I just watched My Sister's Keeper and I did like the movie- I enjoyed watching it and felt it was a thought provoking story- but the glaring in-accuracies threaten to send the wrong message regarding the use of Pre-Implantation Genetic Diagnosis and the ethics surrounding solid organ transplant.
Now, Pre-Implantation Genetic Diagnosis (PGD) is a technology that can be used to select certain embryos for implantation in the mother. Just as described in the movie, a sibling may be "created" in this manner and specifically selected to be an HLA match to an ailing child.
But, normally, the cord blood is harvested, and that's typically where the use of the new sibling for "spare parts" ends. Once the cord blood has been used in a transplant, the sibling would not typically serve as a bone marrow reservoir. If the bone marrow transplant failed the sibling would NOT be a repeat donor.
Also, from my limited experience with transplant medicine, I've seen that PGD is NEVER used for the purpose of solid organ transplants. The doctor in the movie seemed that he would be on-board with the transplant, and the use of the younger sibling for this purpose. In real life, a doctor would NOT agree to this. Kidney donors are carefully selected, not just for their biological compatibility, but also for the emotional ability to cope with being involved in the transplant process. Organs are NEVER taken from an unwilling individual.
So, it was a sad and moving story, and I enjoyed the move for that, but it sends the message that PGD is used to create "spare parts" and gives the illusion that this technology presents ethical quandaries that in fact do not exist. Anyone reading this blog can be assured that American children are not currently being forced to give up their spare kidneys. Even if a (minor) child begged to give his or her kidney to an ailing sibling, the kidney would not change hands (abdomens?).
Friday, January 29, 2010
Monday, January 25, 2010
Health Care Issues
I watched a Dateline episode yesterday; the subject was Healthcare and the detrimental effect it's having on patient care. It really brought to light some of the actual problems with an insurance industry hell-bent on profits, but it also brought to light some of the problems that surround end-of-life care and the expectations of families.
There was a heartbreaking case- a man with cancer wanted to enroll in a study that promised cutting-edge treatment unavailable through other channels. Of course, the study covered costs directly related to the study, but outside of that, the man's insurance was supposed to kick in. And, his insurance company refused to pay for expenses related to the desired experimental treatment. There were some appeals, and the insurance company ultimately decided to cover him. But, by that time, the man no longer qualified for the study as he had gotten sicker.
The patient got sicker and sicker, and his wife spoke of a traumatic day when he took a turn for the worst, and she was supposed to make decisions regarding his code status.
The insurance company managed to avoid paying some potentially large bills by delaying the man's care. But, the wife seemed under the assumption that this care would be life saving, and that the insurance company had in essence killed her husband. And then, for reasons unknown to me (based on the fact that I was only watching this on television and have only one side of the story), the wife seemed unfamiliar with DNR/DNI and code status. She described the day her husband took a turn for the worse; a "crash cart" had appeared and she was reportedly asked to make some fast decisions.
From being in the hospital, I remember talking to the family of an end-stage cancer patient. They did not want to make the patient DNR DNI because the patient's daughter had seen a code when she was with her mother in the emergency room, and as she said, "It really works!" Her mother was virtually comatose, and a code was likely to bring nothing more than broken ribs and more heartbreak. The family saw DNR DNI as equivalent to doctor assisted murder.
The insurance companies are so hell bent on profit that care is often refused or delayed; but millions are spent every year on end of life care for patients for whom a medical code is more cruel and pointless than anything else.
But, as someone who believes that discussion of a patient's code status is important, and furthermore that DNR/DNI is sometimes a good thing as opposed to a failure of medical care, I am a card carrying Death Squad member.
I feel terrible for the woman on Dateline; while I think that the case illustrated important issues surrounding code status, it also shows that families of the critically ill are forced to argue and fight with insurance companies. A lot of wasted time and heartbreak, and the big picture is lost.
There was a heartbreaking case- a man with cancer wanted to enroll in a study that promised cutting-edge treatment unavailable through other channels. Of course, the study covered costs directly related to the study, but outside of that, the man's insurance was supposed to kick in. And, his insurance company refused to pay for expenses related to the desired experimental treatment. There were some appeals, and the insurance company ultimately decided to cover him. But, by that time, the man no longer qualified for the study as he had gotten sicker.
