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Month: January 2017

First, Do No Harm

First, Do No Harm

Some people think that they are doing “good” for people because they believe there is a big discovery or reward for society behind a study they are conducting. Many studies that people conduct could actually present some important data, but the means in which they are conducted can ruin the credibility of the study. For example, the various studies that the Nazis conducted were meant to advance their military. The people that were conducting the studies truly thought they were doing something good for the nation of Germany. However, the way that the conducted the studies and the racism they used to select the participants was horrible and completely ruins the validity of the results.

One of the readings we did was about Dr. Fata, an oncologist, that had the complete opposite mentality. He was giving chemotherapy to those who didn’t have cancer and he gave too much chemotherapy for those who did have cancer. He let money step in front of his morals and that is why this happened. I experienced the impact of Dr. Fata’s harm first-hand as my father was one of his patients. My father did have cancer, but he reduced the quality of his life before he passed away from the disease because of the excess chemotherapy. Had Dr. Fata kept the saying “do no harm” in mind, the final years with my father could have been much more enjoyable. I will always keep this in mind as a doctor and it really highlights the fact that doing no harm is the first thing a doctor needs to consider.

Finally, it is important that we discuss these topics so similar events never happen again. As the saying goes, history certainly does repeat itself, but in harmful medical practices, I hope we can prove that wrong.

Communication and Decision Making

Communication and Decision Making

Dr. Zikmund-Fisher’s discussion was quiet capturing. I was hooked from the start and I absolutely loved it. What I got most from his conversation was not to try and eliminate risks 100% completely because that is basically impossible. What I learned was to minimize harmful risks that can cause some damage. I find that very important because life is full of harmful risks. To completely eliminate risks would mean living in a box and that is a harmful risk itself. I think his talk allowed me to open my mind and actually see the world with a better view. With a view that life can be taken for granted. I am someone who is a believer that you can live life happy and that includes risks. Take some risks because you have too. Eat some cookie dough every now and then, but maybe the first step would be to minimize the amount consumed, but never to fully cut out.

My intended profession is to be a dentist. As a dentist, I want to do one simple thing: Make people smile. It is essential to be a good communicator because that helps my patients develop a relationship with me. I want to be that friendly dentist and I want to help them out. When my name goes around, I only want positive things heard and that would give the public a even better understanding of who I am and what I do: Who I am as a person and how I connect with my patients on a person level.

Blog 2: Communication and Decision Making

Blog 2: Communication and Decision Making

After hearing Dr. Zikmund-Fisher’s discussion, I was pleasantly surprised that his views actually aligned with mine. I feel that too often, professionals feel the need to exert their knowledge and ‘power’ over their patients. Dr. Zikmund-Fisher had a different outlook, and we share the standpoint. You can’t always TELL someone what they should do. Sometimes you just have to give them the facts and hope they make the best decision they can. There are so many factors that contribute to a person’s thought process, and we can not always just be the over arching hand that controls their choices. That being said, even though we share some of the same opinions, he still taught me something that I had not previously considered. People have actual concerns and issues when they are refusing an option. Although I technically knew this, I did not consider how it would affect their decision-making processes. This leads into why it is so important to be able to communicate with those you work with. Asking questions like “what concerns do you have” or “what is holding you back from pursuing this option” allows for open conversations that can shape how a patient views their options.

That being said, even though we share some of the same opinions, he still taught me something that I had not previously considered. People have actual concerns and issues when they are refusing an option. Although I technically knew this, I did not consider how it would affect their decision-making processes. This leads into why it is so important to be able to communicate with those you work with. Asking questions like “what concerns do you have” or “what is holding you back from pursuing this option” allows for open conversations that can shape how a patient views their options.

Like they say in IGR, ‘No one knows everything, but together we know a lot”. I think this can easily translate to decision making and communication. It is never our job to force people to do what we think is best. On the contrary, it is always our job to inform, guide, and listen so that both our patients and ourselves end up with the best outcome possible. This is sometimes easier said than done, so what strategies do you think should be implemented to help guide people in the decision-making process?

