All posts by PatientX

Things Medical School Failed To Prepare Us For In Kuwait

This post is fat too long which is why I never published it. Please try and read it … pretty please …all 6 of you who still visit this site.

Your first day in medical school: three subjects for one year: biology, physics and chemistry, mostly rodents, reptiles and Schiff bases…stuff I can’t remember anymore, nor will I ever need.

Your second and third year in medical school: You’re finally seeing a human body for the first time, you see the parts (anatomy), the mechanisms (physiology) and the witchcraft (biochemistry).

Your fourth and fifth year: You analyze diseases, study about pathology and microbiology but barely see twenty patients a year; half the time you don’t know what they are doing or what you’re doing to them just taking a general patient history (interview) and physical exam (forget the diagnosis, that’s miles off).

The final year: you read, read, read and read – realising that you’ve barely seen enough to know what or how to recognise what you’re reading if a patient even suffered from it.

Graduation Day: You’re happy! YOU ARE DONE! But what now? Where do you go from here? You’ve passed, you know your stuff but don’t know what’s next ; The reasons why you went to medical school are forgotten and you’re not all that inspired, you want to treat people but don’t even know how to prescribe yet.

That’s a summary of my medical “education” and as most of you can tell, I’m not exactly satisfied by it. Now, I’m not an educator, I’m no teacher. They need to inspire, to possess that ability to make you trust them enough to guide you; they have to have that gift that lets them build a mental structure in which information can be stored and eventually made useful. Sadly, few of my superiors did – and looking around at the new batch of interns from both Kuwait and abroad – few seem inspired. Don’t get me wrong, they work hard, right to the bone, they have skills but not the useful ones.

How many of the young doctors you see or meet actually make you feel comfortable, know how to ask the right question at the right time, know how to relay to someone they have a grave disease such as cancer or that a loved one died minutes ago?

How many of the doctors reading this (if any.. ) actually feel a sense of awe at what they do? How many of us actually enjoy reading about how IV fluids (drip…or ‘drib‘ as they say in Kuwaiti slang) were originally made, how the inhalers (‘Ventolin’) we use evoloved, why we tend to wear green, blue or green scrubs rather then white or grey ones? Or who the first open heart surgeon and how did he achieve that milestone? How many of us were taught the ethics behind palliative care? Contraception? Experimental treatments? Or how clinical trials evolved and the difference between them and standard treatments?

Medical history isn’t the reason why you went to medical school, it isn’t how you save lives, but in that third year when all you know is the Krebs cycle (the gearbox of your metabolism) and the anatomy of the Brachial plexus (nerves in your arms) you need to feel inspired by people who’ve done it before you. You need to find a reason to read, to debate, to analyse and to understand and during that final year, you need to learn why trying out new treatments for MS and charging people for it is unethical and why the current manager (‘mudeer‘) is a douchebag and why patients blame you for cancer rather than try to understand it…

You don’t learn these things in textbooks on surgery, rheumatology or internal medicine, and contrary to popular belief, you won’t learn them by parading the hallways in your new white coat and seeing fifty patients in the E.R.; you learn them by reading about ethics, sociology and other humanities that underpin our profession.

Kuwait University and others like it have the ability to reshape education and inspire us. The reason why they can is – because unlike other institutions – they were built from the ground up to educate us; other institutions need to attract research grants to survive,we don’t.

We also have experienced faculty, there are people currently teaching who were there when stomach stapling came to Kuwait and can tell us how they tackled it, how they dealt with errors made during those first cases. We have people who saw Viagra become the drug du jour and who saw the eradication and rebirth of tuberculosis in Kuwait.

We need to reshape our education and have graduates who can debate, discuss and be knowledgeable in our field without feeling the need to read about ethics once a day. Maybe then we’ll stop hearing about how doctors who “don’t know my name“, “don’t spend enough time with me” or are “too brash” or “shayif nafsa” (arrogant) – maybe then doctors won’t get slapped around too much.

I’ll leave you with the following quote relayed to me one afternoon years ago, inspiring a sense of awe. John Cardinal Newman describes a university as a citadel built with the purpose of:

‘Raising the intellectual tone of society, at cultivating the public mind, at purifying the national taste, at supplying true principals to popular aspirations, at giving enlargement and sobriety to the ideas of the age, at facilitating the exercise of political powers, and refining the intercourse of private life.’

I only hope that one day the spirit of the above quote materializes at the local university, one whose faculty and students should really expect much more from each other.

To Medically Err Is Human; Pointing A Futile Finger

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Give me a month. Any given month, just one month without a horror story, give me a month in which no one makes a medical error, one month in which we don’t hear about some person’s horror story at the hands of evil doctors and the henchmen in nurse’s outfits.

Chances are you can’t, because there aren’t any. Medical errors are seemingly inevitable, they have to happen, just like car accidents and farting in public, mistakes happen. They are part and parcel of having healthcare. After all; unlike the airline industry and the people who make the iphone we don’t really have a blueprint or a service manual.