The patient got sicker and sicker, and his wife spoke of a traumatic day when he took a turn for the worst, and she was supposed to make decisions regarding his code status.
The insurance company managed to avoid paying some potentially large bills by delaying the man's care. But, the wife seemed under the assumption that this care would be life saving, and that the insurance company had in essence killed her husband. And then, for reasons unknown to me (based on the fact that I was only watching this on television and have only one side of the story), the wife seemed unfamiliar with DNR/DNI and code status. She described the day her husband took a turn for the worse; a "crash cart" had appeared and she was reportedly asked to make some fast decisions.
From being in the hospital, I remember talking to the family of an end-stage cancer patient. They did not want to make the patient DNR DNI because the patient's daughter had seen a code when she was with her mother in the emergency room, and as she said, "It really works!" Her mother was virtually comatose, and a code was likely to bring nothing more than broken ribs and more heartbreak. The family saw DNR DNI as equivalent to doctor assisted murder.
The insurance companies are so hell bent on profit that care is often refused or delayed; but millions are spent every year on end of life care for patients for whom a medical code is more cruel and pointless than anything else.
But, as someone who believes that discussion of a patient's code status is important, and furthermore that DNR/DNI is sometimes a good thing as opposed to a failure of medical care, I am a card carrying Death Squad member.
I feel terrible for the woman on Dateline; while I think that the case illustrated important issues surrounding code status, it also shows that families of the critically ill are forced to argue and fight with insurance companies. A lot of wasted time and heartbreak, and the big picture is lost.
Thursday, December 31, 2009
Step 2 CS
There are 3 board exams required for licensing. USMLE Step 1 is the first. This is taken after the second year of medical school and covers all the knowledge acquired during the first two years. Neuroscience, genetics, pathology, pharmacology, physiology, epidemiology, and microbiology are some of the subjects included. It's the hardest of the 3 exams, and the score counts the most. The average score is roughly 220. That's the three digit scores. Then there's the two digit score, a mysterious number that isn't a percentage or a percentile. 75 is passing. I have a 230, which correlates to a 98. I'm not sure how one relates to the other.
Some residency programs have "cut off's" and supposedly won't even consider lower scoring applicants. These tend to be the more competitive programs- the ones on the "ROAD" to happiness (Radiology, Ophthalmology, Anesthesiology, Dermatology) as well as Ear Nose and Throat, and Neurosurgery. I'm really not sure how hard and fast these cut-offs are, but I do know that when our Step 1 scores were released, one of my classmates sadly decided that Neurosurgery wasn't in the cards for him. Another was convinced he would never be an a Radiologist. The former chose another field, the latter is a second year Radiology resident.
Step 2 is taken after third year of medical school, the clinical year. It comes in two parts, CK, or Clinical Knowledge, and CS, or Clinical Skills. It's a little easier, and covers mostly clinical medicine. The score for Clinical Knowledge is also given out as a three digit, and the mysterious two digit, score. It's mostly important for those who feel they didn't do well enough on step 1. My score was again, a 230, and this time, my two digit score was a 95. Step 2 Clinical Skills tests students on their patient interactions. Each student must pay over a thousand dollars to interview, and perform physical exams on, actors.
Step 3 is the final test, usually taken during, or after, intern year. It's supposedly the easiest of the three steps, and supposedly, the score counts the least.
Anyway, I'm studying for CS right now. The patients are actors so in many cases they don't have actual physical findings. So, they act. If a patient is supposed to have a heart murmur, he or she will say "hush hush hush" when you put the stethoscope over the chest. No air going into the left lung? The patient holds his breath while moving his shoulders up and down as you hold your stethoscope over the left lung.
And, if you laugh, this means you lack empathy. Laughing puts you in danger of failing, in which case you will have to pay over a thousand dollars to take the test again.
I hope I don't laugh.
Some residency programs have "cut off's" and supposedly won't even consider lower scoring applicants. These tend to be the more competitive programs- the ones on the "ROAD" to happiness (Radiology, Ophthalmology, Anesthesiology, Dermatology) as well as Ear Nose and Throat, and Neurosurgery. I'm really not sure how hard and fast these cut-offs are, but I do know that when our Step 1 scores were released, one of my classmates sadly decided that Neurosurgery wasn't in the cards for him. Another was convinced he would never be an a Radiologist. The former chose another field, the latter is a second year Radiology resident.
