Wednesday, June 26, 2013

Higher standards

I've noticed that I hold doctors to somewhat higher standards when it comes to health-related or safety issues.

For example, when I smell cigarette smoke on a doctor coming back from their break, I get pretty irritated at them. I mean, they SEE the horrible effects of smoking. How could they make that choice? Ditto when I found out about a doctor at the hospital who went biking without a helmet.

A while ago, I made a post about how I got worried whenever my daughter had vaccines, so I am sympathetic to vaccination fear. A family practitioner commented on the post that she had the same worries and for that reason, spread out vaccines in her own kids and patients, and even skipped vaccines that weren't totally "necessary." I confess, I wasn't very nice to her, but I was livid. How could a doctor behave that way?

I think if a doctor ever told me she was giving birth at home, I'd probably flip my shit.

We probably shouldn't put doctors on a pedestal like that. I mean, they (we) are only human. I make lots of stupid health choices, like I eat fast food sometimes and I don't exercise (although to be fair, I've seen a disproportionate number of serious sports injuries in my field). But I don't know... I just expect more from doctors, including myself.

Maybe that's unfair though.

22 comments:

  1. Long time reader, first time commenter. I 100% agree with you and I think you have every right to feel that way! In fact, I don't think I have ever disagreed on a thing you've ever said! To me, doctors and nurses (and all other health professionals) SHOULD be non smokers, vigilant with vaccinations, exercise and healthy eating etc and I also get quite upset when co workers go outside for some 'fresh air'. If health professionals can't practice what they preach, especially considering we are the most knowledgable in health matters and that patients look up to us for help and guidance, then how on earth can we expect out patients to follow suit?

    Ditto for obese doctors too. My favourite is working with overweight anaesthetists or surgeons on bariatric lists!

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  2. I agree with you! My husband is somewhat of a health freak with the foods he eats. If he had more time he'd be at the gym. However, I know he has colleagues who are unhealthy due to smoking, or over-eating. What ever happened to leading by example?

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  3. I agree with you. There's a big difference between smoking, giving birth at home, or vaccination refusal and the occasional dietary indiscretion/short cut. Interestingly the hospital where I work recently made the decision not to hire any smokers in the future. I don't actually feel the same way about obesity (except perhaps morbid obesity) since study after study has shown how difficult it is to lose weight, and because the detriment to health isn't nearly as pronounced and the public health burden not nearly so large as with those other issues. Plus, most fat people don't want to be fat, whereas someone who gives birth at home is basically giving the finger to the medical establishment.

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    1. The public health burden of obesity is MASSIVE. I'm not sure how I feel about employers choosing not to hire smokers or the obese, but let's acknowledge at least that these two things are by far the biggest contributors to "preventable" morbidity and mortality, and thus enormous healthcare expenditure in the western world.

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    2. I think obesity is a much trickier issue than smoking in terms of hiring policies. There are so many factors that contribute to weight... I mean, if you have to take steroids or certain other medications, that can cause a large weight gain through no fault of your own. Many people eat well but still have trouble losing weight. Whereas smoking is fairly black and white. Plus people are more likely to gain weight as they get older so hiring non-obese people is little guarantee they'll stay that way, but who starts smoking after age 25? Almost nobody.

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    3. The research shows that obesity contributes about 1/10 of the disease burden / costs that smoking contributes to society. In fact, as you get older, having an "overweight" BMI is actually protective to health. Not saying obesity is costless, just that people tend to overestimate its relative importance. At any rate, not interested in getting into a big fight over it, but just thought I'd point that out.

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  4. I'm amazed that I know a few forensic pathologists that ride donorcycles... I mean, motorcycles.

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  5. Being in OB might make anyone want to stay out of the hospital for their birth even more, like being a factory farm worker would make you want to raise and eat only your own chickens.

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    1. Although I am generally pro-healthy choices for doctors (role models and all that), I would NEVER want to be in the ICU. And if my kid ever were to be in a hospital, I wouldn't leave his side for one damn second. I KNOW what happens there and how decisions are made. I'm stayin' at home until I need a fricking blood transfusion. And even then, I'll try a rare steak first.

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    2. Doubt it. Because anyone working in OB has seen or heard of horrendous homebirths that end up transferring to the hospital then the OBs and hospital staff try to salvage a potentially terrible outcome.

      And they've also seen plenty if situations where thank god they were in the hospital and able to intervene before things became disastrous.

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  6. We have several cardiologists who smoke where I work. They're trying to tell their patient's how bad smoking is for them when they reek. Can you blame the patients for not listening?

    I lost all respect for healthcare professionals early on though. My first few weeks we were invited to do a volunteer healthcare screening and talk to some patients in the community. I was there with a few nurses and a physician. One of the nurses was using it as a podium to sell fake, homeopathy crap (magnetic shoe inserts, healing water bottles, homeopathic remedies, etc). She sold that crap as a sidejob and would swoop in on anyone who tested positive for anything or had some non-specific complaints and give them her business card. I wanted to crawl into a hole. I was so embarrassed for my facility. I wasn't confident enough to tell her to quit at that point, and nobody else acted like there was anything wrong with it.

