Alternative

This article “What Do Doctors Say To ‘Alternative Therapists’ When a Patient Dies?” by Ranjana Srivastava appeared on my Facebook newsfeed yesterday.  I couldn’t resist reading it.  I think you should read it too.

First of all, it is clear I am a big nerd when this is the most eye catching thing I saw on Facebook.

But, the big reason it is eye catching is because I was curious what it would say.  And it said what I thought it would.  We say nothing.  We don’t talk about it with others.  We talk about it amongst ourselves.

It also echoed a lot of feelings I would describe having around alternative therapies.

I am probably one of the more “loosey-goosey” of the people in my department when it comes to alternative therapies.  I am touchy feely, I inherently trust people and I do believe that there is value in a lot of things we can’t or haven’t necessarily studied.  I’m that kid who did a presentation on medical marijuana in research rounds and concluded that it isn’t all bad and we really need to look into the stuff more because people are using it whether or not we think they are or should.

I ask people what they take over the counter or with supplements.  I explain why I ask.  You see, some products, although “natural” act in ways that counteract the actions of chemotherapies or radiation or other drugs.  Sometimes in terribly harmful ways.  Ways that make cancers not respond to treatments.  Or ways that make side effects worse.  I ask because I care.  Not because I want to judge you or make you feel foolish.

Actually, some of the drugs that we give people are “natural.”  Some chemotherapies are plant derived.  They are natural and very toxic, but when used appropriately can treat cancers.

I see nothing wrong with trying something different when nothing is working.  I see nothing wrong with adding things that have low risks of harms that may help.  I see nothing wrong with doing things that are healthy for you.

I do see something wrong with people who are encouraged to spend their life savings on a “miracle drug.”  When people risk their lives to procure enough cannabis to make the oil they were told online was a “cure.”  When people entrust their health to internet “doctors” and people who make a profit from preying on the sick and the scared.

Many of the “miracle” agents on the internet are anecdotes.  Sure, everything starts as an anecdote.  But, that is why things are tested, because we are often wrong and they are one-off events.

There is some laboratory in anecdotal data about cannabinoids.  I’m not refuting it.  I’ve read it.  But, there is no cold hard evidence for it as a cure for cancer in humans beyond the odd case.  Could it be coming?  Maybe… But that day isn’t today.  And there is cold hard evidence for other treatments in some cancers.

It scares me that some people believe the person that will make a fortune off of them buying their concoctions is more trustworthy than the person who makes the same amount of money whether or not they take the treatment.   It upsets me that people think I am the one brainwashed because I am offering medicine with evidence behind it, with the experience of time, the monitoring of governing bodies and the backup of provincial funding.

It terrifies me to know that supplements and some complementary therapies (not all) are not regulated at all.  In fact, often they aren’t even containing what they claim or have contaminants that can be harmful.    And people die from complications from these therapies.  Just like conventional medicine.  But in a lot of cases we don’t even know some of the risks.

When something claims to work almost all of the time or have no side effects… It probably isn’t for real.  Too good to be true is something I see a lot.  But people want it to be true.  And why not?  Some people have nothing left to lose.  But really, everyone has something to lose.

It also makes me sad that some of my colleagues think all complementary or alternative therapies are bad or dangerous.  It is scary to see people doing things we don’t understand, so I get it.  And it is hard to trust when people you cared for and gave your all for die, sometimes because they gave it all up for the wrong choice.

Miracles happen.  There are things we don’t understand how they work, but they do.  There are things we know do work and they scare some people because of misinformation or lies spread through all kinds of media.

When people forgo conventional treatments or risk counteracting treatments for something advertised on the internet or sold by an alternative provider, it makes me uncomfortable.  I’ll be honest.  When people die doing this, it makes me sad.