Step 2 is taken after third year of medical school, the clinical year. It comes in two parts, CK, or Clinical Knowledge, and CS, or Clinical Skills. It's a little easier, and covers mostly clinical medicine. The score for Clinical Knowledge is also given out as a three digit, and the mysterious two digit, score. It's mostly important for those who feel they didn't do well enough on step 1. My score was again, a 230, and this time, my two digit score was a 95. Step 2 Clinical Skills tests students on their patient interactions. Each student must pay over a thousand dollars to interview, and perform physical exams on, actors.
Step 3 is the final test, usually taken during, or after, intern year. It's supposedly the easiest of the three steps, and supposedly, the score counts the least.
Anyway, I'm studying for CS right now. The patients are actors so in many cases they don't have actual physical findings. So, they act. If a patient is supposed to have a heart murmur, he or she will say "hush hush hush" when you put the stethoscope over the chest. No air going into the left lung? The patient holds his breath while moving his shoulders up and down as you hold your stethoscope over the left lung.
And, if you laugh, this means you lack empathy. Laughing puts you in danger of failing, in which case you will have to pay over a thousand dollars to take the test again.
I hope I don't laugh.
Sunday, December 13, 2009
Splitting
I was pretty sure my resident didn't like me. On my team at the hospital, the main players were my attending, the resident, and a medical student. The attending has the highest rank- she was the one on the team who'd graduated from medical school and who'd finished residency. Dr. Mia, the resident, was lower on the totem pole. She'd graduated from medical school two years prior to my stay, and was working her way through a Psychiatry residency. The medical student was what I was supposed to be. She was doing her third year clinical rotations.
Mental patients, particularly those with personality disorders, do something called "splitting." This basically means that they either really like someone or really dislike someone. As an example, if I really liked the nurse on the night shift, and really disliked the nurse on the day shift, for no apparent reason, this might qualify as splitting. Those lucky enough to bask in the light on the positive side of a split may be showered with compliments. But, this may be short lived, as the splitter can very easily move someone from one category to another. Someone who is wonderful one day, may be terrible the next from the point of view of the splitter. This usually causes problems, because the splitter often complains about certain people on the team, and when the behavior isn't recognized, the splitter may succeed in manipulating those trying to help her.
I was certain that Dr. Mia didn't like me. But I actually can't say that for sure- I do know that I didn't like her. She told me that I shouldn't worry about not returning to medical school, as many people are successful with college degrees. I didn't really NEED to become a doctor. Leaving medical school wouldn't be such a problem. This caused my eyes to fill with tears, and I answered her questions grudgingly, staring at her shoes during our sessions. Would Dr. Mia be happy if her dreams of becoming a doctor evaporated? I wondered bitterly. Her words swirled around my head and I became angrier and more resentful towards her as the days continued. I liked the attending and the medical student. I worried that my obvious dislike of Dr. Mia would be contrasted with my feelings towards the medical student and attending, and that my team would decide I was "splitting."
Patients who split are considered more difficult so I tried valiantly to hide my feelings.
"Splitting" is most notably associated with Borderline Personality Disorder, a label that is often a euphemism for "I don't like this patient." Personality disorders are also called "axis II" disorders. When evaluating the psychiatric patient, a doctor tries to fill each of 5 categories, called the 5 axes. Axis I disorders include Bipolar Disorder, Schizophrenia, and Major Depression, among others. These are generally considered "not the patient's fault" or sometimes "biologically based." Treatment is generally covered by insurance. Axis II disorders include anti social personality disorder, borderline personality disorder, and dependent personality disorder. Axis II disorders are usually considered to be lifelong, and related to a patient's character. Someone with an "Axis II" problem is often considered to be someone with undesirable character traits. Axis II disorders are usually not covered by insurance. Axis III includes any medical problems, such as pneumonia or diabetes. Axis IV includes any social stressors the patient may have. Being a medical student might go in this category. Axis V is denoted by a number, from 1 to 100, which reflects the patient's over all function. A patient who is a 10 is likely confined to a hospital. Someone who scores 100 is able to function in the world.
