Tuesday, January 15, 2013

Diabetes and Boogers

*Image credit diabetes.org
So as not to absolutely disgust my readers, I won' t bother with certains kinds of visuals for this post, LOL!! But I have to say that after leaving elementary school, I hadn't thought much about the word "booger". And when I took my first biology class in high school and from that point forward, I began referring to boogers as "superficial mucosal material".

So I was super, duper surprised to see the word booger in a response to a case-study article about distinguishing type 1 from type 2 diabates. The statement, mentioned in a letter to the editors of that article, is here:


Now there were a couple things that stood out about the response other than the very BOLD use of the word booger. I was very intrigued by his brief discussion of how as a Resident, he had not supported the decision of Attending and the result had been the death of the patient. That got me thinking about a similar story on GradyDoctor's blog about how she had been "vetoed" by a Resident Surgeon, only to be correct (I can't recall if this case resulted in an amputation or the death of the patient). In both cases, I'm reminded of why patient care is NOT appealing to me, because I don't know how I would react if I made a decision about a case, had my decision vetoed by a superior, and the patient died as a result. I'm thinking I wouldn't respond very well.

Now, I imagine Docs deal with this type of thing all the time, but it probably isn't talked much about due to the litigious society we live in. And I understand that perfectly well. Of course, no one Doctor knows it all, all the time, and obviously I get that too. But part of why I think health disparities exist is because some well meaning Docs have NO CLUE of the nuisances that make providing care to minority patients different from the majority. For example, I recall when I was a volunteer in a rural health clinic an elderly woman came into the clinic for services (and I can't for the life of me remember exactly what that was). Anyway, the Doctor asked her when she had last taken her medicine and she responded "fo' day in the morning". I had a great relationship with this Doc, so when she proceeded to write 4 o' clock in the morning in her chart, I whispered to her that fo' day in the morning meant dawn, which at that time of year, was 2 hours later than she thought. I can't recall what the medication was, but I DO remember that giving the patient another dose of whatever it was so soon after the first one could have been catastrophic for the patient.

Unfortunately, I think this type of "miscommunication" happens a LOT more than folks probably want to admit, simply because there aren't enough culturally diverse folks IN medicine. The thing now is that having been accused one too many times of being a "know-it-all" in a couple professional settings (99.9% in Pharma), I'd be slightly hesitant to speak up. But here is where I'll need to sew another layer of elephant skin onto the one I already have, because potentially saving a life is worth whatever flack I could possible receive for speaking up (at least, that's what I keep telling myself when I think about my time working in Pharma). I'm just hoping that in medicine, unlike in Pharma, being right (about the new drug they were rushing through clinical trials) won't result in me being shown the door. And based on my medical experiences over the years, I'm reasonably certain that will be the case.

Other news this week is that I had a tutoring session with a local med student taking Medical Pharmacology, and it was an absolute BLAST!!! Besides the obvious reminder of what "the goal" is, it was just a lot of fun going over the material. Man, I'm SUCH a geek!

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