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Monthly Archives: January 2007

Although starting medical school means many different things to different people, we are all unified in this transition by the fact that we are joining something larger than ourselves: we are joining a team. Like any other team, there are codes of conduct, battles of pride, and the constant struggle for unified strength against common enemies, from disease to imposed restrictions on our autonomy to our own mistakes and shortcomings. Nonetheless, despite the inevitable hardship and challenge, there are many perks. Of all the sources of American health care costs, it’s somewhat surprising that relatively few try to argue for the reduction of one of the highest costs: physician salaries. I’m fine with that. Why? Not just for purely selfish reasons, but it’s my firm belief that medicine is one of the few occupations where good, intelligent people can be rewarded with financial benefits and personal satisfaction for being both. In this profession, you don’t have to sell your soul to succeed: instead, your strength of spirit, your generosity, and your kindness actually make you better at what you do.

It is nothing short of a blessing and a privilege to be a part of this profession: for every one of us who sits in class each day, there is at least one or perhaps many others who missed their chance, more likely than not for unfair reasons outside their control (including disease and poverty, our longstanding adversaries). On this team, what sort of player will you be? The type who hogs the ball, caring only about his own success? The type who needlessly gets into fights, penalizing the entire team? Many medical schools are successfully encouraging cooperation among students by making courses Pass/Fail; “gunners” and cutthroats are now more likely to be social pariahs than the accepted norm. However, many still don’t take the statement “Your classmates are your future colleagues” to heart, thinking that the behavior of a doctor on the other side of the country would bear no significance on them. Nonsense. Look at Anna Pou. Jack Kevorkian. Bill Frist. Richard Cabot. Michael Debakey. In various ways, these physicians have had profound effects on the way medicine is practiced, the way physicians interact with the public arena, or the way we will practice medicine soon. Yet, one doesn’t need to have a high profile to affect the way your colleagues practice medicine. The ways that we as individuals interact with our patients, with the public, and with one another deeply influences the environment in which we practice, for better or worse. A patient with a poor rapport with one doctor might see you next, and he may be deeply scarred by his prior experience and needlessly untrusting in his approach to you. A potential donor to your program might rescind her offer, discovering that other practices in your hospital regularly use antiquated techniques. A colleague who might offer you some advice and constructive criticism to help improve your practice or technique might hold back, knowing that you have previously shown yourself to be too proud to change. Face it: despite your pride, you are going to change, but everyone else around you will too. We are in the same boat, together, and as a professional team, we will sink or sail together. If but one person chooses pride and selfishness over teamwork, we are all at risk of failure. If we as individuals truly deserve the opportunities given to us, we need to prove it. Fortunately, it’s not something we have to do alone.

This month, the city of Bangor, Maine is starting to outlaw smoking in cars when kids are riding in the vehicle: this is a small step in the right direction toward minimizing the damage to public health caused by cigarette smoking. In recent times, cities and states (including a state as backwards as my home, Louisiana) have outlawed smoking in public gathering places such as restaurants, coffee shops, offices and some bars (though some still permit smoking). It’s ancient history now, but if you’re actually paying attention to the theater management’s messages before the movie or the safety instructions prior to takeoff on a plane, you will note that most of these businesses have forbade the use of cigarettes for many years now. It might not actually be a new idea, but I would like to propose this next step: smoking with children present (in the home or otherwise) should be considered child abuse (and should be penalized accordingly).

One of my potential interests with respect to future specialization is Pulmonary and Critical Care Medicine, particularly due to my longstanding interest in asthma. With asthma playing a significant role in my childhood as well as being detrimental to the health of my physician-stepmother, I’m very interested in taking an active role in combatting this common disease, clinically and in research. Another realm to manage the effects of this (at best) troublesome and (at worst) fatal disease is through public health. I understand that at this time, starting smoking is a lifestyle choice for many individuals (though continuing may be a health matter with regards to nicotine addiction), but the victims of the effects of secondhand smoke do not volunteer to be exposed. Most significant of these victims are children of parents who smoke: they have no choice but to continue to live with their parents who might otherwise be the best parents that they can possibly have.

Nonetheless, secondhand smoke exposure to children dramatically increases the incidence of asthma, pneumonia, bronchitis, and even Otitis Media (Middle Ear Infection) . Secondhand smoke not only can trigger the development of the diseases, but they can also trigger episodes such as potentially lethal asthma attacks. Although less common now, it is well known that smoking during pregnancy increases the risk of disastrous events: miscarriage, stillbirth, low birth weight, and SIDS (Sudden Infant Death Syndrome).

There are many things that good parents normally wouldn’t do to their children: beat them (i.e. cause physical blunt/sharp trauma), verbally and emotionally abuse them (i.e. learding to psychiatric disorders), or intentionally starve them (i.e. severe nutritional deficiencies). Parents also don’t normally offer alcoholic drinks to their 8-year-old kids. Properly managed alcohol consumption is perfectly acceptable in adults. Mismanaged alcohol consumption (i.e. binge-drinking, alcoholism) is not. Similarly, although it is clear that smoking increases the risk of developing many diseases, properly managed smoking among adults is legally acceptable (though increasingly less socially acceptable). Smoking, unlike alcohol, has nonbehavioral side effects that must be managed: secondhand smoke, as opposed to violent or abusive behavior associated with alcohol. As such, secondhand smoke should be a legal liability, just as physical, traumatic abuse (as assault and battery among adults or child abuse with children) is a legal liability. Adults can legally smoke as much as they would like in their own homes, private spaces, and public facilities that allow smoke. Adults who don’t smoke can easily choose to avoid these areas. Children sometimes don’t have that choice.

Sources:

EPA: http://www.epa.gov/smokefree/healtheffects.html
[There is a good article on this subject as addressed by the Surgeon General in the June 28, 2006 issue of the Washington Post.]

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