When a psychiatrist speaks of someone with "axis II issues" he or she usually means someone with "undesirable character traits." I learned in a subsequent psychiatry rotation that tattoos, sitting cross legged in a chair while speaking to a doctor, and attachment to a stuffed animal past the age of 15, are all indicative of axis II issues.
Mental patients, particularly those with personality disorders, do something called "splitting." This basically means that they either really like someone or really dislike someone. As an example, if I really liked the nurse on the night shift, and really disliked the nurse on the day shift, for no apparent reason, this might qualify as splitting. Those lucky enough to bask in the light on the positive side of a split may be showered with compliments. But, this may be short lived, as the splitter can very easily move someone from one category to another. Someone who is wonderful one day, may be terrible the next from the point of view of the splitter. This usually causes problems, because the splitter often complains about certain people on the team, and when the behavior isn't recognized, the splitter may succeed in manipulating those trying to help her.
I was certain that Dr. Mia didn't like me. But I actually can't say that for sure- I do know that I didn't like her. She told me that I shouldn't worry about not returning to medical school, as many people are successful with college degrees. I didn't really NEED to become a doctor. Leaving medical school wouldn't be such a problem. This caused my eyes to fill with tears, and I answered her questions grudgingly, staring at her shoes during our sessions. Would Dr. Mia be happy if her dreams of becoming a doctor evaporated? I wondered bitterly. Her words swirled around my head and I became angrier and more resentful towards her as the days continued. I liked the attending and the medical student. I worried that my obvious dislike of Dr. Mia would be contrasted with my feelings towards the medical student and attending, and that my team would decide I was "splitting."
Patients who split are considered more difficult so I tried valiantly to hide my feelings.
"Splitting" is most notably associated with Borderline Personality Disorder, a label that is often a euphemism for "I don't like this patient." Personality disorders are also called "axis II" disorders. When evaluating the psychiatric patient, a doctor tries to fill each of 5 categories, called the 5 axes. Axis I disorders include Bipolar Disorder, Schizophrenia, and Major Depression, among others. These are generally considered "not the patient's fault" or sometimes "biologically based." Treatment is generally covered by insurance. Axis II disorders include anti social personality disorder, borderline personality disorder, and dependent personality disorder. Axis II disorders are usually considered to be lifelong, and related to a patient's character. Someone with an "Axis II" problem is often considered to be someone with undesirable character traits. Axis II disorders are usually not covered by insurance. Axis III includes any medical problems, such as pneumonia or diabetes. Axis IV includes any social stressors the patient may have. Being a medical student might go in this category. Axis V is denoted by a number, from 1 to 100, which reflects the patient's over all function. A patient who is a 10 is likely confined to a hospital. Someone who scores 100 is able to function in the world.
When a psychiatrist speaks of someone with "axis II issues" he or she usually means someone with "undesirable character traits." I learned in a subsequent psychiatry rotation that tattoos, sitting cross legged in a chair while speaking to a doctor, and attachment to a stuffed animal past the age of 15, are all indicative of axis II issues.
Sunday, November 29, 2009
The Hospital Continued
I settled into a daily routine. Every morning, I awoke, and lined up in front of the dining room in anticipation of breakfast. We’d all get to choose between raisin brain, frosted flakes, and cheerios with the option of a muffin and a banana. I usually chose frosted flakes with whole milk, complemented with hospital issue coffee. I’d tried a number of methods to hide the hospital-issue taste, and a mixture of regular sugar, splenda, and cream worked best. Then, I’d choose one of the round tables; I generally tried to sit with Sara, Jon, and Maddie. And, there was usually free entertainment.
There was the morning that Vera, an Armenian patient who had been admitted for unclear reasons, as she seemed to have a low level of craziness that didn’t seem to fit any diagnosis, and didn’t seem to be the sort of thing one could fix with medication. She was the weird aunt that people tolerate at family reunions, the one who makes dinner a little more interesting. She was a stout woman of generous proportion and one morning, tired of her diabetic diet, she did what no patient dared; she ran AROUND the food cart and tried to help herself to the muffins, sugar laden cereals, and other forbidden goodies, only to be lead away forcibly, shouting something about PATIENTS RIGHTS. I’d been in the hospital as a student long enough to know that this sort of behavior happened on the non-psychiatric wards on a regular basis.