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  7. I'm a doctor. I'm going to spread out my kid's vaccines. Similarly, there's no reason to give a hep B vaccine on the day of birth with a known HBV-negative mother -- the immune system isn't even fully functional on day 1. This one can wait without compromising anyone's safety.

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    1. That one isn't a requirement. But I wouldn't skip any of the pneumococcal ones, and definitely not tetanus, pertussis, measles and diphtheria. We've had ridiculous pertussis outbreaks here, and multiple deaths. H.inf is nasty.

      The TB/BCG and HepB - for sure not necessary (and apparently not helpful for the BCG). In health care though, I'm happy I have both vaccines.

      And I admit, I never got the HPV. I'm super paranoid about the HPV. It's too new for me. I've half-heartedly recommended it, but I don't feel comfortable with that one at all...

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    2. I feel that the people who make the decisions about vaccine timing do it with the best evidence in mind. It would be arrogant for me to say I knew better than these people. Nobody, even the doctors, who spread out the vaccine can give me any hard evidence to show the recommended way is more dangerous.

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  8. If you're not comfortable why would you recommend it?

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  9. On the scientific side, I understand not respecting a physician who doesn't seem to follow scientific advice for things like vaccines. On the other side though, sometimes patients are more comfortable working with a doctor who seems more human, ie has faults, and knows what it's like to struggle with something like obesity or quitting smoking.

    Case in point, I was a formerly very fit hardcore athlete, but due to an injury and crazy full-time work/full-time school schedule put on quite a bit of weight. I was commenting that what I needed to do was start swimming again as a good way to exercise despite my injury but was feeling self-conscious about being in a suit around my institution's uber endurance athletes at the gym. My doctor, who is bit heavier said "if I can do it, you can." She was right, I got a new swimsuit later that week.

    My mom is morbidly obese and scared to go the doctor for fear of judgement and some harsh comments she's received. She knows she needs to make changes and is actively trying to do so and working with someone who's not a specimen of fitness makes her feel more comfortable getting care to maintain and eventually improve her health. It's it better she see's someone who makes her comfortable, who isn't a stellar example of health than not going at all?

    Some times it's easier to take advice from someone who doesn't seem perfect as they have a better idea of what you're struggling with. They don't need to disclose personal info or even verbalize it to make patients feel more comfortable.

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  10. I'm a primary care doctor. I've been to births in hospitals in the US, Bahamas, and Jamaica and over 50 at home births - I'd choose at home with qualified care. You can do IVs, meds for bleeding, antibiotics. But one on one care with at least 1 doctor. Minimal intervention. I wonder how many doctors in the states have ever seen more than 10 natural births without any intervention. The atmosphere is totally different at home. Plus, way less infection risk. The times I've seen transports, its usually for C-sections and we knew it was coming.
    Now, in Jamaica - I would definately choose home. No running water, no dopplars, no IVs, women bring their own linens. :)

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    1. I'd like to hear more about how to get my U.S. obstetrician to monitor my birth with minimal intervention while ready to maximally intervene if necessary. During med school a maternal fetal medicine specialist told me that today's OBs just don't want to wait patiently for things to happen on their own so interventions like pitocin and C-sections get overused. How can I find an obstetrician who has experience using less intervention?

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    2. You are more likely to find that from a certified nurse midwife who delivers in a hospital.

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    3. I think a midwife in the hospital is a fine choice. But if things take a wrong turn, you don't want to have your baby not getting oxygen for even a 10 minute ride to the hospital.

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  11. I gave birth at home. But I want to keep reading your blog so don't flip your shit.

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  12. On one hand, I agree that it can seem hypocristical for a doctor to give health advice while reeking of cigarette smoke. But I honestly think that not hiring smokers goes too far. That basically gives the hospital the right to make "do I approve of the risks you take in you recreational time" something that affects you. We should all have the ability (especially if we are in the position to actually know and understand the risks) to weigh those risks against what we perceive as the benefits and make our own decision. That is part of living our lives. I don't wear a helmet on a bicycle and I enjoy riding my motorcycle (with a helmet, though sometimes I think I'd be better off without, because if I crash at 60mph+ I may not WANT to wake up)...to me, those things are worth the risk. There's no point in arguing with me over it, because I know the stats, I know the worst case scenario, and I have actively chosen to take that risk for myself. My employer should not be the one who gets to make decisions like that. If their purview extends to my smoking status (I don't smoke, btw), then is it really a long stretch for them to consider a motorcyclist 'high risk' or 'hypocritical'? I just think it's a slippery slope and the benefit is minimal. It's a judgemental way to set up a system, and while it may seem great while their judgements align with my values, subscribing to it opens the door with no guarantee that our values will always coincide.

    On the other hand, doctors who give misinformation or inappropriate vaccine schedules are making that decision for someone else and their child, which is out of line. The doctors role is to educate the patient and help them make their decision, and that means informing them of the current standard of care...if they choose to mess with that for their own child, that's their decision. If they choose it for another person's child without fully explaining it to them and letting it be the parent's choice, that's NOT so fine.

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