Tag Archives: Medicine

On Medicine and Being Late

Sometimes I feel like I have the best patients in the world. Especially when I’m late. “Don’t worry, doctor.” “That’s the way things go, doc.” That’s what I’m told. But I can’t stop feeling bad about any delay.

The truth is that delays are inevitable in healthcare, but that doesn’t mean lateness should be normalised.

A good doctor, a doctor who does the best he can, will always choose to spend a few more minutes with a patient if it means that he is giving him or her a higher quality treatment – even if it also means that those in the waiting room will have to wait a little longer.

Things take time. There are thirty minute jobs, there are one hour jobs, and there are hour-and-a-half jobs – and so on. Often, you’ll only be able to properly scope the time needed after starting.

In this respect, a delay can even be seen as a sign of quality – as a mark of the doctor who cares. Other times, the delay happens because of an unpredictable situation: an unwilling child, a wound that doesn’t stop bleeding, a stitch that doesn’t stay in place. It’s rare that a patient is delayed because the doctor felt like going out for coffee.

So I am grateful for how understanding my patients are. They realize that if I had to, I would also spend extra time with them, on their appointment.

Even so, I hate being late, and it’s something I always try to avoid. Because I have the notion that a delay doesn’t result in a localised effect – if I delay a person, I am stealing time from everyone who comes next. What’s more, I’m making these people late for their affairs, stealing time from those who are counting on them. Delays have a domino effect that reaches far more than those immediately involved.

Likewise, I am sympathetic to my patient’s delays. Life does not always work the way we want, and even with the best intentions, accidents happen. But when someone starts coming in late repeatedly, then I have to draw attention to it, not only for my sake but for the sake of the other patients who are delayed as a consequence.

In the end, common sense and tolerance are the principles I try to follow, and I see that most of my patients do so, too. And in the rare case where someone complains, I try not to take it personally, because we must never forget that the other people’s time is as valuable as ours.

This article appeared in its original form under the “Secrets of Oral Health” column of the newspaper “A Gazeta das Caldas.”

Dentist-Monkeys From the Future

I once took a course where the teacher said that, given the right gear, he could teach a monkey to perform a root canal.

At the time, we made fun of the concept. It was an exaggeration, of course, to promote the wares peddled by the course’s sponsor. But the idea stuck. And today, I think back on it with some sympathy. 

Performing a root canal is mostly a mechanical act. It requires a certain sensitivity; you need the knowledge of how to treat each canal relative to its shape and thickness. But, when it comes down to it, it’s manual labour of mechanical repetition.

I confess my ignorance regarding a monkey’s motor skills. But I don’t see why, within the next 10 years, we can’t have a robot doing the work of a dentist. And doing it better than most dentists!

Does this mean that dentists would face unemployment? No; at least not immediately. I think it would take a few more decades until the robots would be able to discern what to do in each case.

The robot would be better than the human at knowing the pressure to be applied; how to handle the instrument; how deep to go, safely; the exact amount of irrigation to apply to the canal; etc. But it would rely on the dentist for:

  1. Determining what kind of treatment to perform.
  2. Specifying the operation’s parameters (I.E .: choosing the appropriate program for the type of canal)

That is, the dental profession would be less about manual labor, and more about diagnosis and identification of the proper treatment process. Which would free dentists for more intellectual work, and give them the capacity to work on many more cases.

Of course, this has a drawback: in some countries (this is the case in Portugal) we already have more dentists than we have work for them. So what would happen when the dentists most likely to acquire technology became hundreds of times more productive, freed from the need for manual labor?

And this being a problem that affects such an extremely specialised professional class, what to say about simpler jobs, such as driving trucks or collecting garbage? The robots will need a human supervisor, but they will replace many more workers than will be needed to control them… After all, they are more efficient and don’t need to sleep.

Mechanization is at our doorstep. We have to think seriously about a way of disassociating the income needed for a dignified life from one’s working hours. 

Because in our future, there are many robots, and much less work for almost everyone.

Photo Credit: DocChewbacca Flickr via Compfight cc

How To Find A Good Physician

Here’s something that no-one wants to talk about: physicians are regular people. We like to put doctors on a pedestal because they are in charge of our health, and we’re like to feel that our health is in the hands of the best, but the best are very few, and it’s improbable that you’ll be assigned even a good doctor on chance alone.

As is the case of most professions, physician quality follows a normal distribution. A few are very bad at their job, some are merely bad, most are average doctors, some are good doctors, and again, a few are very good at what they do. 

Bell Curve
Example of a normal distribution, AKA “Bell Curve”

By merely showing up to the hospital or clinical practice, the law of averages will assign you an average physician. You might like to think it is otherwise, that your doctor is the best, but that is just you being delusional. And average is fine in most situations. You don’t need Hugh Laurie to prescribe you a flu shot or mend a broken arm. 

But if you’re in a situation where something is wrong with you, and you’re not quite sure what it is, average doctors will either not know what’s wrong with you, or will default to the most statistically probable diagnosis. That’s not a great system for health care.

You can identify a good doctor by:

  1. Time spent on your appointment. This is especially relevant on the first appointment, or the first appointment about a new situation. Anything less than 30 minutes is not acceptable. Good physicians will regularly spend a full hour with their patients. They will make thorough examinations and ask a lot of questions.
  2. Ability to answer questions and explain things. A good doctor will tell you the why’s and the systems behind what’s happening. If a physician can’t explain why it’s important that you get a specific blood marker under control, for example, but merely states that you should, that’s a sign that he doesn’t understand what it’s for, he’s just following a cheat sheet with average values. Most doctors will tell you that you should lower your cholesterol, but they are stumped if you ask them what cholesterol does.

To Get The Right Diagnosis, Look For a Third Opinion

People are still not used to asking for a second opinion. Again, they mistakenly believe that they were assigned the best person available. As I pointed out above, this is statistically incorrect. 

Depending on the severity of your situation ( and a good way to judge it is the level of discomfort it causes) or the level of violence of the proposed treatment, you might want to get a second opinion from another doctor.

If the second doctor concurs with the first one, that’s pretty decent. You can probably go ahead with a modicum of safety.

If not, then you need a tie-breaker. Yes, you need a third doctor, a third opinion. I mean, you have little other way of making an educated guess about which of the previous two doctors knows best.

I understand this is very annoying. Doctors are expensive, and appointments are time-consuming. What about people who don’t have the money to go to a private practice?! Yeah, I don’t have a good answer to that. I’m giving you the info because I believe that it’s better to know than to not know, but I realize it’s difficult to act upon.

Good luck!