The Gift

By Richard P. Holm MD

Like a lot of men who make their way to my internal medicine office, Mark Ekeland came by the urging of his wife. He even put it this way, She told me to make the appointment because Ive been really dragging lately. This is classic guy.

During the examination I felt the liver and to my dismay it came down quite a bit below the rib cage, indicating that it was enlarged. The blood tests indicated bile duct blockage, liver cell destruction, no Hepatitis A, B, or C, and the ultrasound test did not show gallstones or tumor but only a large liver.

After a phone consultation with a gastroenterologist, a liver biopsy was done, which proved a rare liver scaring disease called Primary Biliary Cirrhosis. This kind of cirrhosis has nothing to do with alcohol but rather an immune system gone awry, and predicts a gradual worsening, eventual liver failure, and a premature death.

Over the ensuing ten years I watched as my patients condition worsened. Although never complaining, his muscles wasted, his color turned grey-green, his belly swelled, and he seemed to age right before my eyes. 

One day he came close to death bleeding from varicose veins of the esophagus, and although near the top of the transplant list, he still waited. Since there was such a great demand for organs, it looked like he might not get one in time. 

Then, a relative of his wife offered to be a living donor, an incredible gift of half of her liver. The transplant happened rather soon after, and it was a glorious thing to watch Marks general health come back to him over the next three or four months. 

Now four years later, Mark enjoys and savors every healthy day because of the courage and compassion of his donor, and the miracle of modern medicine. 

Take home message:
The advancement of science has offered remarkable treatments for what used to be terminal conditions;
All of us should do what we can to help those in need of organ transplant. Sign a donor card AND tell your family about your wishes to donate if tragedy should happen;
Living donors, and those willing to donate after brain death provide a gift for a lifetime of marvelous relief from illness and suffering.

Tom Daschle for Health and Human Services Advisor

By Shawn Vuong

Well its pretty much official, our own Tom Daschle will be the secretary of HHS.  What does this mean for doctors and patients in South Dakota?  What does this mean for doctors and patients nationwide?  

Some don't believe Daschle is the right man for the job.  They may be worried about his past voting history, his history of partisan politics, or even his wife's job as a lobbyist that may play in conflicts of interests.  Others think he's perfect.  Either way you look at it, he's going to be a key component of the healthcare reform that America is about to see.  

To get a good idea of what's in store for us, I plan on reading "Critical: What We Can Do About The Health-Care Crisis" by Daschle.  The book came out Feb 2008, and I think its going to be the outline of what's to come.

Are South Dakota's Current Abortion Laws Hurting Doctors?

By Shawn Vuong

While many South Dakotans are glad we are done with "Initiative 11" Zita Lazzarini thinks South Dakota has already taken it too far.  Today in the NEJM, Lazzarini says that the current law that was passed in 2005 known as the "abortion script" threatens the physician-patient relationship.

At one level this type of law pushes our state's beliefs onto doctors and patients.  Also, the abortion script may actually be keeping doctors from giving scientifically based information to allow for an informed consent.  Lastly, Lazzarini says that if we let the states push it this far, what's next?  Who knows what other ethical dilemmas the state will try to push onto doctors & patients.  

If legislatures can mandate that physicians provide women with ideological, vague, intimidating, and false information about abortion, what is to stop them from intruding further into physician–patient discussions regarding end-of-life decisions, the use of future stem-cell–basedtherapeutics, the efficacy of birth control, or the role of condoms in preventing sexually transmitted infections?

How important is the doctor-patient relationship to you?  Whether you are pro-choice or pro-life should not make a difference in this issue.  Imagine that you are in the hospital with your loved ones, and the doctor was mandated to tell you and make you sign paperwork that the end-of-life decisions you and your loved ones are making are wrong.  

Doctors Feeling Gloomy?

By Shawn Vuong

Yesterday I was talking about my worries of becoming a bitter doctor.  But why do doctors loose morale?  Today, Sarah Rubenstein of the WSJ gave me some insight on this matter.

