Thoughts on NY Med: Part 2/2

This week, I've been analyzing some episodes of NY Med. Last post I discussed Dr. Oz's view on some requirements for surgery. And they didn't involve the patient's state of health.

Today, I'm going to look at another aspect. Let's call it . . . expectations.

We, as medical providers, have a set of expectations for our patients. We assume, rightly or not, that when you come to the ER you'll generally be on board with what the medical game plan is. After all, we've been through medical training and most of our patients haven't. There is the thought that you'll defer to our training and years of experience when we give you the medical game plan for your complaint.

Conflict arises in this scenario when a couple of things happen that I'll highlight below.

1. The family has a preconceived idea of what the medical care should be and thinks, perhaps, we're not doing our jobs correctly if we don't do their medical game plan. A good example of this in pediatrics is the use of CT scans for concussion. We don't need a CT scan to diagnose a concussion-- or grade a concussion. A physician can diagnose that from your symptoms. The use of CT in head injury is to look for something that would require a neurosurgeon to fix. Like a clot that would need to be evacuated. Generally, the patient will exhibit a focal neuro deficit (I can't move one arm) that gives a hint this might be occurring. Oddly, vomiting in head injury is not the gold standard of solely determining need for CT scanning-- neither is LOC or amnesia though these will play into the whole picture. We actually don't want kids to get exposed to radiation unnecessarily because they have long lives ahead of them for potential mutations to occur that could lead to cancer.

2. The family disagrees with the proposed game plan. In kids-- a good example would be us suggesting IV fluids for vomiting and/or diarrhea. "But, I don't want her to get an IV!" We sort of stand back and scratch our heads. Then why did you bring her in?

We like to fix things . . . and when you don't let us . . . we do wonder why you came to visit.

In episode #4 of NY Med-- a young gentleman gets shot in the leg. The physician goes on to explain that he's going to leave it in place.

"This kid's so lucky he got shot in the thigh. I mean, there's no better place for him to get hit. There's nothing there but muscle. He will have no permanent issues from this."

He goes onto explain that "bullets travel so fast that they're sterile. He gets a dose of antibiotics and a tetanus and we just let it heal."

Then mama bear shows up and the conversation goes something like this . . .

Mama Bear: "I would like you to remove the bullet."

Surgeon: "Once it's healed we can electively take it out. That's better with less chance of infection."

Mama Bear: "What do you mean? I cannot understand. You mean when he's 50 and can't heal as good? You do it when he's young."

Surgeon: "This is pretty standard . . . not taking (the bullet) out at this point."

Mama Bear: "This is not standard to me."

Surgeon: "This is why you're not a doctor. He has a high chance of infection right now (if we do the surgery.)

Father Bear: "Let's just work with the doctor."

There is sometimes a very fine line, or balance, to maintain between the family and the medical teams expectations and these types of situations can definitely add to tension in your novel.

What do you think?

Thoughts on NY Med: Part 1/2

About one year ago, ABC news ran a documentary series entitled NY Med where TV cameras followed around medical personnel to show real life in the hospital setting. This is the medical institution where Dr. Oz works which I'm sure was one of the reasons the hospital was chosen-- I mean, right?

And of course-- you knew I'd be watching. You could have called me up. Oh right, I wouldn't have answered.

Watching medical documentaries is a true source of entertainment.

There were several situations from the show that were interesting to me that I thought we'd discuss here in this forum that I would LOVE to know your thoughts on.  I found the episodes for free on Hulu. Here is the link to the first situation we'll be discussing. It is the very first segment so you wouldn't have to watch far.

Situation One:
A male patient comes in for a consult with Dr. Oz in regards to possibly needing heart valve surgery. He'd begun to experience some shortness of breath (SOB is how it is sometimes annotated in medical charts-- so if you see this the doctor was not trying to insult you.)

The conversation goes like this:

Dr. Oz: Are you here by yourself?

Jack: Yea.

Dr. Oz: Why?

To which the patient responds with something indiscernible.

They begin to discuss the surgery.

Dr. Oz: Who is going to have your power of attorney in case something bad happens to you?

Jack: Uh, I'll probably give it to my ex-wife.

Dr. Oz: You're still close to her?

Jack: Yea, Yea.

Dr. Oz: Can I call her?

Wow-- and he really does call his ex-wife on the phone-- speaker and everything.

He later explains the following:

"I'm very concerned when a patient walks into my office and they don't have family with them. It is a very concerning sign because it means that they may be isolated socially. I have made the mistake of operating on people who had no one who loved them. So I now insist that that person identify one person who they love and who loves them back because if you don't have a reason for your heart to keep beating . . . it won't."

Wow.

On a personal note, some of you know I had a family member in the hospital for a month. He'd had a big abdominal surgery and suffered some complications. I was in relieving my aunt one day when the doctors were rounding. A necessary discussion ensued about my relationship and if they could discuss his medical case in front of me. This led to the doctor commenting about how much better patients do when they have family visiting and helping to care for them.

What do you think about this stance? Do you think it should be a requirement for surgery?