After breakfast, the two teams of doctors, medical students, and residents would start their walking rounds. I’d participated in such rounds, although they made more sense when one is on a surgery service and the rounds consist of brief bedside visits where we’d make sure the patient was farting, pooping, and eating. In the psychiatric hospital, the team would ask how the patient felt, and whether she was in danger of hurting herself or others. In the interest of privacy, when one roommate was being interviewed, the other had to leave. I once had the unfortunate experience of being in the shower when the team came to round on my roommate. I had no clothes with me, and while I’d planned to come out of the shower in a towel, to dress in my own room, I found myself stuck in the bathroom until the team was finished with my roommate. Then, it would be my turn to answer personal questions in front of a large group.
After this, we’d have our morning activity. My favorite was dance therapy, which was taught by a painfully enthusiastic woman named Elizabeth who had red curly hair and sparkly purple eye shadow. It wasn’t that I liked dance therapy, it was that I liked making fun of dance therapy. And there was really nothing anyone could do about it- I was already crazy so if I wanted to leap into the air and flap my arms, there really wasn’t anything anyone could do about it. Morning activities usually only lasted an hour and a half at most, so the rest of the morning was usually spent sitting in the activities room watching television. There had been a ping pong table, but a schizophrenic patient had been instructed by voices to smash the thing. There was a piano, but patients were only allowed to play during a designated two hour period each week. And, there were computers and books, but these were all locked in the library. We were allowed into the library on Saturday afternoons and we each got ten minutes on the computer. And, while I sometimes wanted to sit in my room and read, I learned early on that this was “bad.” Good patients participated in all activities and sat in the activities room, only retreating to the privacy of their bedrooms at bedtime, or during walking rounds.
So, I sat in the activities room, watching a television station chosen by one of the more assertive patients. Sometimes we watched the news or Law and Order, but mostly we watched BET and soap operas. Lunch time was at noon, and usually patients had started to line up at 11:45. Then, we’d get some version of what we’d picked out from the menus distributed the day before. I usually tried to choose sandwiches or other bland food as I was mistrustful of any attempts at fine cooking by the hospital kitchen. I did enjoy the powdered mashed potatoes, and usually pocketed several dinner roles and cookie packets, even though this was considered “bad.”
The afternoon consisted of another hour and a half of activities. My roommate had a group session for substance abuse, but the rest of us were relegated to dance therapy, writing therapy, art therapy, or any number of other activities designed to keep mental patients well. This was followed by more television. Some patients commandeered the pay phones and talked to friends and relatives. The rest of us sat until 5:45 when we’d start lining up for dinner. And, I’d usually sit with my Sara, Jon, and Maddie. And then, I’d leave with my Snackwell cookies, dinner roles, and butter. Visitors could come between 7 and 9 pm. The “good” patients remained in the common area whether or not they had visitors. The evening was punctuated by medication time.
There was the morning that Vera, an Armenian patient who had been admitted for unclear reasons, as she seemed to have a low level of craziness that didn’t seem to fit any diagnosis, and didn’t seem to be the sort of thing one could fix with medication. She was the weird aunt that people tolerate at family reunions, the one who makes dinner a little more interesting. She was a stout woman of generous proportion and one morning, tired of her diabetic diet, she did what no patient dared; she ran AROUND the food cart and tried to help herself to the muffins, sugar laden cereals, and other forbidden goodies, only to be lead away forcibly, shouting something about PATIENTS RIGHTS. I’d been in the hospital as a student long enough to know that this sort of behavior happened on the non-psychiatric wards on a regular basis.
After breakfast, the two teams of doctors, medical students, and residents would start their walking rounds. I’d participated in such rounds, although they made more sense when one is on a surgery service and the rounds consist of brief bedside visits where we’d make sure the patient was farting, pooping, and eating. In the psychiatric hospital, the team would ask how the patient felt, and whether she was in danger of hurting herself or others. In the interest of privacy, when one roommate was being interviewed, the other had to leave. I once had the unfortunate experience of being in the shower when the team came to round on my roommate. I had no clothes with me, and while I’d planned to come out of the shower in a towel, to dress in my own room, I found myself stuck in the bathroom until the team was finished with my roommate. Then, it would be my turn to answer personal questions in front of a large group.
