Scalpel’s Edge

Prevention and treatment

// January 15th, 2010 // No Comments » // Health

One of my young friends (just 3 months old) was recently diagnosed with a inborn error of metabolism after neonatal screening. Any negative outcomes are easily prevented with dietary supplements, and my friend will probably never suffer any consequences.

The interesting part of this story is that his father is not just a genetic carrier, but actually has the disease, which has never been diagnosed. So this 30-something, apparently healthy guy has started new treatment and feels remarkably well. He now has the opportunity to have testing for all of the bad things that might be going on because of this condition, and, if he is lucky, have permanent problems treated and prevented.

It may just be my circle of friends, but I have met a number of people recently who have benefitted from their relatives disease screening. I know people whose kids have been diagnosed with learning disorders at school screening, only to benefit from the treatment themselves. And in my work with breast cancer patients, I have met many women having treatment for breast cancer they have not even developed yet. (This happens when a relative with breast cancer has a genetic association detected, allowing treatment of others carrying the same gene.)

Screening tests are a conspiracy by the government, in the same way that immunisations are. Basically, they are a financial decision - providing the screening test to hundreds of people in order to prevent the disease in one is cheaper than treating the one. However, I am pretty sure they don’t always take into account the added benefit to genetic relatives.

This tickles me. Is our medical screening and prevention culture the start of a landslide? How can we measure the effect of the neighbour getting a colonoscopy because he hears first hand about colon cancer? Can we count the benefit of treating diseases in adults that weren’t even described 30 years ago when they were having their heel-prick tests? Incredible.

Image Credit: Redglow

Mechanics and Surgeons

// January 8th, 2010 // No Comments » // Health, Surgery

I picked up my car from the mechanic yesterday, and I was reminded of the classical stereotype of a surgeon with no bedside manner, and a condescending air.

Our mechanic is an older guy from a Mediterranean ethnic background, and I’m sure that had some impact on his behaviour to me. Within minutes of arriving to pick up the car with my husband, he had started discussing me and my driving with my hubby. I felt like a 50s hausfrau, a kept woman.

I have since been examining my negative reaction, and I guess I can’t get insulted about the suggestion that I know nothing about cars, because I don’t. But I am insulted by being treated like a child, and condescended to.

It strikes me that this is the exact situation many patients are in. I have recently had a bout as a patient consumer, and it didn’t really bother me, partially because I am familiar with the institutions, and I can trust well-chosen doctors and take their advice.

Untrained patients have no idea about medical details, physiology, anatomy and pathology. Most don’t understand the concept of risk. Perhaps there is also the assumption that we are out to rip them off, like mechanics. If patients can’t trust, they must always be double-thinking, checking up with their neighbours and the internet, and other sources. You add a busy, tired surgeon into the mix, and you get someone who is (sometimes) vague, is not always sure in themselves what the treatment is, and I can understand the seed of the stereotype.

I can’t help but wonder why surgeons are targeted more than other doctors, though. Are we less decisive? More untrustworthy? Look richer? Less able to communicate with normal people?

Image Credit: MikeBaird

Surgical manners

// June 1st, 2009 // 1 Comment » // Health, Surgery

One of the surgeons I work for has a typical surgeon’s manner. It’s a bit uncommon, now, especially with young fellows. I imagine there used to be a deal made between the surgeon and their society - you revere me and I will allow the hospital and my patients to use up my life. The deal has changed, so the behaviour has, too.

This boss seems to have little empathy for staff. I’m not sure if it is true, as he is really a nice guy, but he certainly gives that impression. You know how some people think that they know how things are meant to work, so get shocked when other people don’t? Like that. I don’t know how he deals with patients, as I never see him outside theatre.

I wanted to share the one thing he has taught me recently. We had a complicated case, and there were a few technical difficulties with the video equipment. Then his favoured instruments weren’t available. Then the staff started to get cranky at him, and the tension started to rise. And this was a complicated case, in a spare theatre, with fill-in staff.

So I learnt that attitude is one of the most important surgical skills. My surgeon expected the best of everyone in difficult circumstances, and got disappointed. Our plan should not be to expect the best and get disappointed. We need to expect the worst and enjoy the relief when people step up.

The other important skill is to plan for hassle-free work. Surgeons are the master of their workplace to some degree, and can manipulate what operations get performed in what situation, especially for elective cases. Especially in the times we expect everyone around us to let us down, we need to keep a margin of safety. Save your regular list, with familiar staff, for tough cases. No one has the right to get miffed if they have planned poorly. Be on time, have a familiar anaesthetist, be honest about the length of the list.

I know this sounds basic, but I have to write it down, because it just keeps bouncing around in my head. A tense workplace with standoffs between staff is unsafe. It’s a long career. Being a donkey at the beginning of a career doesn’t win points.

Image: malia (Flickr)

Motivated to run

// May 11th, 2009 // No Comments » // Health, Surgery

Yesterday was Mother’s day, and for the first time, I ran in the Mother’s Day Classic in Melbourne. This was a part of trying to get fit, and, as I severely hate running, was an exercise in stressing my body (and psyche) despite protests.

Most of the other runners there were also serial fun-runners, or representing various fitness and training clubs. However, there were a big proportion of people running for a cause. The Mother’s Day Classic supports breast cancer research, and many participants wore a tribute placard with the name of their affected relatives and friends. This is pretty typical of charity runs, but I found it particularly moving to see young kids, and obviously unfit adults struggling in memory of “Nanna” or “Mum” or “Auntie Dorrie,” or even “Myself.”

I have not got a strong family history of breast cancer, and I have few friends who have been affected. However, in my few years of training I have done a lot of breast surgery. I have met young women, trying to decide if they will risk getting pregnant again. I have met older women traumatised by an screening interval cancer. I have met elderly women who presented with an advanced cancer after nursing their husband through a long illness.

Breast Cancer is common, so research gets government funding. I believe we have the right to government funded research into common diseases. But I also believe we have the responsibility to contribute to quality healthcare. On the weekend I realised that I believe that extends to medical research. We can expect basic research to continue, but if we care about our medical future, or the treatment of our friends and family, then we should support it.

I was running for selfish reasons yesterday, and happy enough that a portion of my fee was sent to a charity I support. But many people were running and walking because they care, and are taking responsibility. That’s impressive.