For what purpose do we practice medicine? For ourselves (i.e. to improve ourselves or out of interest) or for others? Trick question: it's both. Keep this in mind throughout this post.

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On Monday, I went to the HIV/AIDS Awareness Night event organized by one of the student groups. I was pleasantly surprised to see the ID (infectious disease) physician I shadowed, Dr. P, at the event. I also recognized one of the HIV patients on the patient panel, who I saw while shadowing Dr. P.

While we got our dinner, the event began with a 20-minute clip of interviews of two young men living with HIV. Then Dr. P introduced himself as the panel moderator. Each of the 4 HIV patients introduced themselves as well as another ID physician. The remaining hour-and-a-half was devoted to the panel Q&A.

To hear what these patients went through - and still go through - was strangely motivating. It was incredible to hear their stories, their ups and downs, their will to keep moving forward. Two of the patients were diagnosed with HIV in the 1980s and the other two were diagnosed recently (within the last 10 years), so we heard about how things were different then compared to now . . . and how some things regrettably haven't changed.

Each patient recounted how they found out about their diagnosis, and I can't forget the last patient's (an African-American male) experience. He had divorced his wife in the 1980s and was raising their kids as a single parent. His doctor, a white male, thinking himself a savior (the patient's words, not mine) came to the patient's door and gave him the diagnosis. In front of the patient's kids. ::facepalms:: It simply shocked us in the room that a doctor would have the lack of common sense and the audacity to do such a thing.

Throughout the panel discussion, I'm sure a singular thought echoed in the minds of all the med students in the room: "How can we be better? How can we do better? How can we make things better for patients like you?" I learned a lot from this 2-hour event. I admire the patients' courage for coming in and speaking to us, and I admire how Dr. P is there for his patients (I think the 4 patients were all his) and the relationship he developed with each of them. There were a few instances where I felt almost moved to tears.

Dr. P said something I don't think I'll soon forget: "Even today, even though things are better, there's perhaps no other disease that still carries with it the kind of stigma that HIV does." It's true. Even health professionals - health professionals - sometimes react abhorrently (and unjustifiably so) when hearing that a patient in front of them has HIV.

After the event ended, I went down and talked to Dr. P to tell him how much I appreciated him being there and how highly I thought of the event and the patients. I also spoke with the other ID physician. We got talking on public health and the research being done on developing a vaccine or cure against HIV. Talking about the vaccine trial and the "test and treat" model being proposed to "treat away the HIV epidemic" was refreshing. It was invigorating to speak almost on par with an ID physician on such things. He called ID as being "primary care on steroids." I'd agree with that. :-P

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On Wednesday, I went to a lunch talk organized by another student group. A speaker with Tourette's syndrome and Hirschsprung's disease came to give the talk. He told us about his life experiences with these two diseases as he tic'd away (verbal and physical tics). He was a very charismatic speaker and he had aspirations to become a pediatric surgeon (in the footsteps of his pediatric surgeon who saved his life), until he took a year off after undergrad and realized he could probably help more people by doing what he currently does - that is, giving inspirational/motivational talks.

He also said some things that I won't soon forget. There are things that doctors probably should do that med school doesn't prepare for. Med school doesn't adequately prepare students to care for people as whole people. Almost every class we have in the M1 and M2 years are "basic science" classes - anatomy, biochem, physiology, neuroscience, pathology, microbiology, pharmacology, etc - but few classes prepare us for all the other "non-medical" things that definitely impact a patient's health. Med school doesn't prepare us on how to break the bad news of a HIV diagnosis or on how to counsel a HIV patient through stages of depression. It doesn't prepare us on how to help a middle-schooler with Tourette's make friends or on how to talk to other people about having Tourette's. Too often we're taught - either implicitly or explicitly - how to break patients down into symptoms and pathologies, even while being told the whole time that patients are not "HIV' or "Tourette's." Easier said than done.

The speaker left us with an acronym he invented: HAATS. Humor. Acceptance. Advocacy. Tolerance. Support. Humor helps one cope in a healthy way - to laugh at oneself and at others. Acceptance of oneself with a condition or some difference. Advocacy for oneself and for others; many times patients don't have an advocate for themselves, and so the doctor must fulfill this role. Tolerance of others, that not everyone can or will understand - and that's okay. Support from family, friends, medical staff, etc are critically important.

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After reading the 2 accounts above, I ask again: for what purpose do we practice medicine - for oneself or for others? The answer's still true now as it was at the beginning. But I think it's worth remembering the latter purpose. And that's not just for health professionals, but for all of us.

If you want to read more about the Tourette's speaker, you can go to his website at: www.whatmakesyoutic.com.

I very recently read the following article in the Los Angeles Times, The doctor is in -- but not for long. It reports a decrease in physician work hours from an average of 55 hours/week to 51 hours/week between 1977 to 2007. The study can be found for free here: Trends in the Work Hours of Physicians in the United States by Staiger et al. in the Journal of the American Medical Association (JAMA).

Now, both articles above interpret this decrease in physician work hours as somewhat troubling, the LA Times almost "blaming" doctors for their newfound laziness (compared to teaching, law, and journalism). The study reports the decrease to be most prominent in younger physicians (defined as 45 or younger). The study concludes that this 5.7% decrease in physician work hours averaged over the 630,000 or so doctors in the 2007 workforce translates to losing about 36,000 doctors. That's pretty dramatic. 630,000 doctors to take care of over 300 million Americans is quite some feat.

