Start & Run a Medical Practice. Michael Clifford Fabian

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СКАЧАТЬ much more exciting can it get than saving a person’s life? Picture yourself walking into an emergency room and seeing a young child gasping for air and unable to breathe. This young patient was eating a big candy and was given a fright by a friend, resulting in the candy being suddenly lodged in the child’s throat. I was actually on call once when this very scenario occurred and I was called immediately to the emergency room. Luckily enough, I was not far from the emergency room and was taking a short break in between surgeries; I was able to rush to the situation in no time.

      Once I assessed the problem and saw how potentially grave this situation could be, I rushed the patient to the operating room. Due to the position of the candy in the throat, the patient was very fortunate that complete obstruction of the airway did not occur; in other words I had enough time to remove the candy in a more controlled environment and with the appropriate instrumentation. With the help of an anesthesiologist, a careful anesthetic was carried out. Using a steel rigid instrument (laryngoscope) and with a combination of a vacuum device and grasping forceps, the candy was successfully removed. The child woke up from the anesthetic without complication and the parents as well as all health-care parties involved in the care of this patient were ecstatic. Once I had some free time, I ventured back to the emergency room so that I could give feedback to the staff there, and thanked them for their part in the care, and positive outcome, of our mutual patient.

      1.3 Rewarding

      In the situation of a patient with cancer, it can obviously be very traumatic for all involved — especially the family, but the medical staff too. I can remember one child coming to the hospital very ill with fevers, loss of weight, and a recent history of bruising easily. After several investigations, which were all done on that day in the professional building where the doctor’s office was located, he was sent to the local hospital. All of this occurred because the family doctor was very concerned about some type of blood cancer. After the appropriate history and clinical examination in the emergency room, the child underwent an urgent bone marrow biopsy, in order to send some of the aspirate for analysis. A diagnosis of leukemia was made on that same day. As the patient was already in the hospital, he was started on chemotherapy. All of this happened within 24 hours.

      Chemotherapy can be a very difficult time for the patient as there are many side effects. Also, there is no guarantee that a patient will be cured and will subsequently survive. I was doing pediatric training at the time and was able to follow this particular patient through the entire treatment phase. Fortunately, this patient responded well to chemotherapy and was cleared of the blood cancer, at least for the short term, and maybe forever. Seeing the patient almost on a deathbed in the emergency room and then seeing a healthy child walk out of the hospital is an amazing experience. This is just one example of how rewarding a career in medicine can be.

      1.4 You want to help people

      I believe the BOAT concept — an acronym I devised — is the key to success for a happy career in medicine, particularity relating to job satisfaction. I believe it covers what I see as a fundamental concept for choosing a career in a health-care profession — not just wanting to help people, but an unconditional desire to help people.

      1.4a “B” — unconditional desire to help people despite the “background” of the patient

      You often cannot choose who your patients will be and what their background is. I always like to give the example of training or working in an inner-city hospital. The patients that arrive at the doorstep might be far from what you envisioned when you chose medicine as your career. You might find a patient with poor personal hygiene who is combative and rather abusive, verbally. This could be further complicated by a lack of ability for adequate history taking, making for diagnostic challenges. While this might not be a desirable situation for many people working in the medical field, there are just as many health-care professionals who prefer to work in this kind of environment. The level of satisfaction that can be gained from helping people in these deplorable situations can be immense.

      You might also have strong religious beliefs and have a patient who lives a lifestyle that fundamentally conflicts with your personal beliefs, morals, and ideals. As a doctor, you cannot impose your own values on a patient. You have to be impartial when treating a patient. There are a few situations in which you might defer the treatment to a colleague if you feel uncomfortable with the situation at hand. Performing abortions is one such example. In my opinion, nobody should be forced to perform abortions, and conversely nobody should be denied a legal abortion because of a doctor’s personal beliefs.

      1.4b “O” — unconditional desire to help people despite the “outcome” of the patient

      Imagine going into medicine thinking that you are always going to be able to make people better? This is often not the case. Picture yourself taking care of the medical needs of a family — a mom, a dad, and two children. The one child is nine years of age, doing well at school, an aspiring figure skater, and already thinking of doing some future humanitarian work at this young age. Very suddenly, the child starts having seizures, never having had a medical problem in the past. After all the necessary investigations, an aggressive brain tumor is diagnosed. This is obviously devastating for all. Despite having all the latest treatments available, including advanced surgery, the child deteriorates, and ultimately dies. Although you can be certain you tried your best, including acquiring the help of colleagues, you have no control of the final outcome — something you have to be aware of, and be able to deal with.

      Another patient of yours, a healthy middle-aged man, has elective surgery on his sinuses. During the anesthetic, there is a significant complication as a result of the patient’s previously undetected raised blood pressure. His past blood pressure readings appeared to be within normal limits. As a result, under anesthetic he is given medication to lower the blood pressure. This results in a chain of events, ultimately causing a stroke. The patient wakes up with significant impairments, including memory loss and some long-term consequences. Who would have thought that this would have happened to one of your patients? This is certainly an outcome no doctor would have wanted.

      1.4c “A” — unconditional desire to help people despite their “appreciation” level

      You have to want to help patients because that is something you truly want to do, without the expectation of any kind of appreciation in return. So let’s imagine you in this position:

      You are a family physician working in a small rural community. There is one hospital in town, and you are covering the Emergency Room (ER) for the night. While attending a birthday celebration for one of your children, you are called urgently to the ER to attend to a passenger injured in a motor vehicle accident. You arrive at the ER to find a young woman lying in a neck brace, speaking appropriately and moving all her limbs. You investigate for many things over the next three hours, including a possible neck injury. In this case you decide the patient is stable enough to stay in the local hospital overnight.

      You talk to the patient’s family to give them an update of the situation. More family members have arrived, and you now have about ten people staring you in the face and looking rather worried, which is totally understandable. If this was my sister, mother, or friend I would be worried too. While you try to tell them what is going on, they seem frustrated that you do not have more specific answers as to the exact nature of the patient’s injuries. The family also expresses concern about why you are taking care of this patient in the local hospital, and have not transferred her to the “big city hospital.” During all of this conversation, nobody has acknowledged that you have just spent three hours trying to figure out what’s going on with the patient, and little do they know that you left your own child’s birthday party to attend to their family member so СКАЧАТЬ