Complimentary and alternative therapies can be many things… I send people for massages, acupuncture, reiki and I think chiropractors do good work. I encourage spirituality and  and exercise.  I preach good diets and appropriate vitamin supplementation depending on need.   I think cannabis can be an option for some people for symptom control.  I am okay with you doing something else so long as it isn’t putting you or your treatment at risk.  I can’t stop you from doing something I don’t agree with or trust because you are your own person.  But, I can be honest and tell you why it is concerning.  I can review the evidence.  I can help you interpret it because I have a background in reading that kind of stuff when many people don’t.   I’d rather know than not know in any case because your health is important to me.  And I make no gains or losses by having someone take “my treatments.”

I just want people to be healthy and safe.

Conventional medicine can’t save everyone.  Neither can alternative medicine.

It is scary, but things go wrong.  Alternative therapies (namely the various supplements and drugs and cleanses) can cause a lot of problems.  But, we don’t talk about it when things go right.  We also don’t talk about it when things go wrong.

Talking would be a good start. Regulations would be wonderful.

There will always be people out there trying to make money and preying on the sick and vulnerable. Sadly, these people give everyone a bad reputation and are the source of my distrust and skepticism.  I know there are practitioners out there who think they are doing good and maybe are not.  That is where better regulations and research could make a change.  And I know there are practitioners out there doing amazing work with the best interest of the patient at heart.

An open mind is good.  Educated professionals are better.  But, I think that opening up the lines of communication between professionals but also with patients could make a movement towards making a difference.  At least in some cases.

Advertisements

Reblog: “In Defense of Doctors”

I read this the other day on a friend’s Facebook page and I liked it enough to want to share it with other people.  Check it out, it is called “In Defense of Doctors” by The Murrays.

In a day and age where everyone has information at their fingertips, it seems that distrust of the medical system is everywhere.  I work and function in that system every day.  I also am a patient in that same system.  I have to trust it.  I can be well educated and informed, but I go in expecting my physician or nurse or other caregiver to know their stuff too.  These people go to school for years.  They sacrifice their lives.  They don’t want to do stuff to harm you.  I’m certain of it.

I have on more than one occasion come home and worried about a patient I left at work.  Or spent hours scouring the internet for the right answer.  That is what it means to be in a caring profession.

Please trust that we care.  And we have your best interest at heart.  We sacrificed a lot to get here.  It doesn’t stop with you.

My flu shot soapbox

Please allow me to pull up my soap box…

It is time for what is becoming my annual flu shot rant (see here and here for previous).

I got my flu shot this week.

Unless you are allergic to it or have another medical indication to not get it, you should too.

I mean, we are all running around terrified of Ebola and really, afraid of getting sick in general.  But, most of us are too chicken (or cocky or ill informed or paranoid) to get a simple measure that prevents a common and potentially deadly illness.  It is simple, it does not make you sick and the risks are really low (you can actually get some similar complications at random or from a bout of the flu).

Just to point out some facts… You can get the flu shot if you are pregnant.  This came up at work the other day.  It is not contraindicated.  It is advised (I know, there is limited data on fetal risk because the population data does not suggest an issue, but if there was a giant issue, they wouldn’t be doling it out to pregnant women… That is bad PR and asking for a lawsuit).  You can also get the flu shot while on most cancer treatments if you time it based on the advice of your doctor (ao came up at work)ls.  It is free in a bunch of workplaces and also if you have a chronic condition that puts you at risk if you were to get the flu.

Last year, I had, at one point, 3 people in ICU on ventilators (aka life support) with the flu.  The FLU.  And they were all in their 40s-60s.  Not old people.  Not necessarily people who were sickly before.  Crappy luck.  Bad strains.  None of them had received flu shots.  They all survived.  Not everyone is that lucky…  I also had a patient I cared for on an oncology related service die from complications related to the flu during their cancer treatment.

I have watched people die or nearly die from the flu.  I don’t want to watch more.

I know the vaccine isn’t perfect. Sure, there are years where they miss the mark in picking the viruses, but they still do confer some immunity and other years they are spot on.  I know people don’t trust doctors because apparently we have been brain washed.  And there is limited research on each specific year’s vaccine (because they are basically similar with different strains).   But, I like to hedge my bets.  It is simple, quick, easy and has more evidence behind it than most of the stuff seen on talk shows.

