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| According to Men’s Fitness Magazine, Columbus was America’s 18th fattest city in 2009. I am unfamiliar with the algorithm that produces this ranking, but my experiences at OSU strongly support the conjecture that Columbus is a fat city. BMIs are typically >30 on most of my services. Due to the overwhelming prevalence of obesity, many practitioners have become desensitized to this health issue. There is also a notable taboo in American culture against criticizing someone’s weight, making it a discussion that most feel inclined to avoid, particularly if weight is not directly related to the patient’s chief complaint. Thus, it was quite refreshing when on a fourth year clerkship, I had the honor of working with an attending who routinely told patients if they were too fat. The service was a specialty service and though patients’ diabetes, heart disease, and other sequelae of obesity were complicating their presenting problem, my attending could have easily focused on their acute problem and left their weight problem for someone else to resolve. Instead, he took the time to speak with each individual about their diet and exercise habits, the health risks associated with obesity, the benefits of weight loss, and how a healthier lifestyle would improve their clinical picture. Though weight is a touchy subject, most patients weren’t offended by his suggestions, rather they were appreciative that someone was helping them address a significant problem. The majority of patients were well aware that their weight was detrimental to their health and were open to trying lifestyle changes. I considered this physician to be an ideal physician because he was willing to take ownership of his patients and broach a difficult subject. He is a specialist, and could argue easily that weight control is not his responsibility, but he was willing to take the time to address it anyway, knowing that weight loss could significantly impact his patient’s long term prognosis. He's taking obesity (considered by some to be America's fastest growing epidemic) and assuming his share of the medical burden, setting a prime example for us all. | | |
| HOPI
Subject is a 26 year old female HD1 s/p first day of med 4. Onset of med 4 was acute, lasting about ten hours, and accompanied by confusion and fatigue that have since resolved. Symptoms were a 7 out of 10, exacerbated by darkness, superiors, hunger, and hot air balloons. Nothing made the symptoms better. During this time, she was unable to fulfill her ordinary social roles or complete most ADLs.
PE
On examination, she lies prone in no acute distress. She is disheveled, likely due to neglect of ADLs as mentioned above. She occasionally addresses herself in the third person.
On her left fourth metacarpophalangeal joint, she wears a .5 mm band.
Cranial nerves II-XII grossly intact.
Some evidence of emotional scarring is evident, but prior radiographic studies suggest that these have been stable for at least four years with no signs of progression or inflammation. Scar pattern suggests she was terrorized by velociraptors.
She is short in stature and appears deconditioned, but is mobile. Strength testing is 4/5 in all four extremities. Patient is uncooperative with tendon reflexes or MMSE.
Other attempts at physical exam were thwarted when patient bit her examiner.
Assessment
Unable to assess situation at this time due to poor insight. May be better assessed in hindsight.
Plan
Suggest increased effort in completion of ADLs and follow up appt in 6 months.