Here are some of the bracing findings from 11,950 primary care docs and specialists who responded to the survey:

94% said the time they’ve devote to non-clinical paperwork in the past three years has increased. 63% said the paperwork has meant they spend less time per patient.

82% said their practices would be “unsustainable” if proposed Medicare pay cuts were made.

78% believe there is a shortage of primary care docs in the U.S.

49% said that over the next three years they plan to reduce the number of patients they see or stop practicing entirely.

60% would not recommend medicine as a career to young people.

42% said professional morale is either “poor” or “very low.”

17% rated the financial position of their practices as “healthy and profitable.”

6% described morale of their colleagues as “positive.”

Wow, if that isn't depressing I don't know what is.  Paper work, a shortage of doctors, and low morale possibly through low reimbursements, insurance controlling care, and less doctor-patient time.  I may be wet behind the ears in the world of medicine, but I can tell you one thing, I am going into medicine to take care of people.  If a primary care physician told me that all the paper work they do keeps them from seeing the patient, I'd dodge primary care like the plague.  Many other medical students already are dodging away from primary care.

A couple questions come to mind after reading this.  First and most obvious question, how do we fix this?  Also, since Dr. Holm is a family doctor himself, I would like to know what his general opinion is on this article.  Is morale really low here in South Dakota?  Are family physicians here feeling the pinch of administrative work, low reimbursements, and insurance control?

Healthcare Costs Part 1

By Richard P. Holm MD

Maybe it was ten years ago I heard a political reformer pose the question: What if we paid for groceries like we pay for health care in the U.S.& how different would it be? He described buying groceries where there would be no reason to look for a bargain, but rather motivation to buy the most expensive items, and everybodys basket would be filled to the brim.

I think there is still some truth to the comparison, because in this world of third party payers for health care, the consumer is still not driven to look for value. Rather it seems the employer who buys the insurance has to do that. But in 2008 there are some changes we would have to make to the grocery-store/health-care comparison.

Now you find that there are only three grocery stores in the state, and you have to go to the store your employer chose. Upon arrival to the store you find a very elaborately decorated and expensive building, the carts are robotic, the aisles are wide and beautiful, and there are way more managers than checkout people, due to government beaurocracy.

Looking around you realize that every customer in the store seems to have a different way of paying for the food. One person has a plan where all the food is free, once he reaches his deductible, but it pays only for certain food, and he cant figure out what that is, except to know that generic beans are always paid for. And then there are customers who have managed care advisers walking around the store with them pointing out which food is not available to them. What's more, there are many people outside the store that can't get in.

It is not a perfect metaphor but it makes one point very clear the system is a mess. In this age of healthcare reform, please be pro-active and contact your Washington legislators.

Primary Care Shortage Worsened

Med School to Doctor Transition

By Shawn Vuong

These last two posts highlighting some of the medical education we would like to give through this blog to the general public, has had me look back on my extremely short medical career (currently in week 17).  

Healhcare reform is in the air, and from what I've read and heard about the morale of health care professionals, it is at an "all time low."  Many professors and physicians come in to teach us different topics, and many say, "It looks bleak out there, I hope you know what your in for."  

What worries me is the transition.  What happens to the altruistic medical student who wants to save the world?  What beats him/her into submission and makes them into bitter doctors? Is it the troubles we deal with during our residency training?  

A recent article by Dr. Edwin Leap makes me think so.  He calls out to all residents and interns as medicine's last hope.  It is inspiring and really heartwarming, makes me want to go out and save a life.  Hopefully I can keep this in the back of my mind for the rest of my hopefully long and fulfilling career.  

Be our hope, my friends!  Be the hope of medicine, the hope of the wounded parents and febrile children, the gasping elderly and the poisoned teens.  And learn to see all you do through the eyes of a higher calling.  That perspective, if you can develop it and hold tightly to it, will keep you happier than any political reform or paycheck ever could.