After this, we’d have our morning activity. My favorite was dance therapy, which was taught by a painfully enthusiastic woman named Elizabeth who had red curly hair and sparkly purple eye shadow. It wasn’t that I liked dance therapy, it was that I liked making fun of dance therapy. And there was really nothing anyone could do about it- I was already crazy so if I wanted to leap into the air and flap my arms, there really wasn’t anything anyone could do about it. Morning activities usually only lasted an hour and a half at most, so the rest of the morning was usually spent sitting in the activities room watching television. There had been a ping pong table, but a schizophrenic patient had been instructed by voices to smash the thing. There was a piano, but patients were only allowed to play during a designated two hour period each week. And, there were computers and books, but these were all locked in the library. We were allowed into the library on Saturday afternoons and we each got ten minutes on the computer. And, while I sometimes wanted to sit in my room and read, I learned early on that this was “bad.” Good patients participated in all activities and sat in the activities room, only retreating to the privacy of their bedrooms at bedtime, or during walking rounds.
So, I sat in the activities room, watching a television station chosen by one of the more assertive patients. Sometimes we watched the news or Law and Order, but mostly we watched BET and soap operas. Lunch time was at noon, and usually patients had started to line up at 11:45. Then, we’d get some version of what we’d picked out from the menus distributed the day before. I usually tried to choose sandwiches or other bland food as I was mistrustful of any attempts at fine cooking by the hospital kitchen. I did enjoy the powdered mashed potatoes, and usually pocketed several dinner roles and cookie packets, even though this was considered “bad.”
The afternoon consisted of another hour and a half of activities. My roommate had a group session for substance abuse, but the rest of us were relegated to dance therapy, writing therapy, art therapy, or any number of other activities designed to keep mental patients well. This was followed by more television. Some patients commandeered the pay phones and talked to friends and relatives. The rest of us sat until 5:45 when we’d start lining up for dinner. And, I’d usually sit with my Sara, Jon, and Maddie. And then, I’d leave with my Snackwell cookies, dinner roles, and butter. Visitors could come between 7 and 9 pm. The “good” patients remained in the common area whether or not they had visitors. The evening was punctuated by medication time.
Tuesday, September 15, 2009
Normalcy
It occurred to be today, as I surreptitiously took a pill and washed it down with soda from Noon Conference, that I'm actually pretty normal. Yeah, I've had my issues- and I've started the process of telling my story via my blog, but right now, I take medication, I see my doctor every so often, and I'm actually living a relatively normal life.
Of course, I have the aggravation that goes along with having a chronic illness- I have to make sure I've always got health insurance. Sometimes my health insurance doesn't cover the full cost of my medications (as in right now) and I have to beg the drug companies to supply me with free meds. Also, I have to make sure when I travel that I bring my medications with me, enough not only for the duration of my trip, but also a little bit extra should something unexpected occur. I was on vacation earlier this year and had the opportunity to stay longer than initially planned. Sadly, I didn't have enough medication. I could have had my doctor call in a few days of medication, but I would have had to pay out of pocket. So, I went home as initially planned. Had I actually had extra medication, I am sure my sunburn would have been much worse than it was. So maybe I was lucky. But, anyway, it's just one of those issues anyone with a chronic illness can probably relate to.
In a way this helps me with patient care. I'll ask patients if they can afford their meds. When they cannot, I actually can point them in the direction of helpful resources.
Another advantage is that I am very knowledgable abut the meds that I take, and this can sometimes give me the appearance of having read a lot. On rounds, when I pipe up, "Well, perhaps Wellbutrin isn't the best because it lowers the seizure threshold..." it might appear that I spent the previous day poring over UpToDate.
Of course, I have the aggravation that goes along with having a chronic illness- I have to make sure I've always got health insurance. Sometimes my health insurance doesn't cover the full cost of my medications (as in right now) and I have to beg the drug companies to supply me with free meds. Also, I have to make sure when I travel that I bring my medications with me, enough not only for the duration of my trip, but also a little bit extra should something unexpected occur. I was on vacation earlier this year and had the opportunity to stay longer than initially planned. Sadly, I didn't have enough medication. I could have had my doctor call in a few days of medication, but I would have had to pay out of pocket. So, I went home as initially planned. Had I actually had extra medication, I am sure my sunburn would have been much worse than it was. So maybe I was lucky. But, anyway, it's just one of those issues anyone with a chronic illness can probably relate to.