 

Blog 2: Communication and Decision Making

Blog 2: Communication and Decision Making

I was very surprised that Dr. Zikmund-Fisher still advised people to do what they felt was best for them, and not what is statistically safest. I had a preconceived idea that people who consume and work with research for public health would practice the safest possible means of living by practicing what others in their field preach, but that is not the case. I agreed with him that instead of blindly following what experts in the field may say about every possible dangerous thing, it is always best to follow what you believe will allow you to live a happy life, and take the risks which you are willing to live your life the way you choose. Coming from someone whose mother obsessed over ever new study and warning for simple, relatively safe food items, it’s nice to hear someone talk about the other side for a change.

As a nurse, it’s probably a little important to be good at communication. If I don’t communicate clearly enough, someone could die, which sets the stakes a little high. Translating what treatment I intend to carry out from medical terminology to common language can be tricky, and doing it right makes the difference between a well-informed patient and one who knows nothing about their treatment, which means they can’t make well-informed decisions. That’s a dangerous recipe that could lead to more pain and suffering instead of a healed patient. I have to help patients make decisions not by what I think is best, but by informing them impartially about their choices and letting them decide what’s best for them, whether that be the decision to undergo a potentially risky surgery, or whether or not their favorite cookie dough is a safe choice to eat

Blog 2: Communication and Decision Making

Blog 2: Communication and Decision Making

The thing that surprised me most from Dr. Zikmund-Fisher’s discussion was the idea of benefit and loss in doing things. When we think of smoking, we think of it as a bad habit that only causes harm and has no actual benefit. In Thursday’s class however, we were given the example of an old woman, dying of cancer (not lung cancer) that longed to smoke a cigarette with an old friend. The cigarette wasn’t going to kill her any faster than her cancer would, so who would we be to deny her that one smoke?

This also works the other way around. We think that many things are only beneficial even when there’s a downside that may not be as apparent. No one would argue that insulin is bad for a diabetic, it would still change that person’s daily life drastically and that may not be something the patient is willing to do. The main point of this discussion was that we oftentimes don’t think about the cost something might have to a person. The benefits may be very apparent and to many an absolute no-brainer while others may not be willing to take on such a burden.

I will try to always keep this discussion in the back of my mind in the future, especially when I’m practicing medicine. Most of the time it’s not up to me to make a decision regarding a patient’s life and it’s extremely important to present facts neutrally and let choices, in the end be the patient’s. I will usually not know the exact circumstances a patient’s in and the only person that knows what they can and can’t handle is the patient himself.

Risky Business

Risky Business

Everything we do in our everyday life has some sort of risk associated with it. Whether it’s walking to class in the middle of the day or cage diving with great white sharks, every action has a risk. Dr. Zikmund-Fisher brought this to our attention. Now both of these actions are decisions. In class, Dr. Zikmund-Fisher lectured us on decision making decisions regarding ones health. My favorite example used in class was the debate on whether or not we should make vaccines mandatory. On one hand personal autonomy is important. We should have the liberty to do whatever we want as long as it does not involve harming others especially when there is a small risk; however, there is also the argument that not being vaccinated will not only harm you, but everyone else around you. Are the risks worth the benefits? Is minimizing the risk of disease worth the minimal risk of having some sort of negative repercussion from the vaccine itself? What do you think? Should personal autonomy or the benefits of vaccines be the norm in medicine?

Blog 2: Communication and Decision Making

Blog 2: Communication and Decision Making

Dr. Zikmund-Fisher brought to light some interesting insight about communications and decision making.  Prior to the discussion I never thought about the risks associated with almost every action I take throughout the course of the day.  Everything from eating in the dining halls to simply walking from one class to another has an associated risk yet I consciously decide to make that choice.  Lets take eating mojo cookies for instance.  It’s a well documented fact that eating cookies is not a healthy habit but that still does not stop the majority of us from grabbing one on the go.

 

Communicating and giving advice on the best course of action will be an integral role in my future profession as a physician.  A physician’s primary job is to analyze the patient at hand and impart their scientific knowledge so that the patient can ultimately make the final decision.  This can only be accomplished through effective communication between both patient and doctor.  Furthermore, as an aspiring surgeon, it will be all the more critical to converse and effecitviely communicate with my team in the operating room.   Since communication, as seen by the lecture and description above, is a key component of any profession, my question to you all is the following: What measures can we take to improve upon our ability to communicate?

