29 November 2009
Psychosurgery 2009
Neurosurgery for psychiatric illnesses seems to be making a comeback in the US. I vividly remember as a medical student seeing flattened patients who had undergone these procedures in the early 1970’s. They were fairly primitive but did extinguish some of the most repetitive obsessive compulsive disordered behaviours. Perhaps now with vastly improved imaging modalities of the brain and better surgical techniques, operations will be more precise and relieve sufferers of long term burden that can wreck their lives.
08 November 2009
Thailand travel
Travelling in Thailand to Hua Hin, some 200 km south of bangkok to a beach side resort ton that has grown dramatically since i was here seven years ago. There is now a six lane highway through the town. The market is a pleasant clean place with much less of the hassle of Bangkok. The weather is hot and steamy. One forgets how oppressive tropical heat can get and how lethargic it makes you feel. Still the compensations are fantastic massage and a laid back lifestyle with a smiling local population. The Asara Spa is beautifully designed. The service impeccable and we leave tomorrow for a day in Bangkok before flying to the cradle of civilization Athens...
01 November 2009
VIP medicine
VIP medicine
There are some patients in every practice who feel entitled. They demand extra services and they are often wealthy or connected. Such people do not like to wait for the doctor. They will often use modern technology to attract your attention demanding your mobile phone number or your e-mail address to provide them with extra access to your service.
They will insist on paying you the highest level of remuneration for your work often plying you with flattery and perhaps small gifts or favours. But very soon you begin to develop a strange codependence that leaves you with an uneasy feeling.
Celebrities are notorious for such behaviour with doctors but lately the VIP medicine has spread to the general community. It is often difficult to say no to requests from such patients who may demand all sorts of favours from excessive prescription drugs for imagined physical or psychological pain to disabled parking permits and even certificates to exclude them from attending jury duty or court. Alas, most GPs have great difficulty in not complying with patient requests. This is not taught at university and is probably the most important skill that young medical students and doctors need in their everyday armamentarium. There is not a clinical day that goes by when the word ‘no’ needs to be articulated and oft repeated. For such patients have selective hearing loss, they believe through experience that all their wishes will be fulfilled and anybody who thwarts them will suffer their slings and arrows. VIP treatment is hazardous. The line between patient and doctor is often blurred with coercion sometimes subtly exerted on an unsuspecting practitioner. Rich and famous patients are different and a doctor treating them needs to be mindful of these potential difficulties. The film, music and professional sport industries are notorious for applying pressure to doctors so that the show which must go on, can go on.
I remember vividly escorting a movie star through the emergency department of a large Sydney teaching hospital after he had fallen from his motorcycle during a shoot at nearby film studios. There was an entourage of nurses, first-aid attendants, film company executives and personal assistants thronging around the patient's bed. The blowtorch was applied to me when I was told that every 24 hours that this star could not appear was costing hundreds of thousands of dollars in downtime for the entire crew. I was expected to work miracles.
Famous rock singers with viral upper respiratory tract infections set to appear before 20,000 screaming fans demand immediate and ongoing treatment. Pressure will often be applied to prescribe unnecessary antibiotics or even corticosteroids in an attempt to return the star to full health as fast as possible. Doctors who do not comply are rapidly dispensed with and a new practitioner is sought through the grapevine.
Demanding patients will monopolise your time and tie you up in knots unless you set up clear and effective boundaries.
Here is an example of such an interaction
“ Look doctor, I know what I want, I've had it before. It works every time my schedule is so packed today. Can't you just send a script down the pharmacy and my assistant will pick up later this afternoon? I promise to make it worth your while. Hang on Doctor, the director wants me on the set. I have to go now. Thanks for everything. I’ll make sure there are two tickets for you at the premiere.”
So begins the slippery slope, the ethical compromise and the clear sensation that medical protocols have gone by the wayside in the presence of overwhelming force.
It is easy to understand how both GPs and even specialists can be seduced by such unrelenting pressure exerted by the most manipulative people on earth. The smell of the greasepaint, the roar of the crowd and a wad of notes are potent forces in turning one's head.
The secret though remains clear in the words of the old Shakespearean adage ‘ above all, to thine own self be true’
Ask yourself would you do this for any other patient? If not, just say no. Say ‘no’ again and walk away from the bright lights. It is far more comfortable in the shade.
There are some patients in every practice who feel entitled. They demand extra services and they are often wealthy or connected. Such people do not like to wait for the doctor. They will often use modern technology to attract your attention demanding your mobile phone number or your e-mail address to provide them with extra access to your service.
They will insist on paying you the highest level of remuneration for your work often plying you with flattery and perhaps small gifts or favours. But very soon you begin to develop a strange codependence that leaves you with an uneasy feeling.
Celebrities are notorious for such behaviour with doctors but lately the VIP medicine has spread to the general community. It is often difficult to say no to requests from such patients who may demand all sorts of favours from excessive prescription drugs for imagined physical or psychological pain to disabled parking permits and even certificates to exclude them from attending jury duty or court. Alas, most GPs have great difficulty in not complying with patient requests. This is not taught at university and is probably the most important skill that young medical students and doctors need in their everyday armamentarium. There is not a clinical day that goes by when the word ‘no’ needs to be articulated and oft repeated. For such patients have selective hearing loss, they believe through experience that all their wishes will be fulfilled and anybody who thwarts them will suffer their slings and arrows. VIP treatment is hazardous. The line between patient and doctor is often blurred with coercion sometimes subtly exerted on an unsuspecting practitioner. Rich and famous patients are different and a doctor treating them needs to be mindful of these potential difficulties. The film, music and professional sport industries are notorious for applying pressure to doctors so that the show which must go on, can go on.
I remember vividly escorting a movie star through the emergency department of a large Sydney teaching hospital after he had fallen from his motorcycle during a shoot at nearby film studios. There was an entourage of nurses, first-aid attendants, film company executives and personal assistants thronging around the patient's bed. The blowtorch was applied to me when I was told that every 24 hours that this star could not appear was costing hundreds of thousands of dollars in downtime for the entire crew. I was expected to work miracles.
Famous rock singers with viral upper respiratory tract infections set to appear before 20,000 screaming fans demand immediate and ongoing treatment. Pressure will often be applied to prescribe unnecessary antibiotics or even corticosteroids in an attempt to return the star to full health as fast as possible. Doctors who do not comply are rapidly dispensed with and a new practitioner is sought through the grapevine.
Demanding patients will monopolise your time and tie you up in knots unless you set up clear and effective boundaries.
Here is an example of such an interaction
“ Look doctor, I know what I want, I've had it before. It works every time my schedule is so packed today. Can't you just send a script down the pharmacy and my assistant will pick up later this afternoon? I promise to make it worth your while. Hang on Doctor, the director wants me on the set. I have to go now. Thanks for everything. I’ll make sure there are two tickets for you at the premiere.”
So begins the slippery slope, the ethical compromise and the clear sensation that medical protocols have gone by the wayside in the presence of overwhelming force.
It is easy to understand how both GPs and even specialists can be seduced by such unrelenting pressure exerted by the most manipulative people on earth. The smell of the greasepaint, the roar of the crowd and a wad of notes are potent forces in turning one's head.
The secret though remains clear in the words of the old Shakespearean adage ‘ above all, to thine own self be true’
Ask yourself would you do this for any other patient? If not, just say no. Say ‘no’ again and walk away from the bright lights. It is far more comfortable in the shade.
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