In a way this helps me with patient care. I'll ask patients if they can afford their meds. When they cannot, I actually can point them in the direction of helpful resources.
Another advantage is that I am very knowledgable abut the meds that I take, and this can sometimes give me the appearance of having read a lot. On rounds, when I pipe up, "Well, perhaps Wellbutrin isn't the best because it lowers the seizure threshold..." it might appear that I spent the previous day poring over UpToDate.
Monday, September 7, 2009
"Mentally Ill" Hopkins Resident
I'm still planning on recounting my story through this blog, but that project's on hiatus right now 'cause I'm busy with other things (clerkships, studying...)
Anyway, I happened to come across some news articles online regarding this Hopkins surgery resident who was fired from his program for being "mentally ill." Mentally ill? What do they even mean by that? You can't fire someone simply for being mentally ill. They have to be mentally ill and posing a danger to patients, or some other such thing. It's really odd that this guy's whole career is on the line because someone has decided to label him "mentally ill." Now, technically, depression is a "mental illness" So, all you depressed people out there? Everyone on an SSRI? You're all mentally ill. And you can't work at Hopkins. Schizophrenia is also a mental illness. So, I'm sad to say that if you're schizophrenic, you also will not be able to successfully complete a surgical residency at Hopkins should your secret get out. As for myself, any hope I had of becoming a Hopkins surgery resident was dashed to pieces when I found that those who are "mentally ill" are not welcome.
It's interesting to me that this guy was placed in a broad category that includes severely ill schizophrenics, histrionics with borderline personality disorder, and the depressed. I'm trying to figure out which disorder this guy probably had.
Maybe he had paranoid schizophrenia and was having delusions that those at Johns Hopkins were coaching residents on what to report on an ACGME survey. I think that's it, the most likely diagnosis. The resident, at age 30, presented with paranoid delusions. And anyone who thinks that Hopkins would try to hide anything from the ACGME is crazy, totally nuts. There was that guy a few years ago who seemed to think that "hours" should be "regulated" at Hopkins. That's not really a paranoid delusions, I would call that a bizarre delusion, perhaps. I'm not even sure if that's correct. Well, then he started having paranoid delusions. He held the belief that everyone at Hopkins KNEW that he was the one who complained about these alleged "hours regulations." What a nut case.
Anyway, I happened to come across some news articles online regarding this Hopkins surgery resident who was fired from his program for being "mentally ill." Mentally ill? What do they even mean by that? You can't fire someone simply for being mentally ill. They have to be mentally ill and posing a danger to patients, or some other such thing. It's really odd that this guy's whole career is on the line because someone has decided to label him "mentally ill." Now, technically, depression is a "mental illness" So, all you depressed people out there? Everyone on an SSRI? You're all mentally ill. And you can't work at Hopkins. Schizophrenia is also a mental illness. So, I'm sad to say that if you're schizophrenic, you also will not be able to successfully complete a surgical residency at Hopkins should your secret get out. As for myself, any hope I had of becoming a Hopkins surgery resident was dashed to pieces when I found that those who are "mentally ill" are not welcome.
It's interesting to me that this guy was placed in a broad category that includes severely ill schizophrenics, histrionics with borderline personality disorder, and the depressed. I'm trying to figure out which disorder this guy probably had.
Maybe he had paranoid schizophrenia and was having delusions that those at Johns Hopkins were coaching residents on what to report on an ACGME survey. I think that's it, the most likely diagnosis. The resident, at age 30, presented with paranoid delusions. And anyone who thinks that Hopkins would try to hide anything from the ACGME is crazy, totally nuts. There was that guy a few years ago who seemed to think that "hours" should be "regulated" at Hopkins. That's not really a paranoid delusions, I would call that a bizarre delusion, perhaps. I'm not even sure if that's correct. Well, then he started having paranoid delusions. He held the belief that everyone at Hopkins KNEW that he was the one who complained about these alleged "hours regulations." What a nut case.
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