 

Blog 2: Communication and Decision Making

Blog 2: Communication and Decision Making

Brian Zikmund Fisher is a Public Health Faculty member and researcher. He uses his knowledge to understand all the factors that lead to decisions one makes about their health. In lecture we discussed about the desire to have individual autonomy versus the decision you make affects others around you. We discussed times when the patient does not have control, for example when medication is being prescribed. We coerce patients to do what the doctor wants. For example, Jacobi vs. Massachusetts was the first time the state punished people for not following medical advice. In 1905 the Supreme Court ruled that individual right is overturned when keeping the greater society healthy and safe.  There are also times when health care providers are informing, but not motivating a patient. For example, abortion or chemotherapy. There are certain cases as well when the patient has all the control. For example, during organ donations or resuscitation. But most often we see the second, where we are shaping our information in order to maximize that individuals outcomes. This surprised me because even though doctors and physicians have the best in mind, they do forget that they do know the implications, but not what is right for that particular person and the patient has the right/choice to steps to take for their health. As Mr. Fisher said, we have to be aware of moments when we say something factual and not relaying something you value through facts. We have to make decisions based on the information we are provide and not let those facts dictate what we do. Another concept that surprised me in this lecture is that the FDA is doing something similar to what was done in the 1900’s when health propaganda was used. It was not the content but the intent. It was not their intent to help individuals make better decisions but to make the right decision. To inform you, to make you do what the experts wanted, not what you wanted. Change your attitude, compliance without coercion. As a future doctor, what I will keep in mind is that in order to help my patients we both have to work together to provide a solution. I have to remember that what I may think is right, may not be right for that particular person. Its very important to be a good communicator because there could be multiple factors that may affect a patient, but you wont know unless you are able to communicate. We have to always keep the boundary between fact and valued fact.

Blog Two: Communication and Decision Making

Blog Two: Communication and Decision Making

Dr. Zikmund-Fisher’s discussion brought up some interesting points about the decisions we make that I would not have thought about myself. Many of us like Dr. Zikmund-Fisher still choose to do what we want even after knowing the risks. For instance, people who go the gym know the risks of injuring their backs when deadlifting or squatting but many people including myself still choose to do those workouts. The reason why we do I think goes back to the point that someone brought up in lecture that we will do what we want if we can minimize the risks and increase the benefits. When doing those workouts, using the right form minimizes the risks and doing so increases the benefits of the workout.

It will be a critical part of my profession to be able to be a good communicator if I become a doctor of anesthesiology. This profession relies on having a trusting relationship between the patient and the doctor who is going to deliver anesthetics. The profession also requires doctors to devise the best anesthetic plan with the patient by sharing the risks and benefits of each option. It’s important that we help them in making the best decision because their health and sometimes their life is in our hands. Regardless what field of medicine someone may choose, we are all committed to improving the lives of our patients and doing so requires a good relationship with the patient so it is important to have good communication skills.

Blog Two: Communication and Decision Making

Blog Two: Communication and Decision Making

In the past two weeks I’m sure that many of us have spent more time thinking about how we communicate and make decisions on a daily basis; There are a multitude of communication methods and settings, and nearly every decision we make has some risk associated with it. What is best for what we expect our careers to be? How, in the setting of healthcare, can we ensure that the patient is both well informed but also not influenced by our own bias when it is unnecessary?

In Dr. Zikmund-Fisher’s discussion I was most surprised to realize that there is likely not a single medical decision that can be made which has no “cost” associated with it. Whether it be physical, mental, monetary, or some combination of each even something as simple as making a conscious decision to improve one’s posture has ramifications. Although at times this principle may become trivial (indeed I feel the argument that improving posture could negatively affect one’s mental health is weak), one point that is to be taken away from this is clear: as future healthcare providers we must realize and evaluate potential costs and benefits for all procedures given to patients.

As far as I’m aware my goal is still to go into the medical field, which of course means that I will have to be very good at communicating and decision making so that patients feel comfortable asking questions and I can give them the best responses/advice when it is necessary. This is a vital component to medicine because it minimizes miscommunications and allows for decisions to be made in a case by case fashion so that they reflect what is best for a specific patient. Through my recent literature review and discussions with medical professionals I’ve found that communication is oftentimes lagging today in medicine, especially as the pressure to go faster increases and we become more dependent on technology. As an upcoming generation of leaders and best in the medical field we have an obligation to change this trend, because improved communication means improved patient care.