This is why I’m using the bible of all medical error literature to date – and the keystone of America’s healthcare revolution – to prove my point. The U.S. Institute of Medicine white paper entitled “To Err is Human ….” estimates that between 44,000 and 98,000 people die from medical errors in the US annually. That’s more than the people heart attacks and strokes combined kill in Kuwait and is more than those who are killed by breast cancer in the US.

Having said that the study was written in 1999 and the number would probably be three times as high this year if it weren’t for the boffins who wrote the document and forced people to follow it.

There’s another reason why I chose this study, it’s because we have the same problem as the US. We have lots of doctors, lots of hospitals/practices and not enough oversight (three exams make you registered to practice, 2 more make you a specialist in the US and you can do all five without looking at a patient) so I figured their answer would be ours. After all, we’ve imported everything from ketchup to coffee chains and managed to make them work, might as well do the same for policy; besides we know it works because they’ve managed to reduce medical errors to about 10% of the original number over ten years.

The study looked into every major medical error, every big lawsuit and settlement and every single post mortem they could find and came up with the following:

  • They found that medical errors occur in three stages: failure to diagnose (wrong tests, wrong timing of tests, old and redundant tests), failure in treatment(delay in treatment, lack of drugs, technical error during a procedure) and failure in prevention (lack of patient follow-up, lack of foresight given patients current condition)
  • Creating a nationwide program for leadership, research, tools, and protocols to enhance the knowledge base about safety and patient awareness. In other words, integrating administration into day to day healthcare and making it part and parcel of the practice of medicine.
  • Developing a nationwide public mandatory reporting system and by encouraging health care organi¬≠zations and practitioners to develop and participate in voluntary reporting systems meaning that you need to report any problems you face without being blamed for them directly and providing the manpower required to piece together the sequence of the events that lead to the problem.
  • Providing standards to adhere to and aspire to within each branch of healthcare. As it stands we don’t provide doctors with job descriptions when they are hired, only a set of arbitrary rules.
  • Putting in place safety systems in health care organizations to ensure safe practices at the delivery level.

The point I’m trying to make with this whole post is the fact that in all of the above not a single doctor/nurse/security guard was beaten, sued or had his license stripped. If anything the strategy outlined tell you to go back and hold yourself accountable for what you’ve done and find out where you went wrong and how to fix it then share what you’ve learnt with the people you work with so that the same mistake doesn’t happen again.

I am quick to point out however that the study doesn’t condone negligence in which someone has made a deliberate error that they should not have (i.e. cutting a nerve because it simplifies the surgery or giving a patient an overdose so that they sleep and leave you alone for the night only to find them not breathing in the morning).

So perhaps the newspaper stories, TV interviews and patient export program may not be quiet as effective (or affective ….still can’t tell the difference) as teaching medical students and doctors in training to review medications they’ve given and procedures they’ve performed and sharing their experiences with their colleagues………

Oh well …I’m not holding my breath…

The Study mentioned can be found on Google books but be for-warned it’s about 300 pages long …….

On Kuwait Politicians and Windex

I’d like to thank Hilaliya for letting me post in his website and promise and do solemnly swear not to use words like ‘slut’, ‘prick’, ‘shit’,¬†‘bastard’, ‘tits’, or ‘whore’, ‘hooker’, ‘slut’ (twice ….. apologies ……), ‘bitch’, ‘hoo hoo’, ‘pee pee’ or ‘prick.’

It’s very hard for us as Kuwaitis and as humans in fact to live without politics and politicians. For one thing we wouldn’t have anything to complain about or anyone to blame and lets face it our parents would have very little to do at family gatherings if it weren’t for these close-minded, hypocritical, lying, cheating, corrupt and lurid men (and recently women) who we have chosen to represent us and our stake in the country we live in.

Sadly, however as with most things involving money, power and the public eye, politics has become a foray for those of us who are smart – for the most part, some can’t write their names yet but it’s still early and I doubt that the people who voted for him know the significance of literacy in the modern world – have scrupulous and rather mercurial morals.

So how do we fix our politicians? (And no I do not mean neuter them – although the idea may appeal to some; it is simply not a solution in the civilized world).

How do we make them represent us the way they should and promised? Unlike the cure for cancer, the flying car or cloning, not even Hollywood could come up with an answer…politicians can’t be fixed because they didn’t get into politics to change things, they got into politics to become famous and gain respect.

And they can’t be held accountable because no one can…lets face it, I’ve never been held accountable for a single unpaid bill or parking ticket and neither have you. We even have people who have been convicted of manslaughter in the US and are living happy k-town-esque lives and we enjoy our freedom to bypass rules, get things done quickly and forget about that speeding ticket.

So what solution could we possible come up with? (Before you ask, truth serum doesn’t work)

The answer apparently lies in cleanliness and lemon scented Windex…According to Professor Liljenquist of some University I’ve never heard of morals are largely dictated by how fresh the place smells….ugh…She compared how likely people were to be charitable in a Windex scented room and in a standard one and found that people were about twice as likely to be charitable and morally bound if you provided them with a clean environment.

But the trouble with that – apart from the fact that it sounds like hogwash – is that knowing the people within our current “Majless,” they’ll probably end up killing each other for the government tender to provide lemon scented, morally assured freshness in their meeting hall.