Wednesday, February 10, 2010
Snowmaggedon And Physician Responsibility
This post by Steve Simmons, MD, originally appeared at Better Health.
I practice medicine in the suburbs west of Washington, D.C., and everywhere I look I see 30 or more inches of snow. I keep reminding myself of where I am--not unlike a man pinching himself to ascertain wakefulness--because the view my window affords me is tailor made for the usual snow typical to Buffalo, N.Y. Two days after the snow stopped falling, schools are cancelled indefinitely, most side streets have yet to see a plow, and tens of thousands are without electricity, including my partner's family huddled together like in a dark basement enjoying the extra two or three degrees of warmth to be found there.
It is hard, but not impossible, to practice medicine when the pace of modern society grinds to a halt. Yet at least we, here, enjoy the benefits of living in a country with a well developed infrastructure prepared to rebound instead of recoiling from nature. To compare our "snowmageddon" (a term used on the news here) and the earthquake in Haiti would be both inappropriate and naive; yet, our daily lives have distinctly altered and in that an understanding of the fragility of society and the responsibility of a physician is possible. Still, there are many differences. We ask when our power will be returned, not if; snow will melt, but buildings don't un-crumble; and while my neighbors shiver together in their homes, many Haitians seek their loved ones with a shovel.
I know a few physicians who have been to Haiti and spoke with another today whose trip is planned for next week. I admire them all. Another doctor recently returned from Haiti was on the local news last night, shoveling the mountain of snow that had been waiting for him on his return home, a smile was on his face. The story they tell of Haiti isn't funny; it is one of an absent medical infrastructure and chaos, and still they go. One doctor described the coordination of Haitian medical relief as being akin to a group of five-year-olds playing soccer. Another story tells of doctors fleeing an angry crowd surrounding an unequipped hospital, their guards brandishing M16 rifles.
Nothing we see here could ever compare to these stories. However, people have died of carbon monoxide poisoning, accidents and the inevitable snow-shoveling heart attacks. My concern must be with my family and patients here and now. What do they need? What role should I play to best serve them today? We have been unable to open our office, let alone get to it but my practice does not rely on seeing patients face-to-face to treat. We don't have to generate insurance paper-work to keep the lights on or meet our overhead. Our laptops are open and pharmacies are filling our prescriptions. In our practice we continue to care for our patients using the telephone and e-mail to apply basic triage to patients we have already met and know. Most phone call visits are limited to upper and lower back pains plus a medley of other sore muscles, ligaments, and then attitudes, as the forecast for Wednesday morning's weather included up to 20 more inches of snow for our area.
American doctors, fortunate enough to practice medicine in the 21st century, should not become complacent or too dependent on the daily flow of patients through our offices. We must be able to adapt to circumstance and react to emergency. Society will depend on us and I, for one, am optimistic that our profession stands ready and will meet any challenges thrown our way as evidenced by recent events. The bravery of physicians volunteering in Haiti ennobles our entire profession and we can all feel pride in their actions. The responsibility towards all of our patients will not lessen after unforeseen events. Rather, it will increase and the chance to respond magnificently awaits us all as we support our patients in the seemingly mundane affairs of day-to-day living.
Until next week I remain yours in primary care,
Steve Simmons, MD
This post originally appeared on Better Health, a network of popular health bloggers brought together by Val Jones, MD. Better Health's mission is to support and promote health care professional bloggers, provide insightful and trustworthy health commentary, and help to inform health policy makers about the provider point of view on health care reform, science, research and patient care.
Labels: Haiti
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Members of the American College of Physicians contribute posts from their own sites to ACP Internist and ACP Hospitalist. Contributors include:
Albert
Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the
University of California, Los Angeles School of Medicine, where he
also did his internal medicine training. Certified by the American
Board of Internal Medicine, Dr. Fuchs spent three years as a
full-time faculty member at UCLA School of Medicine before opening
his private practice in Beverly Hills in 2000.
Zackary
Berger
Zackary Berger, MD, ACP Member, is a primary care
doctor and general internist in the Division of General Internal
Medicine at Johns Hopkins. His research interests include
doctor-patient communication, bioethics, and systematic reviews.
CasesBlog
Ves
Dimov, MD, ACP Member, is an allergist/immunologist and Assistant
Professor of Medicine and Pediatrics at the University of Chicago,
where he evaluates and treats both pediatric and adult patients.
David
Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally
renowned authority on nutrition, weight management, and the
prevention of chronic disease, and an internationally recognized
leader in integrative medicine and patient-centered care.
db's
Medical Rants
Robert M. Centor, MD, FACP,
contributes short essays contemplating medicine and the health care
system.
DrDialogue
Juliet
K. Mavromatis, MD, FACP, provides a conversation about health topics
for patients and health professionals.
Dr.
Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal
medicine for more than a decade and is an Associate Professor of
Medicine at an academic medical center on the East Coast. His time is
split between teaching medical students and residents, and caring for
patients.
Everything
Health
Toni Brayer, MD, FACP, blogs about the rapid
changes in science, medicine, health and healing in the 21st century.
FutureDocs
Vineet
Arora, MD, FACP, is Associate Program Director for the Internal
Medicine Residency and Assistant Dean of Scholarship & Discovery
at the Pritzker School of Medicine for the University of Chicago. Her
education and research focus is on resident duty hours, patient
handoffs, medical professionalism, and quality of hospital care. She
is also an academic hospitalist.
Glass
Hospital
John H. Schumann, MD, FACP, provides
transparency on the workings of medical practice and the complexities
of hospital care, illuminates the emotional and cognitive aspects of
caregiving and decision-making from the perspective of an active
primary care physician, and offers behind-the-scenes portraits of
hospital sanctums and the people who inhabit them.
Gut
Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist
at the University of North Carolina School of Medicine, and the
Program Director for the GI & Hepatology Fellowship Program. He
specializes in diseases of the esophagus, with a strong interest in
the diagnosis and treatment of patients who have difficult-to-manage
esophageal problems such as refractory GERD, heartburn, and chest
pain.
I'm
dok
ACP Member Mike Aref, MD, PhD, ACP Member, is an academic
hospitalist with an interest in basic and clinical science and
education, with interests in noninvasive monitoring and diagnostic
testing using novel bedside imaging modalities, diagnostic reasoning,
medical informatics, new medical education modalities, pre-code/code
management, palliative care, patient-physician communication, quality
improvement, and quantitative biomedical imaging.
Informatics
Professor
William Hersh, MD, FACP, Professor and Chair,
Department of Medical Informatics & Clinical Epidemiology, Oregon
Health & Science University, posts his thoughts on various topics
related to biomedical and health informatics.
Just
Oncology
Richard Just, MD, ACP Member, has 36 years in
clinical practice of hematology and medical oncology. His blog is a
joint publication with Gregg Masters, MPH.
KevinMD
Kevin
Pho, MD, ACP Member, offers one of the Web's definitive sites for
influential health commentary.
MD
Whistleblower
Michael Kirsch, MD, FACP, addresses
the joys and challenges of medical practice, including controversies
in the doctor-patient relationship, medical ethics and measuring
medical quality. When he's not writing, he's performing
colonoscopies.
Medical
Lessons
Elaine Schattner, MD, ACP Member, shares
her ideas on education, ethics in medicine, health care news and
culture. Her views on medicine are informed by her past experiences
in caring for patients, as a researcher in cancer immunology, and as
a patient who's had breast cancer.
More
Musings
Rob Lamberts, MD, ACP Member, a med-peds and general
practice internist, returns with "volume 2" of his personal
musings about medicine, life, armadillos and Sasquatch at More
Musings (of a Distractible Kind).
Musing
of an Internist
Justin Penn, MD, ACP Associate Member,
attended medical school at the University of Washington School of
Medicine and trained in internal medicine at the University of
Rochester, where he is serving as Chief Resident.
Prescriptions
David
M. Sack, MD, FACP, practices general gastroenterology at a small
community hospital in Connecticut. His blog is a series of musings on
medicine, medical care, the health care system and medical ethics, in
no particular order.
Reflections
of a Grady Doctor
Kimberly Manning, MD, FACP,
reflects on the personal side of being a doctor in a community
hospital in Atlanta.
Technology
in (Medical) Education
Neil Mehta, MBBS, MS, FACP,
is interested in use of technology in education, social media and
networking, practice management and evidence-based medicine tools,
personal information and knowledge management.
White
Coat Underground
Peter A. Lipson, MD, ACP Member, is a
practicing internist and teaching physician in Southeast Michigan.
The blog, which has been around in various forms since 2007, offers
musings on the intersection of science, medicine, and culture.
Other blogs of note:
American
Journal of Medicine
Also known as the Green
Journal, the American Journal of Medicine publishes original clinical
articles of interest to physicians in internal medicine and its
subspecialities, both in academia and community-based practice.
Clinical
Correlations
A collaborative medical blog started
by Neil Shapiro, MD, ACP Member, associate program director at New
York University Medical Center's internal medicine residency program.
Faculty, residents and students contribute case studies, mystery
quizzes, news, commentary and more.
Interact
MD
Michael Benjamin, MD, ACP member, doesn't accept
industry money so he can create an independent, clinician-reviewed
space on the Internet for physicians to report and comment on the
medical news of the day.
PLoS
Blog
The Public Library of Science's open access
materials include a blog.
White
Coat Rants
One of the most popular anonymous blogs
written by an emergency room physician.

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