Sunday, August 14, 2005

"Many find the job of being a modern patient, with its slog through medical uncertainty, to be lonely, frightening and overwhelming."

At last, inspiration strikes for my ERAS personal statement. An article in the NY Times discusses the challanges facing modern patients. In the move away from paternalism doctors no longer tell patients, "This is what's wrong and here's what we're going to do about it." Instead patients are presented with a diagnosis along with a list of treatment options. Coronary artery disease? Bypass, stent, or medical managment. Lung cancer? Surgery, radiation, chemotherapy, or palliative care. Patients are left to weed through vast amounts of imformation trying to weigh the pros and cons of each options without the background knowledge that 4 years of medical school and 3 or more years of residency provide. Doctors often try to offer treatment options without showing bias toward one or another to prevent detracting from patient autonomy. And the fear of lawsuits makes it more appealling to not give a definite answer. Give all the options and let the patient decide -- you can't get sued for that. And with primary care doctors having to see more patients in order to pay the bills, they are left with little time to sit with an individual and explain different treatments and answer questions. Add it all up and you have patients who have to rely on internet searches and various doctors' opinions and then manage their own care.
"You can get good health care," Ms. Gaines said. "But there isn't good relay, getting you to the resources and the resources to you." She meets with panicky, bewildered patients and occasionally shares with them her story, if only to make one point: "I tell patients all the time: 'I know this is hard to believe, but you want to know who is managing your health care? It's you or no one.' "

After over 3 years of medical school I've decided to become a member of the ever diminishing minority -- I'm going into primary care. I hope that I maintain that through my residency. I want to be a doctor who takes the time to get a complete history and talk with my patients. I want to offer them advice about current treatments and point them toward reliable resources. I want to make thoughtful referrals to specialists and help my patients get through the maze of modern healthcare.


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