selling my soul....

So in continuing themes of hot debate, I decided to discuss the whole pharm rep thing this week.

I started my family rotation---I'm at a clinic on the south side of town which means I see a lot of patients who do not have much money, especially for medications, and most of them are on 4 or 5 chronic meds. This gets pretty pricey. In starting this year, I signed a pharma free pledge, meaning I wouldn't except anything from pharm reps except for information. I lasted 3 weeks before I accidentally ate a breakfast that was hosted by some pharm company ( I had no idea at the time). Since then, I've had a couple of lunches here and there. As much as I hate it, I am broke, and its nice not to have to buy my lunch everyday. But at the same time I know it increases prices of the meds to my patients.

Apparently, at the clinic I'm working at they have pharm lunches everyday. The entire staff partakes. Today was a half day for me, but the person I was working with really wanted to "support" the pharm rep because "it must be really difficult to be a pharm rep." So I stayed. I wanted to see this person eating up everything they had to say as well as their free lunch. We got our food, sat down and started munching away while the pharm reps asked the doc how she was doing, what her plans were for the summer, how her kids were, etc. I finally piped up and asked how their bisphosphate drug compared to calcium and vitamin D supplements. They quoted a couple of studies and then discussed how pharm reps weren't allowed in several clinics around town, and how this was the detriment to medicine. I didn't really listen then---It was the first time I've ever questioned a pharm rep---I usually run for the hills, worried I will be consumed by the ads and free pens, but I have to say, it felt good to ask questions---kind of like it does while I'm in class.

I hope to never sell my soul, but to continue to question. I hope to not rely on drug supported lunches someday. But for now, while I'm broke, I'm going to eat and question.

To be remembered by our patients

Yesterday we started the conversation of to circumcise or to not circumcise. It can be a pretty serious debate between physicians as well as families. (has anyone seen the scrubs episode??) But there are some real medical advantages such as decreased incidence of childhood phimosis---a condition where the male foreskin cannot be retracted from the head of the penis. (phimosis is normal in infants, but pathologic in children or adults) The real problem is when phimosis gets infected or if paraphimosis occurs. And its the treatment of paraphimosis thats the kicker.

This brings me to the title of this blog. Its wonderful when patients remember you and have nice things to say about their doctor. Every doc wants to be remembered for something. The treatment for paraphimosis can be circumsion or it can be done the hard way. This entails 4 people to hold the kiddo down. Then one person grabs the foreskin and forcefully pulls it down. This results in mild to moderately bleeding, and a severely traumatized kid. A doc described the aftermath of this treatment: He was walking down the frozen food isle in the local grocery store about 6 months after treating paraphimosis on a 4 year old uncircumcised kiddo. The kiddo took one look at the doc, grabbed his penis, and ran screaming toward his mother. The family actually had to change doctors because the child was so traumatized.

And we say we all want to leave an impression on our patients.

Looking back

I remember back to my first few months of medical school when I was studying neurology. It happened to be one of my toughest classes in medical school, but at the same time I remember thinking the brain is amazing. This was also the time that I thought medicine was amazing and that we could heal all.

I attended a wedding that fall and met a friend of the family who had a 12 month baby. He was adorable. His mom told me he was recently diagnosed with cerebral palsy (CP). I quickly searched my my mind for that disease, but my mind was blank. I hadn't learned about it yet. His mom found out I was in med school, and typically started asking me tons of medical questions about CP, to which I knew none of the answers, but feeling reassured that medicine could save all, I told her that neurologists were doing amazing things these days and I was sure there would be an answer for her. I went back to school and looked up CP in our huge neurology book, and found that it didn't exist in there. I let it go and completely forgot about the whole thing.

Until now.

I've seen several CP kiddos in clinic and in the hospital. Although the severity of the disease is different for each kid, the prognosis is not good. I feel horrible for dropping the ball on that cute kid I saw 2 years ago. I had no idea what his mom was experiencing and I just played the "everything will be alright" card without really thinking and then moved on. I am sorry.

Billy Rubin

Today we had a 2 day old kiddo come into the hospital because of increased bilirubin levels or a fancy medical term that I've been known to use---hyperbilirubinemia. The treatment for increased bili is to expose the kiddo to UV lights. It binds up the free bilirubin and takes care of the job.

The two other med students and I, plus a resident, and a nurse went in to meet the happy couple and the brand new baked-duck-to-be. One of the main reasons why this disease occurs is because of dehydration. Mom and dad were pretty freaked out, but were eager to learn how to breast feed their kiddo better. The resident had mom de-gown and show her what she's been doing during feeds. The resident was explaining how to engage the entire breast to help the kiddo out, while we stood behind her trying to get a peek of what was going on. Dad just kept shouting "Stick the whole thing in her mouth!" "Stick it in her mouth!" "Just stick it in!" I would have loved to be a patient on the other side of the curtain.