare disease and begin listing the symptoms they complain of. At the end, make up a false symptom (e.g. “shaking of the left hand”). If the patients all suddenly start to shake their left hands (which causes them to panic more), it is likely that their panicking brain is causing the symptoms rather than some pathogen. Symptoms subside after the patients relax.

Interestingly, mass hysteria affects women much more than men.

Posted in Psychology & Medicine

ICU Syndrome

Posted on by Jinavie

ICU stands for intensive care unit and is the place where patients are sent after an operation to stabilise and recover under supervision. ICU patients commonly have a very unique and strange post-operative experience.

ICU syndrome is a type of delirium where the patient experiences severe anxiety, fear, hallucinations or delusions. Although the cause has not been determined, it is likely related to post-op stress, the segregation and loneliness in the ICU room and confusion from coming out of anaesthesia. This is especially the case if an emergency situation led to the surgery being longer than expected or resulted in additional surgery, causing extreme confusion in the patient.

A patient suffering from ICU syndrome tends to be extremely excited and unstable. They may develop intense paranoia or distrust (especially against medical professionals), which can lead to fits or dangerous acts such as pulling out cannulas and lines. A friend or loved one talking calmly to the patient has a great effect in helping the patient overcome the delirium. Therefore, allowing the family to visit to keep the patient company and calm is an effective way to prevent ICU syndrome. However, if the situation spirals out of control, a sedative or anti-psychotic may need to be administered.

A study states that about 25% of patients admitted to the ICU suffer from ICU syndrome. It is one of the most common causes of delirium and any patient can get it (elderly patients are more likely to). Interestingly, there is a theory that medical professionals are more likely to suffer ICU syndrome after an operation.
Nowadays, the term ICU syndrome or ICU psychosis is discouraged and is instead grouped under delirium (which is an actual psychiatric disorder, not just a general term).