Don’t kill my patients.  Don’t kill my family.  Get the shot, it is extremely unlikely to make things worse and it probably will make things better.

Rant over.  I’ll step down again for now.

 

Bear Hug

Some days, you wonder if you are doing enough, caring enough, loving enough.

You go to rounds and hear things like doctors don’t care or don’t spend enough time with patients.  And you sit there wondering how you can do more.  Because maybe, just maybe, they could be right.

You spend time researching to help someone.  You talk someone through even the simple things.  Sometimes you just make small talk because it seems right.  You stay late.  You go in early.  You think about them when you are home.

Then, someone you cared for dies.  And you get a big, tearful bear hug from the most challenging family member.

Suddenly, it is all worth it.  Suddenly, I believe it might just be enough.  Suddenly, I remember God put me here for a reason.

How Did That Happen?: How to overwhelm the pulp out of a new resident

I have been off my blogging game.

I blame starting core Rad Onc.  I keep staying late and studying at night and all of that stuff.  Funny how when you are doing something you actually love you tend to work more.

I also blame summer.  The nice weather nights have us out and about meeting up with friends.  Last night, we had a hymn sing at the nursing home we volunteer at with our small group and then went out for ice cream.  Tonight was coffee with a couple we know from back home who recently moved here.  So awesome.

I am a week overdue on a How Did That Happen? post.  So, that is what you shall receive.  stethoscopes1

I have been spending my last week orienting and mentoring our new, delightful R1.  My How Did That Happen? is how to overwhelm the pulp out of a new resident (in case you didn’t already know).

**Note: This is kind of sarcastic and based on things that really do happen.  There are some things I think administration and faculty can do better with.  There are some things that I can’t see solutions to… Just facts of starting new jobs.

  • First of all… DON’T OVERWHELM THEM.  This is my for real advice.  This will fail.  Starting residency at baseline is kind of overwhelming.  But, bits of information at a time and having someone available as help and back-up is better than just slamming it all in a book or presentation at once.
  • Have multiple giant orientation sessions for the incoming residents from the university, the hospital.  Fill them with tons of information that is both useful and useless intermixed with facts about failures, crying and patients dying.  Make sure that it is unclear what is useful or useless and make it seem like terrible things will happen.
  • Make sure to start them on call the first day or so of residency.  Nothing is better than really starting out with a bang.
  • Send out various passwords and user IDs to different email accounts and expect the person to sort them out themselves.
  • Have a very not user friendly computer system with a million different log-ons, passwords and variations.  Review these in orientations, but don’t do any practical training, that would be too helpful.
  • Use four digit paging in a hospital where you have to dial 7 numbers that can differ between sites.  Expect new person to call you back promptly.
  • Let new people loose in the hospital without giving a tour. 
  • Take the new person a tour on a hot day after a full day of orientation to show them everything.  Realize that they will remember very little of this.  Do it anyway.
  • Leave them to figure out everything on their own.
  • Tell them all of your call horror stories.
  • Take them to visit the ward.  Show them where everything is.  Show them the charts.  Talk about writing notes, finding computers and how the rooms are organized.  Introduce them to the all of the staff on the ward who promptly start asking who they are looking after. 
  • Go to a session about how to use an EMR only for the radiation oncology patients and for radiation planning.  Use technical terms just to really keep them on their toes.
  • Give them the sickest patients. 
  • Ask them to read around everything they saw that day.  The list of topics totals a page.  Oh, and review the clinic charts for tomorrow too.  Hope you can work the disconnected computer systems!
  • Talk to them about booking vacation.  That is months away.  On rotations that “you just need to take vacation from.”
  • Tell them you are so glad to be done intern year, it really does get better (this can be good… it can also instil fear of what is yet to come).
  • Try to tell them everything they need to know ever in one day.  Or at least make them think that is what is happening.

 

What things happened to you that overwhelmed you as a new resident or med student or employee in general?