An Untold Fact About The GP Shortage

General practice is in a bad state in Vancouver, and probably most of Canada, because of the well known shortage in general practitioners. Many people can't find a GP and those that have one hesitate to visit their doctor because they know that they're doctors are overbooked and appointments need to be made far in advance. Somewhat nonsensical because most of us can't predict that we will be sick two weeks ahead of time. This leads to obvious problems because if patients don't see their doctors regularly, their doctors cannot catch their illnesses early and control their disease before it becomes more harmful to the patient and more expensive for the system.

Doctors, educators, and public health officials often discuss these issues when they publicly debate the GP shortage. However, an aspect of the problem that is not discussed as often are the unnecessary mistakes made by physicians who are overwhelmed with an unrealistic schedule. Doctors know that there is a GP shortage, so they often find it difficult to turn away a new patient who has nowhere else to go; thus GPs tend to have too many patients.

Next, consider the fact that these GPs develop very close relationships with their patients and feel obligated to see them as soon as possible when they become ill.

Having a large patient population and wanting to ensure no patient is turned away means that GPs will have many patients to see each day.

Then realize that these doctors have lives, families waiting at home, and that they can't stay in the office all day. They would stop time for you if they could, but they can't, really.

Many patients + wanting to see all of them + time is finite = 10 minute visit

The 10 minute visit is an attempt to maximize efficiency while minimizing any potential harm to patient care. However, any time you speed up ANY process, you risk making silly mistakes. These errors are often easily correctable, but sometimes they aren't. Compromising patient care is something no doctor ever wants to do, but it is something that will happen. Even in a perfect system, doctors will make mistakes (sorry, they're human too), but in an imperfect system, doctors will make more.

There are two ways to resolve this problem:

1) We can improve the system. This would mean improving general practice and luring more med students into the field so that there will be fewer patients per general practitioner and then each doctor can spend more time with their patients.

2) We can make perfect doctors. That means they would have to be robots. Getting a DRE sucks now. It'll probably be a lot worse if it's done by a robot.

Malpractice: Don't Rush The Surgery

Take a look at your palm. Now make a fist as tight as you can. Chances are you can now see two seperate tendons running over the middle of your wrist. One of these tendons is the tendon of palmaris longus. 10% of the population will NOT see this tendon when they make a fist because they were born without it. It's not a big deal, the tendon is pretty useless functionally. Thus, when a patient tears an elbow ligament, surgeons often scavenge the palmaris longus tendon and reattach it to the elbow in place of the torn ligament.

We were told an unfortunate story about a surgeon who rushed a surgery and cut into a patient's wrist, hoping to scavenge the palmaris longus tendon. Turns out that this patient was in the 10%, he did not have the tendon. Guess what is usually underneath the tendon? The median nerve. This surgeon cut clean through the nerve controlling the muscles of the patient's thumb, index, and middle finger. These fingers are now non-functional for this patient. A really tragic case and a reminder to all physicians not to rush their surgeries.

Reminder: Wrist Bone Pneumonic

So Long To Pinky Here Comes The Thumb

Scaphoid, Lunate, Triquetrum, Pisiform. (Proximal)
Hamate, Capitate, Trapezoid, Trapezium. (Distal)

Data Storage Laws and Electronic Medical Records

Rules surrounding data storage are becoming more and more important as we become a more digital society. The BBC reports that Microsoft senior vice-president Brad Smith is calling for international trade laws around data storage.

Apparently different countries have different rules around how long data must be stored and when it must be destroyed. This can become a confusing issue to navigate for companies offering data storage to an international market. Should they follow the data storage laws of the country that the consumer inputted the data from or the country the data is being stored in?

Rules around data storage also complicate electronic medical records, which some hail as the next technological revolution in medicine. Medical data is completely confidential, so many would argue the idea of storing the data outside of the country is preposterous. This takes away the complexity of having two sets of laws around the storage of the data; however, it means that we cannot take advantage of cheaper rent and maintenance fees found by establishing data centers in foreign countries. Keep in mind that having these data centers within our borders does not really make the data more secure. Hacking only requires accessibility and if the data center is connected to any kind of network on the internet, its physical location has no influence on its security. So does it really make sense to demand that medical data is stored within the country?