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| Most professions should treat people equally regardless of socioeconomic class, but I have always thought that teachers, priests, and doctors ought to be held to a higher standard in this regard. In the same way the rich aren’t entitled to receiving communion before the poor, an indigent patient with pneumonia seeing the same doctor as a tycoon should receive the same amount of attention and treatment. In my brief time in medicine, I have not seen much discrepancy between healthcare for the rich and healthcare for the poor with any given practitioner. But today, I learned about executive health. There is no Wikipedia entry for executive health, but it is the hospital equivalent to flying first class. Executive health caters to the well-to-do, targeting corporate leaders, high-ranking politicians, and the like. When you arrive at the hospital, you are greeted with complimentary valet parking. Instead of the crowded ER, you go to a private waiting area with complimentary snacks, and once admitted, you’re ensured a private room. You are always guaranteed the same physician, regardless of who the attending is when you are admitted. All service is prompt, and on the floor, you are pampered. In the outpatient setting, you are privy to in-depth physical exams and work ups ordinarily reserved for the critically ill, after which you receive personalized exercise, nutrition, and stress management assessments. While executive health’s goals and promises are the ideal standard of healthcare, and it would be an honor to be a part of a team that provides such excellent service, I am bothered by the fact it is only there for those who can afford it. I feel the existence of executive health undermines the egalitarianism of healthcare, and that the opening of each new executive health department, cheapens the altruism of medicine with a taint of elitism. The shortened waiting times for those in executive health keeps the more important people in society from wasting their time. Perhaps what unsettles me about this premise is that if the time of executive health members is more valuable, then can you extrapolate that so are their lives? Do they then deserve limited medical resources, like organ donations, more than an ordinary individual? Once a process for creating a socioeconomic rift in healthcare exists, I fear the discrepancy will inevitably widen. There are many things that I think the rich can be privy to (gourmet food, sports cars, destination weddings) but I don’t think better healthcare should be one of them. Note: This is commentary based solely on my own very limited experience with executive health supplemented with information I found on the web. I have heard no arguments for or against it. I welcome your input. | | |
| Early last week, my roommate came home with a 12 pack of Slim Fast shakes. As I passed by the kitchen she said, "Hey, I put one in the fridge for you." I never drink diet coke, let alone Slim Fast, but I figured she was just being nice and wanted to share her food. I forgot all about it. When she got home the next day, she opened the fridge and said, "Looks like you forgot your shake." Since she had noticed, I drank the chocolate Slim Fast shake for breakfast the following morning during clinical skills lecture. We had a neck brace workshop after lecture. I volunteered to have the brace demonstrated on me. "Alright," said the EMT, "Let's see. First thing you do is look at the neck to pick the right collar. You look like a..." He glances at me, "I'd call you a no-neck." Nervous giggles from my classmates. I am not a health-conscious eater. Last year, my mother bought me a scale as a housewarming gift, but I don't ever use it. I never ever go to the gym or make an effort to exercise, though my roommate did invite me to do a slim in six video with her two weeks ago, which I declined. Despite my poor eating habits and non-existent exercise regiment, I have never been concerned about my figure, but I did find it suspicious that I'd gotten two remarks in two days. The next day in clinical skills lab, we had to start peripheral IVs. In common med school format, after practicing on the mannequins, we were instructed to practice on each other. I sat down with my partner and we began looking for a good vein. The professor came over, took a look at my arms and said I would be a difficult stick. Then, she turned to the rest of my group and said, "Once in a while, you'll get a fat patient with poor veins like her." She gestured toward me and had me show my arms to the group. Three hints like that are an unlikely coincidence. So, while I was studying with my roommate at Barnes and Noble today, I brought her a health magazine. She flipped through it and came across this inspiring article about two friends who lost 200 lbs combined. We looked at each other and decided that we can be just as awesome. Well, we can't lose 200 lbs combined or we would weigh a total of 40 lbs (which would be fine if we were housecats or small dogs, but is not practical for our purposes). So thank you all for the hints. My roommate and I downloaded the "Lose It" app for our iPhones and have set the goal of losing a combined weight of 35 lbs by mid-May. Hope this committment stops the snarky comments. P.S. Some suggested weight watcher's recipes that did not make it mainstream for obvious reasons. My personal favorite is the Fluffy Mackerel Pudding. http://www.candyboots.com/wwcards.html Credit for finding this site goes to my brother. | | |
| Would you let me be your OB/GYN?
The past 5 years, I've had my heart set on going into psychiatry, but these past two months, I've begun to question that decision. I have enjoyed my OB/GYN rotation far more than I thought I would. At the end of the day, as I walk home from the hospital, I am always glad that I went in and look forward to going in tomorrow. Those who know me well know that losing a close friend to addiction was my primary motivation for pursuing a career in addiction psychiatry. As I talked to my roommate tonight, she perceptively pointed out, "If you went into OB/GYN, you'd be doing it for yourself, and if you went into psychiatry, you'd be doing it for someone else."
When the decision is phrased so astutely: pursue a career for myself or a career for someone I lost a long time ago, the inevitably answer is that I need to hold onto what's mine and let go of what isn't mine anymore.
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