I suppose I'm the devil's advocate as I find it irritating that the study concludes the decrease in physician work hours to be worrisome for the US health care. To me, it's overdue and about time for this decrease in work hours.

Let's put the hours into perspective. Assuming a 5-day workweek, 55 hours/week translates to 11 hours/day. That would be like getting to work at 6am and not leaving until 5pm, or getting to work at 7am and not leaving until 6pm, etc. Again assuming a 5-day workweek, 51 hours/week translates to just over 10 hours/day; so 6am until 4pm, or 7am until 5pm, etc. If you haven't noticed, that's still a lot of time spent in the office, and that's not including time spent commuting to/from work. The study also doesn't take into account all the paperwork and other aspects of being a doctor that are often done outside the office or from home. I believe that younger physicians are more tech-savvy and are more likely to utilize online resources and such from home.

The study correlates the decreased work hours with lower reimbursement rates in urban areas compared to rural areas. Let's address this. In urban areas there's often a "saturation" of primary care physicians. In more than one lunch or dinner panel with residents, some of them mentioned their concern over being (potentially) unable to find a job in an urban setting, and so sometimes decide to specialize. When you have more doctors in an area for a given population, each doctor sees fewer patients . . . and so likely works fewer hours. In contrast, rural areas have fewer doctors because fewer doctors want to practice there. And because there are fewer doctors, there's a greater need for them; thus, they work longer hours out of necessity to their patients and they well deserve to be reimbursed more for their increased work.

A point briefly mentioned in the study was the thought that younger physicians wish to have a more balanced lifestyle. As if that's a crime? . . . Is there something wrong to want to have time to spend with one's family and go to their children's events? Is there something wrong with wanting to take a vacation every now and then? Refer to the first point I made - that even with the reduction in work hours on average, it's still a lot of time at work. Times have changed since the 1970s. The rise of the two wage-earner family means that each wage-earner can afford to work fewer hours to support the family.

I remember reading a blog post on EverythingHealth by Dr. Toni Brayer called New Doctors - New Culture that hits at many of the points I've made. That post was written in 2008 and it continues to ring truer and truer every day. One of the top concerns of many of my female classmates is how to balance work with family - how can a doctor work so much and still be there for his/her kids? Something has to give.

So I ask: should the health of others be held above one's own health? Above the time one spends with one's own family and friends? Aren't doctors humans as well with very human needs and limits?

I think it's easy to forget that doctors are people too, that we're not all-knowing and unfeeling automatons. The reduction in work hours shouldn't be maligned, they should be welcomed as being more reasonable and more conducive to having a life outside the office. But certainly something has to be done to compensate those lost hours. The variables affecting the production of new doctors are complex and many (and I won't go into them here). But it all begins with a better health care system than currently exists in the US.

We had to watch this film in class today, and I must say I was thoroughly impressed. Emotionally rattled (not sure if this is the best expression). It quietly makes the tears run down your face. Plus great camerawork and otherwise a well-made film.

Basically it's a story about a woman who has to live with AIDS.
She lives the kind of life that probably is a good representation of a lot of other people in the same situation, but it is her spirit that sets her apart and blows you away.

We must be grateful for what we have and make the most out of our future...

A middle-aged Chinese woman came to the clinic who spoke little English. As the only med student on staff that morning who could speak Mandarin Chinese, I was asked to help with the medical interview. While I wasn't obligated to offer translation help, it was a unique opportunity I couldn't pass up. As a result I've realized a few things:

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Despite being fluent in (conversational) Mandarin, there were many questions I was unable to ask the patient directly. I knew how to say many common medical terms (e.g. hypertension, high cholesterol, diabetes), but there were many more that I was simply unable to recall (e.g. cancer) even though I know the words. Furthermore, because I have no training in medical Chinese, there were many things I had to ask in a roundabout way - such as asking the patient if her condition worsened at particular times during her menstrual cycle (that was super awkward).

The work-up on that one patient took about 3 hours. Everything is at least doubled in time due to need to work through a translator (me). If I hadn't been available and willing, there was a translation service over the phone - but that might've been much worse, at least time-wise.

Because we live in an ever-increasingly global world, and particularly in the US as a very diverse country, the value of knowing multiple languages is indispensable, especially in the health care fields. Language still remains as a major barrier in delivering optimal medical care. A second language offers more than simply the ability to translate, as languages are almost invariable tied to cultures. As such, a language may offer some insight into cultural values that may prove very useful when treating a diverse patient population.

When there is a language barrier, the translator is potentially more important than the doctor. The patient looks to you, the translator, as the doctor's words. While a patient may give respectful deference to the doctor, they really look at you to speak the doctor's words and serve as his/her proxy in a sense. Therefore the demeanor and attitude of the translator is critical to ensure open and honest communication.

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While ideally both doctor and patient speak the same language(s), this is not always possible (indeed, it rarely is). Heck, even if they do speak the same language(s) there may still be communication issues. It is equally unrealistic to require entering medical students to be proficient in more than one language. As such, the role of translators - preferably professional - is critical and often necessary.