Considering laws regarding how long medical data must be stored, we currently have rules around how long paper medical charts must be held by a physician. Would these rules be the same if/when we move to digital records? Digital records are much easier to manage than their paper counterparts, so it may make sense to store them indefinitely, or at least for a longer period of time. This would certainly be of added benefit in research. We could learn a great deal if we had over 40 years of patient data to study. Of course, this is only true if researchers gain patient consent to view the data.

As data storage becomes a more frequent point of discussion in politics, I think we will see health officials begin to weigh in on data storage policy, at least with regards to how data storage affects health care.

Patient Trust

Nanos Research reports that physicians are the most trusted professionals by Canadians. 77% of respondents considered medical doctors' standards of ethics and honesty to be "high" or "very high". These results aren't terribly surprising considering physicians know they must carry themselves in a manner that elicits trust. After all, they ask you very personal questions, make you to strip naked for examinations, and occasionally anaesthetise you before cutting you open and placing instruments inside your body. If they didn't have your trust, they would be unemployed.

What does constantly surprise me is how much trust patients have in me, a medical student. When I first started seeing patients last year, I assumed most of them would be unwilling to see me and tell me that they came in to talk to an actual doctor. This never happened, not once, patients were more than happy to talk to me. In fact, most of them were happy to play a part in training the next generation of physicians (which I and all my classmates are of course grateful for). Of course, in the beginning all I did was perform a medical interview, but still, these patients were willing to answer personal questions asked by a complete stranger with less than two months of training.

Now in second year, I have a better understanding of how to perform a medical interview and several clinical exams (read: "I can actually do stuff"); yet, this year has been even more astonishing than the last. A few months ago, a family allowed me to examine their seven day old daughter. They let me place a giant microphone to her chest (also called a stethoscope), shine a bright light into her eyes (looking for the red reflex), palpate her head (feeling for fontanelles), and feel her abdomen for any abnormalities. These parents didn't know me, but because I'm a physician (in training) they trusted me with their new child.

That's a lot of responsibility. I better go study...

Nanomedicine Begins Changing the Face of Medicine

"Sir, you have glioblastoma multiforme, a brain cancer with a very poor prognosis. Normally your chance of survival would be very low..."

"Normally?"

"Don't worry, we're sending in the robots*..."

Nanomedicine is the use of nano (meaning very very small) technology in health care. Nanomedicine is an exciting new field that will probably change management options for a wide array of diseases. Of course, I say this as an electrical engineering graduate, who worked at Microsoft, and is now in med school...so my passion for the topic may not be representative of the general feeling in the medical community. However, I recently came across two articles that show how nanotechnology is truly moving medicine forward.

First, an article recently published in h+ discusses a recent study demonstrating nanotechnology fighting brain cancer. This nanotechnology seems to be far more effective than chemotherapy and radiation therapy, and safer than surgery, which are the current treatment options. Nanoparticles were used to target cancerous cells. Once they were bound to the cancerous cells, a light beam activated them and made them toxic, kill the attached cell. These nanoparticles can clear 80% of a brain tumour in 5 minutes!

Second, not only can nanotechnology fight existing cancer, but it is being used to detect cancers earlier than current technology allows. Detecting cancer early makes treatment more effective and reduces those cancer related complications we all hate, like death.

Nanotechnology has amazing potential to increase patients' quality of life and reduce their disease burdens. In an attempt to emulate Nostradamus, I predict that there will be a vast array of new developments within nanomedicine in the next 5 years and after that we will start seeing the use of nanotechnology as a common option in every physician's medical toolbox.

Emergency Rooms and Sick Children, Not a Waste of Time

The Vancouver Sun has an article wherein ER doctors can be found encouraging patients to come in with their children if they have even the smallest concerns about their childrens' health. I found this surprising because many of the ER doc bloggers are constantly complaining about parents who come in with their children who have nothing worse than a bad cough.

I wonder if the physicians in the article meant what they said or if it was the only statement they could make considering it really wouldn't be acceptable to say "stop wasting our time with your kids' runny noses". The difference in opinion could also be attributed to a difference in Canadian ER docs from American ER docs (who are certainly more avid bloggers), or perhaps a different opinion coming from this ER doc who is in a quieter hospital than most metropolitan ER docs.